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Vegans and Vegetarians: Plant-based diets often lack sufficient B12, as it is primarily found in animal products
Early non-response is not failure
Gastrointestinal effects: the main titration bottleneck Nausea, diarrhea, constipation, and vomiting run around 40 to 44% overall, dose-dependent in how many people report them but mild-dominant in severity: severe events stay at or below about 1.7% in any category even at the top dose. In the obesity program the by-dose rates run nausea 25/29/28%, diarrhea 19/21/23%, and vomiting 8/11/13% at 5/10/15 mg. They concentrate during escalation and ease with time on a held dose
Most long-term protocols settle at 12 mg per day because the doseresponse curve plateaus
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