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If serum B12 levels are persistently low, consider alternative therapy (e.g., intramuscular or subcutaneous vitamin B12 therapy)

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Optimise your nutrition Fix any gut issues Check MTHFR, MTRR, MTR and other associated genes for mutations and supplement if necessary Consult your Functional Medicine health practitioner about which form of B12 supplement is best for your condition

After treatment initiation and dose increases, patients should be observed carefully for signs and symptoms of pancreatitis (including persistent severe abdominal pain, sometimes radiating to the back and which may or may not be accompanied by vomiting)