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Metformin use and vitamin B12 deficiency: New MHRA guidance - DiabetesontheNet
High-dose oral b12 protocols Oral b12 can overcome absorption issues through mass action
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Supply Duration:1 month supply
not present in plants Daily requirement: ~ 2–3 µg/day Body stores: 2–5 mg , mostly in the liver (sufficient for 2–5 years) Absorption Pathway : In the mouth/stomach: B12 is protein-bound in food Stomach acid and pepsin release B12 from food proteins B12 binds to haptocorrin (also called R-binder or transcobalamin I) secreted by salivary glands and gastric mucosa In the small intestine : In the duodenum , pancreatic proteases degrade haptocorrin Free B12 then binds to intrinsic factor (IF) , a glycoprotein secreted by gastric parietal cells The B12–IF complex travels to the terminal ileum , where it binds to cubilin receptors and is absorbed via receptor-mediated endocytosis 1 In the enterocyte and bloodstream: Inside enterocytes, B12 dissociates from IF It binds to transcobalamin II (TCII) for systemic transport Only B12–TCII complex (called holotranscobalamin ) is biologically active and taken up by tissues Storage and transport: B12 is stored in the liver (main site), but also in muscle Transcobalamin II transports active B12 to tissues
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