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However, these patients had multiple risk factors for b12 deficiency beyond semaglutide use, including previous gastric surgery that permanently alters stomach anatomy and reduces intrinsic factor production

However, if untreated, a vitamin B12 deficiency can lead to serious symptoms, including nerve damage or pernicious anaemia a condition when your body doesnt have enough B12 to make the red blood cells it needs

The ileum is generally regarded as the major site of cobalamin absorption in mammals [2], but significant absorption was also shown to occur in the jejunum of cats and dogs [23]

It's not just poor circulation it could be B12-related nerve issues