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Cyanocobalamin has to go through a complex conversion process within the body in order to become active and many people cannot do these conversions well, so often much of the dose goes unused (even with a shot)

This isn't just a list of steps

In each heart, to every one of them, I remain a green-feathered parrot in a golden cage of memory, but when I was living each day was a smattering of eggshell fragments smeared with predators saliva

While the IOM had based B12 needs on the amount required to correct hematological parameters for people with pernicious anemia, the EFSA had almost 20 more years of research to draw on, and concluded that the most suitable approach was basing needs on biomarkers (serum B12, holotranscobalamin, MMA, and homocysteine)