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This usually occurs in individuals with underlying digestive conditions, those who have trouble absorbing all nutrients through digestion, or those with pernicious anemia, which specifically prevents B12 absorption

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NNMT is an enzyme that catalyzes the transfer of a methyl group from S-adenosylmethionine (SAM) to nicotinamide (NAM), producing 1-methylnicotinamide (MNA) and S-adenosylhomocysteine (SAH)