NAD (nicotinamide adenine dinucleotide) is a co-factor that’s used by every single cell in your body. It repairs your DNA, reduces inflammation, improves memory, and even helps regulate your sleeping schedule. Recently, pro athletes and top-level performers have been using NAD as a crucial supplement. Athletes use it to increase stamina and physical output, and those in the biohacking world use it for cognitive enhancement. It’s been employed in weight loss and addiction clinics, as well as brain injury centers. In short, it’s the difference between feeling drained and feeling like you can conquer the world. The supplement is called NAD.
First discovered by scientists in 1906, NAD is integral for how our body creates and stores ATP. ATP is the energy source. Remember in biology class, when everyone learned that the mitochondria is the powerhouse of the cell? NAD is the fuel that allows the mitochondria to create ATP. It’s fuel—on a cellular level. And since ATP is used for every process in the body, that makes NAD the indispensable supplement that it is.
We have a lot of naturally occurring NAD in our systems when we’re young. But as we age, we produce less and less of it. Our cells even have a way of keeping track of how much NAD is available. So, when we run low on NAD, our body starts to shut down the genes that are high performance. Our body deactivates these “superhuman” genes that improve our recovery, increase metabolism, and up our neurological functions. In short, the body goes into “maintenance mode”.
If we have a really low pool of NAD, then we are unable to keep up with our basic needs. We start building up inflammatory cells, toxic compounds, and free radicals. In a healthy state, our cells can detoxify and purge this natural stockpile. When we are unhealthy, these bad players accumulate to a point that we are unable to manage them.
When the cells in the body say, “I don’t have enough energy in the pool” it’s got to figure out a way to maintain life and do it at all costs. The body then shifts into a different metabolism and creates senescent, zombie-like cells—they’re not quite dead and not quite alive. These cells are stuck in limbo—in a state of not reproducing because that requires energy. These cells then metabolize an inefficient fuel source: sugar. Although sugar is a readily available and usable fuel, metabolizing it produces a lot of chemicals, toxins, irritants and inflammation. And so these cells stay like this for a while, semi-alive, like zombies, swimming in bad toxins that eventually cause enough DNA damage which accumulates to cause pre-cancerous (and eventually cancerous) cells. The amount of NAD in our bodies regulates all of the above processes. And every organ in our body, every cell, has a different need for NAD, a different baseline requirement.
To summarize so far, once NAD is used up and we’re not able to generate it or convert it, our body switches to a different type of metabolism. This shift from an aerobic to anaerobic metabolism is not only less efficient, but it also creates senescent cells and eventually a toxic environment for your body and even your DNA.
One of the reasons why NAD has been in the spotlight recently is due to research about its effects on longevity. Researchers believe that the NAD/NADH ratio is one of the main triggers that our body uses to change from a normal, healthy, and longevity-promoting metabolism to something that’s more degenerative. This process creates pathological disease in addition to poor aging.
NAD and Longevity
The main culprit for our aging is DNA damage. NAD is a co-factor for multiple enzymes that respond to repairing the DNA quickly. Repairing spontaneous changes in DNA replication and histones (the end-points of the DNA) as well as repairing the damage from UV light, toxins, and inflammation are all big energy demands for our body. NAD is the primary source that those enzymes use and are needed to trigger those reactions. PARP (poly ADP-ribose polymerase) is the enzyme that uses NAD for DNA repair. NAD is directly related to what are called Sirtuin genes (there are 7 of them) as well as the PARP genes. Genetic repair is needed to help increase our longevity. This system does not go dormant and requires constant activation. This explains the large energy demand it creates. The Sirtuin genes also trigger a cascade of reactions that direct our metabolism to more efficiency and longevity. The improved efficiency creates energy from an ideal source (fatty acids) that has a minimum amount of toxic byproducts (free radicals and reactive oxygen species). Less byproducts cause less damage to our DNA.
