Ask the Expert: NAD+ Supplementation
By Toby Amidor, MS, RD, CDN, FAND
Today’s Dietitian
Vol. 25 No. 7 P. 8
Q: My clients have been asking me about nicotinamide adenine dinucleotide (NAD+) in supplement form. What is it, and is there any scientific evidence behind its antiaging marketing claims?
A: Celebrities Kendall Jenner and Hailey Bieber are touting the antiaging benefits of NAD+, which have increased consumer demand for this supplement. NAD+ is a component involved in cellular nutrition said to increase cellular energy and support healthy aging. The human body makes NAD+, but the amount produced by the body declines significantly with age, which is why supplementation to combat cellular aging has become so popular. This article discusses cellular nutrition and its importance, the research behind NAD+ supplements on the market, and counseling strategies for RDs.
What Is Cellular Nutrition?
Cells use nutrients to power bodily functions, but nutrients can be used only if cells are working properly. Cellular nutrition provides cells with the macronutrients (ie, carbohydrates, protein, and fats) and micronutrients (eg, vitamins A and D, folate, zinc) necessary to function efficiently and optimally, which are found in a nutrient-dense and antioxidant-rich diet. Vitamins and minerals play a critical role as cofactors in many cellular processes, while antioxidants help counter cellular oxidative stress.1 Protein, fats, and carbohydrates are used for specific cell functions.
According to Taylor Wallace, PhD, CFS, FACN, principal and CEO of the Think Healthy Group, LLC, and an adjunct associate professor at the Friedman School of Nutrition Science and Policy at Tufts University (www.drtaylorwallace.com) in Washington, D.C., “NAD+ levels decline as we get older, and some researchers think it may be linked to related diseases and dysfunctions that occur as a result of aging.”
In addition, Mona Rosene, MS, RD, global director of scientific affairs at ChromaDex (https://www.chromadex.com) in Longmont, Colorado, explains that NAD+ is depleted over time due to aging and exposure to different metabolic stressors, including a poor diet high in added sugars and fat, a sedentary lifestyle, and excess sun exposure. “Our research has shown that we lose up to 65% of NAD+ between the ages of 30 and 70,” she says.
The Research
According to Wallace, several animal models have suggested that supplementation with NAD+ may increase health, improve immunity, enhance athletic performance, and prolong avoidance of age-related diseases. However, “there’s an absence of clinical evidence in humans, and we know animal models don’t translate to what happens in humans more times than not.”
There are several published studies that demonstrate how mitochondrial dysfunction, a hallmark of aging, is closely linked to declining NAD+ levels.2,3 According to Rosene, “Mitochondrial function and health decline over time. NAD+ is known to play a critical role in helping maintain and support mitochondrial health. While we can’t stop the aging process, we do have hacks to slow it down, one of which is supporting cellular and mitochondrial health through supplementing with NAD+ precursors.” This may, therefore, help maintain optimal cellular function and resilience.4
The precursors of NAD+ include nicotinamide mononucleotide (NMN) and nicotinamide riboside (NR), which animal studies have suggested may increase NAD+ production and slow the aging process. Both of these precursors are sold as supplements marketed to possess antiaging effects.
Burgeoning Market
Consumer demand for antiaging supplements is growing.5 According to Global Market Insights, the size of the NAD+ supplement market was more than $488 million in 2021 and was expected to grow 13% between 2022 and 2030.5,6 As a result, consumers can find a variety of brands that offer NAD+ supplements as NR or NMN. Below is a sample of supplement brands on the market.
• Life Extension NAD+ Cell Regenerator (www.lifeextension.com) is an NR-based NAD+ supplement that claims to promote cellular energy production and support cellular metabolism. Recommended dosage is one 300 mg capsule per day.
• TruNiagen (www.truniagen.com) claims it uses NR for cellular energy metabolism, repair, vitality, and healthy aging. Capsules are sold in 100 mg doses with recommendations to take one to three pills per day.
• Renue Lipo NR (https://renuebyscience.com) claims to increase lifespan. Recommended dose is one 300 mg capsule per day.
