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B12 is an essential nutrient, and its deficiency is common, especially among individuals following restricted diets like vegetarianism or veganism, pregnant or breastfeeding women, older adults, those who have undergone gastrointestinal surgery or have gastrointestinal disorders, and people with an autoimmune condition known as pernicious anaemia

At the molecular level, it modulates the expression of over 4,000 human genes, roughly 6% of the genome, according to a 2012 Broad Institute Connectivity Map analysis published by Pickart, Campbell, and colleagues

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NNMT (nicotinamide N-methyltransferase) is an enzyme that methylates nicotinamide, draining methyl donors and reducing NAD+ salvage

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Approximately 90% of participants in both groups also were taking riluzole, an approved ALS therapy sold as Rilutek, Tiglutik, and Exservan