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Although a fairly large proportion of patients have reported a number of side effects, particularly at the gastrointestinal level (nausea, vomiting, diarrhoea), these side effects tend to diminish over time and adherence to treatment remains high, with about 5% of patients discontinuing treatment due to side effects

However, some people are at greater risk: People who eat a restrictive diet that does not contain enough B12

I do think the high folate w/ the (absent?) B12 is suspicious

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K-means clustering analysis of amplicon sequence variants by animal demonstrated that NNMTi-treated DIO mice switched to LD had a distinct microbiome pattern that was highlighted by decreased Erysipelatoclostridium and increased Lactobacillus relative abundances compared to vehicle counterparts