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Vitamin B12 deficiency can be occurring while vitamin B12 levels are at levels not typically associated with deficiency due to the presence of deleterious MTHFR mutations. 5 If you have one or more MTHFR, MTRR or MTR gene mutations, you will be less able to methylate B12 or convert your B12 to methylcobalamin

Dose escalation should be individualized, and patients should be counseled that the starting dose is not therapeutic for glycemic control but rather intended to reduce gastrointestinal adverse effects during treatment initiation

For best results, pair the treatment with a balanced diet and regular activity

Warm baths or heat application may provide symptomatic relief for muscle aches, whilst cold packs can reduce inflammation if there is localised swelling

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