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Ensure laterality (right, left, unspecified) is properly documented

The telling sign of this is elevated homocysteine and methylmalonic acid despite normal folic acid, B6, & B12 levels (11)

Keep in mind prolactin only stimulates milk production

This approach avoids the digestive system, resulting in rapid absorption

Another possibility is that obesity could lower serum vitamin B12 levels through decreased dietary intake or absorption, increased catabolism, and sequestration in adipose tissue, or changes in the gut microbiota profiles which could affect the metabolism of vitamin B12

VITAMINE B12, INTRODUCTION ET SOURCES DITTIQUES 2