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In one Spanish hospital series of adults with a very high B12 and no supplementation, structural liver disease was present in roughly a quarter

Benefit #3: Improved Insulin Sensitivity (Strong Evidence) Evidence Quality: Multiple animal studies with human relevance Mechanism: Enhanced glucose metabolism through NAD+ restoration 5-Amino-1MQ significantly improves insulin sensitivity through metabolic optimization

It is less preferred but used when there is less chance of absorption through skin

Methylcobalamin is the active, methylated form of B12 that directly participates in the methionine cycle as a methyl donor for homocysteine remethylation