Medical conditions affecting absorption warrant particular attention : Pernicious anaemia : an autoimmune condition destroying gastric parietal cells, requiring lifelong B12 injections Gastrointestinal surgery : particularly gastric bypass, gastrectomy, or terminal ileum resection Inflammatory bowel disease : Crohn's disease affecting the terminal ileum impairs absorption Coeliac disease : untreated disease damages the small intestine, reducing B12 uptake Medication use : long-term metformin therapy (MHRA safety alert) or nitrous oxide exposure Symptoms suggesting possible B12 deficiency include : persistent fatigue, weakness, paraesthesia (pins and needles) in hands or feet, glossitis (sore, red tongue), mood changes, memory problems, or unexplained anaemia
Small molecule inhibitors of nicotinamide N-methyltransferase (NNMT). Journal of Medicinal Chemistry, 59(19), 90399056
The rate may be affected by: Starting weight Calorie intake Appetite response Physical activity Protein intake Sleep Stress Medication tolerance Metabolic health Treatment consistency A lack of rapid change does not automatically mean another peptide should be added
What I call my less worse phase