Another function of NAD is triggering and helping our mitochondria by improving efficiency, mitophagy, and mitochondrial biogenesis. Mitophagy is the process of dismantling mitochondria that aren’t working properly and recycling those parts for better use. While the body is getting rid of the poorly functioning mitochondria and replacing it with better functioning mitochondria, it improves our metabolic efficiency.
When you have poorly functioning mitochondria you’re going to have inefficient energy production and that inefficiency is what creates more waste products, such as free radicals. NAD is crucial to the body’s naturally self-cleaning mechanisms.
As mentioned before, redox (reduction/oxydation) reactions are how our bodies conduct their antioxidant functions. If there’s a free radical, a highly reactive molecule, then we have enzymes that come in, convert it, thereby making it less toxic. Antioxidants in our diet help fuel this process.
Naturally Acquired NAD
Our bodies primarily receive and create NAD from dietary sources. Niacin and tryptophan are the dietary precursors of NAD. The Nicotinamide part of NAD is niacin (vitamin B3). Tuna, salmon, chicken breast, peanuts, pork chops, beef, mushrooms, brown rice, avocados, green peas, and sweet potatoes are just a few of the food sources high in niacin. Tryptophan provides precursors via a different pathway and can be found in chicken, eggs, cheese, fish, peanuts, pumpkin and sesame seeds, milk, and turkey.
But this is the most important fact: our bodies need so much NAD to function that we don’t get enough from our dietary sources, so we require another mechanism that makes it always readily available. That is the Salvage Pathway. Most of the NAD we utilize comes through this pathway. It is a cyclical chain of reactions that constantly recycles NAD at a rapid rate.
Supplementation of NAD
Direct supplementation of NAD has been done but can be cumbersome. The Salvage Pathway turned out to be the main pool of NAD to influence via supplements, and it has been the focus of much of the research. Researchers found different NAD precursors that plug into the Salvage Pathway at different points. NMN (nicotinamide mononucleotide) and NR (nicotinamide riboside) are the two main options. Both are equally effective and have valid research to support their benefits. The idea is that they will all eventually end up as NAD.
Sublingually (Under the Tongue)
This is one of the most effective means of increasing NAD in your body. Currently there’s a company in Colorado manufactures a sublingual supplement. It is NMN (nicotinamide mononucleotide) and all you have to do is squirt it under your tongue for it to go right into your bloodstream. NMN is a precursor which converts into NAD. There are no side effects, aside from the slightly weird taste, which goes away quickly. It brings energy, clarity, and better performance.
Since the supplement enters your bloodstream directly via the sublingual route, it does not get sequestered in your liver. That means more for the cell and more effective increase in NAD serum levels. In addition, it has a liposomal formulation that allows it to go through the cell membrane easily, thus giving a noticeable boost after passing through the blood-brain barrier.
As it stands now, there are currently no research papers testing it but conceptually, this method should work. You apply NAD topically by placing it on the gauze portion of a patch that has an undetectable low-level charge created by a single use battery. You let it sit on your skin for 4-6 hours, and the NAD transmits through the skin and into your bloodstream. It’ll enter your bloodstream slowly, and there might be the slight possibility of some skin irritation, but that is all. It’s an incredibly gentle way to get NAD into your system, thus avoiding the big rush that happens with methods of more rapid absorption. Some people report feeling great clarity, as if their brains were turned up. This supplement can be taken daily, but the cost can be expensive as you have to get the patch and NAD separately.
Intravenous / Intramuscular (Injection)
The other ways to get NAD directly are intramuscular and intravenous, which are fairly similar. NAD use and research first began intravenously. It was the only way to increase levels quickly and effectively. Thus it goes directly into the bloodstream at whatever dose we choose. Infusing moderate to high doses can create a rush. A high dose is not going to hurt you, but people may feel chest discomfort, mild difficulty breathing, abdominal discomfort, sweating, flush, mild headaches and possibly diarrhea. Giving yourself a too-high flood of energy feels awful. When NAD is administered this quickly the body is unable to adapt, triggering your cells to release chemicals which they normally hold onto. Imagine giving your child 5 espressos at once…and a Snickers bar…that’s what you’re doing to every one of your cells. So your body is going to freak out. Ideally, infusions should be done over 4-8 hours every 1-2 weeks at the most.
