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Individuals with gastrointestinal conditions affecting absorption require careful monitoring: Pernicious anaemia (autoimmune condition destroying intrinsic factor-producing cells) Crohn's disease or coeliac disease affecting the terminal ileum Following gastric surgery (gastrectomy or bariatric procedures) Chronic pancreatitis Small intestinal bacterial overgrowth (SIBO) People taking certain medications may experience impaired B12 absorption: Metformin (diabetes medication)the MHRA Drug Safety Update advises monitoring B12 levels in patients on long-term treatment, particularly those with anaemia or peripheral neuropathy [17] Proton pump inhibitors (PPIs) and H2-receptor antagonistslong-term use reduces stomach acid necessary for B12 release from food [18] [19] Nitrous oxide (anaesthetic or recreational use) can inactivate B12 in the body [9] [21] Pregnant and breastfeeding women , particularly those following plant-based diets, should ensure adequate B12 intake to support foetal and infant neurological development

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