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113 It is known that perturbations in the microbiome can influence the production and absorption of nutrients, especially B vitamins, and hence it is, therefore, possible, as discussed above, these effects of metformin on the gut flora may contribute to the observed effects on vitamin B 12 status, with other possible consequences yet to be identified

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Nicotinamide N-methyltransferase (NNMT) is a cytoplasmic enzyme that catalyzes the methylation of nicotinamide (NAM) with the methyl donor S-adenosyl-methionine (SAM) to form methylnicotinamide (MNAM) and S-adenosyl-l-homocysteine (SAH) (Van Haren et al., 2016)

He says Texas Air National Guard choppers were also assisting with rescues