Should NAD+ be a staple in your supplement lineup?

This post was written by Zhixi Liu, PharmD, Parkview Health.

NAD+ supplements have been gaining attention due to their potential to support healthy aging along with possible benefits for metabolism, cognitive function and skin health. In this post, we'll take a closer look at how this molecule functions in the body and what current research says about adding it to your wellness regimen.

What is NAD, and what does it do?

Nicotinamide adenine dinucleotide (NAD) is a natural substance found in the body's cells and is a necessary compound responsible for cellular processes. If mitochondria are the "powerhouse" of the cell, then NAD is the "shuttle bus" that picks up the electrons and drops them off. Other functions include cell communication, metabolism and DNA repair.

It's also available as a supplement and comes in two primary forms: NAD+ (the oxidized form, meaning it has a positive formal charge on one of its nitrogen atoms) and NADH (the reduced form of NAD because it holds extra electrons). As people age, NAD+ levels may drop. This decrease could contribute to certain age-related diseases and to how the body turns food into energy. Because of this, many researchers are studying ways to boost NAD+ levels.
 

How to increase NAD+ levels

Although NAD+ forms naturally in the body, lifestyle factors such as regular exercise and sufficient sleep also help maintain its levels. Foods like turkey, cabbage, cucumber and soybeans also contain NAD+.

Studies have shown that NAD+ supplementation is generally safe and effective at doses ranging from 250 mg to 1,000 mg per day, taken orally once or twice daily in capsule or tablet form. However, individual needs and responses can vary.

Some clinics offer NAD+ IV therapy, which they claim works faster and provides more benefits. Current evidence supporting intravenous administration is limited, and the long-term safety remains unclear. The treatment is not FDA-approved for any medical condition, so it's important to talk to a doctor before trying it.
 

The benefits of NAD+ supplementation

While research is still underway, some findings suggest NAD+ may offer benefits in several key areas of wellness, including:

• Metabolic health: Research indicates that NAD+ supplementation can help the body handle sugar and fat more effectively, lower weight gain from high-calorie diets, and support the body's use of insulin. This mechanism can be especially helpful for individuals with metabolic syndrome or diabetes.

• Heart health: NAD+ may keep blood vessels healthier, protect the heart from damage caused by poor blood flow, and help the heart pump more strongly. Some clinical studies also report lower blood pressure and better cholesterol profiles in older adults who are overweight or obese.

• Brain function: Supplementing with NAD+ may help defend the brain from cognitive decline, including difficulties with reasoning, memory, attention, problem-solving, and decision-making. This makes it a promising area of study for conditions such as Alzheimer's disease and Parkinson's disease, where NAD+ levels are often depleted.

• Physical performance: Studies have shown that NAD+ can improve physical activity, muscle strength and overall activity. For instance, supplementation with nicotinamide mononucleotide (NMN), a form of vitamin B3 that the body converts into NAD+, has been linked to improved walking speed and enhanced physical performance in older adults.

• Anti-aging: Because NAD+ levels naturally decline with age, supplementing may help reduce some age-related health issues. In animal studies, extra NAD+ helped extend healthy years and reduce age-related decline.

• Sleep quality: NAD's role in regulating sleep-wake cycles has been linked to improved sleep quality in older adults, supported by better scores on sleep quality surveys.
   

Safe usage

NAD+ supplementation is usually well-tolerated, with only mild side effects reported. These may include:

• Muscle pain

• Nervous system disturbances (e.g., anxiety, sleep disruptions)

• Fatigue

• Headaches

When selecting supplements, look for those tested by reputable third-party organizations such as NSF International or the U.S. Pharmacopeia (USP) to ensure optimal safety and quality. These companies verify a product's purity and quality and adhere to strict safety standards.

Though NAD+ supplementation is considered safe and has a low incidence of side effects, more studies are needed to explore the benefits and risks. Always consult with a healthcare provider before starting any new supplement regimen.

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Additional Resources

1. Nicotinamide adenine dinucleotide (NAD+): essential redox metabolite, co-substrate and an anti-cancer and anti-ageing therapeutic target (https://doi.org/10.1042/BST20190033)

2. NAD+ metabolism and its roles in cellular processes during ageing (https://www.nature.com/articles/s41580-020-00313-x)

3. Nicotinamide Adenine Dinucleotide in Aging Biology: Potential Applications and Many Unknowns (https://doi.org/10.1210/endrev/bnad019)

4. Preclinical and clinical evidence of NAD+ precursors in health, disease, and ageing. (https://doi.org/10.1016/j.mad.2021.111567)

5. efficacy and safety of β-nicotinamide mononucleotide (NMN) supplementation in healthy middle-aged adults: a randomized, multicenter, double-blind, placebo-controlled, parallel-group, dose-dependent clinical trial (https://doi.org/10.1007/s11357-022-00705-1)

6. Ingestion of β-nicotinamide mononucleotide increased blood NAD levels, maintained walking speed, and improved sleep quality in older adults in a double-blind randomized, placebo-controlled study (https://doi.org/10.1007/s11357-024-01204-1)

7. Nicotinamide Adenine Dinucleotide Augmentation in Overweight or Obese Middle-Aged and Older Adults: A Physiologic Study (https://doi.org/10.1210/clinem/dgad027)

8. Evaluation of safety and effectiveness of NAD in different clinical conditions: a systematic review (https://doi.org/10.1152/ajpendo.00242.2023)