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In adipocytes, this produces a 1.2 to 1.6-fold increase in intracellular NAD+ Lipogenesis suppression : Increased NAD+ availability in adipocytes suppresses lipogenic pathways, reducing fat synthesis and storage SAM/SAH ratio modulation : Inhibiting NNMT's consumption of SAM alters the SAM/S-adenosylhomocysteine (SAH) ratio, which may affect broader methylation dynamics Muscle effects : In aged mice, NNMT inhibition improved muscle proteome and metabolome profiles through mechanisms distinct from exercise, suggesting direct effects on muscle cell biology How 5-Amino-1MQ Differs from NAD+ Precursors# These approaches are mechanistically complementary, though their combination has not been studied

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Alternatively (and this is the approach I take for many patients), if you are experiencing significant symptomatic improvement then you can just continue to take the B12 shots indefinitely

She had been exclusively breastfed due to not wanting solid foods