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Plants are not a reliable source of B12

High homocysteine levels are associated with an increased risk of heart disease and stroke as it may promote the formation of blood clots and excess free radical cells, and may impair normal blood vessel function

Hydroxocobalamin has been found to be more effective than cyanocobalamin in treating symptomatic conditions when administered by injection, although Carmel recommends cycling between the two

Use an insulated medication travel case with gel packs that maintain 2 to 8 degrees Celsius without freezing the medication

Reported adverse effects tend to be mild and transient in anecdotal accounts, but the absence of comprehensive clinical data means rare or serious risks cannot be excluded