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Combining Wegovy, Ozempic, and Tirzepatide with B12 (Cobalamin)

Incretins with B12

Some websites offer Wegovy, Ozempic, and Tirzepatide with B12 injections. Tirzepatide plus B12 compounds are sold at higher prices.

They claim that the compounding boosts weight loss. How true are these claims?

For people unaware of the effects of Wegovy or Tirzepatide plus Vitamin B12 Supplementation, I decided to explain how these vitamins might influence your overall health and weight loss journey.

Semaglutide (Ozempic, Rybelsus, and Wegovy) and Tirzepatide (Mounjaro or Zepbound) are incretin mimetic drugs.

These drugs act on your stomach, pancreas, and brain to make you feel full, enhance your metabolism, and influence how your body absorbs certain nutrients.

The primary mechanism by which they cause weight loss is delaying gastric emptying (slowing your stomach to move the food you eat forward into the intestines where it gets absorbed).

Vitamin B12 is not associated with weight loss. Rather, it may cause weight gain. Combining it with Semaglutide or Tirzepatide is not intended to lose more weight.

But, because obese individuals, those on weight loss medications such as Tirzepatide (Zepbound or Mounjaro) and Semaglutide (Ozempic, Wegovy, or Rybelsus), and individuals who have had bariatric surgery (Gastric sleeve or gastric bypass) have lower levels of Vitamin B12, they need Vitamin B12 supplementation.

How to inject Ozempic in stomach?



Why Vitamin B12 Supplementation is Essential?

Vitamin B12 is a water-soluble vitamin. Most adults in the US have adequate intake of Vitamin B12 from food sources.

The NHANES data showed only 3% of men and 8% of women had an intake of  Vitamin B12 below the recommended average intake [Ref].

However, certain individual groups are at a higher risk of developing Vitamin B12 Deficiency. These include:

  • Individuals on a Vegan Diet:

Vitamin B12 is found only in animal diets. People on a vegan diet need vitamin B12 supplements to have adequate stores.

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  • Individuals who have inflammatory bowel disease or malabsorption syndrome:

Vitamin B12 requires a healthy intestinal mucosa for proper absorption. Individuals with inflammatory bowel disease (Crohn’s disease and ulcerative colitis) and those who have malabsorption syndromes (celiac disease, pancreatitis, etc) can not absorb vitamin B12 properly.

Vitamin B12 supplementation either as intravenous injections or intramuscular injections or sublingual tablets is preferred over oral vitamin B12 in these patients.

  • Alcoholics:

Alcoholics usually have multiple nutritional deficiencies. Vitamin B12 supplementation is important along with thiamine and other vitamins.

  • Individuals with pernicious anemia:

Pernicious anemia is a medical condition where people can not absorb vitamin B12 because of the lack of intrinsic factor.

Intrinsic factor is a protein that is required for the absorption and transportation of vitamin B12.

A deficiency of vitamin B12 develops in people who have either low levels of intrinsic factor or who have antibodies that prevent the binding of vitamin B12 and intrinsic factor or the autoantibodies destroy the intrinsic factor.

People with pernicious anemia usually require life-long parenteral (Intravenous or intramuscular injections) vitamin B12 supplementation.

  • Diabetics, older, and Obese Individuals:

Compared to the general population, diabetics and older individuals are usually at a greater risk of vitamin B12 deficiency.

Vitamin B12 deficiency is prevalent in diabetics including both Type 1 and Type 2 diabetes [Ref].

Similarly, older individuals usually have poor nutritional status because of teeth problems, anorexia, and dietary restrictions.

Obese individuals have been found to have low vitamin B12 levels in an American study [Ref]. Why obese people have low vitamin B12 levels is not fully known.

Some explanations may be a low lean muscle mass ratio fat mass, reduced intake, decreased absorption, and vitamin B12 trapping in fatty tissue.

