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JAMA 1997

The primary mechanism by which metformin interferes with vitamin B12 absorption involves calcium-dependent membrane action in the terminal ileum, where vitamin B12 is absorbed

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However, studies show people with obesity and type 2 diabetes are more likely to have low vitamin A levels

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Thus, with warfarin, thrombocytopenia is the common end result of the L-NAME and/or L-arginine administration