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The MHRA advises monitoring B12 levels in patients on long-term metformin treatment

In vitro studies showed that B 12 exerts superoxide dismutase activity, i.e., B 12 can react with superoxide (O 2 ), producing H 2 O 2 at high rates approaching the reaction rates of the physiological defense enzyme superoxide dismutase [73]

da Silva Morais, A

No formal dosing protocols or randomized trials exist, so medical supervision and lab monitoring (CBC, liver panels) are essential when using such stacks