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A decrease in NAD + levels directly affects the metabolism of the bodys three major energy substances: sugar, fat, and protein, inducing MetS ( + levels across various mouse tissues, including adipose (Yoshino et al., 2011), skeletal muscle (Trammell et al., 2016), and hypothalamus (Sasaki et al., 2014), concomitant with the development of obesity

Contraindications/Precautions Cyanocobalamin is contraindicated in those with hypersensitivity to cobalt moiety or cobalamin molecule due to the risk of anaphylaxis (9)

I think it at least needs to be brought up in our patient population, so we can be part of the conversation at least

Gregory, G

Nat Methods 8 , 424429 (2011)