• NOVOST Boost (https://novoslabs.com) is an NMN-based supplement that claims to be a powerful longevity ingredient that boosts energy, metabolism, and DNA repair. Recommended dose is two 125 mg capsules per day.
• ProHealth Longevity NMN Pro 300 (www.prohealth.com) claims to help combat aging, improve heart health, and promote muscle strength. Recommended dose is two 300 mg capsules per day.
Recommendations for RDs
One of the basic factors of cellular nutrition is consumption of vitamins, minerals, antioxidants, and macronutrients. This means that balanced nutrition should be the primary focus for clients with concerns about aging. In addition, Rosene says the diet shouldn’t be high in fat and added sugars, which are two metabolic stressors that decrease NAD+.
After addressing diet, if clients still want to supplement with NAD+, dietetics professionals should ensure they take the recommended doses on the bottles. According to a 2020 review study, NAD+ supplements are safe for human consumption short term—up to 12 to 24 weeks.7-9 However, more long-term studies are needed to determine their safety in children, pregnant and lactating women, individuals on medications, and those with lower immunity. Currently, NAD+ supplementation is contraindicated in these populations. In addition, NMN and NR supplements have been associated with similar side effects, such as digestive discomfort, but currently, there’s no evidence of medication interactions. Nevertheless, research has suggested that NAD+ supplements may increase the prevalence of cancer and metastases and therefore aren’t recommended for patients with active cancer or cancer survivors.10
— Toby Amidor, MS, RD, CDN, FAND, is founder of Toby Amidor Nutrition (tobyamidornutrition.com) and a Wall Street Journal bestselling author. She’s written 10 cookbooks, including the upcoming Up Your Veggies: Flexitarian Recipes for the Entire Family (October 2023) and The Family Immunity Cookbook: 101 Easy Recipes to Boost Health. She’s also a nutrition expert for FoodNetwork.com and a contributor to U.S. News Eat + Run and other national outlets.
References
1. Fielding R, Mayer J, Boston C, Pepper, Lebrasseur N, Molina A. Defining aging cellular nutrition and its influence on age-associated cellular decline. The Gerontological Society of America website. https://www.geron.org/images/gsa/documents/whatshotcellularnutrition.pdf. Published November 2021.
2. Zhou B, Wang DD, Qiu Y, et al. Boosting NAD level suppresses inflammatory activation of PBMCs in heart failure. J Clin Invest. 2020;130(11):6054-6063.
3. Brakedal B, Dölle C, Riemer F, et al. The NADPARK study: a randomized phase I trial of nicotinamide riboside supplementation in Parkinson's disease. Cell Metab. 2022;34(3):396-407.e6.
4. Verdin E. NAD+ in aging, metabolism, and neurodegeneration. Science. 2015;350:1208-1213.
5. López-Otín C, Blasco MA, Partridge L, Serrano M, Kroemer G. The hallmarks of aging. Cell. 2013;153(6):1194-1217.
6. Ahuja K, Malkani T. Nicotinamide adenine dinucleotide market size & statistics, 2030. Global Market Insights website. www.gminsights.com/industry-analysis/nicotinamide-adenine-dinucleotide-market. Published September 2022.
7. Radenkovic D, Reason, Verdin E. Clinical evidence for targeting NAD therapeutically. Pharmaceuticals (Basel). 2020;13(9):247.
8. Kim M, Seol J, Sato T, Fukamizu Y, Sakurai T, Okura T. Effect of 12-week intake of nicotinamide mononucleotide on sleep quality, fatigue, and physical performance in older Japanese adults: a randomized, double-blind placebo-controlled study. Nutrients. 2022;14(4):755.
9. Radenkovic D, Reason, Verdin E. Clinical evidence for targeting NAD therapeutically. Pharmaceuticals (Basel). 2020;13(9):247.
10. Maric T, Bazhin A, Khodakivskyi P, et al. A bioluminescent-based probe for in vivo non-invasive monitoring of nicotinamide riboside uptake reveals a link between metastasis and NAD+ metabolism. Biosens Bioelectron. 2023;220:114826.