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Without sufficient methylfolate and vitamin B12, MTR wont convert as much homocysteine to methionine, leading to a buildup of homocysteine and limiting methionine

3.3 Changes in serum cobalamin by supplementation route and dosage Across 35 comparisons, the mean percentage increase in serum cobalamin following supplementation was approximately 293%, confirming the overall effectiveness of vitamin B12 interventions (Supplementary Table S4)

On physical examination, his blood pressure is 132/89 mm Hg, and he appears well

Most patients at our Miami clinic begin noticing changes by the second or third injection, with the clearest effects appearing 2 to 4 weeks after the cycle ends