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IGF-1 levels should be checked monthly for the first three months, then quarterly

Other established risk factors include: Hyperlipidemia Metabolic syndrome Obesity Atrial fibrillation Chronic kidney disease Sedentary lifestyle Sleep disorders, particularly obstructive sleep apnea Sleep disorders may contribute to CSVD through intermittent hypoxia, sympathetic activation, endothelial dysfunction, and impaired glymphatic clearance

With such sufficient consumption, factors such as gastritis, antacid drugs, ageing stomach changes and gut surgery would still prevent your body from utilising B12, leading to fatigue and lack of energy

Trends Mol Med (2019) 25(2):11223