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Patients should be reviewed 812 weeks after commencing treatment to assess: Symptomatic improvement, particularly resolution of fatigue and neurological symptoms Haematological response (normalisation of haemoglobin and mean cell volume) Reticulocyte count typically rises within one week, indicating bone marrow response Repeat serum B12 testing is generally not useful after starting parenteral therapy, as levels remain elevated for months

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thetaiotaomicron creates competition by using a surface-exposed lipoprotein, which binds cobalamin with such affinity that can remove it from intrinsic factor, a cobalamin transport protein necessary for absorption in humans and animals [14]

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Another benefit of this peptide is its ability to promote slow-wave sleep (e.g