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& Gupta, V

When a person with Down syndrome has vitamin B12 and/or folate deficiency, the increase in the homocysteine level may not be great enough to overcome this starting low value of homocysteine

3 In B12 deficiency, methylmalonic acid (MMA) can accumulate, and it is thought that elevated MMA, alongside elevated homocysteine, contributes to damage of the myelin sheath (which protects nerve cells and speeds up nerve transmission), which can cause irreversible neurological problems

This completely bypasses the digestive system, avoiding the very absorption issues that tirzepatide creates

These molecules are designed to be membrane-permeable, meaning they can cross cell membranes and access their target enzyme inside cells

For women with confirmed B12 deficiency due to malabsorption or pernicious anaemia, intramuscular hydroxocobalamin is the first-line treatment in the UK