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Medical conditions affecting absorption warrant particular attention : Pernicious anaemia : an autoimmune condition destroying gastric parietal cells, requiring lifelong B12 injections Gastrointestinal surgery : particularly gastric bypass, gastrectomy, or terminal ileum resection Inflammatory bowel disease : Crohn's disease affecting the terminal ileum impairs absorption Coeliac disease : untreated disease damages the small intestine, reducing B12 uptake Medication use : long-term metformin therapy (MHRA safety alert) or nitrous oxide exposure Symptoms suggesting possible B12 deficiency include : persistent fatigue, weakness, paraesthesia (pins and needles) in hands or feet, glossitis (sore, red tongue), mood changes, memory problems, or unexplained anaemia

10.1111/petr.14297 57

[DOI] [PubMed] 27.Choi H-J, Kim S-J, Mukhopadhyay P, Cho S, Woo J-R, Storz G

Metformin (Met), a first-line medication for type 2 diabetes, has been shown to protect against IIRI in mice by reducing oxidative stress [15]

Sodium-glucose cotransporter-2 inhibitors and primary prevention of atherosclerotic cardiovascular disease: a meta-analysis of randomized trials and systematic review