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That system can break down if you: Take acid blockers (PPIs like omeprazole) or antacids regularly Have low stomach acid from age or chronic stress Have had GI surgery (gastric bypass, bowel resection) Live with conditions like celiac, Crohns disease, or IBS Have autoimmune pernicious anemia Even with high-dose tablets (e.g., 1000 mcg), only a small fraction may reach your bloodstream