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Disruptions in the intrinsic factor (IF) pathway, including impaired IF production due to autoimmune conditions (pernicious anemia), damage to the ileum from diseases like Crohns or celiac disease, or surgical resection of the ileum, can severely impair B12 absorption
For B12 to be absorbed properly, it must bind with a protein called "intrinsic factor," which is produced in the stomach
Clinical basis: NICE vitamin B12 deficiency recommendations, NHS vitamin B12 deficiency treatment guidance and NHS hydroxocobalamin information
Sublingual (under-the-tongue) supplements have 40-50% bioavailability and are often recommended because they bypass potential absorption issues caused by Ozempic
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