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Essential metabolic can be impaired as a result of decreased mitochondrial activity brought on by low NAD+ levels

[6] [3] [10] A mild deficiency may not cause any discernible symptoms, but moderate deficiency can cause various symptoms, such as feeling tired, lightheadedness, headaches, cold intolerance, pale skin, sore tongue, upset stomach, loss of appetite, hair and skin color changes, numbness or tingling (pins and needles) of the fingers and toes, and tinnitus, and vision, cognitive or psychological problems

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