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Chronic heavy alcohol consumption can impair B12 status through poor dietary intake and malabsorption, though occasional alcohol is unlikely to significantly affect supplement absorption

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Although vitamin B12 defi­ciency with these classic hemato­logic and neuro­logic signs and symptoms is rare (Hughes‑Jones & Wickramasinghe SN, 1996), low or marginal vitamin B12 status (serum B12 200‑300pg/mL [148‑221pmol/L]) without these symptoms is more common (i.e., up to 40% in Western populations), especially in individuals with low intakes of vitamin B12‑rich foods (NIH, 2024)