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PLOS Genet 14:e1007561

Oral supplementation (50150 micrograms daily) is appropriate for dietary deficiency in vegans and vegetarians with intact absorption, with MHRA guidance recommending monitoring in at-risk groups

The change is not a direct side effect but rather a secondary response to rapid metabolic shifts and appetite suppression

This approach aligns with the growing recognition that the future of pain management lies not in blocking pain signals indefinitely, but in actually healing the underlying pathology

The addition of semaglutide to this already high-risk group showed further b12 decline, but whether this represents a medication effect, dietary changes from additional appetite suppression, or natural progression of post-surgical deficiency remains unclear

This results in more sustainable improvements with fewer side effects compared to traditional hormone therapies