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While high-dose oral B12 (1,000 mcg daily) may be effective in some cases, intramuscular hydroxocobalamin remains the standard NHS practice

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Common symptoms include: Persistent fatigue Low energy levels Shortness of breath Dizziness or feeling faint Irregular heartbeats (palpitations) Pale or yellowish skin Reduced appetite or unintentional weight loss If left untreated, B12 deficiency can lead to serious complications, including nerve damage, cognitive issues, and changes in mood

In addition, the ketogenic diet has a better response when used as an additional treatment along with antiseizure medications [111]