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It has to distinguished that the replacement therapy should be only undertaken to restore the physiological levels, never to exceed physiological ranges

[51] Diagnosis [edit] According to one review: "At present, no 'gold standard' test exists for the diagnosis of vitamin B 12 deficiency and as a consequence the diagnosis requires consideration of both the clinical state of the patient and the results of investigations." [52] The vitamin deficiency is typically suspected when a routine complete blood count shows anemia with an elevated mean corpuscular volume (MCV)

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These include: Complete Blood Count (CBC) to check for better anemia Serum Vitamin B12 levels to make sure the dose is right Methylmalonic acid (MMA) and homocysteine levels to see how the body is reacting Reticulocyte count to see how the bone marrow is doing Clinical Improvement Markers We also watch for signs of improvement in how patients feel

In adipocytes, NNMT inhibition elevates NAD and SAM and suppresses de novo lipogenesis in a concentration-dependent manner, consistent with on-target activity [13]