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Treatment based on symptoms instead of blood values The recommended treatment in the Netherlands consists of a hydroxocobalamin injection of 1mg every two months, after an initial loading dose of 10 injections in 5 to 10 weeks

This timing allows AMPK activation to proceed without NAD+ limitation, maximising mitochondrial biogenesis and fat oxidation

Most users report initial effects like increased energy within the first one to two weeks

On the other hand, chronic kidney disease causes fast excretion of cobalamin through urine, resulting in low levels

Careful monitoring of blood pressure is recommended when initiating therapy in hypertensive patients, and those with baseline low blood pressure should use B-containing injections cautiously