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Metformin for diabetes and proton pump inhibitors for acid reflux can both interfere with B12 absorption over time

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[1] [3] The injections work by bypassing the digestive system entirely, delivering B12 directly into muscle tissue where it can be absorbed into the bloodstream

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[DOI] [PMC free article] [PubMed] [Google Scholar] 186.Hensley C.T., Wasti A.T., DeBerardinis R.J

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Similarly, addition of NAD + and ALDH to human lymphocyte cultures exposed to acetaldehyde decreased SCE induction (Obe et al., 1986)

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