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chronic liver disease and hepatitis may present with elevated levels Renal impairment : Reduced clearance can contribute to accumulation, though this is rarely clinically significant Solid tumours : Certain malignancies, particularly hepatocellular carcinoma and metastatic disease, may elevate B12 levels [3] Evidence suggests that unexplained markedly elevated B12 levels without supplementation may sometimes be associated with underlying disease

This is problematic because muscle mass contributes to metabolic rate, functional capacity, and long-term health

While the vote is only advisory and must still go through a formal rulemaking process, it could give patients the mistaken impression that these unapproved peptides are FDA-endorsed and accelerate their use through compounding pharmacies