If you’re actively seeking natural therapies to slow aging, you’ve probably heard of NAD. NAD-boosting supplements have attracted a bunch of attention for their promise in reducing cellular aging, protecting against age-related chronic disease, and perhaps extending lifespan.
There’s a lot to unpack about NAD, including how it may benefit sleep by the powerful influence it has over circadian rhythms. Because NAD plays such a critical role in so many fundamental physiological processes, there are also questions about the full impact of increasing NAD levels on health and disease risk. Let’s take a closer look.
What is NAD?
NAD—short for nicotinamide adenine dinucleotide–is a molecule that performs an array of important helper functions in the body. NAD is a coenzyme, which helps enzymes function effectively. NAD plays a critical role in several cellular functions, including:
- Repairing DNA
- Helping cells produce energy from food
- Protecting cells from stress
- Facilitating gene communication
NAD plays an important role in maintaining healthy metabolic function, and protects the brain from damaging oxidative stress. Critically for sleep, NAD contributes to the regulation of circadian rhythms and sleep-wake cycles.
Our bodies produce NAD on their own. As we age, NAD levels decline. Lower levels of NAD are associated with cellular aging, as well as metabolic dysfunction and greater risks of chronic, age-related diseases including diabetes, cardiovascular disease, and neurodegenerative diseases such as Alzheimer’s and Parkinson’s.
The recognition of the role this molecule plays in circadian rhythms, cellular health, metabolic and neuro-protection—all of which can contribute to greater longevity—have many people interested in increasing NAD levels. Supplements that increase NAD contain what are known as NAD precursors, which are substances that convert to NAD once in the body. NAD supplements often contain one of two compounds: NR (Nicotinamide Riboside) or NMN (Nicotinamide Mononucleotide), both of which are derived from niacin, otherwise known as Vitamin B.
These Vitamin-B compounds that stimulate production of NAD are also found in some foods, including cow’s milk, mushrooms, yeast, and beer.
There’s evidence that the practice of intermittent fasting can increase NAD levels. I’ve written about how intermittent fasting can affect and improve sleep.
Potential benefits of increasing NAD levels
For sleep and circadian rhythms. There’s a complex, two-way relationship between NAD and circadian rhythms, one that influences sleep-wake patterns and other important physiological processes, including metabolism.
Like so many of our body functions, NAD activity is regulated by circadian rhythms. But in ways scientists are increasingly discovering, NAD also helps to regulate and control circadian function in the body, helping to keep daily bio rhythms on track and in sync. Among the roles that NAD plays in maintaining healthy circadian function? It helps the body’s circadian system communicate with cells, specifically about mitochondrial—or energy producing activity.
Mitochondria are the engine of our cells, the parts of cells that drive energy production, and enable cells to burn stored energy as fuel. Mitochondrial activity is governed by circadian rhythms, and when this activity isn’t working optimally, it will have broad effects across the body, including for sleep-wake cycles and metabolic health. NAD appears to provide an important communication link between our circadian systems and the mitochondria within our cells. NAD also helps maintain the proper activity of the genes that communicate circadian messages, and works to repair DNA that directs circadian function.
When NAD levels are off—too high or too low—circadian rhythms are likely to thrown off as well. Age-related decline in NAD may be one reason that circadian rhythms are less robust and in sync with age, and sleep can become more restless and less restorative. And NAD’s impact on other health systems—including metabolism, cardiovascular and brain health—can have powerful indirect effects on sleep cycles.
A quick recap on the ways NAD can benefit sleep:
- NAD levels are regulated by daily bio rhythms
- NAD also plays an important role in keeping circadian rhythms in sync—and with them, daily cycles of sleep
- NAD helps to repair and protect the genes that drive circadian rhythms
- NAD helps the circadian clock communicate with cells throughout the body
For neuroprotection. NAD is prominently involved in maintaining the health of brain cells. NAD stimulates production of a protein—PGC-1-alpha—that protects against damage to the cells of the brain. Studies in animals have shown that supplements that increase NAD elevate the production of that neuroprotective protein, and limit the production of the damaging beta-amyloid proteins associated with Alzheimer’s disease, as well as the neurological damage associated with Parkinson’s disease. Research in animals has shown increasing NAD can improve memory. We haven’t yet seen studies in humans to demonstrate what cognitive benefits can be achieved by increasing NAD with supplements, but this animal research looks promising.
For metabolic health. NAD and supplements designed to elevate this compound have attracted a great deal of attention as a nutritional therapy to treat metabolic conditions, including obesity, prediabetes and diabetes. NAD is deeply involved in energy metabolism at a cellular level, and there are links between declines in NAD and metabolic dysfunction. The role that NAD plays in maintaining healthy circadian rhythms is important to metabolic health, as well as to sleep. Metabolism is maintained by circadian rhythms—they regulate our appetite, when and how well we burn energy (aka calories), how much energy we have for exercise, how well our bodies transfer glucose from blood to cells. Studies in animals show that increasing NAD levels can improve insulin sensitivity, increase glucose tolerance, and may help make it easier to lose weight. A low metabolism encourages weight gain, which elevates our risk for obstructive sleep apnea. Keeping at a healthy weight, with healthy metabolic function, are two ways to protect sleep, especially as we age. Several clinical trials in humans are underway, which I hope will give us more information about how NAD supplementation may benefit a healthy metabolism.
