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The specific metabolic benefit appears to result from gut bacteria modifications, increased Bifidobacterium and decreased Firmicutes species

Pediatrics 123 (3), 917923

Essentially, a vitamin B12 deficiency is characterised by a lack of vitamin B12, or folate

Interestingly, vitamin B12 deficiency itself can sometimes affect neurological function, potentially including the nerves that control bowel function, so treating a deficiency may actually improve rather than cause bowel symptoms in some cases

Taken together, these data suggest sustained efficacy, particularly in patients with Hunner lesions or with active bladder inflammation