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So you are absorbing less B12 AND eating less of it simultaneously

further suggest that semaglutide may impact the gut microbial community during treatment, and the basal microbiome may predict changes in HbA1c in semaglutide users (despite methodological limitations and the need for replication) ( Consistent with these findings, a recent clinical pilot study further demonstrated that liraglutide not only promoted weight reduction and improved glycemic control in patients with obesity and T2D, but also induced significant shifts in gut microbial composition ( and diversity) and metabolic pathways, reinforcing the concept that microbiota modulation may contribute to the therapeutic effects of GLP-1 RAs ( To synthesize the currently available human evidence, Table 1 summarizes clinical studies evaluating gut microbiota composition in patients receiving GLP-1 receptor agonists

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Inflammation 31 , 9198 (2008)

If the therapeutic target is inside the gastrointestinal tract, poor absorption into the bloodstream is not a bug it is arguably a feature, because it keeps the active molecule concentrated where it is needed and limits systemic exposure