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Supplementary Table S1)

Patients should be aware that hydroxocobalamin may cause side effects such as nausea, vomiting, and diarrhea

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Sources of depletion can include: Mitochondrial energy production (a normal and essential process, but creates harmful byproducts like ROS) Chronic infections, gut dysbiosis (including SIBO and Candida ), and ongoing inflammation Air pollution, heavy metals, and environmental toxins 17 Ultra-processed foods, sugar-sweetened beverages, and foods high in advanced glycation end products (heavily browned foods) 18 Pesticides and herbicides 19 Alcohol and smoking Psychological stress Even vigorous exercise (a healthy stressor that still creates oxidative byproducts) 20 Understanding this helps explain why simply eating well sometimes isnt enough, and why targeted nutritional strategies make a meaningful difference