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Without peer-reviewed human data, assertions of efficacy or safety stand primarily on animal studies, case reports, and anecdote

This difference, while seemingly small, is important to prevent contamination and ensure patient safety during injections

Patient Acceptance of intranasal cobalamin gel for vitamin B12 replacement therapy

Gentle swirling (not shaking) until powder dissolved

Concretely, the beneficial commensal genera decreased, including FP (226, 227), Clostridiaceae , Rikenella , Bacteroides , Prevotella , Roseburia , Pseudobutyrivibrio , Escherichia/Shigella , and Raecalibacterium (228), whereas the pathobiont genera rose, including Lactobacillus (229), Ruminococcus , Akkermansia , Bifidobacterium , Fusobacterium , Erwinia , and Streptococcus (230, 231)