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Emerging findings demonstrate that mitophagy cannot remove impaired mitochondria, leading to the accumulation of dysfunctional mitochondria during neurodegeneration [9]

Several factors can impair B12 absorption: Reduced stomach acid production (achlorhydria or hypochlorhydria), common in older adults and those taking proton pump inhibitors or H2-receptor antagonists long-term, impairs the release of B12 from food proteins Pernicious anaemia , an autoimmune condition destroying parietal cells and reducing intrinsic factor production, completely blocks the primary absorption pathway Gastrointestinal disorders including Crohn's disease, coeliac disease, or surgical removal of stomach or ileum sections directly damage absorption sites Metformin , commonly prescribed for type 2 diabetes, may reduce B12 absorption through unclear mechanisms

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Ongoing research continues to evaluate its long-term safety, metabolic benefits, and potential role in preventing obesity-related conditions such as type 2 diabetes, heart disease, and sleep apnoea

e-pub ahead of print 7 May 2014

I would suggest working with a professional to understand why levels have dropped and identify this underlying cause