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The acidic BM niche improves the egress of cAMP via MRP4 (44) and cAMP efflux might regulate extracellular ADO levels and thus optimize the autocrine and paracrine immunosuppressive effects of ADO

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Deficiency after gastric banding is therefore primarily related to: Reduced dietary intake and food tolerance , limiting consumption of B12-rich foods Use of acid-suppressing medicines (PPIs or H2RAs) , which can impair the release of B12 from food proteins and reduce absorption of food-bound B12 Crystalline B12 the form found in supplements and fortified foods does not require acid or pepsin for release