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When a cell over-expresses NNMT, it does two costly things at once: it burns through methyl-donor capacity, and it diverts nicotinamide away from NAD+ regeneration into an inert metabolite (1-methylnicotinamide) that gets excreted

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Recommended dosing includes step-up doses of 5 mg, 25 mg, and 200 mg, followed by 200 mg weekly for 10 doses, then 200 mg biweekly

Pregnant women who are strict vegans or vegetarians are at an increased risk for deficiencies

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And critically, it acts on the hypothalamus to reduce appetite, creating powerful satiety signals that make people eat significantly less without feeling deprived