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[62] [63] The mechanism of action is straightforward: the hydroxycobalamin hydroxide ligand is displaced by the toxic cyanide ion, and the resulting non-toxic cyanocobalamin is excreted in urine

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CSPI has argued that move would threaten the publics health because the FDA doesn't review supplements for safety or effectiveness before they hit the market

This is why you might take supplements for months and still not feel a difference

The use of MOTs-C as a companion to GLP-1s, to prevent muscle loss, might get around this shortcoming of GLP-1s, but rigorous research is needed to prove [its effectiveness]