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However, B12 injections do not directly cause weight loss or significantly increase metabolism in people who already have adequate B12 levels

While the etiology of NTD is multifactorial, some studies have found that blood concentrations of homocysteine or holo-transcobalamin to be lower in NTD-affected infants and mothers compared to non-affected controls (reviewed in 59)
If staying at very low doses long-term worked as well, RCTs would reflect that by now

Human evidence: Very limited, older clinical observations in specific patient groups
