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16,17 It is unclear whether B12 is absorbed via the oral mucosa or in the small intestine with sublingual administration, and research into this question is scarce

12 , 13 Opposite effects are observed in dysbiosis conditions (eg, a low Bacteroidetes to Firmicutes ratio), where high levels of lipopolysaccharides and pro-inflammatory cytokines (eg, interleukin-1, interleukin-6, tumor necrosis factor ) are produced by gut bacteria (Figure 1)

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medRxiv 2026, IQVIA PharMetrics cohort (n=20,504 non-diabetic weight-loss users), incident allodynia 35 vs 15 per 1,000 person-years against bupropion-naltrexone, adjusted HR 2.15 (95% CI 1.572.96)