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The stakes are high on both sides: for patients who depend on these treatments, and for providers who face potential enforcement risk if they continue prescribing compounds that ultimately are not approved for the 503A Bulks List

Methylmalonic acid is a by-product of propionic acid metabolism through the enzyme methylmalonyl CoA mutase

It should be noted that these are generally processed products and tend to be high in sugar, which should be taken into account if this route is to be used, as it does not seem very sensible to obtain B12 from processed products

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In individuals with symptomatic B 12 deficiency despite normal dietary B 12 intake, B 12 malabsorption is the most likely cause and should guide parenteral therapy

You may still be eating better, walking more, tracking meals, or taking a medication as prescribed, yet the scale barely moves