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As a recent scientific review explains, 4 Owing to its size and charged nature, NAD+ cannot passively pass through cellular membranes, including the plasma membrane. ...this probably occurs indirectly through the generation of NAD+ degradation products, such as NMN, NR or NAM, which act as precursors. In other words, NAD+ taken orally must first be broken down into these smaller molecules before it can re-enter cells and contribute to NAD+ synthesis

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A doctor usually diagnoses a vitamin B12 deficiency according to a physical examination and blood tests

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