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Understanding these potential mechanisms helps clinicians and patients identify strategies to minimise discomfort whilst maintaining adequate B12 intake

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Hematologic and biochemical monitoring throughout the trials revealed no concerning patterns in blood counts, liver function tests, kidney function markers, or other laboratory parameters

Two downstream consequences are mechanistically central: nicotinamide is preserved for re-entry into the NAD+ salvage pathway (raising intracellular NAD+ availability), and SAM is preserved for other methylation reactions

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