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The liver also plays a role in the enterohepatic circulationa recycling process where B12 is secreted in bile and reabsorbed in the intestinewhich may be disrupted in advanced disease

(PubMed) Lauer AA, Grimm HS, Apel B, et al

10.1089/acm.2006.12.881 Summary Keywords vitamin B12, efficacy, bioavailability, therapeutic approaches, meta-analysis, cobalamin Citation Mazur M, Ndokaj A, Salerno C, Vallone J, Ardan R, Bietolini S, Carrouel F, Wilk A, Sarig R, Ottolenghi L and Bourgeois D (2025) Efficacy of sublingual and oral vitamin B12 versus intramuscular administration: insights from a systematic review and meta-analysis

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Some research teams combine the MOTS-c 5-amino-1MQ stack with growth hormone secretagogues like ipamorelin or CJC-1295 to target both fat oxidation (MOTS-c, 5-amino-1MQ) and lean mass retention (GH secretagogues)

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