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They may get little to no B12 from their food, because vitamin B12 only occurs naturally in animal sources

Beverelli F, Bea ML, Puybasset L, Giudicelli JF, Berdeaux A (1997) Chronic inhibition of NO synthase enhances the production of prostacyclin in coronary arteries through upregulation of the cyclooxygenase type 1 isoform

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This process depends on: Vitamin B6 (P5P) as an essential enzyme cofactor Adequate availability of glycine and glutamate Sufficient cellular energy (ATP) Proper liver and mitochondrial function When this pathway is inefficient, glutathione production may be impaired even if homocysteine, B12, or folate levels appear normal