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Symptoms of B12 deficiency may include Megaloblastic anemia (large red blood cells with abnormal nuclei) Fatigue Paleness Heart palpitations Dementia Weight loss Infertility Numbness and tingling in hands and feet Depression, mania, delirium, psychosis Poor pregnancy and breastfeeding outcomes (neural tube defects, developmental delays, failure to thrive, anemia in offspring) Low red and white blood cell counts or platelets Glossitis of the tongue Erectile dysfunction or bowel/urinary incontinence Recommended Daily Intake for B12 Recommended Dietary Allowance (RDA) Daily B12 requirements depend on age, sex, and dietary intake (5) Assessing B12 Status Typically serum B12 levels are used to determine vitamin B12 deficiency (keep in mind normal value ranges may vary slightly depending on the laboratory)

This means that they can begin to work much faster than other supplements such as B12 tablets and other medications

Clinics generally advise against starting treatment for anyone who: Is pregnant Has a personal or family history of thyroid cancer Has a history of multiple endocrine neoplasia (MEN) syndrome BMI and health history serve as a useful starting point for this evaluation, not an absolute cutoff, since metabolism and overall wellness also weigh into a provider's decision

Anecdotal/observational reports (body composition, energy, recovery) exist in performance settings, but lack standardized dosing, controls, and validated endpoints

Change medicated water on a daily basis and supply as sole source of drinking water for treatment duration