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Recommendation: Pharmaceutical semaglutide/tirzepatide can last 30-45 days

Tissue-level deficiency of cobalamin is associated with an increase in the urinary and serum concentrations of an organic acid called methylmalonic acid, which is an alternative product of a cobalamin dependent pathway within the mitochondria

Patients may experience: Persistent fatigue and weakness Breathlessness on exertion Pallor or a slightly yellowish tinge to the skin Heart palpitations Neurological symptoms are of particular clinical concern, as nerve damage caused by prolonged B12 deficiency can be irreversible if not treated promptly

Encourage weight loss and maintenance