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The biological evidence is robust at the cellular level, and clinical results are promising but limited by small study sizes, industry sponsorship, and absence of independent replication

[23] [24] The MHRA advises testing for B12 deficiency if symptoms or signs develop in patients taking metformin, and considering periodic monitoring in those at risk

These findings urge researchers and clinicians to assess the implications of GSH in promoting chemotherapy resistance and to evaluate the duration of GSH intake during treatment to optimize outcomes

[45] Enzyme-coupled method have also been applied to detect carnitine formation, by using the enzyme carnitine acetyltransferase and 14 C-labelled acetyl-coenzyme A to give labelled acetylcarnitine for detection

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