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Urinary or plasma methylmalonic acid (MMA), a substance produced in the body thats dependent on B12, is also helpful for detecting early stages of B12 deficiency

According to the report from Neelakantan et al

however, a progressive decline was observed after 10 weeks

Additionally, NAD + is required for fatty acid metabolism during -oxidation, glutaminolysis generating -ketoglutarate, mitochondrial shuttling of metabolites, and lactic acid fermentation 35

A 2025 meta-analysis of 16 studies involving 6,098 participants found no statistically significant difference between intramuscular, oral, and sublingual B12 supplementation routes