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However, you should only use supplements with exceptionally high doses (over 1,000 g per serving) long-term on the advice of a doctor

In humans, two enzymatic reactions are dependent on vitamin B 12 methylmalonyl coenzyme A mutase (MUT) reaction and 5-methyltetrahydrofolate-homocysteine methyltransferase (MTR) reaction (Fig 2)

Its not clear whether the same effect occurs in humans, and large reviews of human data from 2024 to 2025 have not shown an increased risk, but the family-history exclusion remains in place across all GLP-1 SmPCs