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While manageable in the short term, these challenges can gradually erode adherence, making long-term use difficult even for those who initially respond well

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Those with documented deficiency in B12, B1, or B6 Patients with peripheral neuropathy (tingling, numbness, burning extremities) Those with lower back pain and sciatica with a neurological component Diabetic patients especially those on metformin (B12 depletion) Strict vegans the only people with complete B12 dietary absence Elderly adults with impaired B12 absorption Post-gastric or intestinal surgery patients Who Should Use with Caution