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When symptoms or risk factors suggest deficiency despite a reassuring serum B12 number, functional markers help clarify cellular B12 status

Some participants lost even more

Deficiency after gastric banding is therefore primarily related to: Reduced dietary intake and food tolerance , limiting consumption of B12-rich foods Use of acid-suppressing medicines (PPIs or H2RAs) , which can impair the release of B12 from food proteins and reduce absorption of food-bound B12 Crystalline B12 the form found in supplements and fortified foods does not require acid or pepsin for release

Giugliani et al