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However, it can also be the result of low B6, low folate, renal failure, or hypothyroidism

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The reaction begins when methionine synthase takes a methyl group from active folate (5-methyltetrahydrofolate) and uses methylcobalamin to transfer that methyl group to a naturally occurring amino acid called homocysteine

Not necessarilymany patients use B12 injections proactively for energy and immune support

Others who may be more susceptible to vitamin B12 deficiency are patients diagnosed with Crohns disease or celiac disease, and those who have undergone intestinal procedures such as weight loss surgery

Whilst some studies found beneficial effects in patients with AD 36 and dementia 90 and in shift workers, 91 others found no improvements in patients with sleepwake rhythm disorders