Referral to secondary care is indicated for severe or rapidly progressive neurological symptoms, diagnostic uncertainty, suspected bone marrow failure, or in pregnancy or paediatric cases
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B12 is crucial for converting food into usable energy, so restoring optimal levels can significantly reduce tiredness and lethargy
[16] Vials should be stored upright at 20-25 C in the original light-resistant container, protected from moisture and heat sources, and gently rolled between the palms to redissolve any oil stratification before withdrawal without vigorous shaking that can introduce air bubbles
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NNMT depletes cells of NAD+, a crucial coenzyme required for mitochondrial function and energy production