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It is also integral to energy metabolism, as it acts as a cofactor in the conversion of food into usable energy at the cellular level

(2) M A Heffernan 1, A W Thorburn, B Fam, R Summers, et al (2001) Increase of fat oxidation and weight loss in obese mice caused by chronic treatment with human growth hormone or a modified C-terminal fragment International Journal of Obesity and Related Metabolic Disorders, 2001 Oct, Volume 25 (Issue 10), Pages 1442-9

The NICE Guideline NG239 (2024) and the AAFP clinical review both support this approach

Vitamin B 12 deficiency can develop with heavy regular use of nitrous oxide N 2 O, also known as "laughing gas", used for anaesthesia in a clinical setting or as a propellant gas, commonly abused as a recreational drug