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Long-term, high-dose proton pump inhibitors may also affect B12 absorption in some patients

10.1038/tp.2013.14 9 FryeR

Mood changes: Vitamin B12 and related compounds may temporarily influence mood or energy levels

Clinical improvement was also observed in oxidative stress markers, with improvements in methionine levels (p=0.05), homocysteine levels (SAH, p=0.007) and the ratio of S-adenosylmethionine (SAMe) to SAH (p=0.007), indicating improvement with methylation at the cellular level and a decrease in oxidative stress in the body 2

More than two thirds of the B 12 excreted in bile is reabsorbed in the small intestine, but this reabsorption is reduced in people with pernicious anaemia or other causes of B 12 malabsorption.5859 Nitrous oxide toxicity The Association of British Neurologists has recently issued guidance on recognising and managing nitrous oxide toxicity associated with B 12 deficiency.14 It recommends rapid initiation of alternate-day intramuscular hydroxocobalamin therapy, and maintenance of this treatment until all symptoms have resolved or there is no further neurological improvement, with long term B 12 therapy depending on the presence of deficiency on presentation, together with total abstinence from the use of nitrous oxide

Gallegos, A