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Severe loss of quality of life, due to symptoms such as debilitating fatigue, insomnia (B12 is required for synthesis of melatonin), mental illness, and neurological symptoms

All trials employed randomized, double-blind, placebo-controlled designs, representing the gold standard for clinical research

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Interaction with fasting and ketosis Both fasting and ketogenic diets increase NAD+ levels through various mechanisms

Its value in a clinical setting comes from what it is not: it does not disrupt appetite, hormones, insulin, or IGF-1

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