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The literature identifies hypoglycemia as the most significant documented risk, driven by IGF-1 LR3s effect on cellular glucose uptake, alongside receptor desensitization with prolonged exposure and contraindications for individuals with a history of malignancy

When looking at the endogenous NAD + fluxes at the systemic level, most organs do not synthesize NAD + de novo, but can utilize NAM made in the liver 39

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