Restorative proctocolectomy (RP) is a common surgical procedure utilized in the management of inflammatory bowel disease (IBD), primarily ulcerative colitis (UC). This procedure involves removal of the colon, and the formation of a pouch from the distal portion of the ileum, the primary site for absorption of vitamin B12. Vitamin B12 deficiency has been linked to fatigue, depression, memory loss, weakness, neuropathy, and altered bowel habits. In RP, surgical manipulation of the ileum, an altered microbiota, and pouchitis may potentially impair vitamin B12 status.