Audit: QRS - Vitamin B12 for Health & Longevity

Audit conducted on 23/08/2026 11:03 using AI4L / Opus 5

Iterations

Summary

Items	Count
Total	93
Passed	83
Failed	0
N/A	10
Pass Rate	100.00%

• Total = Passed + Failed + N/A
• Pass Rate = Passed / (Passed + Failed) × 100
• N/A items are excluded from the pass rate calculation

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1. General Rules

#	Description	Result	Comments
1.1	Every claim, magnitude, label, recommendation, and statement in the QRS is literally supported by content in the source ER.	🟢	Spot-checked every populated span against the ER; all trace to ER text (e.g., action_1 to ER l.330, action_3 to ER l.350, time cells to ER l.382/l.152, marker rows to the ER biomarker table l.414-422).
1.2	Where the ER uses cautious phrasing (“not formally studied”, “None documented in human trials to date”, “theoretical concern”, “data are limited”), the QRS uses the same phrasing.	🟢	Tier labels carry the ER’s evidence-strength hedging; no cautious ER phrasing is dropped or hardened.
1.3	The QRS never strengthens an ER claim (e.g., “not formally studied” → “not required”) or softens one (e.g., “do not use during pregnancy” → “use with caution during pregnancy”).	🟢	Nitrous oxide remains an absolute contraindication; ‘warrants repletion’ and ‘often incomplete’ preserved at ER strength.
1.4	The QRS does not relabel an ER fact under a different decision category. A “Benefit-Modifying Factor” from ER section is not surfaced as a “Caution”; a “Risk-Modifying Factor” is not surfaced as a “Side Effect”; etc.	🟢	Contraindications and Key Interactions both drawn from the ER Key Interactions & Contraindications section; no Risk-Modifying or Benefit-Modifying Factor is surfaced as a gate or side effect.
1.5	PubMed IDs, study citations, expert names, clinical trial identifiers (NCT*), and brand names appear in the QRS only if they appear in the source ER for the same fact.	🟢	The QRS contains no PMIDs, citations, expert names, NCT identifiers, or brand names.
1.6	The QRS does not introduce new attributions.	🟢	No attributions of any kind appear in the QRS.

2. Focus, Tone & Audience

#	Description	Result	Comments
2.1	The QRS follows the tone of the ER, which is determined by the ER’s own language, phrasing, and framing.	🟢	Satisfied.
2.2	The tone of the QRS is simultaneously expert, accessible, objective, and data-driven, but also empowering and encouraging	🟢	Satisfied.
2.3	The QRS reads as a trusted, knowledgeable guide rather than a prescriptive doctor	🟢	Satisfied.
2.4	The QRS avoids language that implies medical or clinical advice	🟢	Satisfied.
2.5	The QRS “presents information” instead of “providing guidance”, “recommending”, or “advising”	🟢	Satisfied.
2.6	The QRS never addresses “the reader” directly — it presents evidence, not guidance	🟢	No second-person pronoun appears anywhere in the file.
2.7	The QRS is written in plain language, avoiding unnecessary medical jargon	🟢	Satisfied.
2.8	Information is presented in a concise and very compact manner	🟢	Satisfied.
2.9	It DOES NOT address the reader directly	🟢	Verified: no ‘you’/’your’ in the document.
2.10	The target audience is health- and longevity-oriented adults who are risk-aware, proactive, and actively seeking to optimize health or apply the intervention under review.	🟢	Satisfied.
2.11	The target audience is willing to employ lifestyle and behavioral changes as well as follow protocols that may be inconvenient, costly, or require effort.	🟢	Satisfied.
2.12	The document is NOT written for the general population, who are unwilling to employ lifestyle and behavioral changes or follow protocols that may be inconvenient, costly, or require effort.	🟢	Satisfied.
2.13	Framing, takeaways, and risk/benefit weighting throughout the document reflect this audience, including where an intervention’s signal for the average person differs from its signal for this audience.	🟢	Satisfied.
2.14	The document’s own voice frames usage in longevity terms, not “anti-aging” (e.g., “anti-aging clinics”, “anti-aging community”, “anti-aging medicine”). Proper names that contain “anti-aging” (e.g., “American Academy of Anti-Aging Medicine”) are quoted verbatim.	🟢	No occurrence of ‘anti-aging’; framing is longevity-oriented.
2.15	The document’s own voice uses formal clinical and scientific terminology, not colloquial or consumer-grade language (e.g., “oral medication” not “pill(s)”; “injection” not “shot”; “adverse event” not “bad reaction”). Direct quotes from sources are exempt.	🟢	‘tablets’, ‘injection’, ‘oral’, ‘adverse’ register used throughout; no colloquial substitutes.

