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The freed B12 then binds to intrinsic factor, a protein produced by gastric parietal cells, forming a complex that travels to the terminal ileum (the last section of the small intestine) where it is absorbed into the bloodstream

Decreased stomach acid and inadequate chewing: an acidic environment is needed to free B12 from food, but low stomach acid and poor chewing are common as we age, and amongst those on long-term antacid and proton pump inhibitor (PPI) medication

Suppliers should ship with ice packs and provide storage instructions

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Example: a ventrogluteal-focused gluteal IM injection model helps students practice safe site identification

A proper lab workup and discussion with a physician are necessary to discover or rule out whether inadequate B12 levels could be at play