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THF plays an important role in DNA synthesis, so reduced availability of THF results in ineffective production of cells with rapid turnover, in particular red blood cells, and also intestinal wall cells which are responsible for absorption

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[11] Notably, clinical studies to date have not identified any severe or lasting adverse events attributable to NAD+ Injection

The mechanism involves complementary pathways

Individuals at higher risk include older adults with reduced stomach acid production, people with gastrointestinal conditions affecting absorption, strict vegans, and those taking medications like metformin or proton pump inhibitors