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They can cause significant muscle loss along with fat loss, which some research suggests may be as high as 30-40% of total weight lost

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10.1089/acm.2006.12.881 Summary Keywords vitamin B12, efficacy, bioavailability, therapeutic approaches, meta-analysis, cobalamin Citation Mazur M, Ndokaj A, Salerno C, Vallone J, Ardan R, Bietolini S, Carrouel F, Wilk A, Sarig R, Ottolenghi L and Bourgeois D (2025) Efficacy of sublingual and oral vitamin B12 versus intramuscular administration: insights from a systematic review and meta-analysis

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