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Vitamin B12 injections are medically necessary for patients with pernicious anemia, severe malabsorption syndromes, post-bariatric surgery absorption failure, or critically low B12 levels with neurological symptoms

The starting dose is typically 20 units (0.6mg)

While these combinations are available through compounders, they differ fundamentally from FDA-approved products in manufacturing standards, quality control, and regulatory oversight

The interest traces to a 2014 Nature paper showing that knocking down NNMT in fat and liver protected mice against diet-induced obesity, glucose intolerance, and fatty liver, partly by shifting adipose NAD+ and SAM levels [4]