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Proton Pump Inhibitors, H2-Receptor Antagonists, Metformin, and Vitamin B-12 Deficiency: Clinical Implications

Vegetarian sources of B12 include chlorella, nori, nutritional yeast and certain mushrooms, but many vegans and vegetarians have insufficient levels of B12 because its not widely found in plants. According to Mullane, not getting enough B12 can result in issues like anaemia, fatigue and more intense symptoms including shortness of breath, palpitations, pale skin, muscle weakness, numbness and tingling in hands or feet, blurred vision and memory loss

Neurological damage may begin before haematological changes appear, and prolonged deficiency can result in irreversible structural changes to nerve tissue, emphasising the importance of early detection and treatment

Chapter II discussed the need for slow withdrawal and gave practical examples of dosage tapering