Much of the current evidence is preclinical (cell and animal studies), and human data is still limited
When NAD+ levels drop, mitochondrial function suffers, energy production declines, and metabolism slows
Most endocrinologists cite 14 days as the conservative limit
Normal vital signs (blood pressure, heart rate, respiratory rate, temperature) and body mass index (BMI) between 18 and 30 kg/m 2 Suboptimal vitamin B12 status (deficient to borderline 200300 pg/mL), defined as serum B12 levels within the lower end of the reference range (234894 pg/mL) Able to provide informed written consent Able to comply with study procedures and follow-up visits as outlined in the protocol 2.2.2 Exclusion criteria Known hypersensitivity or allergy to oral vitamin B12 supplements or any of its components Known history of cobalt allergy or sensitivity Severe malabsorption syndromes, including pernicious anemia or intestinal disorders affecting vitamin B12 absorption Current use of acetaminophen, nonsteroidal anti-inflammatory drugs, antibiotics, antacids, proton pump inhibitors (PPIs), multivitamins, or nutritional supplements containing vitamin B12 History of gastric bypass surgery or other procedures that significantly alter GI anatomy or function Significant renal impairment (estimated glomerular filtration rate [eGFR] 0.05) Supplementary Table 1
Furthermore, with disconcertingly low persistence rates undermining the opportunity for longer term AOM treatment, behavioural support programmes utilising digital health tools will open up a new front-line for competition in 2025, with the need to demonstrate real-world impact on patient outcomes
