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A 2026 biopharmaceutical review in a journal I do not trust said there is no identified high-affinity receptor, no validated molecular target, and a wide disconnect between the tidy preclinical effects and any coherent pharmacology

What the evidence does not establish: Human efficacy at clinically meaningful magnitudes, long-term safety, cardiovascular profile under chronic dosing

When kidney function declines, B12 clearance slows, and serum levels can rise

For example, a severe deficiency can lead to nerve damage and even paralysis

Vitamin C (L-ascorbic acid) destabilizes copper peptides

NAC significantly reduced markers like morning stiffness, disease activity score, nitric oxide, fasting blood sugar, and increased HDL cholesterol, although not all improvements were significantly different from the placebo group