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According to the NIH Office of Dietary Supplements, functional B12 deficiency is most commonly seen in patients with one or more of the following: Age over 50 stomach acid production declines with age, and stomach acid is required to free B12 from food PPI or H2 blocker use reflux medications suppress the acid needed for B12 absorption Metformin use, which interferes with B12 absorption directly Vegan or vegetarian diets B12 is found almost exclusively in animal products Gut conditions including celiac, IBS, SIBO, and Crohns MTHFR mutations that affect how B12 is metabolized once absorbed Heavy alcohol use The symptoms of low B12 are easy to dismiss: fatigue, brain fog, low mood, tingling in the hands or feet, weakness, and shortness of breath on mild exertion

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A good candidate for Vitamin B12 injection is someone who has been diagnosed with a B12 deficiency, which can include people with certain medical conditions, older adults, vegans, and vegetarians who might not get enough B12 from their diet

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Although there is currently no evidence to suggest any adverse side effects from excess vitamin B12 supplementation, there is no need to take excessively high amounts of the vitamin, as the body can only absorb so much anyway

Additional injections of 100 mcg monthly may be needed depending on level of symptom improvement and cause of vitamin B12 deficiency