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They advocate for a treatment approach that is: Symptom-led : Recognising that many patients become symptomatic well before their next scheduled dose, meaning they are being under-treated

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Sessions are typically spaced 4 or more weeks apart to allow the skin to fully heal and new collagen to develop between treatments

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Overgrowth of bacteria: Some people develop vitamin B 12 deficiency as a result of conditions that slow the movement of food through the intestines (diabetes, scleroderma, strictures, diverticula), allowing intestinal bacteria to multiply and overgrow in the upper part of the small intestine