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[DOI] [PMC free article] [PubMed] [Google Scholar] 220.van Haren M.J., Zhang Y., Thijssen V., Buijs N., Gao Y., Mateuszuk L., Fedak F.A., Kij A., Campagna R., Sartini D., et al

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Through the catalytic activity of their microbial nicotinamidase (PncA) enzyme, the intestinal flora can convert NAM to NA, which, in turn, can circulate and stimulate NAD + biosynthesis in mammalian host tissues (presumably also including neoplastic tissues) that possess a functional PH pathway [202]

This nasty chemical damages tissues throughout your body and triggers inflammatory responses that contribute to your misery