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Kidney disease becomes a more convincing explanation for a high B12 when renal findings such as an elevated creatinine or a reduced eGFR are present

The people who found closer to 50% in their urine probably had a slight vitamin B12 deficiency, and some of the vitamin was stored for later use

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Because NAD+ is essential for mitochondrial activity, replenishing NAD+ levels may help optimize energy output , improve oxygen utilization , and support greater endurance during exercise