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(More information) The long-term use of certain medications, such as inhibitors of stomach acid secretion and the anti-diabetes drug, metformin, can adversely affect vitamin B 12 absorption

And it makes it very hard to to apply a blanket rule - some people may manage well with alcohol and injections

These patients who do not fit the criteria but who remain undiagnosed B12 deficient patients become very expensive for the NHS to look after