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Certain health conditions such as intestinal or stomach problems, poor nutrition, cancer, HIV, pregnancy, old age, veganism, and alcoholism can cause vitamin B12 deficiency

While exogenous NAD provides the direct substrate for sirtuin activation and ATP production, 5-Amino-1MQ acts as a membrane-permeable inhibitor of the enzyme Nicotinamide N-methyltransferase (NNMT)

Recognizing these helps ensure appropriate responses

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Your doctor may arrange further investigations including liver function tests, full blood count, and renal function to exclude underlying pathology