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Studies have demonstrated that endothelial NAD+ levels decrease by 40-60% during aging, correlating with reduced nitric oxide bioavailability and impaired vasodilation

This likely contributes to the fatigue most patients experience

We need to get it from our diet, which is where things can get tricky

GLP1: glucagon- like peptide1) Serotonin (5- hydroxytryptamine or 5HT) receptor modulation The nonselective serotonergic antiobesity drugs fenfluramine and dexfenfluramine have been associated with severe side effects like valvular heart disease and pulmonary hypertension

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Deficiency can lead to megaloblastic anemia and neurologic complications, while elevated levels may signal underlying liver disease or malignancy