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But anecdotes and clinic marketing do not substitute for randomized human trials that measure hunger, caloric intake, and long-term weight trajectories

This mechanism becomes clinically important when using high-dose oral supplements (typically 1000 micrograms or more), as it can provide adequate absorption even when the intrinsic factor pathway is impaired

This prevents adverse events and supports appropriate clinical decision-making

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The most frequent symptoms are: Developmental delays Anaemia Loss of appetite Chronic vomiting Weight loss Low brain volume Spasms/cramps Apathy Irritability In the most severe instance, vitamin B12 deficiency can lead to respiratory failures and coma (51)