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But as with any therapy that influences appetite, metabolism, and hormones, there are complex downstream effectsand one thats less commonly discussed is a change in libido

The recommended dose modifications for adverse reactions are listed in Tables 1, 2, and 3

These include: Autoimmune diseases, such as hypoparathyroidism, Graves disease, myasthenia gravis, and type 1 diabetes Crohns disease HIV Vitiligo Celiac disease Having part or all of your small intestine removed Small intestine bacterial overgrowth, a condition where you have harmful bacteria in your intestines that absorb all the B12 before your intestines can Other risk factors for pernicious anemia include: Scandinavian or Northern European ancestry Family history of PA Having gastric bypass surgery (used to treat obesity), which loses cells that absorb B12 Taking medications such as antacids or drugs that treat type 2 diabetes but make it harder for your body to absorb enough B12 Pernicious Anemia Symptoms Symptoms of pernicious anemia may take years to develop because your body can store 1,000 to 2,000 times as much B12 as you need in a day

Org Biomol Chem (2017) 15(31):665667

PubMed Eli Lilly

Nasal spray In those who struggle with B12 absorption, a B12 nasal spray can also deliver large doses of the vitamin directly to your blood stream via your nose