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Other possible causes of the muscle weakening that promotes a hiatal hernia to develop include being born with a large hiatus, persistent coughing, straining during bowel movements, repeated vomiting, or improper technique when lifting heavy objects

How B12 relates to energy production: Facilitates the metabolism of fats and carbohydrates into usable energy Supports red blood cell production, which carries oxygen to tissues Maintains nervous system function, affecting cognitive performance and mood Acts as a cofactor in metabolic pathways that contribute to energy production It is important to note that whilst B12 is essential for energy metabolism, there is no official link between B12 supplementation and increased energy levels in individuals with normal B12 status

Wolf Horrell, M

One of the most common things I look for when I see unexplained high B12 with concurrent symptoms is mast cell activation syndrome (MCAS)