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Pernicious anemia is now understood to be fundamentally an autoimmune disorder that begins with an autoimmune gastritis in which antiparietal cell antibodies produce atrophic gastritis with a resultant decline in intrinsic factor production, evolving over years or even decades (139)

Diet, supplements (e.g., niacin, NR), and exercise help, but may not suffice post-40 due to inefficiency and depletion.[18][19] Oral precursors like NMN increase NAD+ but bioavailability varies

For wellness purposes in non-deficient individuals, there is no universally agreed-upon schedule, and more frequent injections are not necessarily better

What works in a petri dish doesn't always translate directly to a complex organism, and topical application has different considerations than systemic delivery