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Also, be aware with shots (many doctors still give cyanocobalamin shots) that though you may need higher doses of active B12s (like myself), you may not do well when given higher doses of cyanocobalamin in a shot because your body may not be able to do the conversions and you could have negative side effects

doi: 10.3389/fneur.2015.00257

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Furthermore, we found that chronic hypoxia enhanced ceramide catabolism by inducing hypoxia-inducible factor (HIF)-2 and HIF-2-dependent transcriptional activation of alkaline ceramidase 2 (Acer2)