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In an environment with elevated CD38 activity, such as seen in SSc lesional skin, administering NAD + precursors or enhancing NAD + synthesis will have limited effect on increasing NAD + levels, as elevated CD38 continues to degrade NAD +

Other brands opt for a more straight forward approach, knowingly or unknowingly, and sell peptides openly as dietary supplements despite them not legally qualifying as such under the Dietary Supplement Health and Education Act (DSHEA)