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Supplemental material Intervention and placebo The active substance of vitamin B 12 given in the study is 2 mL mecobalamin (5 mg/ml), administered intramuscularly.25 Placebo substance is 2 mL sodium chloride (9 mg/ml), isotonic solution for parenteral use (Baxter) intramuscularly.26 All participants are informed that their urine may turn red, which may occur during mecobalamin injections

These injections deliver a controlled dose directly into the body, allowing deeper action compared to creams or serums

I know my folate will be low, I was on methotrexate for years for RA

Chronic users of certain medications, such as metformin (used to treat diabetes) or proton pump inhibitors (used for acid reflux)