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Your point is a crucial one, and it highlights the deeply felt frustration and perceived inequity experienced by patients with Pernicious Anemia

The table below summarizes common medications that have been associated with reducing the levels of vitamin B12 as well as the proposed mechanism for this interaction.1-12 The order of listed medications is alphabetical and not reflective of severity or level of importance

Dietary Sources for Vitamin B12 and D3 Vitamin B12 Red meat (beef, lamb) Poultry Fish (salmon, tuna, sardines) Eggs Dairy products (milk, yogurt, cheese) Fortified cereals and plant-based milks Vitamin D3 Sunlight exposure (primary source) Fatty fish (salmon, sardines, mackerel) Egg yolk Cod liver oil Fortified dairy and cereals Despite these sources, multiple studies show that diet alone often fails to meet optimal levels, making vitamin d3 and b12 together supplementation common

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After two weeks with no adverse effects, increase to the standard dose