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Long-term untreated vegan diet where deficiency has progressed beyond what oral replacement can comfortably catch up

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Some studies suggest that NAD+ drops by up to 50% by middle age

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Critical limitations identified in the systematic review include predominant use of small rodent models (primarily rats), short follow-up periods relative to human healing timelines, variable dosing regimens complicating dose-response assessment, and lack of standardized outcome measures across studies

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