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Further, biomarker concentrations are tricky to interpret: Total GSH concentration often fails to accurately reflect redox balance, which is better indicated by the GSH to GSSG ratio, plasma/serum concentrations are often a weak correlate of tissue level (the locus of action), and compartmentalization within cells (cytosol versus mitochondria) adds another layer of complexity often out of grasp in clinical samples [31]

Pernicious anemia occurs more commonly in people who already have diseases that are linked to immune-system abnormalities, such as Graves disease, hypothyroidism (under-functioning thyroid gland), thyroiditis (inflammation of the thyroid), vitiligo, and Addison's disease (adrenocortical insufficiency)

The sub-30-minute plasma half-life is the pharmacokinetic basis for twice-daily dosing, though no human study has confirmed this produces better outcomes

1999 Sep 1;40(3):21125

The oral form is not dependable