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Changes in BBB transport are also evident by a decrease in cerebralspinal fluid to serum ratio of insulin [91, 99]

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Weight loss clients are encouraged to take a vitamin B12 injection weekly because a B12 deficiency leads to lethargy, which can be enhanced when following a low-calorie diet

Review supplementation If elevated B12 results from excessive supplementation: Discontinue or reduce high-dose supplements unless medically indicated For patients receiving therapeutic B12 injections for confirmed deficiency, continue treatment as prescribedelevated levels are expected after replacement therapy and do not indicate toxicity Review with GP to ensure supplementation remains appropriate 3