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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

Looking closer at the data, Bloom's team found that changes in blood sugar control or weight while on the drugs had little to do with the relationship of metformin and GLP-1 use to improvements in asthma

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Sleep regularity and major adverse cardiovascular events: A device-based prospective study in 72,269 UK adults