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These include hormonal therapies (such as birth control pills or progestin therapy), medications to address specific underlying conditions (like thyroid medication or insulin-sensitizing agents for PCOS), and in rare cases, surgical procedures

When constipation occurs in someone taking B12 supplements, it is important to consider concurrent medications, dietary changes, reduced fluid intake, or underlying medical conditions

Think of it this way: Methylmalonic acid (MMA) is a metabolic byproduct that accumulates in the body when there isn't enough active vitamin B12 to break it down

PMID: 38797248 9 Vitamin B12 Deficiency: Recognition and Management