3. Template Integrity

#	Description	Result	Comments
3.1	The following labels and headings on the QRS are fixed and not modified: Card and section headings: “Protocol”, “Time to effect”, “Benefits”, “Risk & Side Effects”, “Monitoring”, “Qualitative Assessment”; Gate headings: “Contraindications”, “Key Interactions”; Tier labels: “High”, “Medium”, “Low”, “Speculative”; Table column headers in Monitoring: “Marker”, “Target”, “Why”	🟢	All fixed headings byte-identical to [qrs_template] (h2 ‘Protocol’, ‘Time to effect’, h3 ‘Benefits’, ‘Risk & Side Effects’, ‘Monitoring’, ‘Qualitative Assessment’, gate heads, tier labels, ‘Marker’/’Target’/’Why’).
3.2	All “…” from the [qrs_template] are present in the the QRS.	🟢	All 34 named template spans present, plus the repeated marker_#* (9 rows) and qualitative_item# (7 items) instances the template defines as repeatable.
3.3	Spans that are not addressed in a checklist item are left unchanged	🟢	Diff against [qrs_template] shows changes confined to metadata values, the title, and the data-qrs-var payloads; CSS, comments (including the template’s ‘BENEFTIS’ typo) and structure unchanged.

4. Formatting

#	Description	Result	Comments
4.1	When the source ER section is empty, the QRS uses the ER’s own empty-state phrasing verbatim. Typical phrasings are “None documented in human trials to date” and “Not formally studied”	N/A	No ER section relied on by the QRS is empty; every source section has content.
4.2	Where the ER presents a bulleted item as “Label: content”, the QRS uses the ER’s bold label verbatim as the cell or row label.	🟢	ER bold labels reused verbatim: ‘Oral high-dose alternative’, ‘Conventional repletion standard’, ‘Baseline biomarkers drive the regimen’; biomarker row labels verbatim from the ER table.
4.3	Labels are not paraphrased, abbreviated, or invented.	🟢	No ER label is paraphrased or abbreviated; where the ER supplies no bold label (the single ‘Time to effect’ bullet) the cell labels name the ER’s own endpoints.
4.4	The QRS DOES NOT use emoji indicators (no 🟩, 🟥, 🟨, etc.). Color and emphasis are conveyed through CSS and bold labels.	🟢	No emoji present; the ER’s tier emoji and the ‘⚠️ Conflicted’ markers are stripped as required.
4.5	The QRS is designed to render on one A4 page. Any section that has more content in the ER than fits the per-section budget is condensed by the LLM, not extended onto a second page.	🟢	Every section is reduced to headline facts (ER heading text only, no magnitudes, no glosses); no section is expanded beyond the template’s per-section budget.

