NAD+ in Aging: Role of Nicotinamide Riboside and Nicotinamide Mononucleotide

Posted on January 29th 2020 (about 5 years)

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More than a century of research has demonstrated that nicotinamide adenine dinucleotide (NAD+) is an indispensable mediator of vital metabolic and physiological processes, including energy production, DNA synthesis and repair, and regulation of gene expression – across multiple species.

But aging, metabolic stressors, and the processes that depend on NAD+ work against maintaining adequate cellular levels of this crucial molecule, inevitably pushing us toward decline. The recent discoveries of NAD+ precursors and a greater understanding of how the body synthesizes and recycles NAD+ offer promise that repletion of NAD+ may improve health and forestall the decline that characteristically accompanies the aging process.

NAD+ mediates energy metabolism

The body draws on NAD+ precursors in the diet, such as the amino acid tryptophan and various niacin equivalents, to synthesize the NAD+ it requires. But cellular synthesis falls short of actual need, so the body recycles the various components of NAD+ in a salvage pathway to compensate for the deficit.

This is crucial because NAD+ is fundamental to cellular energy metabolism via its role in the back-and-forth processes of reduction and oxidation – commonly referred to as "redox" reactions. These alternating conversions of NAD's oxidized form (NAD+) to its reduced form (NADH) facilitate glycolysis and fatty acid oxidation to create ATP. It also serves as a cofactor for a litany of enzymes that further aid metabolic processes.

NAD+ facilitates DNA repair

Metabolism and day-to-day living can damage DNA, however, necessitating the activation of in-house repair mechanisms. The PARP enzymes, in particular, detect DNA damage and initiate repair responses by recruiting other DNA-repair enzymes. In this way, PARP enzymes directly influence longevity. In fact, a study in which activity of the PARP-1 enzyme was measured across multiple mammalian species demonstrated that the higher the PARP-1 activity, the longer the lifespan. PARP enzyme activation relies on the presence of NAD+, but it takes a toll on cellular stores of the molecule, decreasing it to 20 to 30 percent of its normal levels.

NAD+ drives sirtuin activation

Other mediators of the aging process are the sirtuins, highly conserved enzymes that play key roles in healthspan and longevity in multiple organisms. They are linked to the regulation of a variety of metabolic processes and have been implicated in the pathophysiology of many conditions related to aging. Sirtuins utilize NAD+ to perform the process of deacetylation to control the activation of genes involved in energy metabolism, autophagy, circadian rhythms, DNA repair, cell survival, and more. Low cellular energy levels – such as would occur during exercising, fasting, or caloric restriction – promote increased production of NAD+, driving sirtuin expression and subsequent activity.

Cellular NAD+ levels are depleted in aging

In light of NAD+'s role in mitigating DNA repair and activating sirtuins, it's not surprising that cellular NAD+ levels are depleted in aging, a consequence of decreased synthesis and increased consumption and degradation. The ensuing NAD+ deficits are associated with many of the hallmarks of aging and may predispose us to age-related diseases and poor immune function. Tissues such as the brain, heart, and skeletal muscle, which have high metabolic demands (and subsequently high NAD+ use), are hit hardest, increasing our susceptibility to Alzheimer's disease, cardiovascular disease, and sarcopenia – a progressive condition characterized by loss of skeletal muscle mass and strength and a leading cause of functional decline and loss of independence in older adults.

Strategies to enhance cellular NAD+ production

NAD+ levels are heavily influenced by lifestyle and particularly things that cause energy stress, like fasting, caloric restriction, and exercise, which all increase the NAD+:NADH ratio. Click To Tweet

Identifying strategies to enhance cellular NAD+ levels is crucial to thwarting the inevitable losses. Healthspan-promoting activities, such as those that induce cellular energy deficits, including fasting, caloric restriction, and exercise, increase NAD+ as the body strives to meet energy needs. But a growing body of research suggests that exogenous sources of NAD+ precursors, so-called NAD+ "boosters," when taken in supplement form, increase cellular levels of NAD+.

NAD+ boosters: Nicotinamide riboside & nicotinamide mononucleotide

Nicotinamide riboside (NR), a niacin equivalent, is present in the diet and is available in dietary supplement form. Nicotinamide mononucleotide (NMN) is also present in the diet and available in dietary supplement form, but it is also an intermediate compound in the NAD+ salvage pathway. Evidence from animal studies suggests that NR and NMN supplementation may be beneficial to health and may delay or prevent the onset of age-related disease. They both raise NAD+ levels and have been shown to counteract the effects of an obesogenic diet, promote mitochondrial health, improve markers of cardiovascular health, and slow both physical and mental aging.

NAD+ decline in aging and potential for intervention. NAD+ facilitates sirtuin activation, DNA repair, and mitochondrial function to enhance healthspan.

NAD+ status in aging and potential for intervention. Cellular levels of NAD+ increase under conditions of energy stress, such as caloric restriction or exercise; via supplementation of NAD+ precursor molecules, NR and NMN, which "boost" synthesis; or via sirtuin-activating compounds (STACs), such as resveratrol or pterostilbene. NAD+ levels decrease during aging due to increased NAMPT activity, as well as age-related cellular demand for PARP-directed DNA repair, immune function, and inflammation.

