Theories include alteration of bile acid metabolism, small intestinal bacterial overgrowth, effects on intestinal motility and interference by metformin on vitamin B12-intrinsic factor absorption in the terminal ileum
These cells are essential in fighting off infections and keeping your immune system in good working order
Your doctor will conduct a comprehensive clinical assessment including: Detailed medication and supplement history , including over-the-counter vitamins and injections Review of symptoms suggesting liver, kidney, or haematological disease Physical examination for hepatomegaly, splenomegaly, jaundice, or lymphadenopathy Additional blood tests , such as full blood count, liver function tests, renal function, and inflammatory markers Depending on initial findings, further investigations may include: Liver ultrasound or imaging if hepatic pathology is suspected Haematology referral for blood film examination, bone marrow biopsy, or specific tests for myeloproliferative disorders Measurement of holotranscobalamin or methylmalonic acid if functional B12 status needs clarification despite high total B12 Targeted investigations based on clinical findings and following NICE guidance for suspected serious conditions Treatment focuses on addressing the underlying cause rather than the elevated B12 itself
The gradual supportive nature of micro-dosing aligns with what these conditions require
