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It inhibits NNMT (nicotinamide N-methyltransferase), an enzyme regulating metabolism, fat storage, and NAD+ consumption.[4][27][6] NNMT methylates nicotinamide, a NAD+ breakdown product, diverting it from recycling and reducing available NAD+

Treating true deficiency can improve deficiency-related symptoms (including anemia-related fatigue and neurologic issues) (see the NIH ODS Vitamin B12 fact sheet )