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Therapy is intensified stepwise

What Happens When You Eat Meat Timeline After Eating Meat (e.g., 100g beef containing ~2-3 mcg B12) Hour 0: You Eat the Meat B12 is bound to proteins in the meat Enters stomach Hour 0-2: Stomach Processing Stomach acid and pepsin release B12 from protein B12 binds to R-proteins (haptocorrin) secreted in saliva and stomach This B12-R-protein complex is acid-stable Moves to the small intestine Hour 2-4: Small Intestine Absorption Pancreatic enzymes degrade R-protein Intrinsic factor (from the stomach) binds to free B12 B12-intrinsic factor complex travels to the terminal ileum Absorption occurs in the terminal ileum via specific receptors KEY POINT: This process takes 4-8 hours minimum absorption is NOT immediate Hour 4-8: Absorption into Blood B12-intrinsic factor complex binds to cubilin receptors in the ileum B12 crosses the intestinal wall Enters portal circulation Goes to the liver first (first-pass through the liver) Hour 8-24: Liver Processing and Distribution The liver takes up much of the absorbed B12 Binds to transcobalamin II (active carrier) and haptocorrin (storage carrier) Released slowly into systemic circulation Peak serum B12 levels: 8-24 hours post-meal (not immediate!) EXPERIMENTAL SCENARIO: Testing Before and After Meat Scenario 1: Test Immediately After Eating Timeline: T = 0: Baseline B12 test drawn Result: 300 pg/mL T = 10 minutes: Eat a large steak (200g, ~5 mcg B12) T = 30 minutes: Retest B12 Expected Result: No significant change Still ~300 pg/mL Why

Depommier, C., et al

"But I think we can't be giving them to 30 per cent of the population