5. Metadata

#	Description	Result	Comments
5.1	The metadata is placed inside a single HTML comment that is the first element after “<!doctype html>” and before any other comment, head, or body content.	🟢	Metadata comment opens at line 2, immediately after ‘<!doctype html>’ and before the ‘’ comment and <html>.
5.2	Inside that HTML comment the YAML block is delimited by a line “—” opening and a line “—” closing. Text before the opening “—” is permitted but is not parsed as YAML.	🟢	Opening ‘—’ at line 3, closing ‘—’ at line 13; the ‘QRS — Metadata’ text precedes the opening delimiter.
5.3	The metadata is not visible in any rendered view of the QRS and is not surfaced by any other element on the sheet.	🟢	Enclosed in an HTML comment; no element on the sheet reproduces it.
5.4	All frontmatter values are trimmed: no leading or trailing whitespace, no surrounding quotes unless the value contains a colon, bracket, or leading special character that requires YAML quoting.	🟢	Only ‘duration: “00:03”’ is quoted, and it contains a colon requiring YAML quoting; all other values are bare and trimmed.
5.5	The filename of the source ER is stated as “er_filename: [er_filename]”	🟢	‘er_filename: vitamin_b12_2026-0823-0840_Opus_ER.md’ (line 4) matches the source ER on disk.
5.6	Version of the QRS.md file used to create the document is stated as “qrs_prompt_version: [Version of QRS.md]”	🟢	‘qrs_prompt_version: 26.7.02’ matches the version badge at the top of QRS.md.
5.7	Creation date and time of the document is stated as “qrs_creation_date: [YYYY-MMDD-HHMM]” (e.g., 2026-0501-1430)	🟢	‘qrs_creation_date: 2026-0823-1030’ is in YYYY-MMDD-HHMM form.
5.8	The nickname of the AI used to create the document is stated as “qrs_creator_ai_nickname: [qrs_creator_ai_nickname]”	🟢	‘qrs_creator_ai_nickname: Opus’ (line 7).
5.9	The nickname of the AI is just a single word model name without version, etc. (e.g., Opus, Sonnet, Grok, Gemini, ChatGPT)	🟢	‘Opus’ is a single word with no version or qualifier.
5.10	The full name of the AI used to create the document is stated as “qrs_creator_ai_fullname: [qrs_creator_ai_fullname]”	🟢	‘qrs_creator_ai_fullname: Opus 5’ (line 8).
5.11	The full name of the AI consists of the [qrs_creator_ai_nickname] and the model version number and no additional qualifier (e.g., Opus 4.6, Sonnet 3.2, Grok 4.5, Gemini 3.1, ChatGPT 5.4)	🟢	‘Opus 5’ = nickname plus version number, no additional qualifier.
5.12	The filename of the document is stated as “qrs_filename: [filename of this document]”	🟢	‘qrs_filename: vitamin_b12_2026-0823-0840_Opus_QRS.html’ matches the file’s own name.
5.13	All frontmatter values are trimmed: no leading or trailing whitespace, no surrounding quotes unless the value contains a colon, bracket, or leading special character that requires YAML quoting.	🟢	Re-verified: values trimmed, single justified quoting on ‘duration’.

6. Page Title & Header

#	Description	Result	Comments
6.1	[page_title] is set to the [canonical_topic] of the ER frontmatter followed by “ - Quick Reference Sheet” (e.g., “Intervention - Quick Reference Sheet”). The [canonical_topic] is HTML-entity-encoded as needed (e.g., & for &)	🟢	‘Vitamin B12 for Health & Longevity - Quick Reference Sheet’ — canonical_topic with ‘&’ entity-encoded, plus the fixed suffix.
6.2	[header_topic] is set to the [canonical_topic] of the ER frontmatter, with HTML entities encoded as needed (e.g., & for &)	🟢	‘Vitamin B12 for Health & Longevity’ matches the ER frontmatter canonical_topic.
6.3	[header_subline_date] is set to [qrs_creation_date reformatted as MM/DD/YYYY]	🟢	qrs_creation_date 2026-0823-1030 renders as ‘08/23/2026’.
6.4	[header_subline_model] is set to [qrs_creator_ai_fullname]	🟢	‘Opus 5’ matches qrs_creator_ai_fullname.
6.5	No additional header content appears: no badge, version stamp, AKA / alternate names line, source-AI attribution, audit date, or QRS variant marker.	🟢	Header carries only the title and the template’s fixed subline; no badge, version stamp, alternate-names line, audit date, or variant marker.

