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Other reasons include: bariatric surgery or bowel resection, age, those with GI diseases such as Crohns and Celiac, people taking Metformin to control their blood sugar and thos taking proton pump inhibitors (Prevacid, Prilosec, etc) for chronic heartburn

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In the withdrawal trial, participants switched to placebo regained about 14% over the following year. Tapering, protein at roughly 0.7 g per pound, resistance training, and follow-up reduce the risk, but no post-stop protocol guarantees maintenance

Regular treatments can help restore low B-12 levels, which are common due to dietary gaps, certain medical conditions, or age-related absorption issues

PLoS ONE 11:e0162887