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"Safety and metabolism of AOD9604, a novel nutraceutical ingredient for improved metabolic health." Journal of Endocrinology and Metabolism 4.3 (2014): 64-77.

Critically, the study documented no significant changes in oral glucose tolerance tests, no alterations in fasting insulin levels, and no changes in serum IGF-1 concentrations across all treatment groups

In rare cases where B12 is essential but acne remains intractable, dermatologists may consider oral isotretinoin, which in the UK can only be initiated by consultant dermatologists and requires strict monitoring, including a pregnancy prevention programme for women of childbearing potential

For others, especially those needing nerve or anemia support, improvements might take weeks or months with consistent injections

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