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Monitoring and adjustment protocols should include: Weight and vital signs at each visit (initially monthly, then quarterly) Assessment of medication tolerance and adherence Evaluation of eating behaviors and physical activity Laboratory monitoring as outlined previously Reassessment of weight-related comorbidities Realistic expectations should be established through shared decision-making

More than 3000 mg per day increases the risk of adverse effects

Separately, ghrelin, produced primarily in the stomach and hypothalamus, binds ghrelin receptors on pituitary somatotrophs and amplifies GH release through a distinct intracellular pathway

Do oral B12 supplements work as quickly as injections

But consistently over weeks

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