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Human data is still limited, so individual results vary which is exactly why this is done with monitoring rather than guesswork
[9] If you do feel flush or itchy, it should be mild and short-lived
1 2 3 "Vitamin B12, folate, and the methionine remethylation cycle-biochemistry, pathways, and regulation" (PDF)
Once your B12 levels are stabilized and your symptoms improve, the team will typically transition you to a maintenance schedule
These include: Lifestyle interventions (dietary advice, physical activity programmes) Licensed pharmacotherapy such as orlistat, or GLP-1 receptor agonists including semaglutide 2.4 mg (Wegovy, NICE TA875) or tirzepatide (Zepbound) where clinically indicated and available Referral to tier 3 or tier 4 weight management services , including bariatric surgery assessment where appropriate Information on NHS weight management services and eligibility for licensed treatments is available via the NHS website and NICE guidance
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