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You do not need to take time off work, social activities, workouts, or even red carpet appearances

Biochem Pharmacol, 31: 1779-1782

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However, it exhibits low cell membrane permeability and demonstrates substantial toxicity in animal models, thereby constraining its potential application as a therapeutic agent (Zweygarth et al., 1986)

So I would say those are the couple of things that I would start with because it changes your life

Treatment with methylcobalamin injections with few definitive ways to test efficacy seems to be a primary factor