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Alcohol impairs fat metabolism, disrupts sleep quality, adds empty calories, and can stress the liver

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Additional at-risk groups include: Vegans and strict vegetarians , who may have low dietary B12 intake People with autoimmune conditions , including pernicious anaemia or type 1 diabetes Individuals with gastrointestinal conditions such as Crohn's disease or coeliac disease, which impair nutrient absorption People who have undergone bariatric surgery , which can significantly reduce B12 absorption Long-term users of proton pump inhibitors (PPIs) or H2-receptor antagonists , which reduce gastric acid and impair B12 release from food Those with a family history of either pernicious anaemia or diabetes For these groups, simultaneous monitoring of B12 status and glycaemic markers is particularly important to avoid diagnostic errors

An infection with Helicobacter pylori bacteria can also lead to lower B12 levels

They check for any health issues, medicines, and past reactions to supplements

The opinions and assertions contained herein are the private opinions of the authors and are not to be construed as reflecting the views of the US Army Medical Research Unit-Kenya or the US Department of Defense