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Atrophic gastritis, with resulting hypochlorhydria, is a major cause, especially in the elderly

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Common medications that may interact with phentermine include: amphetamine antacids antihypertensives, such as beta-blockers atomoxetine bupropion carbonic anhydrase inhibitors dextroamphetamine dopamine epinephrine ethosuximide isoproterenol linezolid lisdexamfetamine lithium methylphenidate monoamine oxidase inhibitors opioids phenylephrine phenytoin selegiline tranylcypromine venlafaxine

Unfortunately, plants cant produce vitamin B12, although some microorganisms on plant material may do so to some extent