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If the GP says that she doesn't have macrocytic anaemia so doesn't need this pattern of treatment, you could point out that NICE guidelines for B12 deficiency say that "Note: clinical features of vitamin B12 deficiency can occur without anaemia and without low serum levels of vitamin B12." cks.nice.org.uk/topics/anae

Relationship to the GH-IGF-1 Axis Because this fragment does not appear to stimulate IGF-1 production in laboratory models, it provides researchers with a tool to study the IGF-1-independent aspects of GH signalling in metabolic biology

Pernicious anemia is an autoimmune disease characterized by the absence of intrinsic factor, a glycoprotein that is necessary for vitamin B 12 absorption [25, 26]

1 It is within the typical ranges achieved long-term with procedures such as the sleeve gastrectomy

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