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Metformin reduces adenosine triphosphate (ATP) production in the mitochondria, which increases adenosine monophosphate (AMP) signaling, leading to increased insulin sensitivity, promotion of glycolytic pathways, and inhibition of gluconeogenesis

Vitamin B12 absorption begins in the mouth but mainly occurs in the stomach and small intestine with the help of intrinsic factor, a protein that helps your body absorb B12. Weight loss surgery results in anatomical changes, such as a smaller stomach, reduced stomach acidity, and changes to the small intestine, that can lead to vitamin B12 malabsorption and decreased intrinsic factor secretion

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Pain killers should be restricted to times of rest