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Certain medical conditions and medications increase B12 requirements: Long-term use of metformin (diabetes medication) or proton pump inhibitors (PPIs for acid reflux) can impair B12 absorption [13] [14] Gastrointestinal conditions such as Crohn's disease, coeliac disease, or previous gastric surgery Autoimmune conditions beyond pernicious anaemia may affect B12 metabolism When to contact your GP : If you are taking B12 supplements or receiving injections but continue to experience symptoms, request a review

The cost-per-effective-dose calculation is closer than the milligram price suggests

Works as intended with lots of extra energy

If you are shifting your injection day, keep everything else constant for at least two to three weeks before introducing additional changes

[CrossRef] [PubMed] 4