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[8] Similarly, patients with gout or hyperuricemia should avoid high niacin intake, as niacin (even in nicotinamide form) can raise uric acid levels and potentially trigger gout flares

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This acid is what separates B12 from the protein it's attached to in foodthe very first step in the absorption process

Conversely, isoniazid and pyrazinamide (tuberculosis drugs) are structural analogs of niacin that can interfere with niacin metabolism, potentially precipitating pellagra in rare cases

Heidi Spratt for advice regarding the statistical analyses

A provider-guided review can help determine whether approved medical weight-loss care, peptide therapy, hormone evaluation, nutrition support, or longevity care is a safer option