Low stomach acid is also a risk factor for developing bacterial conditions such as small intestinal bacterial overgrowth (SIBO), which has been found to be present in about 50 percent of those with Hashimotos
However, increasing oral supplement doses (within safe limits) while awaiting medical review is generally considered safe, as B12 has very low toxicity and excess is excreted through the kidneys
Metabolic Physiology Research Experimental research has suggested that NNMT influences how cells regulate nutrient utilization, energy expenditure, and metabolic signaling
If sublingual doesnt maintain serum B12 above 400 pg/mL, switch to IM injections monthly
Additionally, injections can be given twice a week if deemed appropriate
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