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In some cases, medical conditions or medications like metformin or proton pump inhibitors can interfere with B12 absorption

The prevalence of cobalamin deficiency among vegetarians assessed by serum vitamin B12: A review of literature

We see impacts on muscle mitochondrial function with what I think is a mild deficiency. It needs a human trial, its preclinical, but it sets the stage for an impact of B-12 status on muscle function, Field said