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Vitamin B12 Mechanism of Action in the Nervous System Vitamin B12 influences and regulates the creation and maintenance of the myelin sheaths through four different mechanisms: Required for the formation of lipids and proteins, from which myelin is created Lowers the level of amino acids, which are probably neurotoxic Works like a hormone in the central nervous system and regulates the level of important cytokines and neurotrophic factors Is a crucial antioxidant in the central nervous system and, through different mechanisms, protects the nerves from chronic inflammations, reactive oxygen and nitrogen radicals and toxins (22 24) Vitamin B12 and the Creation of the Myelin Sheaths Both active coenzyme vitamin B12 forms have an influence on the structure of the myelin sheaths

Patients should contact their GP urgently if neurological symptoms worsen, new symptoms develop, or signs of liver decompensation appear, as this may indicate inadequate treatment response or disease progression requiring specialist review

6,8 However, as hepatotoxicity continues to emerge, abdominal pain or right upper quadrant tenderness may surface

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