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The ratio of Firmicutes to Bacteroidetes is a commonly-studied change with an increase often linked to HFD consumption/obesity in mice 43,44 and humans 45,46 (for review, see John and Mullin, 2016 47 )

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For individuals requiring supplementation due to confirmed deficiency or malabsorption, therapeutic doses vary considerably depending on the underlying cause: Dietary deficiency : 50150 micrograms daily orally, or cyanocobalamin tablets as prescribed Pernicious anaemia : Initially hydroxocobalamin 1 mg intramuscularly three times weekly for two weeks, then maintenance injections every two to three months [3] Neurological involvement : More intensive regimens may be required, with hydroxocobalamin injections on alternate days until symptom improvement [3] NICE guidance emphasises that supplementation should be evidence-based rather than speculative

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