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For patients with Lebers disease requiring vitamin B12, consider alternative therapy (e.g., hydroxocobalamin) for B12 supplementation

Research has also shown that supplementing D-mannose can reverse this change, restoring GSH levels and enhancing the expression of GPX4 and SLC7A11, which reduces the occurrence of ferroptosis (Zhou et al., 2021)

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Weight of evidence: Overall evidence is Low-Moderate: multiple animal studies and a growing number of small clinical trials suggest benefits across gutbrain signaling, social and behavioral domains, gastrointestinal symptoms, and neurophysiological patterns, yet most human studies rely on caregiver-reported outcomes, lack biomarker integration, and seldom control for diet, comorbidities, or baseline microbiome composition

Important note: Although oral therapy is very effective, the treatment of a severe deficiency with pronounced neurological symptoms should always be carried out in close consultation with a doctor