Routine testing of vitamin B12 levels in metformin-treated patients should be considered. Because metformin often causes digestive tract upset, many patients are also put on a proton pump inhibitor (PPIs) such as esomeprazole ( Nexium ), lansoprazole ( Prevacid ) or omeprazole ( Prilosec )
The NIH Office of Dietary Supplements identifies post-bariatric surgery patients as a group requiring monitoring and potentially injectable supplementation
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This keeps vitamin B12 levels up and prevents deficiency from coming back
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