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Patients eating at or below 0.7 grams per pound of bodyweight do not have the raw material to convert the anabolic signal into muscle tissue

This timeline matches B12 pharmacokinetics: intramuscular methylcobalamin reaches peak serum concentration at 8-12 hours, but tissue saturation (particularly in the liver and nervous system) occurs over 48-72 hours as the vitamin is transported into cells and converted to active coenzyme forms (Andrs et al., 2018)

At this time, we remain focused on identifying outcome measures that balance feasibility, burden, and impact, while aligning with administration priorities

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