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First, there must be evidence of elevated homocysteine or low B vitamin status
These include: Metformin (used for diabetes or PCOS) Proton Pump Inhibitors (used for acid reflux or GERD) H2 Blockers Birth control pills Certain antibiotics If youre taking these medications long-term, particularly in combination, regular B12 injections might be beneficial
7-9 Additionally, impairment of the autonomic nervous system may lead to constipation, orthostatic hypotension, and excessive sweating
We still see this patient to this day and her pain has still gone away
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