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This complex process means that conditions affecting the stomach or intestines can significantly impair B12 absorption, including pernicious anaemia, atrophic gastritis, previous gastric surgery, coeliac disease, Crohn's disease, and long-term use of certain medications (such as metformin, proton pump inhibitors, and H2 antagonists)

41,47 From a bioenergetics point of view, islet beta-cells are unique, as their intracellular ATP/ADP ratio is regulated by ATP supply and not ATP demand like in most other cell types

Precautions and not-recommended situations include history of pancreatitis, severe gastroparesis or other serious gastrointestinal disease, pregnancy/lactation (discontinue before conception), and type 1 diabetes

Chen J, Chia N, Kalari KR et al (2016) Multiple sclerosis patients have a distinct gut microbiota compared to healthy controls

Many enzymes use GSH as a cofactor or substrate

Short-term use ( 3 days) is reserved for refractory systemic inflammatory response syndrome (SIRS), with close monitoring of infection and electrolyte status