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Yet the consequences are unknown Bioavailability: there are four specific metabolic steps necessary to convert cyanocobalamin into one of the coenzyme forms, which is a clear metabolic disadvantage (3) Utilisation problems: certain hereditary diseases, as well as metabolic disorders, prevent the conversion of cyanocoalamin into the active B12 forms (4) Steals methyl groups: cyanocobalamin requires a methyl group to convert into methylcobalamin, which it takes from the important amino acid S-adenosylmethionine (SAM)

Standard Dose Titrate by 0.1-0.2 mg/day to target (commonly 0.2-0.6 mg/day) Dose titrated every 1-2 months to clinical response and serum IGF-1 per FDA label [6]

The values were assessed using a Beckman DU-65, UV-VIS type, spectrophotometer, at the Department of Biochemistry of the University of Medicine and Pharmacy of Craiova

Imaging and analysis were performed as described above