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Gradual titration is essential to minimize gastrointestinal side effects
Methylcobalamin is the active form of vitamin B12 that can be directly utilized by the body, bypassing the need for conversion
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
Patient Information for Nascobal Patients with pernicious anemia should be instructed that they will require weekly intranasal administration of Nascobal (cyanocobalamin) Nasal Spray for the remainder of their lives
Correcting a true B12 deficiency can improve energy and exercise capacity, which may indirectly help with diet and training
