Fatigue or feeling cold during fast weight loss Fewer cravings for alcohol, snacks, or junk food (commonly reported) When to Slow Down or Stop Vomiting that does not stop within 24 hours Severe upper abdominal pain that wraps around to the back Yellowing of skin or eyes Severe dehydration signs (dizziness, very dark urine, racing heart) Rapid weight loss over 2 lb per week sustained for many weeks (lean tissue loss risk) 13
Colchicine, Neomycin, Aminosalicylic Acid, H2-blockers (e.g., Ranitidine), and Proton Pump Inhibitors (PPIs, e.g., Omeprazole): These oral medications can all interfere with the intestinal absorption of dietary B12, making the need for injectable B12 more pronounced
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