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In extreme or severe cases, you might consider a gut reset with the elemental diet

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A Phase 2 study published in The New England Journal of Medicine (Jastreboff et al., 2023) reported substantial weight reduction in participants with obesity

Injections are typically administered by healthcare professionals and may be given as a series of doses initially, followed by maintenance injections at intervals determined by individual needs

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Therefore, parenteral cyanocobalamin should be administered to a pregnant woman if the benefits outweigh the risks.[15][16] Cyanocobalamin is excreted in the breast milk of nursing women in levels similar to the level of vitamin B12 in maternal plasma.[25] The distributed cyanocobalamin in breast milk has been found to be compatible with breastfeeding by the American Academy of Pediatrics.[26] In addition, there has not been any reports of adverse effects associated with the intake of normal daily requirements of vitamin B12 during lactation