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It is sold under research-use-only labeling and is not regulated as a dietary supplement either

High homocysteine accumulation is linked to various diseases and complications in pregnancy

Most of our patients on metformin with B12 deficiency will fall into the not diet-related category and, therefore, many will eventually require intramuscular replacement

Footnotes CONFLICTS OF INTEREST No potential conflict of interest relevant to this article was reported

Monitoring: Clinicians typically track melatonin rhythm, cortisol patterns, inflammatory markers (hs-CRP), and in some cases, telomere length via commercial testing as a baseline and follow-up tool

The enzyme methionine synthase needs methylcobalamin as a cofactor