People are talking about NAD+ like it’s the holy grail of longevity.
Or at least a no-brainer lever we can pull to increase energy and vitality.
Lately I’m getting lots of DMs and texts from friends as well as questions from patients on longevity treatments like NAD+. Which are legit and which should you skip—especially in light of so many high-priced longevity clinics popping up and celebrities touting the treatments they are getting. (See my posts on peptides and calm tech for my take on other types of therapies).
Personally, I’m all for anything that falls into the can’t hurt, might help—and has some evidence to support it—bucket.
NAD+ falls into that category. Nicotinamide Adenine Dinucleotide (NAD+) is a coenzyme that plays a key role in cellular energy production, DNA repair, and the immune systems’ ability to regulate inflammation. It’s an anti-aging powerhouse.
Here’s the good news: The body naturally synthesizes NAD+ from nutrients in your diet. Foods high in tryptophan—the amino acid found in protein-rich foods including meat, eggs, dairy, nuts, and seeds—and forms of vitamin B3 (namely niacinamide, nicotinic acid, and nicotinamide riboside) found in whole grains like quinoa and brown rice, legumes, nuts, seeds, and green leafy veggies, all help your body produce more NAD+.
Here’s the bad news: levels of this super important molecule decline with age. Recent research suggests the drop might explain why we have an increase in DNA damage and cells become less able to recycle and repair themselves as we get older. The drop in NAD+ contributes to neurodegenerative diseases like Alzheimer’s, metabolic diseases like type 2 diabetes, and cardiovascular diseases like coronary artery disease.
Enter supplementation. There are now dozens of treatments and supplements on the market which promise to boost NAD+ levels for increased clarity, energy, and longevity.
The key to evaluating them is the “can’t hurt” part of my can’t hurt, might help philosophy. With any new supplement or longevity treatment, it’s important to make sure that:
- The risk is worth the potential reward.
- You have clear expectations. The only “miracle drugs” I know of so far are exercise and nutrition.
So, should you try an NAD+ treatment? Here’s my take.
The research says
The excitement around NAD+ as a way to increase energy and vitality is warranted. But whether or not we can meaningfully boost levels of this coenzyme through supplementation or lifestyle choices is a different question.
There is emerging evidence that taking exogenous NAD+ or its precursors might have an impact. But it’s important to say that evidence is not conclusive yet. Here’s what you might do and the benefits you might receive:
NAD+ Infusions
NAD+ infusions and injections are trending in wellness circles and among celebrities. Several clinics now offer intramuscular NAD+ shots or infusions similar to vitamin drips.
These types of therapies fall squarely into that can’t hurt, might help bucket. In theory, the directly injected NAD+ bypasses the digestive system and is immediately available for cellular uptake.
Once in the cells, the extra NAD+ will theoretically boost energy production in the mitochondria, activate enzymes including sirtuins and PARPs which support cellular repair, and enhance neurotransmitter activity while reducing oxidative stress to support brain function.
It’s not yet well understood how much NAD+ can get absorbed and what cells are most likely to absorb it. Some small studies done in mice suggest that NAD+ injections could potentially increase NAD+ in the brain and heart but a lot more research is needed in humans.
My POV: Trying an infusion won’t hurt. If you notice more energy and less brain fog, it might be working for you. Just don’t expect a miracle if you aren’t already making lifestyle choices that support more energy and longevity.
NAD+ Precursor Supplements
The other way to boost your NAD+ levels is by getting your body to make more of it. You can do this by supplementing with an NAD+ precursor like niacinamide, nicotinic acid, or nicotinamide riboside.
The research here is also still emerging—but there is more promising evidence.
Animal studies and a few clinical trials in humans suggest NAD+ precursor supplements may have a significant impact in treating several serious conditions. A few of the most promising human studies:
- A small 2021 study of 25 obese or overweight women with prediabetes took 250 mg of nicotinamide mononucleotide (niacinamide) for 10 weeks. Researchers measured improved insulin sensitivity but didn’t actually detect a rise in NAD+ levels.
- In a 2022 review, researchers analyzed various studies in which participants from various demographics took 1000 mg of nicotinamide riboside for anywhere from 9 days to 6 weeks. Across them all, they reported increases in NAD+.
- Even more promising, a 2022 study found NR supplements increased cerebral NAD+ levels in patients with Parkinson’s Disease and an associated improvement in symptoms.
My recommendation: NAD+ precursor supplements show promise in boosting your levels particularly in the brain and muscles. But given the lack of data on safety and most effective dose and duration, talk to your doctor first. (I don’t recommend these supplements for pregnant or breastfeeding women, for example—not because there’s evidence of danger, there’s just not enough studies to say it’s definitely okay.)
What I’m doing for my own body
I’m focused on revving up my body’s natural NAD+ production via a two-part approach: eating foods high in precursors and creating periodic conditions of energy stress which prompts the body to produce more NAD+.
Eating NAD+ precursors
Given my protein goals, I’m already getting a lot of foods high in tryptophan. To further boost my levels, I’m focusing on adding more foods with vitamin B3 derivative nicotinamide mononucleotide like broccoli, avocado, cabbage, and edamame.
Creating energy stress
When cells are stressed—which is what happens when you exercise or fast—the mitochondria produce more NAD+ to give you the energy you need to power through. I’m currently doing 16-hour intermittent fasting, which has been shown to increase metabolism and lower inflammation. I eat dinner around 6 and then don’t eat again until 10 the next morning, which I’ve found really works for my body. You might have to experiment to figure out fasting windows that are right for you.
I might also consider adding cold therapy to my sauna routine since there is some evidence that cold exposure might increase NAD+.
What I recommend for you
Signs of low NAD+ levels include:
- Fatigue & low energy
- Brain fog & cognitive decline
- Muscle weakness
- Poor recovery from exercise
- Accelerated aging
There are several conditions that can cause these symptoms so I recommend starting with baseline testing at Parsley for a personalized gameplan.
Besides NAD+, three actionable biomarkers we test for that we know are associated with longevity and anti-aging are:
- Inflammatory markers (CrP)
- Insulin sensitivity (A1C)
- Omega-3 index
Become a member at Parsley Health to get a personalized plan for supplementation and lab testing. Use my code RBMDCREW for $150 off your membership.
As always, this newsletter is for informational and educational purposes only and is not intended as medical advice. Always consult your healthcare provider before making any health decisions or changes to your treatment plan.