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Stress response and cortisol modulation Elevated cortisol is a common driver of insomnia and sleep fragmentation

Specifically, eligible studies included participants (P) with a confirmed diagnosis of vitamin B12 deficiency, interventions (I) involving oral or sublingual vitamin B12 administration, comparators (C) using intramuscular supplementation, and outcomes (O) reporting changes in serum vitamin B12 or homocysteine levels

The resulting increase in intracellular NAD+ availability activates sirtuins particularly SIRT1, which regulates insulin sensitivity, gluconeogenesis, cholesterol synthesis, and fatty acid oxidation, and SIRT3, which governs mitochondrial antioxidant defences and energy metabolism

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