Multiple human studies have confirmed zero impact on fasting glucose, insulin, HbA1c, or IGF-1 levels (Thompson et al., 2004)
GRAS status does not equal drug approval, but it does indicate that the regulatory body considered the compound safe for human consumption at the doses tested
Additional risk factors include: Chronic kidney disease : Reduced renal clearance may impair B12 excretion Liver disease : Hepatic dysfunction can disrupt B12 metabolism and storage Myeloproliferative disorders : Certain blood cancers increase B12-binding proteins Concurrent medication use : Some drugs may interact with B12 metabolism, including metformin, proton pump inhibitors, and H2 antagonists Patients with these conditions should have B12 supplementation carefully monitored by their healthcare team
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Green et al 26 Severe clinical abnormalities should be treated intensively with B 12 , cyanoB 12 or hydroxyB 12 : HydroxyB 12 is commonly used in Europe, often at intervals of 23 months, as it seems to have better retention than cyanoB 12
