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adults aged 19 and older have a vitamin B12 deficiency, defined as serum levels lower than 200 pg/mL

This is particularly relevant for significant injuries, post-surgical recovery, chronic conditions that have resisted single-agent approaches, or patients dealing with both musculoskeletal and inflammatory components simultaneously

Additionally, the body needs sufficient stomach acid for the digestion process to absorb vitamin B12 effectively

However, the endothelial damage observed in ME/CFS patients does not appear to correlate with the usual markers of endothelial dysfunction seen in cardiovascular disease such as increased levels of symmetric dimethylarginine (SDMA), asymmetric dimethylarginine (ADMA), and high-sensitivity C-reactive protein (hs-CRP), and reduced levels of arginine and homoarginine (311)

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