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This pathway recycles NAM released during NAD+ cleavage through various NAD+-consuming enzymes including sirtuins, PARPs, and CD38

Vitamin Deficiency: Lack of key vitamins like B12 of folate can affect red blood cell production and produce pernicious anemia

The key difference is the preservative

doi: 10.1146/annurev.pharmtox.42.083001.144616 86 DenuJMTannerKG

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the MHRA advises checking vitamin B12 levels if deficiency is suspected and considering periodic monitoring in those with risk factors [6] Chronic alcohol consumption can damage the gastric mucosa and impair absorption Nitrous oxide exposure (including recreational use) can inactivate vitamin B12 in the body, causing functional deficiency and neurological symptoms If you experience symptoms such as unexplained fatigue, pale skin, shortness of breath, neurological symptoms (tingling, numbness, balance problems), mood changes, or cognitive difficulties, contact your GP promptly