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A randomized controlled trial in 167 older adults (50 years) found two-year supplementation with vitamin B 12 (10 g/day), along with folic acid (200 g/day), vitamin B6 (10 mg/day), riboflavin (5 mg/day), and vitamin D (10 g/day), had no effect on bone mineral density (total hip, femoral neck, or lumbar spine) compared to the control group only receiving vitamin D (10 g/day ) (116)

Medications that alter stomach acid, such as proton pump inhibitors (PPIs) and H2 blockers, as well as the diabetes medication Metformin, can significantly impair the absorption of B12 in the digestive tract

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Some users develop chronic constipation requiring fiber supplementation, increased water intake, or occasional use of osmotic laxatives like polyethylene glycol