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CYA build-up and the increase in kill times has led the Center for Disease Control (CDC) to issue this statement, The CDC recommends not using cyanuric acid or chlorine products with cyanuric acid in hot tubs/spas. This was published in May 2016 in a CDC article called Your Disinfection Team: Chlorine & pH. In November 2016, the Pennsylvania Department of Health published a statement that reads At even moderate levels of cyanuric acid, the amount of time it takes chlorine to kill pseudomonas aeruginosa (the bacteria that causes hot tub itch) can be as much as a hundred times as long as in a hot tub or spa without cyanuric acid. This appeared in the publication Public Swimming and Bathing Places: Operational and Biological Protocol Recommendations. Other Ramifications High levels of CYA have also caused corrosion because they contribute to Total Alkalinity (TA)

Next to NAD + precursors, modulation of NAD + -consuming enzymes showed promising results

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