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If pepsin formation is compromised, the ability of protein bound vitamin B12 to be freed for additional preparations for absorption will be compromised.2-7 In addition, the increase gastric pH also contributes to a greater degree of bacterial colonization and replication within the gastrointestinal tract, thus potentially leading to bacterial overgrowth.2 If bacterial overgrowth also occurs then additional vitamin B12 that was originally ingested for absorption will be utilized by the enteric bacteria thereby reducing the final amount of vitamin B12 available for absorption in the terminal ileum of the small intestine

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Although cyanocobalamin is more readily absorbed, much of it is excreted through the urine before it can reach the cells Cyanocobalamin vs Hydroxocobalamin In comparison to hydroxocobalamin, cyanocobalamin has a significantly worse absorption rate and storability, which is why today mostly hydroxocobalamin is used in B12 injections