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Pernicious anemia: diagnostic approach Vitamin B12 deficiency can be caused by medications, drugs, malabsorption, or malnutrition (Table 2) [12,13]

The benzyl alcohol acts as a preservative, a bacteriostatic agent that inhibits the growth of most potential contaminants

The NHS treatment pathway and the 2024 NICE guideline both assume B12 injections are given in a clinical setting against a confirmed deficiency, not self-sourced and self-administered

Replacing these vitamins and maintaining a healthy diet of folic acid and vitamin b12 often help return the homocysteine level to normal, downgrade cortisol levels to prevent shrinkage of the major parts of the brain, and even treat depression