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[DOI] [PubMed] [Google Scholar] 38.Matteoli G., et al

Neutralization of Oxidative Stress Markers: Studies show that it may reduce elevated levels of the oxidative stress marker malondialdehyde (MDA) and normalize NO tissue values

Patients show symptoms well above this mark, as B12 depletion appears in the cerebrospinal fluid even when blood levels are as high as 550

Patients should also be aware that certain medicationssuch as proton pump inhibitors (PPIs) and metformincan interfere with B12 absorption, though this is less relevant once on injection therapy

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Caution is also advised for patients with a history of pancreatitis or severe gastrointestinal disorders