Every few years, a new “miracle treatment” surfaces. Most of these come and go, but a few of them, such as NAD+ supplementation, appear to have staying power that warrants a closer look.
First, the basics. Nicotinamide adenine dinucleotide (NAD) is a coenzyme found in all living cells. Enzymes and coenzymes are facilitators. They help other chemicals work. NAD+ is either built denovo from amino acids or is recycled via salvage pathways. It exists in two forms, oxidated and reduced. Our focus is upon the oxidated form, NAD+.
Each of our roughly 30 trillion cells have roughly 2000 little power plants, called mitochondria. These little power plants convert food molecules into a standard energy product, ATP. Just as your car runs on gasoline or diesel fuel, your body runs on ATP. It’s a compact, energy-rich molecule, a perfect power source that can be used all over the body to get work done.
The process of making ATP inside the mitochondria involves several steps. Precursor molecules are shuttled along an assembly line designed to move raw energy from one station to the next so that, in the end, neatly packaged, refined ATP is produced. NAD+ is an indispensable component of the shuttle system. Without it, the entire energy assembly line shuts down.
No NAD+ = No ATP =No Energy= Death
As we age, our cells become less efficient in building the energy molecule ATP. When medical scientists look very closely into less energetic “old” cells, or more precisely, cells in old people, they consistently note a REDUCTION in the amount of NAD+. Furthermore, NAD+ blood tests indicate a decrease in serum NAD+ as we age.
This bears repeating. As we age, it is a proven fact that our cells make less energy, and science indicates that one reason for this is reduced NAD+.
Could this explain why even healthy centenarians seem to sleep so much? Could this explain why even incredibly skilled athletes start to slow down as they approach forty? Could this explain why our skin and muscles increasingly lose repair capabilities in middle age? Can we slow the aging process and restore at least a portion of youthful performance by boosting intracellular NAD+? Can pain associated with the wear-and-tear of aging be countered by NAD+?
The short answer? NAD+ is a promising intervention that might be worth trying sooner rather than later.
NAD+ is available in oral, intravenous, intramuscular, and subcutaneous forms. NAD+ is a supplement, not a drug. Intravenous infusions of NAD+ have become very popular in boutique infusion centers, anti-aging clinics, and concierge medicine practices, but are not a typical part of standard medical practices. The data supporting the benefits of NAD+ is still primarily anecdotal, but the supplement does appear to be safe unless kidney and/or liver disease are health issues.
As I survey my patients, I find that many of the “timeless athletes” whom I treat find NAD infusions and injections to be invigorating. They describe a “rush” of pre- and post-workout energy that I feel indicates a boost in ATP production, especially within the muscle cells. The infusions are not inexpensive, so some of them have moved to self-injected or oral forms of NAD+. As we’d expect based upon pharmacokinetics, the oral forms do not seem to create a sensation consistent with a rapid onset of ATP production. In fact, there is debate as to effectiveness of oral NAD+ given how poorly it is absorbed in our intestines. A far better oral choice is likely supplementation with precursors to NAD+, such as NR and NMN. These are readily available and relatively inexpensive, but they are not NAD+.
Based upon my reading and my experience as an anesthesiologist pain specialist and functional medicine physician, I would recommend as follows:
1. NAD+ supplementation is not a substitute for fine-tuned nutrition and resistance training. I’d focus upon anchoring fitness before starting NAD+, and Revive Pain Solutions can help you with this.
2. NAD+ is not a substitute for hormonal and metabolic optimization. Many patients who feel low in energy have significantly suboptimal gonadal and thyroid hormone levels that must be corrected first. We specialize in this correction and optimization.
3. A blood draw to assess serum NAD+ is not mandatory, but it does make sense. The test is not inexpensive, but it gives that critical baseline.
4. Keep in mind that NAD+ supplementation must be ongoing to maintain the benefits it may offer. Once the supplementation stops, ATP levels drop. Are you prepared to commit long-term?
5. For most, the subcutaneous NAD+ injections offer the best bang for the buck. These will be directly absorbed into the blood stream, thereby avoiding the absorption and breakdown issues. Expect to pay from 150 to 400 dollars every month for subcutaneous injections you can self-administer several times a week, translating to 1800$ to 4800$ per year. Doses range from 50 to 500mg three times a week, and cost is very much affected by how much NAD+ you inject. Self-administration requires hypodermic needles, appropriate instruction, and physician oversight.
Are you considering NAD+? Is NAD+ right for you? Schedule a consultation with us. We’ll do an in-depth evaluation and help you make the best decision.