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The MHRA product information for hydroxocobalamin preparations lists several recognised side effects that patients should be aware of before commencing treatment

Most gastrointestinal side effects diminish within 4-8 weeks as tolerance develops during dose titration

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The Akkermansia species muciniphila has been shown to alter glucose and lipid metabolism as well as intestinal immunity 86 , to strengthen the integrity of the enterocyte monolayer to possibly improve intestinal barrier integrity 87 , and to improve glucose tolerance and reduce visceral adipose tissue inflammation in mice fed an HFD 88

doi:10.1128/AEM.02173-12