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Excessive methionine intake in the presence of inadequate intake of folic acid , vitamin B6 , and vitamin B12 , can increase the conversion of methionine to homocysteine , a substance linked to heart disease and stroke

The lack of vitamin B12 may result from any of the following conditions: Addisonian (pernicious) anemia this condition causes autoantibody formation against parietal cells, which results in a lack of IF essential for absorption of vitamin B12 from the intestine Malabsorption impaired absorption of vitamin B12 Gastrointestinal pathology, dysfunction, or surgery these include atrophic gastritis, celiac disease, small bowel bacterial overgrowth, pancreatic insufficiency, Helicobacter pylori infection, gastric carcinoma, and total or partial gastrectomy Diphyllobothrium latum and related species (the fish tapeworm) infestation these parasites compete with vitamin B12 for intestinal absorption

For these patients, oral B12 supplementation (1,000-2,000 mcg daily sublingual methylcobalamin) provides comparable B12 repletion without injection

Week 21+: 15mg (1.5mL or 150 units)

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