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It is also used to give an energy boost, helping to increase activity levels

Other groups of people who have a higher risk include people over age 60, people on certain medications for diabetes, people with Crohns disease, celiac, ulcerative colitis and irritable bowel syndrome and women with a history of infertility or miscarriage

Energy tends to respond first, mood and focus follow within a week or so, and the longer-term, structural benefits build quietly over months

NICE guidelines recommend hydroxocobalamin 1 mg intramuscularly three times weekly for 2 weeks (without neurological involvement) or on alternate days until no further improvement (with neurological symptoms)