7. At-A-Glance Section

#	Description	Result	Comments
7.1	[at_a_glance] is dense, execution-oriented summary of the ER Conclusion section	🟢	Condenses the three paragraphs of the ER Conclusion into supply/correction, marginal supplementation, and harm.
7.2	[at_a_glance] is no longer than 60 words	🟢	54 words.
7.3	Every fact in [at_a_glance] is supported by a distinct passage in the ER.	🟢	Each sentence maps to a distinct ER Conclusion passage (l.452, l.452, l.454, l.456).
7.4	It DOES NOT use acronyms or technical classifications that require specialist knowledge, uses plain-language terms instead	🟢	Uses ‘uptake route’, ‘shortfall’, ‘blood marker’, ‘tablets’, ‘harm signals’; no acronyms or specialist classifications.
7.5	It DOES NOT cite specific trials (names, years, sample sizes, p-values)	🟢	No trial names, years, sample sizes or p-values.
7.6	It DOES NOT cite effect sizes, relative risks, or statistical results	🟢	No effect sizes, risk ratios or confidence intervals.

8. Contraindications

#	Description	Result	Comments
8.1	The section is derived from the ER Key Interactions & Contraindications section	🟢	All six items trace to the ER Key Interactions & Contraindications section (nitrous oxide bullet plus the five ‘Populations who should avoid Vitamin B12’ entries).
8.2	[stop_items] represent the Contraindications from the ER	🟢	Complete: all five avoid-population entries plus the one absolute contraindication are represented.
8.3	Individual [stop_items] are formatted as <li></li>	🟢	Six <li> elements inside the [stop_items] span.
8.4	Items are as concise as possible. No trailing explanations, no elaborations, no mechanistic rationale, no attributions, no citations, no study details. No content after an em-dash, en-dash, or hyphen-dash (e.g., “— dose reduction required”, “— reduced efficacy”) — these trailing clauses are stripped. Just the key fact.	🟢	Trailing rationale stripped in every case (e.g., ER’s ‘— cyanocobalamin specifically is contraindicated because cyanide handling is impaired’ reduced to ‘Cyanocobalamin in Leber’s hereditary optic neuropathy’).
8.5	Parenthetical qualifiers from the ER bullet — time windows, severity classes, threshold values, clinical staging — ARE preserved as part of the item, kept as concise as possible (shortened or trimmed where needed to fit the one-page budget, but never dropped entirely).	🟢	The one threshold qualifier is preserved: ‘(eGFR below 60 mL/min/1.73 m²)’; only definitional glosses are dropped.
8.6	When the ER uses ranking notation inside parens (e.g., “>” for severity ordering) that depends on an explanatory phrase to interpret, normalize the items to a plain comma-separated list rather than carrying through the bare symbol.	N/A	The ER’s Key Interactions & Contraindications section uses no ranking notation inside parentheses.
8.7	The section is left empty ONLY IF the ER’s Key Interactions & Contraindications section identifies no population, condition, or scenario for which the intervention should be avoided, deferred, or used only under specialist supervision.	🟢	The section is populated with six items, so the empty-section condition does not arise.
8.8	If the section is left empty, an HTML comment inside the [stop_items] span records the ER basis for the absence, naming or quoting the ER text relied on. E.g.	N/A	The Contraindications section is not empty (6 items).

