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A randomized controlled trial showed that metformin 850 mg three times per day for over 4 years resulted in a 19% decrease in B12 levels compared to placebo (74)

This suggests that intestinal L cells respond to gut barrier disruption by releasing GLP-1, which involves toll-like receptor 4 (TLR4) signalling, and that Akkermansia plays a critical role by directly inducing L cells to release GLP-1 [9]

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About Ozempic (Semaglutide) Ozempic is the brand name of an injectable semaglutide medication originally developed to help manage type 2 diabetes