The main reason is metformin, the first-line medicine for type 2 diabetes, which can reduce how well the gut absorbs vitamin B12 over time
Keep in mind this is one marker, and lowering it has not by itself been proven to prevent heart attacks or strokes
This is because though cobalamin will take a couple of weeks to reach appropriate levels in the body, especially if deficient, it can last in the body for a long time once it reaches appropriate concentrations
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Vitamin B12 injections begin working at a cellular level almost immediately after administration, though the timeframe for noticeable symptom improvement varies considerably between individuals
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