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This is because our stomach acid goes down, and some medicines can also block it

This was best summed up in a BMJ editorial last year, which noted that diagnosing B12 deficiency can be "challenging" because no "single specific measurement exists to reliably diagnose or refute the presence of B12 deficiency"

Direct comparison studies have been conducted, and the findings are clear: Tirzepatide (Mounjaro) outperformed Semaglutide (Ozempic) both in reducing blood sugar (HbA1c) and in weight loss

[63] There are not enough studies on whether pills are as effective in improving or eliminating symptoms as intramuscular injections

If it still appears cloudy, briefly warm the vial in your palm (not under hot water)