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Now, the difficulty with low B12 levels are that yes, they are more likely to be associated with intestinal problems, but we don't always get overt diarrhea or vomiting with those diseases

The result is a vicious cycle where declining NAD+ leads to worse metabolic function, which can lead to weight gain, which increases NNMT activity further

The combination remains speculative but represents logical stacking based on mechanism understanding

Diarrhea and constipation are also commonly observed, each potentially affecting ten to fifteen percent of patients, with individual susceptibility varying based on factors such as baseline gastrointestinal function, dietary habits, and concurrent medications