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Pernicious anaemia Normally, when you eat foods with vitamin B12, the vitamin combines with a protein called intrinsic factor in the stomach

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Duzniewska et al., 2002

Nevertheless, use of metformin may decrease vitamin B 12 status: a meta-analysis of four short-term intervention trials (up to 4 months duration) in patients with type 2 diabetes found that metformin use decreased serum cobalamin concentrations by 57 pmol/L, which could have clinical implications if such patients have suboptimal vitamin B 12 status (146)

Furthermore, data from the U.S

10.3389/fgene.2019.00435 Front