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Pharmaceutics 14:411

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Your doctor may recommend taking vitamin B12, but they may also advise against taking supplements with very high concentrations of vitamin B12

The mechanisms behind B12 deficiency in metformin users are multifactorial but are probably related to intestinal absorption, so it seems sensible to assume that oral B12 replacement may be less effective, although there is little evidence in this area

Well, normally this vitamin is absorbed in the gut and so a disruption to normal gut function will reduce the amount of vitamin B12 that's being absorbed by the intestines and that will lead to a depletion of the normal body stores, which will then result in a deficiency in this vitamin within the body as a whole

Association of Vitamin B12 with Pro-Inflammatory Cytokines and Biochemical Markers Related to Cardiometabolic Risk in Saudi Subjects