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The most recent comprehensive synthesis is a July 2025 systematic review in the HSS Journal , the musculoskeletal journal of the Hospital for Special Surgery in New York, led by Nikhil Vasireddi at Case Western Reserve University School of Medicine

B12 shots work faster than oral sources of B12 and therefore are recommended for individuals who need rapid improvement

Taken together, the researchers concluded that thyroid function may affect mast cells, and that mast cell degranulation could affect thyroid function.[ref] In patients with autoimmune thyroid disease, mast cells infiltrate the thyroid gland and then degranulate.[ref] Animal studies show that hypothyroidism (low thyroid hormone levels) increases the number of mast cells by up to 4.5-fold

While not required, following a balanced, low-calorie diet can enhance results