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Three Landmark Features The rationale for developing this multimodal supplement combination emerged from the Nottingham groups previous work which identified, three landmark metabolic features of hepatic steatosis: limited serine availability, reduced de novo glutathione (GSH) synthesis, and altered nicotinamide adenine dinucleotide (NAD+) metabolism. They hypothesized that supplementation with L-carnitine tartrate would facilitate mitochondrial fatty acid uptake from cytosol, while the NAD+ precursor nicotinamide riboside would induce hepatic mitochondrial -oxidation and facilitate mitochondrial fatty acid transfer

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(2) reduce clearance rate due to slowed metabolism and renal filtration (131)

Most require documented trial and failure (or contraindication) of metformin, a sulfonylurea, or another first-line diabetes medication

Higher doses of the medication can increase the risk of side effects, including skin reactions

Mukha et al