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It affects an enzyme called NNMT, which acts like a metabolic leakdraining away essential components: NAD (crucial for energy production) SAM (the universal methyl donor) This is significant, especially since NNMT is upregulated in conditions such as obesity, diabetes, Alzheimers, Parkinsons, and aging

For example, individuals with NAFLD exhibit increased intestinal permeability and prevalence of small intestine bacterial overgrowth, and these factors are associated with the severity of hepatic steatosis 19

In the UK, B12 replacement is typically administered via intramuscular hydroxocobalamin injections for patients with confirmed deficiency, particularly those with malabsorption or pernicious anaemia, as specified in the BNF and NICE CKS guidance on B12 and folate deficiency anaemia