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Individuals with significant kidney impairment might be advised to use alternative forms to cyanocobalamin as a precautionary measure, though evidence of clinical harm at standard supplementation doses is lacking

Nat Rev Microbiol (2020) 18(10):55970

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The relationship between NAM metabolism and NAD + utilization indicates that elevated NNMT expression may inhibit energy expenditure and promote fat deposition by limiting NAD + -dependent processes (Trammell and Brenner, 2015)

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