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The methylcobalamin case, examined honestly The supplement industry argument runs: The active metabolic forms of B12 are methylcobalamin and adenosylcobalamin Cyanocobalamin must be converted to one of those active forms before use Some patients have impaired conversion (often attributed to MTHFR gene variants) Therefore methylcobalamin bypasses a potential bottleneck and is universally superior The Paul and Brady 2017 review in Integrative Medicine examines the pharmacokinetic and clinical evidence for this claim

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This leads to decreased respiratory function, reduced ATP production, and elevated levels of ROS, leading to energy crisis and oxidative stress, which ultimately selectively exacerbate the vulnerability and degeneration of medium spiny neurons in the striatum [176]