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On top of the role of NAD + as a direct substrate for the TCA and ETC, much of the influence of NAD + on mitochondrial homeostasis is through the NAD + -consuming enzymes sirtuins

Other groups who may benefit include: Patients following gastric surgery (gastrectomy, bariatric procedures) where intrinsic factor production or absorption sites are compromised Individuals with malabsorption disorders such as Crohn's disease, coeliac disease, or chronic pancreatitis Strict vegans and vegetarians with dietary insufficiency, though oral supplementation is usually tried first Elderly patients with atrophic gastritis or reduced gastric acid production Patients on long-term metformin or proton pump inhibitors, which can impair B12 absorption Individuals with nitrous oxide exposure (recreational or medical), which can cause functional B12 deficiency Diagnosis typically involves serum B12 measurement, with levels below approximately 148 pmol/L (though thresholds vary between laboratories) generally indicating deficiency

The skin will be sensitive to the touch, like that of a sunburn

Never take two doses within 3 days of each other

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