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High-dose supplementationparticularly intramuscular injections that can deliver 1,000 micrograms or morecreates substantially elevated serum B12 levels compared to dietary intake, which may more readily trigger these bacterial changes, though comparative studies between different forms are limited
If you switch the form and the symptoms go away, that tells you the issue wasn't the B12 itself or the level it was the specific form your body had trouble with
For maintenance or prophylactic use (such as in a patient with short-gut syndrome who cannot absorb oral vitamins well), a common regimen is 1 mL IM once weekly
Poor hygiene or reused needles can cause infection, and an injection placed badly can rarely irritate a nerve
Wang Z et al
It works by inhibiting an enzyme called NNMT (nicotinamide N-methyltransferase), which plays a role in slowing metabolism and increasing fat storage as we age
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