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12 Alcohol and B12 absorption Chronic alcohol intake can damage the lining of the gastrointestinal system, significantly affecting the absorption of micronutrients, including B12

The gut microbiota transforms these into secondary bile acids, including deoxycholic acid (DCA), ursodeoxycholic acid (UCA), ursodeoxycholic acid (UDCA), and lithocholic acid (LCA) [98,99,100]

Neuropathology 42 , 93103 (2022)

They can also reduce the generation and accumulation of toxic intermediates like NAPQI during APAP metabolism (Goyal et al., 2019

They can act like fake hormones

The well-known geriatrician-haematologist Larry Solomon, working at Yale University in the USA, wrote 20 years ago: if I had treated only those people who actually had too low serum B12 and elevated MMA values, then I would not have treated approximately two-thirds of the people with a favourable response to B12 supplementation (note: partly via injections, partly via oral supplementation)