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10.3389/fphys.2019.00036 41 LavouC.SiracusaJ.Chalchat.BourrilhonC.CharlotK

The study of drug metabolism is one of the tenets of pharmacokinetics (PK) as metabolism (M), the fourth stage of LADME (a drug's transit through the body), involves the enzymatic biotransformation and non-enzymatic biotransformation of a drug, thereby leading to the fifth stage, excretion (E)

The result: less intrinsic factor, less stomach acid, less surface area for absorption and a near-guaranteed B12 deficiency without lifelong supplementation

Munkholm K, Vinberg M, Kessing LV