NAD+ precursor challenges

Several challenges to NR or NMN supplementation have been identified, however. For example, the doses commonly used in animal studies are extremely high, and in some cases the mode of administration – such as intraperitoneal injection – complicates translating the data to humans.

Concerns about the bioavailability of NR and NMN also need to be addressed. A study that used isotope tracers to track the fate of oral and injected NR and NMN revealed that even at very high oral doses, neither molecule was directly transported into tissues other than the liver. Instead, both NR and NMN were converted into nicotinamide (an intermediary compound in NAD+ synthesis) and was then converted into NAD+. The injected NR and NMN shared a different fate, however, bypassing the feedback mechanisms that regulate synthesis.
In addition, both NR and NMN can destabilize over time, especially in an environment of high temperature and humidity, and subsequently convert to nicotinamide. This intermediary compound may have deleterious effects on health because it reduces sirtuin activation.

A final concern is that of a potential for increased cancer risk. Some evidence suggests that NMN supplementation or NAD+ metabolism may drive tumorigenesis, especially in the proinflammatory environment associated with senescent cells.

NAD+ infusion

With all the challenges and concerns associated with NAD+ boosters, intravenous administration of the parent molecule sounds very appealing. Unfortunately, oral NAD+ has very poor bioavailability. And, while intravenous administration could address some of the bioavailability issues, not only has a NAD+ transporter not been identified, but extracellular NAD+ is not readily taken up into tissues, with possible exception of the brain and heart. A fact suggested by some animal research. Future research will likely elucidate other techniques for – and the feasibility of – direct NAD+ delivery.

Conclusion

NAD+, a molecule that participates in a myriad of metabolic and physiological processes, is crucial for our survival. Cellular NAD+ levels decline with age, however, and drive age-related decline and disease. A growing body of evidence suggests that supplementing with NAD+ precursor molecules may be a viable strategy to forestall the effects of aging.

In this episode, Dr. Rhonda Patrick provides a comprehensive overview of NAD+ and its related precursor molecules, nicotinamide riboside and nicotinamide mononucleotide. She takes a hard look at the animal and human data surrounding their use and describes challenges that must be overcome.

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Comments

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luckssj
05/22/2020

Question? Dr. David Sinclair noted that NMN was the key to slow the aging process down, You say NAD, he said cold is good and your paper said sauna (hot) . As a WFPB/CNS I am confused - can you help out? Steven J. Lucks CNS luckssj@msn.com.

Cronion
02/04/2020

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Cronion
02/05/2020

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Roadkilt
02/01/2020

Interesting video, thanks for the work involved in distilling it down. There has been a lot of work on the benefits of oral 500 mg niacinamide on skin cancer reduction, specifically those prone to precancerous actinic keratosis (basically anyone with fair skin). You never mentioned any relationship there, but did say that niacinamide mono and niaciniamide RNA break down into niacinamide when taken orally. What about just taking 500-1000mg niacinamide daily/orally? Its cheap, well tolerated (maybe skin flushing/reddening in some), with benefits for both cardiovascular/aging and skin improvement? Especially if taken with resveratol?

KarlTreffinger
01/29/2020

Any role in all of this for Apocynin?

FlyOrDieTryin
01/29/2020

Super-interesting information, albiet sort of a tease. If NAD+ has such a profound, ubiquitous biological importance it “seems” like there would have been many human studies done by now to try and quantify the benefits/risks from the various potential mechanisms (e.g., exercise, supplements, fasting). When I hit the lottery, I’ll fund a massive study lead by Dr. Patrick. Thank you very much for your work.

olahyani
01/12/2020

What are your thoughts on Nicotine competing with NAD+ in cells and thereby reducing SIRT1? Could this be one of the causes for reduced lifespan in smokers? If so, would that also affect lifespan for people smoking e-cigarettes?

SWSL
11/20/2019

I’m also concerned after listening to Sinclair that sourcing non-degraded NMN is not practical yet. He basically comes out and says people are likely getting degraded products, no matter how expensive.

Looking into things I found that there is another NAD+ precurser as indicated here: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5398323/

I wonder why this has not entered the discussion. Something we are missing?

gpm3655
11/18/2019

After listening to Sinclair, I’m a little concerned about my sourcing for NMN. If it hasn’t been processed, stored and shipped properly it not only could be useless, but dangerous? DS stated that when NMN goes bad it can actually shut off sirtuins? That is scary!

JamesPaul108
11/17/2019

Nuchido claims that their product, Nuchido TIME+, boosts NAD+ four times more than any other product. https://nuchido.com/products/nuchido-time Their evidence is here: https://nuchido.com/pages/science Can their claims be valid? Please delete my comment if it is your policy not to speak for or against any commercial product.

JamesPaul108
11/17/2019

This article “A Reduced Form of Nicotinamide Riboside Defines a New Path for NAD+ Biosynthesis and Acts as an Orally Bioavailable NAD+ Precursor,” https://www.sciencedirect.com/science/article/pii/S2212877819309160 says that “NRH acts as a more potent and faster NAD+ precursor than NR in mammalian cells and tissues.” Would love to hear your thoughts on it.

JamesPaul108
11/16/2019

Can NR or NMN be absorbed into the bloodstream sublingually? If so, then is that a pathway by which either could be converted into NAD+ without the limiting effect of the liver feedback mechanism?

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