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Higher NAD enhances SIRT1 activity, promoting fat oxidation and mitochondrial remodeling via PGC-1 pathwaysmechanisms consistent with improved endurance and recovery potential (Cant et al., Cell Metabolism

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Taking the supplement with food may improve tolerance

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[2] [1] With neurological involvement: Hydroxocobalamin 1mg intramuscularly on alternate days until no further improvement, then maintenance injections every 2 months