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Shaking creates foam and can shear the peptide chains, rendering the compound denatured and useless

Differentiating from Other Conditions Neurological signs and symptoms can be vitamin B12 deficiency associated or due to other causes such as: Pernicious anemia Syphilis Neurosyphilis Human immunodeficiency virus (HIV)-associated vacuolar myelopathy Toxic neuropathies Tropical myeloneuropathy Your healthcare provider can make a proper diagnosis based on your symptoms, medical history, physical exam, and laboratory test findings

Avoid repeated freeze-thaw cycles, which can degrade the peptides

Naturally, you're wondering what else you can add to the mix to maximize your results

human evidence is limited, the combination is unvalidated, and individual results vary