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Medications and alcohol : Long-term use of certain medications like proton pump inhibitors (PPIs) or metformin, and chronic alcohol use, can interfere with B12 absorption

This reaction can result in decreased metabolic efficiency or even cell death (apoptosis), which has been shown that oxidative stress contributes to a significant number of degenerative diseases

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Many people notice digestive changes earlier than systemic ones, and because the systemic effects are downstream of the inflammatory load, they can take longer and arrive quietly