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When NNMT is overactive, it consumes S-adenosylmethionine (SAM) and reduces levels of nicotinamide adenine dinucleotide (NAD+), a critical coenzyme involved in cellular energy production

For maintenance therapy in individuals with dietary deficiency, doses of 50150 micrograms daily are often sufficient and better tolerated

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Combination with other cardiovascular interventions presents additional unknowns

Sometimes it can be an early clue to a hepatic, renal, hematologic, inflammatory, or malignant process