Other groups who may benefit include: Patients following gastric surgery (gastrectomy, bariatric procedures) where intrinsic factor production or absorption sites are compromised Individuals with malabsorption disorders such as Crohn's disease, coeliac disease, or chronic pancreatitis Strict vegans and vegetarians with dietary insufficiency, though oral supplementation is usually tried first Elderly patients with atrophic gastritis or reduced gastric acid production Patients on long-term metformin or proton pump inhibitors, which can impair B12 absorption [6] [8] Individuals with nitrous oxide exposure (recreational or medical), which can cause functional B12 deficiency Diagnosis typically involves serum B12 measurement, with levels below approximately 148 pmol/L (though thresholds vary between laboratories) generally indicating deficiency

Likewise, autoimmune conditions that affect the stomach lining, such as atrophic gastritis or pernicious anemia, directly impact intrinsic factora protein essential for B12 absorption
Their benefits are most noticeable in people who have low or borderline B12 levels, absorption challenges, or increased needs
The ice cubes are helpful when making distilled water, as they will cause the water vapor to condense on the underside of the lid more quickly
Individual results may vary, and all treatments are subject to medical evaluation and approval