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Natural: hydroxocobalamin Bioactive coenzyme: methylcobalamin & adenosylcobalamin Synthetic: cynanocobalamin As a reaction partner, the body can only directly use the bioactive coenzyme forms of B12

This "paradoxical response" (where treatment temporarily makes symptoms worse) includes: Numbness and tingling Shooting pains Joint pain Increased sensitivity Temporary inflammation (swelling and irritation) While these symptoms generally indicate that treatment is working (as nerves begin to repair themselves), they can be distressing for patients and may require additional treatment for comfort

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The documented pattern is simply a steady daily presence of the inhibitor, held long enough for the downstream metabolic change to accumulate