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Nevertheless, use of metformin may decrease vitamin B 12 status: a meta-analysis of four short-term intervention trials (up to 4 months duration) in patients with type 2 diabetes found that metformin use decreased serum cobalamin concentrations by 57 pmol/L, which could have clinical implications if such patients have suboptimal vitamin B 12 status (146)

The NHS advises that most people can obtain sufficient B vitamins through a varied diet including whole grains, meat, fish, eggs, dairy, legumes, and leafy green vegetables

It is not intended for human or animal consumption.

Patients on Long-Term Medication: Certain medications, including metformin (for diabetes) and proton pump inhibitors (for acid reflux), can reduce B12 absorption over time

Although thiamine deficiency is rare in developed countries, it can lead to severe neurological disorders, emphasizing the importance of adequate thiamine intake for optimal health and as treatment when administered promptly (42)