This brings us to the intramuscular method. We prefer this method over the intravenous path because it eliminates the time commitment and inconvenience of the infusion. The shot of NAD will diffuse, slowly eliminating most symptoms. The dose can be dialed in individually, in the convenience of your home. After your shot you go about your day as normal. The first few times require trial and error to figure out your tolerance. Once that is established, you can decide on an interval. It can be used daily for about 10 days straight to “fill up your tank,” with a wait period until your next dose. Alternatively, you can take NAD once per week for 10 weeks. The interval and dose will depend on your own comfort and tolerance.
Natural Methods (Non-Pharmacologic)
Although there are few studies that have researched the absolute levels of NAD on the following methods, scientists speculate that there might be several other ways of increasing NAD levels without any supplementation. These methods include: intermittent fasting (of a period of 16-24 hours), ketogenic diet (improving one’s fat oxidation increases NAD+ levels), and exercise (in high-intensity interval training).
In terms of exercise specifically, research indicates that resistance training in middle-aged participants restored levels of NAD to recreationally-trained, college-aged individuals. Those participants also increased their muscle citrate synthase activity, which is an indicator of mitochondrial density. Another study found that aerobic exercise increased the levels of NAD precursor, NAMPT, by about 12-28%. Most importantly, exercise reverses the natural decline in levels of NAMPT and NAD, especially for older individuals. Older adults gained even more from exercise. If you’re looking for a non-supplementation route to increasing your NAD levels, resistance training coupled with aerobic exercise might be an effective option.
Although this might appear to be one of the more convenient methods of increasing one’s NAD levels, oral supplements are far from being the best. NAD+ itself cannot be supplemented orally because it will not survive the harsh environment of our gastrointestinal tract. Furthermore, prior to being absorbed and utilized by the body, our digestive enzymes break down NAD. What can survive our digestive tract are NAD precursors, but unfortunately we then run into another problem: liver metabolism. All of the current oral supplementation options are equivalent in strength but suffer the same issue of significant liver metabolism and sequestration. In other words, what does make it past the liver would only increase your serum levels minimally. For that to happen, large doses of precursors are needed daily (approx 3 grams per day). This eliminates almost entirely any initial appearance of convenience.
These NAD precursors include nicotinamide (NAM), nicotinic acid (NA), nicotinamide riboside (NR), and nicotinamide mononucleotide (NMN), and are available via various companies as oral supplements. The problem is that recommended doses are far below what can affect a measurable increase in NAD activity. Furthermore, when taken at high enough doses, the serum increases are marginal. For this reason primarily we do not strongly endorse this method.
Addressing Concerns About NAD
Some might have concerns about NAD as a supplement and its effects. There are a few studies showing that NAD may increase the growth of some cancers. When genetic mutations start accumulating, they can lead to cancer. It’s not just one mutation that causes this effect but the buildup of several. Our body is constantly detecting those mutations and repairing them. Most studies show an anti-cancer effect of using NAD. As yet there is no definitive understanding of how NAD impacts cancer. What is truly important is that there is no information stating it causes cancer. The general consensus at this time is to refrain from using it in any possible situation involving cancer until researchers learn better about how it impacts carcinogenic cells. What we do know is that it is not carcinogenic.
Another concern is that it may activate immune conditions. As with many other supplements, one should only take NAD with an experienced practitioner, but especially when using NAD for therapy in immune conditions, as it may feed or activate immune cells, making symptoms worse. But again, this is only a possibility and not a certainty.
What’s important to remember is that NAD is crucial for your health, affecting your brain functioning and the musculoskeletal system. And our NAD levels inevitably decrease as we age. But through a few different means of supplementation, you can reverse many of these effects. You can feel better, younger, and ready to conquer the world.
Schedule your complimentary initial consultation or your next appointment to learn more and to get started with NAD.