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The gut microbiota-derived deamidated pathway facilitates the utilization of NAM or NR for hepatic NAD + synthesis, suggesting that manipulation of microbiota might offer a new option to manipulate NAD + metabolism

The guanidinoacetate released by the kidneys is methylated by guanidinoacetate N -methyltransferase, which is located predominantly in the liver, pancreas, and, to a much lesser extent, in the kidneys to produce creatine (Wu and Morris 1998)

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NAD+ is a coenzyme critical to cellular energy production and metabolic health

But because dehydration can worsen side effects, it's extra important for anyone on these medications to stay hydrated