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however, this methodology has inherent limitations.182 Furthermore, the guidelines do not differentiate recommendations based on the indication for GLP-1RAs use (eg, diabetes versus obesity) or the specific surgical procedure.74 In cases where patients report gastrointestinal symptoms on the day of surgery, postponement of the procedure is recommended.74 If patients do not adhere to the discontinuation recommendations, the Task Force advises implementing comprehensive gastric protective measures or considering the preoperative assessment of gastric volume via ultrasound

So if you took B12 and felt worse, and your blood B12 is elevated, and you have a constellation of symptoms across multiple systems that's three signals pointing toward MCAS as worth ruling out

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