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The frequency changes across the three phases

Sever et al., 2019)

Patients who already have exceptionally high pyridoxine levels or signs of pyridoxine toxicity (such as sensory neuropathy) should not continue to receive high-dose supplementation until those symptoms resolve

Medical conditions affecting absorption warrant particular attention : Pernicious anaemia : an autoimmune condition destroying gastric parietal cells, requiring lifelong B12 injections Gastrointestinal surgery : particularly gastric bypass, gastrectomy, or terminal ileum resection Inflammatory bowel disease : Crohn's disease affecting the terminal ileum impairs absorption Coeliac disease : untreated disease damages the small intestine, reducing B12 uptake Medication use : long-term metformin therapy (MHRA safety alert) or nitrous oxide exposure Symptoms suggesting possible B12 deficiency include : persistent fatigue, weakness, paraesthesia (pins and needles) in hands or feet, glossitis (sore, red tongue), mood changes, memory problems, or unexplained anaemia