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This could explain why tirzepatide (which stimulates the GIP pathway in addition to GLP -1) can be administered at higher doses than semaglutide (which only stimulates GLP-1), without amplifying the side effects typical of GLP-1 agonists (nausea, vomiting)
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and (2) nicotinamide a NAD+ precursor is diverted away from the NAD+ synthesis pathway into the methylation pathway, reducing cellular NAD+ levels
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