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Mood changes: Vitamin B12 and related compounds may temporarily influence mood or energy levels
More than two thirds of the B 12 excreted in bile is reabsorbed in the small intestine, but this reabsorption is reduced in people with pernicious anaemia or other causes of B 12 malabsorption.5859 Nitrous oxide toxicity The Association of British Neurologists has recently issued guidance on recognising and managing nitrous oxide toxicity associated with B 12 deficiency.14 It recommends rapid initiation of alternate-day intramuscular hydroxocobalamin therapy, and maintenance of this treatment until all symptoms have resolved or there is no further neurological improvement, with long term B 12 therapy depending on the presence of deficiency on presentation, together with total abstinence from the use of nitrous oxide
Clinical improvement was also observed in oxidative stress markers, with improvements in methionine levels (p=0.05), homocysteine levels (SAH, p=0.007) and the ratio of S-adenosylmethionine (SAMe) to SAH (p=0.007), indicating improvement with methylation at the cellular level and a decrease in oxidative stress in the body 2
Long-term, high-dose proton pump inhibitors may also affect B12 absorption in some patients
