One possible explanation is that low serum vitamin B12 levels would trap folate as 5-methyltetrahydrofolate, prevent the generation of methionine from homocysteine, and therefore reduce protein synthesis and lean tissue deposition
( Cleveland Clinic
Furthermore, research on circadian biology suggests NAD+ is tied to the body clock, so morning supplementation might be optimal for metabolic syncing
Assessment considerations include: Serum B12 measurement may be considered before initiating Ozempic in high-risk patients (those on metformin, older adults, those with gastrointestinal symptoms, or with restricted diets) Testing for B12 deficiency should be performed in patients on metformin who develop symptoms suggestive of deficiency, as advised by the MHRA Drug Safety Update Consider periodic monitoring in patients with risk factors for B12 deficiency, rather than routine annual testing for all patients Full blood count to identify macrocytic anaemia, which may indicate B12 or folate deficiency Clinical assessment for symptoms of deficiency: fatigue, paraesthesia, cognitive changes, glossitis, or balance problems If B12 levels are borderline or if clinical suspicion remains despite normal serum B12 (measured in pmol/L, with laboratory-specific reference ranges), additional testing may be considered according to local laboratory protocols