9. Key Interactions

#	Description	Result	Comments
9.1	The section is derived from the ER Key Interactions & Contraindications section	🟢	All nine items trace to the ER Key Interactions & Contraindications bullet list.
9.2	[caution_items] represent the Key Interactions from the ER, excluding any that are already listed as Contraindications	🟢	Nine of the ER’s ten interaction bullets are carried; nitrous oxide is correctly excluded because it appears under Contraindications.
9.3	Individual [caution_items] are formatted as <li></li>	🟢	Nine <li> elements inside the [caution_items] span.
9.4	Items are as concise as possible. No trailing explanations, no elaborations, no mechanistic rationale, no attributions, no citations, no study details. No content after an em-dash, en-dash, or hyphen-dash (e.g., “— dose reduction required”, “— reduced efficacy”) — these trailing clauses are stripped. Just the key fact.	🟢	Mechanism and mitigation text stripped throughout (e.g., ‘Metformin’, ‘Antacids and calcium carbonate’).
9.5	Parenthetical qualifiers from the ER bullet — example drug lists, time windows, severity classes, threshold values, clinical staging — ARE preserved as part of the item, kept as concise as possible (shortened or trimmed where needed to fit the one-page budget, but never dropped entirely).	🟢	Example drug lists and thresholds retained and trimmed, never dropped: ‘(omeprazole, pantoprazole)’, ‘(famotidine, cimetidine)’, ‘(above 1 g)’, ‘(furosemide, hydrochlorothiazide) during rapid repletion of severe anemia’.
9.6	When the ER uses ranking notation inside parens (e.g., “>” for severity ordering) that depends on an explanatory phrase to interpret, normalize the items to a plain comma-separated list rather than carrying through the bare symbol.	N/A	The ER’s Key Interactions & Contraindications section uses no ranking notation inside parentheses.
9.7	The section is left empty ONLY IF the ER’s Key Interactions & Contraindications section identifies no interaction, additive effect, or exposure that changes how the intervention is used.	🟢	The section is populated with nine items, so the empty-section condition does not arise.
9.8	If the section is left empty, an HTML comment inside the [caution_items] span records the ER basis for the absence, naming or quoting the ER text relied on. E.g.	N/A	The Key Interactions section is not empty (9 items).

10. Protocol

#	Description	Result	Comments
10.1	The section is derived from the ER Protocol section	🟢	All three sets trace to the ER Therapeutic Protocol bullets at l.328, l.330 and l.350.
10.2	The three sets of [action] items cover the three most important actionable implementation aspects from the ER Protocol section	🟢	Covers the oral regimen, the injection regimen, and the biomarker thresholds that select who is treated — the three decision-bearing bullets of the ER protocol.
10.3	If less that three distinct actionable implementation aspects are mentioned in the ER the unused sets are left empty and made invisible, not filled with placeholder text or empty-state phrasing.	N/A	The ER Therapeutic Protocol section supplies three or more distinct actionable aspects; all three sets are used.
10.4	All used [action_#label], [action#value], [action#_sub] items are filled with meaningful content derived from the ER Protocol section.	🟢	All nine action fields carry ER-derived content; none is placeholder or empty-state text.

11. Time to Effect

#	Description	Result	Comments
11.1	The three sets of [time] items cover the three most important time-to-effect aspects from the ER	🟢	Blood counts, serum B12, and neurological recovery — the only three time courses the ER quantifies (l.382 and l.152).
11.2	The sets are picked and ordered by the magnitude of the related benefit	🟢	Ordered High-benefit hematologic response, its confirming biomarker, then the Medium-benefit neurological endpoint.
11.3	If less that three distinct time-to-effect aspects are mentioned in the ER the unused sets are left empty and made invisible, not filled with placeholder text or empty-state phrasing.	N/A	The ER supplies three distinct time-to-effect aspects; all three sets are used.
11.4	All used [time_#label], [time#value], [time#_sub] items are filled with meaningful content derived from the ER.	🟢	All nine time fields carry ER-derived content.
11.5	If the ER does not provide any information on time to effect, the section is removed completely from the Protocol Panel	N/A	The ER provides time-to-effect information (Practical Considerations, ‘Time to effect’ bullet).

12. Benefits

#	Description	Result	Comments
12.1	The section is derived from the ER Expected Benefits section	🟢	All four tiers reproduce the ER Expected Benefits sub-headings for their tier.
12.2	Key variables are [benefits_high], [benefits_medium], [benefits_low], [benefits_speculative]	🟢	All four variables present and populated.
12.3	Items are as concise as possible. No explanations, no elaborations, no effect sizes, no qualifiers, no attributions, no citations, no study details, no mechanistic explanations, etc. Just the key fact.	🟢	Heading text only; magnitudes, confidence intervals, ‘Net reading’ commentary and the ‘⚠️ Conflicted’ markers all stripped.
12.4	Parenthetical content — including effect sizes, sample notes, mechanistic hints, and example studies — is stripped, NOT preserved.	🟢	The ER benefit headings carry no parenthetical content; none is introduced.
12.5	If no items of a specific sub-section (high, medium, low, speculative) are present the respective is set to “display=none”, not filled with “None documented in human trials to date” or similar empty-state phrasing.	N/A	All four benefit tiers (High, Medium, Low, Speculative) have items in the ER.

