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The bicarbonate buffers acid the same way an antacid tablet does, just gentler and slower

Fersht A (1999)

The metabolism and elimination of NAD+ (and its by-products) could be altered in advanced hepatic or renal dysfunction, and high-dose NAD+ might theoretically affect cardiovascular dynamics, so practitioners generally avoid or closely supervise NAD+ use in such settings

FIGURE 2 The primary ROS produced by the ETC is superoxide, a free radical with moderate reactivity, whose generation can lead to more reactive or secondary ROS derivatives