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The signs and symptoms of B12 deficiency differ widely

Proton pump inhibitors and similar medications that lower stomach acid might decrease the absorption of vitamin B12 from food, but this is less of a concern when receiving B12 injections because they bypass the digestive system entirely

Low stomach acid can contribute to low iron levels and anemia by affecting nutrient absorption, as stomach acid is needed to extract iron and vitamin B12 from our protein-containing foods

Most therapeutic peptides are rapidly cleaved by gastric acid and luminal proteases (pepsin, trypsin, chymotrypsin) before meaningful absorption can occur