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These conditions digestive conditions, such as Crohns disease and ulcerative colitis autoimmune conditions, such as celiac disease and type 1 diabetes genetic conditions, such as inherited intrinsic factor deficiency and inherited transcobalamin deficiency chronic pancreatic disease pernicious anemia vitiligo Other factors that may lead to a vitamin B12 deficiency can include drinking excessive amounts of alcohol or using certain drugs, such as some heartburn medicines and metformin

doi: 10.1016/j.toxicon.2010.12.016, 44 GaberyS.SalinasC

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Meanwhile, L-carnitine enhanced mitochondrial -oxidation activities and the expression of carnitine palmitoyltransferase 1 mRNA significantly, whereas it depressed the mRNA expression of adipogenesis-related genes

These aren't minor lifestyle footnotes - they're factors that affect both how well the medication works and how well you tolerate it