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It is also important to remember that not every tired or low-energy feeling is caused by B12

Disease states that affect intra-portal insulin levels by increasing insulin resistance causing compensatory intra-portal hyperinsulinemia or by decreasing pancreatic -cell insulin secretion causing intra-portal hypoinsulinemia results in changes to hepatic IGF-I synthesis and secretion, and consequently changes in GH levels via the negative feedback loop

These peptides, which are marketed for a wide variety of health benefits and therapies, have largely been untested in humans

Thus, for a patient with a prior VTE now off treatment, our main advice is to remain well-hydrated and physically active (within reason) during non-fasting hours