  • People on certain medications (metformin and Antacids):

Medications, metformin and proton pump inhibitors, in particular, are associated with a deficiency of vitamin B12.

These drugs inhibit the absorption of vitamin B12 from the GI tract. Although Tirzepatide and Seamglutide have not been clearly associated with a deficiency of vitamin B12, they seem to have at least some effect on its absorption.

Because Semaglutide and Tirzepatide inhibit stomach motility and may impair the absorption of nutrients, they may have direct effects on B12 absorption as well.

Vitamin B12: Causes, Symptoms and Treatment



Combining Wegovy, Ozempic, and Tirzepatide with B12:

Different weight loss and diabetes centers are combining Wegovy, Ozempic, Rybelsus, or Tirzepatide with B12 supplementation to lose weight have better glycemic control, or mitigate the side effects of these drugs.

Vitamin B12 can improve symptoms of fatigue and neuropathy associated with diabetes and B12 deficiency.

Here are some benefits of combining Wegovy, Ozempic, Rybelsus, or Tirzepatide with B12 supplementation:

  • Health Benefits of B12 plus Tirzepatide, Wegovy, or Ozempic:

Vitamin B12 is important for cellular maturation and myelin sheath formation which enhances neuronal signals in the nerve cells.

Improved strength and power:

A high percentage of patients on Wegovy, Ozempic, or Tirzepatide (Mounjaro) report fatigue and weakness.

This could be the result of rapid weight loss or disproportionate muscle loss vs fat loss.

Vitamin B12 deficiency has been associated with an improvement in strength and power via direct stimulation of the brain.

It also improves neuronal function and hence may improve focus and memory.

Improvement in neuropathic symptoms:

Neuropathic symptoms are common in obese and diabetic individuals. These include:

    • Tingling
    • Numbness
    • Paraesthesias
    • Burning feet
    • Tendency to fall
    • Abnormal gait
    • Foot ulcers

One of the most common and reversible causes of these neuropathic symptoms is B12 deficiency.

In addition, obese individuals who are on Wegovy or Tirzepatide may also develop entrapment neuropathies. Entrapment neuropathy occurs as a result of pressure on the nerve because of abnormal posture or obesity.

Tirzepatide can help a person lose weight and improve these neuropathic symptoms. Neuronal recovery is rapid when B12 supplementation is taken in adequate doses.

Memory improvement:

Both B12 and Tirzepatide or Wegovy have been found helpful in delaying cognitive decline and improving memory in individuals with Alzheimer’s disease.

Combining Wegovy or Tirzepatide with B12 may slow down the progression of Alzheimer’s disease more effectively than either drug alone.

B12 supplementation may also prevent brain atrophy which is common in older and diabetic individuals.

Alzheimer’s disease and Effects

Improvement in hemoglobin and Cardiac benefits:

Vitamin B12 is an essential vitamin required for hemoglobin synthesis. It is one of the most important causes of megaloblastic anemia.

B12 supplementation improves the symptoms of anemia as rapidly as within a week. Deficient people may note improvement in well-being within 24 hours of initiating B12 treatment.

B12 supplementation augments the cardiovascular beneficial effects of Wegovy, Ozempic, and Tirzepatide by directly lowering homocysteine levels and indirectly by improving hemoglobin.

Homocysteine is a precursor in the pathway of B12 and folate metabolism. An increase in homocysteine levels is found in folate and B12 deficiency.

Elevated homocysteine levels are associated with an increased tendency of blood clotting and ischemic heart disease.

Thus, combining Wegovy, Ozempic, or Tirzepatide with B12 may result in better outcomes in terms of cardiovascular health.

B12 supplementation improves GI tolerance:

B12 deficiency is associated with a burning sensation in the tongue. The tongue becomes shiny and smooth, and the papillae are lost.

This is called Glossitis. Along with it, people also develop cheilosis and angular stomatitis. These manifest as sore tongue and cracked angles of mouth.

