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Additionally, chronic conditions such as HIV and tuberculosis have been implicated in B12 deficiency due to increased metabolic demand and altered absorption mechanisms ( The diagnosis of vitamin B12 deficiency typically relies on low total B12 levels and elevated concentrations of homocysteine (Hcy), as well as levels of transcobalamin-bound B12 (holoTC) and methylmalonic acid (MMA), which serve as functional indicators of cobalamin insufficiency ( Vitamin B12 requirements fluctuate throughout the life course, influenced by metabolic demand and physiological changes

In particular, the improvement of intestinal wall integrity occurs due to the three main mechanisms: i) increased expression of TJ proteins, ii) decreased levels of pro-inflammatory molecules, and iii) increased intracellular antioxidant potential (Sandoval-Ramrez et al., 2021)

Because B12 is water-soluble, excess is excreted by the body