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doi: 10.1530/EJE-21-0972 [DOI] [PMC free article] [PubMed] [Google Scholar] 39.Saniona

Previous studies have shown that increased levels of anti-neutrophil cytoplasmic antibodies (ANCAs) in SLE patients serum suggest an impaired clearance mechanism for neutrophil debris, a significant source of self-antigens (77)

This restoration of metabolic cofactor availability enables enhanced function of NAD+-dependent enzymes including sirtuins, poly(ADP-ribose) polymerases, and various deacetylases that regulate cellular metabolism, stress responses, and aging processes

B12 might work better if your tiredness comes from being low on vitamins

Alhariri M, Azghani A, Omri A

Since B12 and intrinsic factor HAVE to be absorbed together this can make for a difficult situation