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People who have had bariatric surgery Previous bariatric surgery, particularly gastric bypass, permanently alters the digestive anatomy in ways that reduce B12 absorption

Finally, if the serum cobalamin concentration at the time of reevaluation is subnormal, further work-up is required to definitively diagnose the underlying disease process and cobalamin supplementation should be continued weekly or bi-weekly (for parenteral supplementation) or daily (for oral supplementation)

I have also included oral folate supplements, probiotics and have expanded my diet (but still excluding caffeine, alcohol and sugar)

Association of serum adiponectin levels with artherosclerosis and the metabolic syndrome in obese children

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