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Intramuscular hydroxocobalamin is the preferred treatment for most patients with confirmed deficiency, particularly when malabsorption is present or neurological symptoms exist

(More information) Both depression and osteoporosis have been linked to diminished vitamin B 12 status and high homocysteine levels

By inhibiting NNMT, the body maintains higher NAD levels, which in turn activate SIRT1, a longevity-associated gene, which may improve mitochondrial activity, fat oxidation, insulin sensitivity, and by overall energy balance

For many research protocols, particularly those involving long-term observations or where ease of administration is a significant factor, an oral compound is often the first choice

Common causes include pernicious anaemia (autoimmune condition), plant-based diets without supplementation, gastrointestinal surgery, and long-term use of metformin or proton pump inhibitors