While patients typically experience efficient weight loss, they might feel lethargic and fatigued while taking the medication because of GI side effects and reduced calorie intake
"Running out" of B12 usually reflects falling serum levels rather than total depletion
Aug 2010;61(8):683-690
Eating smaller meals, avoiding high-fat foods, staying hydrated, and dosing escalation protocols all reduce nausea rates in clinical trials and practice
Caution is advised in patients with Leber optic atrophy, a genetic disorder caused by chronic cyanide intoxication (such as from smoking, alcohol or some plants), against the use of cyano-B12 due to its cyanide moiety, whilst hydroxo-B12 is a cyanide antagonist and can therefore be used in these patients
Likewise, a consistent beneficial effect of BPC 157 was evidenced in mice after traumatic brain injury (19)