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Long-term metformin use (the first-line type 2 diabetes drug) can lower B12 in a dose- and duration-dependent way: in the Diabetes Prevention Program Outcomes Study (Aroda and colleagues, The Journal of Clinical Endocrinology & Metabolism , 2016, roughly 1,700 participants), low B12 at 5 years occurred in 4.3 percent of metformin users versus 2.3 percent on placebo, and the gap widened with continued use

Because of this, vitamin B12 is an ideal additive to IV hydration, since dehydration is a major cause of low energy and fatigue.

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