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Sublingual absorption of B12 bypasses some digestive factors that GLP-1 agonists disrupt

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Continuous administration without washout can lead to adaptive downregulationwhere receptors become less responsive to MOTS-c signaling or NNMT inhibition becomes less effective due to compensatory upregulation

The specific mechanism may also be by activating VEGF-A / VEGFR1 -mediated AKT and p38/MAPK signaling pathways to upregulate downstream eNOS expression, which may increase the NO product synthesis, thus promote angiogenesis of gastric mucosa and also interact with endoplasmic reticulum (ER) stress

Consider switching to a standalone B12 supplement or adjusting the timing of different supplements throughout the day