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Medication Interference : Some drugs, such as metformin, used for the treatment of Diabetic patients, and Proton-pump inhibitors, which treat patients with Acid reflux, prevent B12 absorption

"Vitamin B12 is an essential nutrient for human health," Elizabeth Ko, assistant clinical professor of medicine at UCLA's David Geffen School of Medicine, told InStyle

Blunted or impeded therapeutic response to vitamin B12 may be due to such conditions as infection, uremia, drugs having bone marrow suppressant properties such as chloramphenicol, and concurrent iron or folic acid deficiency

Older age, female gender, and severe disease were associated with higher risks of fatigue or more symptoms