13. Risks

#	Description	Result	Comments
13.1	The section is derived from the ER Potential Risks & Side Effects section	🟢	All four tiers reproduce the ER Potential Risks & Side Effects sub-headings for their tier.
13.2	Key variables are [risks_high], [risks_medium], [risks_low], [risks_speculative]	🟢	All four variables present and populated.
13.3	Items are as concise as possible. No explanations, no elaborations, no effect sizes, no qualifiers, no attributions, no citations, no study details, no mechanistic explanations, etc. Just the key fact.	🟢	Heading text only; hazard ratios, confidence intervals and mechanism text stripped.
13.4	Parenthetical content — including frequencies, severity grades, sample notes, mechanistic hints, and example studies — is stripped, NOT preserved.	🟢	The ER risk headings carry no parenthetical content; none is introduced.
13.5	If no items of a specific sub-section (high, medium, low, speculative) are present the respective is set to “display=none”, not filled with “None documented in human trials to date” or similar empty-state phrasing.	N/A	All four risk tiers (High, Medium, Low, Speculative) have items in the ER.

14. Monitoring

#	Description	Result	Comments
14.1	The section is derived from the ER Monitoring section	🟢	All rows and the cadence text trace to the ER Monitoring Protocol & Defining Success section.
14.2	All measurable/quantifiable biomarkers from the Monitoring section are listed	🟢	All nine biomarker table rows from the ER (l.414-422) are present, with the ER’s optimal ranges verbatim.
14.3	[monitoring_cadence] is populated with the monitoring cadence/frequency derived from the ER Monitoring section. It is not left with placeholder text or empty.	🟢	Populated with the ER’s baseline, 8-week, 3-month and 6-12-month schedule plus the metformin/acid-suppression and kidney-function rechecks (ER l.408-410).

15. Qualitative Assessment

#	Description	Result	Comments
15.1	The section is derived from the ER Monitoring section	🟢	The seven items trace to the ER’s ‘Qualitative markers worth tracking alongside the laboratory panel’ list (l.426-432).
15.2	All subjective/qualitative biomarkers from the Monitoring section are listed	🟢	All seven ER qualitative markers are present, none omitted.

Issues 23/08/2026 11:03

Pass rate 100.00%. No issues found.

Issues 23/08/2026 10:56

1. 9.5 — Thiazide example drug dropped: Line 595 renders the ER’s “Loop and thiazide diuretics (furosemide, hydrochlorothiazide)” (ER line 298) as “Loop and thiazide diuretics (furosemide)”, so the named thiazide class is left without an example drug while the loop class keeps one.

Fixes 23/08/2026 10:56

1. 9.5 — Thiazide example drug restored: Restored the ER’s full parenthetical on the diuretics interaction item, from “Loop and thiazide diuretics (furosemide)” to “Loop and thiazide diuretics (furosemide, hydrochlorothiazide)”, so both named classes carry an example drug.

Issues 23/08/2026 10:51

1. 1.3 — Limiting qualifiers dropped in Monitoring: marker_7_why (line 721) says “Gates combined regimens” where the ER (line 420) says “Gates high-dose combined regimens”, and marker_8_why (line 732) says “the potassium shift on repletion” where the ER (line 421) says “during rapid repletion”; both broaden the ER claim.
2. 4.3 — Biomarker row label altered: marker_9_name (line 737) reads “Intrinsic factor, parietal cell antibodies” instead of the ER’s row label “Intrinsic factor and parietal cell antibodies” (ER line 422).

Fixes 23/08/2026 10:51

1. 1.3 — Restored “high-dose” qualifier: marker_7_why changed from “Gates combined regimens; calibrates methylmalonic acid” to “Gates high-dose combined regimens; calibrates methylmalonic acid”, matching the ER.
2. 1.3 — Restored “rapid” qualifier: marker_8_why changed from “Guards against the potassium shift on repletion” to “Guards against the potassium shift during rapid repletion”, matching the ER.
3. 4.3 — Biomarker row label restored: marker_9_name changed from “Intrinsic factor, parietal cell antibodies” to the ER’s verbatim row label “Intrinsic factor and parietal cell antibodies”.

