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For deficiency without neurological involvement or for borderline levels, oral supplementation with high-dose cyanocobalamin (1000-2000 mcg daily) is often effective, as approximately 1% of an oral dose is absorbed through passive diffusion even in the absence of intrinsic factor

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Human trials are limited and not yet conclusive

Frick MA, Woodruff JL, Caudillo YM et al (2025) Orexin/Hypocretin modulates neuroinflammatory response to LPS in a sex and brain-region specific manner in young rats