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doi:10.1001/jamainternmed.2019.1859

While B12 has very low toxicity as a water-soluble vitamin with excess typically excreted in urine, rare adverse reactions can occur

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Symptoms of B12 deficiency B12 deficiency produces symptoms that overlap frustratingly with common tirzepatide side effects : Fatigue and low energy : Often attributed to reduced caloric intake Brain fog and poor concentration : Mistaken for a dietary side effect Mood changes : Depression, irritability, anxiety Tingling in hands or feet : Peripheral neuropathy from B12 depletion Weakness : Often blamed on muscle-related side effects Because these symptoms mirror common GLP-1 side effects, B12 deficiency often goes unrecognized in people taking tirzepatide

Adequate stomach acid and intrinsic factor are required to release the vitamin from the protein