The great thing about vitamin B12 is that, unlike many other vitamins, it is so safe that the FDA has no upper limit
The early dramatic appetite suppression makes accurate tracking feel unnecessary
In addition, differences in corresponding changes in expression levels of genes associated with dendritic cell maturation, interferon signaling, and NF-B signaling pathways in circulating T cells and monocytes have been noted (Jangi et al., 2016)

Potential risks include: Enhanced gastrointestinal side effects (nausea, vomiting, diarrhea, constipation) Increased risk of nutritional deficiencies and protein malnutrition Potential worsening of gastroesophageal reflux symptoms Dehydration risk and acute kidney injury, particularly during dose escalation Increased risk of gallbladder disease and complications Risk of intestinal obstruction or ileus Diabetic retinopathy progression in patients with diabetes, particularly with rapid glycemic improvement Hypoglycemia risk, particularly in patients on insulin or sulfonylureas Cost considerations and insurance coverage challenges Rare but serious risks including pancreatitis and thyroid C-cell tumors (boxed warning) Clinicians must engage in shared decision-making with patients, carefully weighing these potential benefits against risks in the context of individual patient circumstances, surgical outcomes, comorbidities, and treatment goals