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Oral B12 supplements rely on the digestive system for absorption, which can be significantly impaired by gut conditions, age-related changes, or the absence of intrinsic factor (a protein required for B12 absorption)

PMID: 11146367

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These initial studies reported increased NAD + and NAM levels in plasma, and in urine, the excreted NAD + levels increased after 6 h 66 , but it must be noted that these trials utilized small cohorts and short testing periods, and only a minor trend for cognitive improvement was observed 117

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