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Metformin, a first-line diabetes medication, interferes with B12 absorption in the terminal ileum through mechanisms involving calcium-dependent membrane action and bacterial overgrowth

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These include chronic fatigue, anemia, and low energy levels

DOI: 10.1016/j.pneurobio.2010.01.012

Before you consider taking a B12 injection, make sure you inform your doctor as well as your home healthcare service provider: If you have kidney issues or Lebers disease