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The secondary outcomes will be the serum vitamin B12 concentration (pg/ml), adverse events (description, moment of onset and resolution, intensity, cause, steps taken), adherence to treatment (measured at each patient visit via the number of vials used for patients in the oral arm, and the number of injections given in the intramuscular arm), quality of life (measured using the EuroQoL-5D questionnaire), and patient satisfaction and preferences

If blood tests show clearly low levels (thresholds vary by lab, but often below roughly 200 pg/mL) or there are signs of anemia, a provider may recommend weekly injections for the first several weeks as a correction or "rescue" phase

Go slowly

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