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Safia Pirani, MD, consider the patients symptoms, medical history, blood test results, severity and cause of deficiency, absorption concerns, current medications, and response to previous supplementation

Cyanocobalamin is a synthetic form of B that contains a cyanide group, whereas hydroxocobalamin is a naturally occurring form produced by bacteria

Researching vendor reputation, requesting testing documentation, and starting with small orders to verify quality before committing to larger purchases helps protect against counterfeits

This leaves practitioners in a difficult position: acknowledging a promising safety signal while recognizing the profound limitations of unpublished data