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doi: 10.1212/WNL.0b013e31823a0ee4

Seek medical attention promptly if you experience symptoms that could suggest serious underlying conditions, including: Unexplained weight loss or persistent fatigue Jaundice (yellowing of skin or eyes), abdominal pain, or swelling Easy bruising or bleeding , or unusual skin rashes Night sweats , fever, or enlarged lymph nodes Reduced urine output , significant swelling in legs or ankles Persistent itching without obvious skin cause These symptoms may indicate liver disease, haematological disorders, or renal impairmentconditions that can elevate B12 and require specialist assessment

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In the withdrawal cohort, regaining half of the lost weight raised insulin resistance by roughly 35% to 40%, and blood pressure rose as weight returned. Taper frameworks combine about 0.7 g of protein per pound with resistance training before the drug signal fades