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Any problem that causes poor absorption in the stomach or small intestine, such as Crohns disease

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It is also used to manage vitamin B12 deficiencies resulting from specific surgeries, diseases of the stomach or gut, and any other genetic disorders affecting vitamin B12 metabolism

One of MOTS-C's downstream effects is increasing intracellular NAD+ utilization the mitochondria are running harder, so they're consuming more of the NAD+ pool

Hong S, Moreno-Navarrete JM, Wei X, Kikukawa Y, Tzameli I, Prasad D, Lee Y, Asara JM, Fernandez-Real JM, Maratos-Flier E, Pissios P. Nicotinamide N-methyltransferase regulates hepatic nutrient metabolism through Sirt1 protein stabilization. Nat Med. 2015 Aug;21(8):887-94. doi: 10.1038/nm.3882. Epub 2015 Jul 13. PMID: 26168293; PMCID: PMC4529375