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Elevated NAD+ levels activate sirtuins, particularly SIRT1, which are NAD+-dependent deacetylases that regulate numerous metabolic processes including fat oxidation, glucose metabolism, mitochondrial biogenesis, and cellular stress responses

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Blood tests may be needed to determine deficiencies and proper dosing

For any per-user calculation, use the dosage calculator rather than adjusting numbers by hand

separating the two applications by several hours is often advised

These side effects are generally mild and temporary, but it is important to be aware of them