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Vitamin B12 injections may offer a safer alternative for patients concerned about side effects

However, long-term human data is limited

Clinical Manifestations of Vitamin B12 Deficiency Although the classic hematologic expression of vitamin B 12 deficiency is a megaloblastic macrocytic anemia characterized by an elevated mean corpuscular volume and mean corpuscular hemoglobin, and a peripheral smear containing macroovalocytes and hypersegmented neutrophils, up to 28 percent of affected patients may have a normal hemoglobin level, and up to 17 percent may have a normal mean corpuscular volume

It does this primarily by regulating nitric oxide, a molecule that controls how blood vessels expand and contract (Seiwerth et al., 2018)