Adding the clinical framing, because it changes how the question reads.

Vitamin deficiency cascade with cardiovascular risk: after 6+ months of reduced food intake, I developed a subtle but important pattern: low B12 → elevated homocysteine → increased cardiovascular risk marker.

The connection: B12 is a cofactor for homocysteine metabolism. Without adequate B12, homocysteine accumulates. This is ironic — taking a CV-protective medication while developing a CV risk factor from reduced nutrition.

Solution: comprehensive vitamin supplementation and regular lab monitoring. Don't let the medication's benefits be undermined by nutritional deficiencies.

Dr.LeslieOBGYN said:

Vitamin deficiency cascade with cardiovascular risk: after 6+ months of reduced food intake, I developed a subtle but important pattern: low B12 →…

This is my experience too, for whatever a second data point is worth. The detail I would add is minor and it is already implied above.

Dr.LeslieOBGYN said:

Vitamin deficiency cascade with cardiovascular risk: after 6+ months of reduced food intake, I developed a subtle but important pattern: low B12 →…

There is a second half to this that has not been said yet. Albumin binding above 99% is the whole reason weekly dosing works, and it is also why the trough matters more than the peak. People who dose late are not losing a peak, they are letting the trough fall, and the appetite effect tracks the trough.

That is the short version; the long version is somebody else's post.

Dr.LeslieOBGYN said:

Vitamin deficiency cascade with cardiovascular risk: after 6+ months of reduced food intake, I developed a subtle but important pattern: low B12 →…

Continuous metabolic monitoring dashboard for cardiovascular risk — I track everything in a spreadsheet and here's the month-over-month trend for my key markers:

Weight: consistent downtrend, -2.0 lbs/week average
Fasting glucose (finger stick): stable at 85 mg/dL
Blood pressure (home): 115/75 average
Resting heart rate: 65 bpm (down from 81)
Waist circumference: down 15 inches total

The resting heart rate improvement correlates with cardiovascular fitness gains. Everything is moving in the right direction.

Reporting back.

Update. I did go to 2.4mg in the end, and the honest report is that it bought me less than the step before it and cost me two bad weeks. Worth knowing rather than worth repeating.