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Its not just about some metabolite levels going up and others going down

& DeGrado, W

In order to evaluate the suitability of l-carnitine (LC) as an anti-wasting agent for clinical purposes the present review comprehensively summarizes the results from animal and clinical studies showing the effects of supplementation with LC or LC derivatives (acetyl-LC, propionyl-LC) on critical mechanisms involved in skeletal muscle loss under pathologic conditions, such as increased proteolysis, impaired protein synthesis, myonuclear apoptosis, inflammation, oxidative stress, and mitochondrial dysfunction

The short answer is that for most people, B12 injections given in a medical setting have a strong safety record

doi:10.1021/acs.jmedchem.5b00726 71