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Cold packs can introduce unnecessary condensation, moisture exposure, and temperature cycling inside the package during transit

Evidence-Base Disclosure The published evidence base for AOD-9604 consists predominantly of preclinical research animal models (often rats or mice) and in vitro cell-culture experiments

Hence, more studies with human subjects are still required to reach a conclusive decision

At the same time, B12 insufficiency in the liver leads to shrinking of the intestinal cells and malabsorption of nutrients (including B12 itself), leading to a cycle of worsening B12 deficiency

However, research has not confirmed they are safe or effective for this purpose