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Stability is also influenced by temperature variations

Surgical procedures or conditions that affect the gut, such as gastric bypass surgery or celiac disease, can prevent intrinsic factors from binding to B12 and prevent the body from breaking it down before absorbing the vitamin

Assuming Purity: The biggest variable you can't control is the quality of the starting material

Although epidemiologic studies have shown an association between vascular disease and hyperhomocysteinemia, large randomized controlled trials have shown that lowering homocysteine levels in these patients does not reduce the number of myocardial infarctions or strokes, or improve mortality rates