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One such intermediate byproduct is a potent toxin known as acetaldehyde. While acetaldehyde is short-lived, usually existing in the body only for a brief time before it is further broken down into acetate, according to a NIAAA fact sheet, it has the potential to cause significant damage to your cells and tissues in the liver, pancreas, brain and elsewhere

McLaughlin PJ, Cain JD, Titunick MB, Sassani JW, Zagon IS

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In contrast, cyanocobalamin is the synthetic, least expensive form of vitamin B12 and the only FDA-approved form

However, cardiovascular side effects (increased heart rate and blood pressure) led to FDA rejection despite promising efficacy data