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The strongest evidence is preclinical but directly tests NNMT inhibition in metabolic disease models

The acne may develop quickly and feel more inflammatory than usual

Any of these make an auto-immune cause of B12 deficiency (PA, also called autoimmune gastritis 3 ) more likely

This is due to the liver taking up all the circulating FFAs, which then interfere with insulin and IGF-1 signalling (as described above) and eventually leading to hepatic steatosis