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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

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This can happen with improper storage, particularly if the medication was left out of the fridge for too long or exposed to extreme temperatures