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What laboratory and clinical tests should be used to determine whether my relative, who has been on longterm vitamin B12 injections for presumed pernicious anemia despite negative intrinsicfactor and parietalcell antibodies and no current anemia, actually needs continued B12 supplementation?

Gomes, M

Falcinelli S, Picchietti S, Rodiles A, Cossignani L, Merrifield DL, Taddei AR, et al

If vitamin B12 levels become low, treatment is usually simple and effective

Interestingly, hyperglycemia has been reported to induce an increased intestinal permeability through GLUT2-dependent mechanisms and the alteration of tight junction cohesion, thus creating a leaky gut state [53]

Limited, well-timed use around surgical repair, embryo transfer, or ovulation could still exploit the pro-repair and angiogenic effects while minimizing systemic exposure