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The nasal spray is typically reserved for maintaining B12 levels after injections bring particularly low levels back to normal (5)

However, the endothelial damage observed in ME/CFS patients does not appear to correlate with the usual markers of endothelial dysfunction seen in cardiovascular disease such as increased levels of symmetric dimethylarginine (SDMA), asymmetric dimethylarginine (ADMA), and high-sensitivity C-reactive protein (hs-CRP), and reduced levels of arginine and homoarginine (311)

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CL Answer How significant are the risks to drinking tea from China from heavy metals