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Two Phase 3, randomized, double-blind, placebo-controlled trials enrolled 816 patients and measured visceral fat by CT scan

Groups at higher risk of deficiency include older adults (due to reduced stomach acid production), people following vegan or strict vegetarian diets (as B12 is naturally found almost exclusively in animal products), individuals with pernicious anaemia or other malabsorption conditions, those taking certain medications such as metformin or proton pump inhibitors long-term, and people with significant nitrous oxide exposure (including recreational use), which can inactivate B12 in the body

But the fact is that the Cochrane Review of the use of Oral tablets to treat PA is not at all substantial

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