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Reduced states of cobalamin (i.e., +2 and +1) react with dioxygen rapidly to generate a superoxocobalamin.50,51 This species bears analogy to the early intermediates in cytochrome P450 chemistry in which reactive metaloxygen species catalyze the oxidation of pharmaceuticals and other compounds

Recommended testing schedule Baseline (before starting): Complete metabolic panel, CBC, lipid panel, HbA1c (even if not diabetic), B12, folate, vitamin D, thyroid panel, and fasting insulin

Even if the underlying problem is treated appropriately and the digestive tract returns to normal, the vomiting, diarrhea, and weight loss may continuebut now because of the vitamin B12 deficiency, not the initial disease process

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[1] For bariatric surgery patients, it's important to follow the specific protocols recommended by your surgical team, as many UK centres recommend routine intramuscular B12 after certain procedures such as Roux-en-Y gastric bypass

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