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Absorption Problems Some individuals consume enough B12 but cannot absorb it due to conditions such as: Pernicious anaemia: An autoimmune condition that affects stomach cells that produce intrinsic factors needed for B12 absorption Atrophic gastritis: Thinning of the stomach lining Lupus and B12 deficiency: Autoimmune diseases like lupus can reduce B12 absorption Surgical or Medical Interventions People who have undergone gastrointestinal surgeries (like weight loss surgery) or those taking certain medications (e.g., metformin or proton pump inhibitors) are at higher risk

Functional characterization of missense mutations in severe methylenetetrahydrofolate reductase deficiency using a human expression system

We could discover no evidence to suggest that vitamin B12 having effective therapeutic role be on the correction of a specific or potential vitamin B12 deficiency state

That framing matters because bioavailability is often used imprecisely