For cardiovascular health. Diminishing NAD levels are a cause of vascular aging. A number of studies in animals show that supplements that increase NAD benefit the health and function of the cardiovascular system, including reducing stiffness and restoring better, more youthful functioning to arteries, reducing inflammation, and encouraging the growth of new blood vessels. Research in middle aged and older adults has shown that NAD supplements can lower blood pressure and reduce aortic stiffness, both of which elevate risk for heart attack and other age-related cardiovascular conditions. Poor sleep itself is strongly linked to vascular aging, which I wrote about in my first book, Beauty Sleep.
For physical strength and exercise capacity. There’s evidence, through research in animals, that NAD can increase stamina and physical endurance, provide more strength to muscles and also help them function better. Physical strength and the ability to exercise are critical to aging well (and more slowly) and to sleeping well as we do so.
For longevity. NAD has received a lot of attention as a nutritional tool for extending lifespan, and slowing or reversing the effects of aging. Why? For the reasons we’ve discussed here, including its role as a cell protector and buffer against cell damage, its ability to improve cell function, it’s contribution to repairing DNA, supporting healthy gene activity, and regulating circadian rhythms. In addition, research in animals has shown NAD supplements can lengthen lifespan. Studies in humans will deliver important information about how NAD supplementation may work to slow the aging process, and offer protection against age-related diseases.
The cancer connection
Some scientists who study cancer have raised questions about how increasing NAD in the body might affect the growth of cancer cells. It’s easy and understandable to hear the word “cancer” and just panic, and shut down. The reality is that this is a deeply complex question, and not enough evidence exists yet for us to understand clearly the relationship between NAD and cancer, or the possible impact of increasing NAD levels on the growth of cancer cells. There is evidence that NAD is important to the growth of some types of cancer cells, and that reducing levels of NAD might help halt the growth of some types of cancer. Recent research has also pointed to a possible association between an enzyme that is involved in the body’s production of NAD, and increase in cancer cell growth. Curtailing the supply of that enzyme—known as NAMPT—has been shown in animal studies to be effective in decreasing cell and tumor growth for certain cancers, and in treating cancer in combination with radiation therapy.
Other research has indicated that in some cancers, increasing NAD may be helpful in preventing and treating cancer, and limiting levels of NAD may contribute to tumor development, as a result of damage to DNA. (Remember, one of NAD’s most powerful functions is as a protector and repairer of DNA.)
There’s obviously a great deal more to learn about how NAD interacts and influences cancer. Alongside knowing the benefits of NAD that science has shown so far, of which there are many, it’s important for anyone considering using NAD as a supplement to understand the questions that scientists are asking about this important and influential molecule. I’ll continue to watch the science as it emerges.
NAD Supplements: what to know
Always consult your doctor before you begin taking a supplement or make any changes to your existing medication and supplement routine. This is not medical advice, but it is information you can use as a conversation-starter with your physician at your next appointment. The following information applies to NAD supplements containing Nicotinamide Riboside, a commonly used NAD precursor.
Dose depends on individual factors including age, weight, overall health and specific conditions. Research in humans with daily doses of 1000 mg have shown no harmful effects in short-term use. That said, you can find NAD treatments in multiple formats, from ingestibles to IV. Here I am trying it myself in IV format.
I’m convinced of the science and the usefulness of NAD for me, so I also take a daily NAD+ Supplement with Trace Minerals From Morter HealthSystem.
Possible side effects of NAD
NAD is generally well tolerated by healthy adults. Side effects include:
- Stomach problems, including bloating and nausea
- Skin problems, including itching, flushed skin, increased sweating
- Leg cramps
- Changes to stool, and diarrhea
Women who are pregnant or breast feeding. There isn’t currently sufficient evidence to determine if NAD supplements are safe to use while pregnant or breast feeding.
These are commonly used medications and supplements that have scientifically-identified interactions with NAD supplements containing NR (Nicotinamide Riboside). People who take these or any other medications and supplements should consult with a physician before beginning to use NAD as a supplement.
Interactions with medications
Medications to treat high blood pressure. NAD supplements containing NR (Nicotinamide Riboside) may lower blood pressure. Using a NAD supplement simultaneously with blood pressure-lowering medications may lead to blood pressure becoming too low.
Interactions with other supplements
Supplements that lower blood pressure. NAD supplements containing NR (Nicotinamide Riboside) may lower blood pressure. Using a NAD supplement simultaneously with other supplements that lower blood pressure may lead to blood pressure becoming too low. Those supplements include:
- Casein peptides
- Cat’s claw
- Coenzyme Q10
- Stinging nettle
NAD is literally cutting-edge technology and VERY new. While it does not appear to have any serious side effects or long-term effects, human long-term trials are not available. When you talk to your physician about taking NAD supplements, be sure to share all information about the supplements and medications you’re already taking.
Michael J. Breus, PhD, DABSM
The Sleep Doctor™
P.S. Morter HealthSystem is my source for high quality NAD+ that I take daily.
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