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NNMT inhibition increases cellular concentrations of both substrates that the enzyme would otherwise consume: SAM (the universal methyl donor) and nicotinamide (the NAD + salvage precursor)

Some reasons your body may not be able to get enough B12 from food include: Anemia Gastritis Crohns disease Celiac disease Alcohol use disorder Sjgrens syndrome Weight loss surgery, or surgery that removes part or all of your stomach A vegan or strict vegetarian diet (as B12 is only found in animal products) Medications, such as metformin and drugs used to treat gastroesophageal reflux disease (GERD), indigestion, and stomach ulcers Pregnancy Your doctor could also order a B12 test based on your symptoms

In the US, Vitamin B12 shots are available as a synthetic version of vitamin B12 (cyanocobalamin)

It is also important to note that taking large doses of folic acid can sometimes mask the hematological signs of a B12 deficiency, allowing neurological damage to progress unnoticed