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This, in turn, boosts metabolic rate and activates a gene known as sirtuin-1 (SIRT1), also referred to as the "longevity gene." SIRT1 is involved in reducing the risk of various conditions such as diabetes, obesity, metabolic syndrome, atherosclerosis, cardiovascular disease, kidney disease, liver disease, neurodegeneration, and cancer.

Fecal elimination of metabolites also occurs, particularly following oral administration, though quantitative contribution of each elimination pathway varies by route and dose

A vitamin B12 deficiency can lead to anemia, as well as neurological and psychiatric symptoms

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