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The most concerning findings come from two trials using folic acid combined with 400500 g/day of B12: Ebbing (2009) found a statistically significant increase in overall cancer incidence (RR 1.21, CI 1.031.41) B-PROOF found an increased risk of colon cancer (HR 2.17, CI 1.263.75) in the per-protocol analysis (Oliai Araghi, 2019)

Combining with B12 Some compounded semaglutide formulations include vitamin B12 (cyanocobalamin)

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According to British Society for Haematology (BSH) guidelines and NICE Clinical Knowledge Summaries (CKS), the primary beneficiaries include: Key patient groups who may require B12 injections include: Pernicious anaemia patients requiring lifelong hydroxocobalamin 1mg intramuscularly every 23 months following initial loading doses Patients with gastrointestinal disorders including those who have undergone gastrectomy or ileal resection, and patients with conditions affecting B12 absorption such as Crohn's disease or coeliac disease Strict vegans and vegetarians though oral supplementation is usually sufficient unless malabsorption is present Elderly patients who may have reduced gastric acid production affecting B12 absorption Patients taking certain medications including metformin (MHRA advises monitoring B12 levels in long-term users, particularly those with risk factors or symptoms), proton pump inhibitors, and H2-receptor antagonists long-term [6] Individuals with neurological symptoms such as paraesthesia, ataxia, or cognitive impairment related to B12 deficiency Pregnant women with confirmed deficiency (hydroxocobalamin for malabsorption