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As we age, our bodys NAD levels gradually drop due to lower intrinsic production and inflammation/oxidative stress caused by environmental factors

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Two studies found blood methylmalonic acid (MMA) levels to be elevated in more than 60% of elderly individuals with elevated homocysteine levels

The honest boundary is that even the coherent pairing is a mechanistic hypothesis with no human validation, so the most defensible research posture is to study the single compound at its documented dose first, and treat any combination as a further, clearly-labelled research question rather than a default

Semaglutide does not directly affect intrinsic factor production, but the reduced stomach acid environment can compromise the initial separation step that makes b12 available for intrinsic factor binding