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Since B12 is required for both the methionine synthase reaction and the methylmalonyl-CoA mutase reaction a megaloblastic anemia resulting from B12 deficiency is also associated with an accompanying methylmalonic acidemia, whereas megaloblastic anemias caused by folate deficiency are not

doi:10.1016/S0006-2952(03)00504-5

Other clear candidates include patients with BMI 35+ who have tried and failed multiple structured weight loss approaches, patients with obesity plus severe sleep apnea, and patients with a metabolic syndrome phenotype where reducing insulin resistance matters

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While probiotics have a generally favorable safety profile, individual reactions vary