Leaving the vial at room temperature for extended periods accelerates oxidative degradation of the copper complex
53 Low B 12 concentrations in the body may be present in different pathophysiological situations, including pregnancy, old age, smoking, and comorbidities such as hypertension, diabetes mellitus, pancreatic insufficiency, autoimmune gastritis, gastrectomy or gastric bypass, diseases or resection of the ileum, bacterial overgrowth, celiac disease, inflammatory bowel disease, or uremia-related malnutrition
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Nevertheless, studies utilizing more specific biomarkers of vitamin B 12 status, including measures of holo-transcobalamin and methylmalonic acid, have shown more consistent results and a trend towards associations between poor vitamin B 12 status and faster cognitive decline and increased risk of Alzheimers disease (82-86)