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With the drain plugged, the cell keeps more fuel (NAD+) and burns fat instead of storing it [1]

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Contact your GP more urgently or seek same-day assessment if: Neurological symptoms are rapidly worsening You experience significant balance problems or difficulty walking Vision changes occur Severe weakness affects daily functioning You have used nitrous oxide and develop neurological symptoms Symptoms are accompanied by chest pain or severe breathlessness Call 999 or attend A&E immediately if you experience: Sudden severe chest pain or acute severe breathlessness Sudden vision loss Rapidly progressive neurological deficits Loss of bladder or bowel control Specific groups should be particularly vigilant: Vegans and vegetarians should discuss B12 monitoring with their GP, ideally before symptoms develop Patients on long-term metformin should request periodic B12 screening as advised by the MHRA Individuals taking PPIs or H2-receptor antagonists should discuss testing if symptoms develop Those with diagnosed gastrointestinal conditions should report new neurological symptoms promptly Pregnant or breastfeeding women with symptoms should contact their GP or midwife Those with a family history of pernicious anaemia should mention this when discussing symptoms Before your appointment , it is helpful to: Document symptom duration and progression List all current medications and supplements Note dietary habits, particularly animal product consumption Record any relevant family history GPs can arrange appropriate blood tests and initiate treatment where indicated