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Aging reduces NAD+ synthesis pathways while increasing consumption by enzymes like CD38 and PARPs, activated by inflammation and damage.[13][15] CD38, an immune-related enzyme, ramps up with age, breaking down NAD+ precursors

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Most patients at our Miami clinic begin noticing changes by the second or third injection, with the clearest effects appearing 2 to 4 weeks after the cycle ends

Although dietary fiber has been associated with microbiome changes 75 , this is unlikely to account for the microbiome changes observed herein since fiber content was the same across diets

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