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Cyanocobalamin activates the metabolism of carbohydrates, proteins and lipids, promotes the synthesis of labile groups in the formation of choline, methionine, nucleic acids, creatine, accumulation in erythrocytes of compounds with sulfhydryl groups, stimulates bone marrow function, normalization of the nervous system, through the placental barrier, activates the blood coagulation system, in high doses increases thromboplastic activity and prothrombin activity

Journal of Inherited Metabolic Disease 42 (4): 673685

The FDA's decisions in July will ripple across that market as well

So, patients need supplements to get what they need