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Finally, the ketogenic diet effectively reduces neuroinflammation by inhibiting the NF-kB inflammasome and producing the pro-inflammatory cytokines TNF-alpha and COX-2

Oral B12 supplementation may be appropriate for: Dietary deficiency in vegans or vegetarians (typically 50150 micrograms daily between meals) Patients who decline or cannot tolerate injections Maintenance therapy in selected cases, though absorption is unpredictable in malabsorption syndromes High-dose oral B12 (10002000 micrograms daily) can overcome absorption defects through passive diffusion and may be considered as an alternative to IM therapy with careful monitoring when malabsorption is not severe or when IM is declined

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