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Conditions known to be associated with Paradoxical B12 deficiency include: Chronic Fatigue Syndrome Fibromyalgia Myalgic Encephalitis Autism Down Syndrome Cerebral Palsy (Bottinger etal, 2020) Insufficient intake of vitamin B2, Iodine, Selenium and/or Molybdenum Hypothyroidism Rheumatoid arthritis Cystic fibrosis Conditions which are associated with functional B2 deficiency, or where Paradoxical B12 deficiency should be suspected Gestational diabetes Obesity Diabetes Conditions of elevated serum vitamin B12 levels above the norm

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This helps reduce the rare risk of lactic acidosis

Within 2 to 3 days of their first injection, most people feel less exhausted

Chronic pain is common with endometriosis, but it can become debilitating when left untreated

Case example : A patient receives office E/M visits for acute flares and chronic disease management