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Tureek P, Kleisner K

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So Dr Copperfield is advising against testing for B12 despite the following guidance New UKHSA guidance on metformin For patients prescribed metformin, healthcare professionals should: test vitamin B12 serum levels if deficiency is suspected (for example, in patients presenting with megaloblastic anaemia or new-onset neuropathy) and follow current clinical guidelines on investigation and management of vitamin B12 deficiency (for example, see Clinical Knowledge Summary from NICE) consider periodic vitamin B12 monitoring in patients with risk factors for vitamin B12 deficiency, which can include being elderly

Second, B12 undergoes enterohepatic recirculation cobalamin secreted in bile is reabsorbed in the ileum through the same intrinsic-factor pathway so a genetic weakness in absorption is amplified over time by loss of the recycled pool

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