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NAD + is also a precursor to cyclic ADP-ribose (cADPR), a secondary signaling molecule generated by enzymes such as cluster of differentiation 38 (CD38) 7 , and it can be hydrolyzed by sirtuins, which deacetylate histones and regulate gene expression 7

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Nausea, diarrhea, vomiting, and constipation commonly occur within the first month of starting.[ref][ref] Note that for many people, gastrointestinal side effects seem to be dose-related