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The story is still messy because results across studies are mixed

Conclusion: Sublingual and oral B12 supplementation appear to be as effective as intramuscular (IM) injections in improving cobalamin status and reducing homocysteine levels

Supplements must be paired with aggressive pacing strategies to avoid post-exertional malaise (PEM), nervous system regulation techniques, and ongoing medical care from practitioners who truly understand the nuances of complex chronic illness

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small molecules have shorter half-lives with reduced immunosuppression