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Additionally, Semaglutide slows gastric emptying

Statistical Analysis Dichotomous outcomes were analyzed by risk ratios (RRs) and 95% confidence intervals (CIs) using the DerSimonian and Laird random-effects model

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It may be due to slower stomach emptying

Lobeck Aglaophamus sive de theologiae mysticae Graecorum causis libri tres Knigsberg 1829 p

Vitamin B12 Though not a direct effect of fasting, low Vitamin B12 levels can occur with reduced overall food intake or long-term use of certain medications (including metformin, which is sometimes co-prescribed with semaglutide)