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High levels of Hcy can activate the expression and release of inflammatory factors, leading to vascular endothelial dysfunction ( in vitro studies have corroborated the ability of Hcy to induce the release of inflammatory cytokines from ECs, including interleukin-6, interleukin-8, and tumor necrosis factor- (Li et al., 2016)

Medications: acid-reflux drugs (PPIs) and some diabetes medications (such as metformin) can interfere with B12 absorption

10.1111/nyas.15187 22 GrantB.KeanJ.ValiN.CampbellJ.MadenL.BijralP.et al (2023b)

6 Things Every Bariatric Patient Should Know About B12 FACT 1 OF 6 Symptoms appear 13 years AFTER deficiency starts Your liver stores 35 years worth of B12

You may need to take vitamin B12 for the rest of your life, especially if you have neurological symptoms