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Furthermore, decreased NAD+ levels, potentially a consequence of reduced kynurenine, may contribute to fatigue by impairing energy production, and disrupting the coordination of circadian rhythms necessary for effective sleep (reviewed in Dehhaghi et al., 2022)

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If supplementation is responsible, your doctor may recommend reducing or stopping non-essential B12 intake, with repeat testing after an appropriate interval (typically 2-3 months, or longer if you've had recent injections or have kidney disease)