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Anyone taking high-dose supplements should make sure to have their vitamin B12 levels tested periodically

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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

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Bacteriostatic water is sterile water for injection that contains a preservative most commonly 0.9% benzyl alcohol which inhibits bacterial growth and permits a vial to be accessed on multiple occasions