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However, I typically tell patients if they have gotten absolutely no benefit after the 2 nd round that we should move on to another treatment option

All recommendations are explained during the conversation and are also given in a written medical report

In these situations, its usually recommended that you supplement your diet with either a B12 shot or oral supplement

People who are most at risk of being B12 insufficient or deficient are vegans, vegetarians or those who do not eat much red meat older adults, individuals with atrophic gastritis, pernicious anemia, gastrointestinal disorders, those who have had gastrointestinal surgery + people who take certain medications including, but not limited to, birth control pills, H2 receptor antagonists (such as Tagamet, Pepcid + Zantac), PPIs (Proton Pump Inhibitors, such as Prilosec or Prevacid), Chloramphenicol (Chloromycetin) + Metformin