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NAD+ levels decline measurably with age, with stress, and with illness

PubMed Anisimov VN, Khavinson VKh, Popovich IG, Zabezhinski MA, et al

Effects of Low Oxygen Concentrations and Metabolic Inhibitors on Proteoglycan and Protein Synthesis Rates in the Intervertebral Disc

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The 4 week interval represents the optimal balance between rapid therapeutic escalation and physiological adaptation time