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Sun A, Chang JY, Wang YP, Cheng SJ, Chen HM, Chiang CP

Summary: Diarrhoea is an uncommon side effect of vitamin B12 supplementation, occurring rarely and more often related to supplement formulation or excipients than the vitamin itself

For some individuals (depending on PEMT gene variations) Betaine can substitute for folate and B12 in the regeneration of methionine and can be choline sparing via this mechanism

New or worsening neurological symptoms such as paraesthesia or gait disturbance require same-day clinical assessment and prompt parenteral B12 treatment per BSH guidance