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National Institutes of Health (NIH Publication No

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2002 Apr;87(4):1687-91

This metabolic sensing function extends to regulation of key metabolic enzymes such as pyruvate dehydrogenase kinase, which is inhibited by low NAD+/NADH ratios, and lactate dehydrogenase, which is activated by high NADH levels, demonstrating the sophisticated regulatory networks that depend on NAD+ redox status

After this loading phase, most patients transition to monthly maintenance sessions

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