Scenario 2 (Bilateral Knee Injections, Medicare): A patient receives corticosteroid injections in both knees
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After first-line treatments and diagnostics, including diet change, addition of probiotics, and fecal analysis, were performed, a GI panel determined serum cobalamin, folate, and trypsin-like immunoreactivity
plant foods contain negligible bioavailable B12 Excessive alcohol consumption impairs B12 absorption by damaging gastric mucosa and reducing intrinsic factor production High folate intake does not cause B12 deficiency but may mask anaemia whilst neurological damage progresses undetected Vegans require B12 supplementation (at least 10 micrograms daily or 2,000 micrograms weekly) as plant foods are unreliable sources Serum B12 levels below 148 pmol/L indicate deficiency
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