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This study also identified the depletion of the purine metabolite, hypoxanthine, in chronic fatigue patients (according to Canadian Consensus criteria) which may impair ATP production and contribute to the biochemical changes associated with PEM

The liver stores are a bit irrelevant to someone who has PA or a B12 absorption problem though because the mechanism that is used to release them relies on the same mechanism that is used to absorb most dietary B12 so accessing any stores is at best very inefficient

B12 injections can be a valuable tool, but they shouldnt replace a holistic approach to health

Its also not recommended for older adults