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It can also be depleted by chronic stress, alcohol, smoking, digestive issues, cardiovascular disease, illness, and aging because stomach acid production decreases with age, reducing B12 absorption significantly

Lipase inhibitors inhibit gastric and pancreatic lipases in the lumen of the gastrointestinal tract that decrease systemic absorption of dietary fat

What are the symptoms of low B12

Treatment is often initiated at a high dose, followed by a maintenance dose given less frequently, as determined by the patient's B12 levels and clinical response

[2] Oral B12 supplementation generally takes longer to produce effects , with patients often noticing energy improvements within two to four weeks