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Risk factors that should prompt consideration of B12 deficiency include advancing age (reduced stomach acid production), strict vegan or vegetarian diets, pernicious anaemia, gastrointestinal surgery (particularly gastric bypass or ileal resection), long-term use of certain medications (metformin, proton pump inhibitors, H2-receptor antagonists), nitrous oxide exposure (including recreational use), and conditions affecting the gut such as Crohn's disease or coeliac disease

The symptoms of serotonin dysregulation include a range of mental and physical effects

The Clinical Reasoning Tesamorelin is injected before bedtime, at least 2 hours after your last meal

NHS Guidelines on Self-Administering B12 Injections The NHS supports patient self-administration of B12 injections where clinically appropriate and following adequate training