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NNMT normally methylates nicotinamide using S-adenosylmethionine (SAM) as a methyl donor, producing 1-methylnicotinamide and S-adenosylhomocysteine

Although studies suggest all three forms are well absorbed, better retention appears to be achieved with the natural forms of vitamin B12

They can tailor Vitamin B12 injection therapy to meet each patients needs

Similarly, a study based on swimming exercise for a total of four hours showed an increase in NAD + levels, yet also in this case, no measurements of mitochondrial function were performed 309 , reinforcing the need for more exercise-based investigations to further define how NAD + and mitochondrial homeostasis are perturbed and connected during exercise