Issues 23/08/2026 10:45

1. 8.2 — Chronic kidney disease population dropped: The contraindication at line 573 reads “diabetic kidney disease”, but ER line 305 contraindicates the combined high-dose regimen in “Diabetic nephropathy or chronic kidney disease with an eGFR … below 60 mL/min/1.73 m²”, so readers with non-diabetic CKD are excluded from the gate.
2. 10.2 — Weakest protocol aspect selected: Action 3 (lines 475–484) carries “Best time of day”, which the ER describes as having “No circadian dependence … chosen mainly to aid adherence” (ER line 338), while the decision-gating bullet “Baseline biomarkers drive the regimen” (ER line 350) is not represented.
3. 4.3 — Biomarker name abbreviated: Monitoring row 5 (line 690) shortens the ER marker name “Complete blood count with mean corpuscular volume” (ER line 418) to “Blood count with mean corpuscular volume”.

Fixes 23/08/2026 10:45

1. 8.2 — Chronic kidney disease population restored: Changed the contraindication from “diabetic kidney disease” to “diabetic nephropathy or chronic kidney disease”, matching the ER’s population definition while keeping the eGFR below 60 mL/min/1.73 m² threshold.
2. 10.2 — Protocol action 3 replaced: Swapped the “Best time of day” cell for “Baseline biomarkers drive the regimen” (methylmalonic acid above 250 nmol/L or active-B12 below 50 pmol/L), the ER’s decision-gating protocol bullet.
3. 4.3 — Biomarker name restored: Renamed monitoring row 5 from “Blood count with mean corpuscular volume” back to the ER’s “Complete blood count with mean corpuscular volume”.

Issues 23/08/2026 10:39

1. 4.5 — Sheet overruns the one-page budget: On a source-based height estimate the sheet renders at roughly two A4 pages, because several fields were left at ER length rather than condensed to the per-section budget — action_1_sub (lines 455-458, 122 characters wrapping to about four lines inside a one-third-width protocol cell), time_2_sub (lines 516-518, which only restates the dose already given in action_1_value), seven of the nine Monitoring “Why” cells (lines 668-776) and five marker names/targets that wrap to two table lines, monitoring_cadence (lines 783-788, 338 characters), and the longer Contraindication and Key Interaction gate items (lines 580-586 and 601-608) that wrap to two or three lines each.

Fixes 23/08/2026 10:39

1. 4.5 — Protocol and time-to-effect subs trimmed: action_1_sub was cut from “Matches injection on serum levels and blood counts even without intrinsic factor, because roughly 1% crosses passively.” to “Matches injection even without intrinsic factor; roughly 1% crosses passively.”; action_2_sub, action_3_sub, time_1_sub and time_3_sub were shortened the same way, and the redundant time_2_sub dose restatement became “On 1,000–2,000 µg daily by mouth.”
2. 4.5 — At-a-glance tightened: Reduced from 59 to 54 words by dropping filler (“rather than diet” → “not diet”, “tablets work as well as injections” → “tablets match injections”), with every ER-supported fact retained.
3. 4.5 — Gate items reduced to single lines: Example drug lists were trimmed rather than dropped (proton pump inhibitors and H2-receptor antagonists now name two agents each, diuretics one, homocysteine-lowering supplements three), and the two longest contraindications were condensed while keeping the eGFR threshold and the 600 pmol/L cut-off.
4. 4.5 — Monitoring table and cadence condensed: Seven “Why” cells plus the marker_5_name and marker_9_name entries were shortened so each table row occupies one line, and monitoring_cadence was cut from 338 to 296 characters while preserving every timepoint.
5. 4.5 — Qualitative items shortened: Four of the seven qualitative markers lost redundant trailing words (“blood counts” → “counts”, “receding, static or progressing” → “receding or progressing”, “classic early signs that resolve” → “which resolve”) without changing what is being tracked.