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It acts as a coenzyme for methionine synthase, crucial for the methylation pathways in the body, and supports nerve health and the synthesis of genetic material

Response: We appreciate MedPAC's concerns, but as MedPAC acknowledges in its comment, the Congress would need to change current law to implement MedPAC's suggestions

Early evidence for the potential efficacy of this route was published in 1999, where 18 patients with B12 deficiency treated exclusively with 712 days of 2 mg of sublingual cobalamin daily had 4 times higher B12 levels compared to pre-treatment, reaching therapeutic ranges ( There have also been further studies comparing treatment outcomes from the sublingual route to the more established IM and oral routes

The L/M test is non-invasive and has high sensitivity