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Others experience loose stools or diarrhea, particularly after high-fat meals

Once the deficiency is addressed, a maintenance dose can be given to keep B12 levels within the optimal range

Starting with simple self-care and footwear changes, progressing to injections if needed, and considering surgery only when other options have been exhausted

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Strong evidence, from decades of treating individuals with inborn errors of B 12 metabolism, supports the safety of parenteral, lifelong, even high dose hydroxocobalamin, sometimes even at very high doses.6768 Long term epidemiological studies also indicate that treatment with pharmacological B 12 doses and the corresponding increase in serum B 12 do not increase mortality.69 Data on the safety of cyanocobalamin, when administered with high frequency (ie, one to two times a week) for a longer period of time, are lacking

Maternal vitamin B12 levels at approximately 18 weeks gestation is a reliable predictor of vitamin B12 status in lactation and in the infant through the first 6 months of life