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18 Support for the poorer bioavailability of cyano-B12 comes from a study comparing sublingual cyano- with methyl-B12 (both 1000 g per day), which found that both forms led to a normalisation of B12 status, but B12 levels increased significantly more in the methyl-B12 form compared with the cyano-B12 form, although the formulations also had other differences the former was a tablet, the latter a spray

It should be noted that these studies measured total Cbl levels, but as previously mentioned, the biologically available form of Cbl, TCN2-Cbl, comprises only approximately 2030% of the total Cbl level, which may lead to a significant number of false negatives for clb deficiency

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Sublingual B12 was administered in laboratory conditions, where there was no dose omission, making it difficult to extrapolate real-world effects, where patient compliance may not be as good