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There is some evidence that the diabetes drug metformin (Glucophage) may reduce vitamin B12 absorption when used for several years

Signs that you may be deficient in B12 may include (but are not limited to): weakness, tiredness, or light headedness, heart palpitations and shortness of breath, nerve problems like numbness or tingling, muscle weakness and loss of appetite/weight loss

Older adults face an increased risk due to diminished stomach acid production, which is necessary for B12 absorption

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Barker N, Ridgway RA, van Es JH, van de Wetering M, Begthel H, van den Born M, et al