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Healthcare professionals should maintain awareness that GLP-1/GIP medicines, whilst highly effective for their intended indications, require holistic management addressing not only glycaemic control and weight but also nutritional status and overall metabolic health

Low energy, tiredness and brain fog that has not responded to lifestyle changes Vegetarians and vegans who do not get B12 from animal foods Patients with absorption issues such as IBS, coeliac disease or pernicious anaemia, with appropriate GP oversight Anyone on long-term metformin or proton-pump inhibitors that lower B12 absorption Older adults whose stomach acid has dropped with age Patients looking for mood, focus and recovery support alongside a balanced diet Aftercare For the first forty-eight hours

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Acknowledgements The work was funded by the Engineering and Physical Sciences Research Council International Centre-to-Centre grant no EP/S030336/1

However, when the assay was repeated with 5-amino-6-fluoro-1MQ, an analogue of 5-amino-1MQ that did not interfere with the NAMPT assay, no inhibition of NAMPT was observed with analogue concentrations between 30 and 600 M (data not shown)