So I will say just three more things, two of which are touched on above: B12 is stored in the liver for when we need it and normal dietary intake does not need to be high, but if you cant absorb it you do need injections
Tirzepatide-Specific Safety Considerations GI symptoms are generally mild to moderate Risk of hypoglycemia when used with insulin or sulfonylureas Rare risk of pancreatitis (class effect) Possible thyroid C-cell effects (class warning) Heart rate increases have been documented, but are generally modest Retatrutide-Specific Safety Considerations Higher overall rate of side effects compared to tirzepatide in Phase 2 data More pronounced heart rate increase this is a dose-dependent effect directly related to glucagon receptor activation (glucagon is known to increase heart rate in pharmacological doses) At 12 mg doses, some participants experienced increases in heart rate of 46 bpm above baseline
van Marken Lichtenbelt, W
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In Canada, advice from the British Columbia Medical Association outlines that 1 mg daily oral CN-Cbl should be used for pernicious anemia or food-bound cobalamin malabsorption (FBCM) whereas in most other cases, a daily dose of 250 g may be used ( In Netherlands, controversy arose when the Dutch Organization of General Practitioners published a 2014 viewpoint that 1 mg daily oral OH-Cbl can be utilised as treatment in cases with a cobalamin count below 148 pmol/L and clinical symptoms, with the Dutch B12 Society disputing the efficacy of this and insisting that the advice from the Dutch Healthcare Institute Pharmacotherapeutic Compass should be followed instead (IM/SC starting dose of 10 injections of 1 mg OH-Cbl at intervals of at least 3 days
