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Modern lifestyle habits have significantly increased risk factors for both deficiencies

See the AAAaAI review, a related PubMed case series and an FDA pharmacovigilance memo for more detail

Anyone taking methyl-donor-sensitive medications (some psychiatric drugs, methotrexate, methylated B-vitamin protocols at high doses): NNMT shares the methyl donor SAM, so theoretical interactions exist

For individuals with digestive sensitivities, those taking acid-reflux medications, or anyone on a plant-based (vegan/vegetarian) diet, absorbing enough B12 through food or pills is virtually impossible

In high-risk patients, use semaglutide with caution