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Systematic Review Orthopaedic Sports Medicine (2025) The 2025 systematic review by Vasireddi, Hahamyan et al

Its been my experience that many patients on oral and sublingual forms of B12 notice a dramatic improvement upon switching to B12 shots

The substitution of carboxamide at the alkyl terminal (KL2, KL4 and KL5) or removal of the nitrile group from the dihydropyridine ring (KL6) moderately reduced their adjuvant activity (Extended Data Fig

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Not surface-level fixes

For this reason vegetarians and vegans who eat little or no animal products should monitor their vitamin B12 levels plus folate level( another B vitamin)and take a supplement if required