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Several factors can impair B12 absorption: Reduced stomach acid production (achlorhydria or hypochlorhydria), common in older adults and those taking proton pump inhibitors or H2-receptor antagonists long-term, impairs the release of B12 from food proteins Pernicious anaemia , an autoimmune condition destroying parietal cells and reducing intrinsic factor production, completely blocks the primary absorption pathway Gastrointestinal disorders including Crohn's disease, coeliac disease, or surgical removal of stomach or ileum sections directly damage absorption sites Metformin , commonly prescribed for type 2 diabetes, may reduce B12 absorption through unclear mechanisms
Clinical laboratories generally define vitamin B12 deficiency as a serum level below 148 pmol/L, which is approximately 200 pg/mL
These reactions typically resolve with continued use as the skin acclimates, or with dose reduction
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Without adequate collagen production and proper organization of collagen fibers, wounds heal with reduced strength and may be more prone to reopening or developing problematic scars
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