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B12 Regulation in the Body Vitamin B12 regulation relies on drinking enough water and proper absorption to produce saliva and stomach acid

However, serum B12 has a limitation: it can appear within the reference range even when cellular-level deficiency exists, because it captures both active and inactive forms of the vitamin

Additional risk factors include: Chronic kidney disease : Reduced renal clearance may impair B12 excretion Liver disease : Hepatic dysfunction can disrupt B12 metabolism and storage Myeloproliferative disorders : Certain blood cancers increase B12-binding proteins Concurrent medication use : Some drugs may interact with B12 metabolism, including metformin, proton pump inhibitors, and H2 antagonists Patients with these conditions should have B12 supplementation carefully monitored by their healthcare team

Benzyl alcohol is a common issue