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This NAD+ elevation activates sirtuins, particularly SIRT1 in adipocytes and hepatocytes, which deacetylates and activates numerous metabolic regulatory proteins including PGC-1, a master regulator of mitochondrial biogenesis, oxidative metabolism, and thermogenesis

It is required for healthy red blood cell production, maintenance of the myelin sheath, synthesis of DNA, and metabolism of homocysteine

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Additionally, the lack of stomach acid increases the amount of bacteria that use B12, making less of the vitamin available for the body to use

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That's why, when reported, outcomes tend to be inconsistent and heavily dependent on the person's routine