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Once a patient is on a maintenance dose, their B12 levels are generally stable, and a single days difference is unlikely to have a clinical impact

There are lots of things that happen to us, but there are things that we control, such as our diet

Nevertheless, given that clearing senescent cells in peripheral tissues has systemic benefits, including the reduction of systemic inflammation, we cannot rule out the possibility that D+Q in the periphery may positively impact the brain (113)

Switch from cyanocobalamin to methylcobalamin (or vice versa), drop the dose, or change the delivery route

Clinically, however, the evidence is mixed : Vitamin B12 has a well-established role in energy metabolism, especially in deficient individuals

Monitoring progress and response is key to determining the optimal balance between effectiveness and tolerance