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Aug 2017;126(8):602-605

However, practical frameworks are needed to help clinicians apply these novel and often off-label therapies in real-world care

The GRADE assessment showed moderate certainty of evidence for the increase in serum vitamin B12 levels and low certainty of evidence for homocysteine reduction, both across all studies and within RCT-only and observational-only subgroups

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Some fermented foods and algae contain B12 analogues, but these are generally not bioavailable and should not be relied upon as B12 sourcesthey may even interfere with true B12 absorption