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You Consume Excessive Amounts of Alcohol Like nicotine consumption, the consumption of excessive amounts of alcohol can lead to vitamin B12 deficiency

While specific data on micronutrient status during tirzepatide therapy are limited, clinical experience suggests that maintaining optimal nutritional status supports the preservation of lean muscle mass during weight loss, enhances energy levels, and promotes overall treatment tolerability and success

it works upstream, on an enzyme called nicotinamide N-methyltransferase (NNMT) that fat cells over-express when they become metabolically sluggish

Biochem Mol Biol Int

William Castle demonstrated that gastric juice contained an "intrinsic factor" which when combined with meat ingestion resulted in absorption of the vitamin in this condition