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Other Gastrointestinal Disorders Affecting B12 Other conditions like gastric bypass surgery, atrophic gastritis, and pancreatic insufficiency can also cause B12 malabsorption

The rate of loss accelerates during the dose escalation phase and typically peaks around weeks 16-32 when you reach higher maintenance doses

The medication also slows gastric emptying, meaning food stays in the stomach longer and nutrient absorption is more gradual

What to Expect During Recovery Once treatment begins, recovery typically follows this timeline: First Few Days to Weeks: Many people notice an increase in energy and improvement in symptoms like fatigue and weakness within the first week of treatment