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Nevertheless, use of metformin may decrease vitamin B 12 status: a meta-analysis of four short-term intervention trials (up to 4 months duration) in patients with type 2 diabetes found that metformin use decreased serum cobalamin concentrations by 57 pmol/L, which could have clinical implications if such patients have suboptimal vitamin B 12 status (146)

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(2016) reported that in cats with exocrine pancreatic insufficiency, when cobalamin was supplemented in combination with enzyme treatment, the probability of positive response to treatment was three-fold higher [74]

B12 helps with healthy brain function, blood cells, and nerves and assists with energy, performance, and endurance

Those with pre-existing cardiac conditions or on medications affecting potassium levels may require closer monitoring

By supporting these pathways, NAD therapy may promote overall cellular health and resilience