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Some of the benefits are also lost along the way

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The clinical value of cytokines in chronic fatigue syndrome

Pharmacokinetic drugdrug interaction and their implication in clinical management

Although it does not appear to interact with the gut microbiota directly, evidence suggests that the vagus nerve can sense microbial signals in the form of bacterial metabolites, or be influenced via microbiota-mediated modulation of enteroendocrine (EECs) and enterochromaffin (ECCs) cells in the gut epithelium 86 (Figure 2)

If your bloodwork shows declining B12 levels despite the compounded formulation, your prescriber may recommend additional oral or sublingual B12 supplementation