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You may not get enough B12 in your diet if you are: Vegan Vegetarian Over 50 Living with digestive conditions that affect nutrient absorption, such as IBS, celiac, or Crohns disease Taking certain medications like metformin or proton pump inhibitors (PPIs) What are the symptoms of B12 deficiency

Excessive NAM depletion directly reduces the substrate supply for NAD+ synthesis, leading to decreased intracellular NAD+ levels

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And if your B12 is already solidly in the optimal range, adding more on top of that does very little