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Some people do have difficulties ingesting supplements, at which point a higher dosage can be prescribed (up to 10,000 mcg) by your doctor, in order to ensure you are getting the sufficient levels your body needs

When prescribed, lipotropic injections are typically given subcutaneously into the fatty tissue of the abdomen, thigh, or upper arm, often as part of an at-home routine using a provided kit

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This means most middle-aged adults are walking around with barely any NAD+ at all