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Vitamin C in extremely high doses (more than 1000 mg taken with a b12 supplement) may reduce b12 absorption when taken together

Studies suggest that a significant proportion of long-term metformin users may develop biochemical B12 deficiency, though estimates vary widely depending on the population studied, the duration of use, and the B12 threshold applied

Methotrexate may also cause inflammation in your lungs, leading to scar tissue buildup