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From a clinical perspective, if blood tests reveal isolated B12 deficiency, a standalone B12 supplement or prescribed treatment would be the appropriate intervention

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However, a 2017 expert review and best-practice statement produced by the American Gastrointestinal Association (6) concluded that Long-term PPI users should not routinely raise their intake of vitamin B-12 beyond the Recommended Dietary Allowance (RDA) and that Long-term PPI users should not routinely screen or monitor vitamin B-12. Moreover, a 2014 commentary concluded that there is no evidence that pathological levels of the biochemical markers of B12 are more common in metformin-treated compared with nonmetformin-treated patients, despite lowering B12 in serum or plasma (7)