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Diet, supplements (e.g., niacin, NR), and exercise help, but may not suffice post-40 due to inefficiency and depletion.[18][19] Oral precursors like NMN increase NAD+ but bioavailability varies

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[11] Long-term metformin therapy reduces calcium-dependent intrinsic-factor binding, lowering B12 absorption and potentially necessitating higher or more frequent parenteral doses

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