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High-dose supplementationparticularly intramuscular injections that can deliver 1,000 micrograms or morecreates substantially elevated serum B12 levels compared to dietary intake, which may more readily trigger these bacterial changes, though comparative studies between different forms are limited

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In addition, incomplete efficacy and the capacity of SnCs to evade elimination by upregulating alternative survival pathways (such as MCL-1) 54,55 or modulating immune checkpoints underscore the need for more sophisticated therapeutic approaches 56

There are also no official human dosing guidelines although we do make recommendations based on the anecdotal data