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Regarding gut-liver axis, several studies have indeed established that the trigger that causes systemic/liver inflammation to exacerbate liver injury (211) is prevented by betaine through stabilizing TJs between enterocytes and preventing the translocation of harmful gut-derived toxins/pathogens to the liver (34, 202, 203)

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When your B12 levels are low, these processes slow down and you may feel tired and sluggish

This is consistent with the glucagon receptor component of the drugs mechanism

Ensure you are drinking plenty of water and using a highly bioavailable liposomal form to see the best results