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[16] Although cyanocobalamin lacks a defined upper-toxicity threshold due to its water solubility and renal elimination, exceptionally high cumulative doses have been temporally associated with acneiform eruptions, altered potassium homeostasis, and theoretical thrombotic risk, emphasizing the importance of evidence-based dosing

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Science 347 (6220), 419

It has also been shown to lower homocysteine levels, a molecule linked to inflammation and cognitive decline, with longitudinal studies linking optimal B12 levels with improved cognitive function, mood and reduced risk of neurodegenerative disease