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Pharmacies typically put an expiration date of one year ( or less , such as in Pennsylvania) on the prescription label
The result is a vicious cycle where declining NAD+ leads to worse metabolic function, which can lead to weight gain, which increases NNMT activity further
This is especially true under conditions of hepatic stimulation by glucagon which results in increased gluconeogenesis and the energy for this process is derived primarily from the oxidation of fatty acids supplied from adipose tissue
Only this bound form of B12 can be correctly transported to the tissue and body store and thus utilised by the body (7, 8)
Age-related changes in gastric function can reduce food-bound B12 absorption whilst synthetic supplement absorption remains adequate
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