Other GI symptoms of B12 deficiency which are also very common in people using Wegovy, Ozempic, or Tirzepatide are abnormal taste, heartburn, fullness, gases, nausea, anorexia, abdominal pain, vomiting, and diarrhea/ constipation.

B12 supplementation may reduce the GI side effects of Wegovy and Tirzepatide.

A study on rodents revealed that the new Vitamin B12 Conjugate + GLP-1 Exendin 4 compound reduces the GI side effects of the GLP-1 and may be better tolerated than a GLP-1 agonist alone [Ref]

  • Does Tirzepatide plus B12 help you lose more weight?

No. Tirzepatide can help you lose weight but combining it with B12 does not help you lose more weight.

In fact, weight loss is one of the symptoms of B12 deficiency. When you start taking B12 supplements, you may gain weight.

This is because your GI symptoms associated with B12 deficiency improve, including nausea, vomiting, glossitis, distaste, oral ulcers, and flatulence.

If you are not tolerating Tirzepatide, taking B12 supplements may relieve some of your GI symptoms.

In addition, Tirzepatide with B12 may also help you ease your symptoms of fatigue, lack of energy, and burning feet.

  • Does Wegovy plus B12 help you lose more weight?

No. Similar to Tirzepatide with B12, Wegovy with B12 is not superior in terms of weight loss compared to Wegovy alone.

However, B12 supplementation may help in relieving the side effects of Wegovy, especially the gastrointestinal side effects.

B12 plus Wegovy may also improve your overall well-being and improve fatigue, lethargy, and neuropathic symptoms.



How to take Vitamin B12 with Tirzepatide or Wegovy?

The oral route of vitamin B12 supplements is generally preferred over the parenteral route.

However, people with intrinsic factor deficiency and those with GI problems such as Crohn’s disease may not get any benefit from oral vitamin B12 supplementation.

In one study, an adequate amount of B12 was absorbed in patients with intrinsic factor deficiency when higher oral doses of vitamin B12 (1000 ug) were taken [Ref]

Parenteral B12 (Intramuscular or intravenous) B12 injections are very effective. In mild deficiency, they can be injected weekly.

Weekly B12 injections are preferred as they can be given on the same day as Wegovy or Tirzepatide injections.

However, for B12 injections, you need to visit a healthcare facility. Self-injections are never advisable.

Another best option is sublingual B12. Sublingual B12 supplements are increasingly being used because they are available in higher doses, have no or few GI side effects, and do not require intrinsic factor for absorption.

Studies have shown that sublingual B12 in doses of 1000 to 2000 ug are as effective as intramuscular injections and should be preferred over intramuscular injections [Ref].

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Take Away:

Combining Ozempic, Wegovy, or Tirzepatide with B12 has multiple benefits. With the significant weight loss caused by Semaglutide or Tirzepatide, you may feel more exhausted or develop nutrient deficiencies.

Adding Vitamin B12 supplementation can help you recover from fatigue, exhaustion, and GI side effects of Semaglutide and Tirzepatide.

However, Vitamin B12 does not itself cause you to lose more weight. The weight loss effects are solely due to Wegovy or Tirzepatide.

Taking daily sublingual B12 is preferred over weekly intramuscular injections. Hence, unless NOVO or Eli Lilly formulate Wegovy plus B12 compounds or Tirzepatide with B12 compounds, it is not recommended to follow random weight loss clinics’ experiences.

You can simply take a B12 supplement while following a weight loss journey.

Good luck and Take care of your self!

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What do you think?

Written by Dr. Ahmed

I am Dr. Ahmed (MBBS; FCPS Medicine), an Internist and a practicing physician. I am in the medical field for over fifteen years working in one of the busiest hospitals and writing medical posts for over 5 years.

I love my family, my profession, my blog, nature, hiking, and simple life. Read more about me, my family, and my qualifications

Here is a link to My Facebook Page. You can also contact me by email at or at My Twitter Account
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