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But a growing number of Americans are now taking peptides that, unlike those drugs, haven't undergone a rigorous testing and approval process

The theoretical concern is off-target methylation interference, since NNMT isnt the only methyltransferase in one-carbon metabolism pathways

Another option is to use an injectable form, although a 2023 analysis of several large studies and two meta-analyses found no solid evidence that injectable methotrexate was better absorbed or had fewer side effects than pills

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At the same time, it was agreed that symptoms affecting the central nervous system (mental function and neurological function), followed by those affecting the peripheral nervous system, are the most difficult symptoms to link to B12 deficiency (Figure 1), suggesting the need for more specific awareness in a primary medical care setting and an improvement in examination options