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In addition to the endogenous cellular pathways, recent studies have also investigated the role of the gut microbiome in affecting NAD + levels

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For instance, a study on ME/CFS demonstrated the efficacy of the tricarboxylic acid (TCA) cycle metabolite oxaloacetate in improving symptoms (Cash and Kaufman, ME/CFS and fibromyalgia Both ME/CFS and FM are characterized by metabolite alterations that suggest dysregulation in energy (Germain et al., 2016) and lipid metabolism (Germain et al., 2016), FM (da Silva et al., Tryptophan metabolism appears to be differentially altered in ME/CFS and FM, relative to healthy controls, potentially contributing to the symptoms of each condition