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Without adequate stomach acid, b12 remains bound to food proteins and passes through the digestive system unabsorbed
Patients should seek immediate care if they develop fever (temperature 100.4F or 38C), chills, flank pain, severe abdominal pain, persistent vomiting preventing oral intake, signs of dehydration (decreased urination, dark urine, dizziness, dry mouth), or altered mental status
The exact mechanisms underlying these cardiovascular benefits are still being investigated but may involve a combination of improved blood sugar control, weight loss, and direct effects on blood vessels and the heart
If fatigue persists despite these measures, discuss with your healthcare provider whether the dose escalation schedule should be adjusted