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Most practitioners use defined cycles (48 weeks) rather than indefinite use, though some chronic conditions warrant longer-term protocols

B12 supplementation is not one-size-fits-all

These effects may be more pronounced in patients with altered gastric anatomy Pancreatitis risk : Patients should be informed about symptoms of acute pancreatitis (severe abdominal pain, sometimes radiating to the back, with vomiting) and seek immediate medical attention if these occur Gallbladder disease : Increased risk of gallstones and gallbladder-related problems, particularly with substantial weight loss Dehydration and acute kidney injury : Reduced fluid intake combined with gastrointestinal side effects may increase risk of dehydration Nutritional concerns : The combination of reduced stomach capacity and appetite suppression may increase the risk of nutritional deficiencies, particularly protein, vitamin B12, iron, and calcium Hypoglycaemia risk : Especially in patients taking diabetes medications, careful monitoring and dose adjustment may be necessary Diabetic retinopathy : Patients with diabetes should have appropriate eye screening, as rapid improvement in glucose control may temporarily worsen retinopathy Medication absorption : GLP-1 receptor agonists may affect absorption of oral medications due to delayed gastric emptying Pregnancy and contraception : These medications are not recommended during pregnancy or breastfeeding

Washington, DC: National Academy Press