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The methylcobalamin case, examined honestly The supplement industry argument runs: The active metabolic forms of B12 are methylcobalamin and adenosylcobalamin Cyanocobalamin must be converted to one of those active forms before use Some patients have impaired conversion (often attributed to MTHFR gene variants) Therefore methylcobalamin bypasses a potential bottleneck and is universally superior The Paul and Brady 2017 review in Integrative Medicine examines the pharmacokinetic and clinical evidence for this claim

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22,23 In patients with a normal or low-normal serum vitamin B 12 level, complete blood count results demonstrating macrocytosis, or suspected clinical manifestations, a serum methylmalonic acid level is an appropriate next step 1,2,6,18 and is a more direct measure of vitamin B 12 's physiologic activity