NAD+ boosting Supplements - Are They Legit?

I recently did a deep dive on a supplement for a patient, and thought I might share what I found on my blog as well. I think it highlights what is typically found in regards to clinical trials done on dietary supplements - in short, the trials are usually small in number, with few participants and short study times, making it hard to draw any significant conclusions.

This particular supplement is Nicotinamide Riboside (NR), which is given to boost nicotinamide adenine dinucleotide (NAD+) levels. Declining levels of NAD+ are seen with aging and thought to be related to or possibly cause the associated ill effects of aging such as decreased energy, weight gain, loss of muscle mass etc. Supplements containing NR or other NAD+ boosting agents claim to essentially be the fountain of youth. Tempting to believe, of course. And in truth, the studies are showing some promising findings that should result in more study, though after doing this research I am far from ready to buy in. Here’s what I found:

There have been about a dozen studies on using oral Nicotinamide Riboside to boost NAD+ in humans.  Like a lot of studies done on supplements, these were all really small trials, so talking about 10-40 people in the various trials.  A few of them were the more robust randomized controlled placebo blinded type that we like to see, but most were not.  And most of the trials were short, ranging from 1 week on the supplement to 20 weeks.  About 3/4 were done on healthy or overweight populations, and the rest were targeting specific diseases like Parkinsons or heart failure.  Reassuringly, all of the trials showed that taking 250mg - 2000mg per day was safe.  Almost all of them also showed that taking the supplement did increase NAD+ levels.  Unfortunately, the studies weren't able to show any improvement in things like weight, blood pressure, muscle function or insulin sensitivity.  They were able to show improvement in mitochondrial function and reduction in inflammatory markers and other cellular level processes, so that's really promising, but these changes were typically only found in the studies done on a population with a health condition, rather than the general healthy population.  Further, those cellular changes didn't translate to any meaningful clinical outcomes, meaning despite the microscopic tests showing results, there was no improvement in blood pressure, weight, physical function etc.  

SO.  My take away from all that.  The supplements are likely safe, at least in regards to the NAD+ boosting elements.  And they hold a lot of promise - just because the trials to date have not shown that they can improve clinical outcomes does not mean that they don't work, it just means further study is needed.  Like I said, only a few trials and all in a small amount of people for a short amount of time.  But there's also nothing in these studies that warrant the boasting and price tag of these supplements. 

If you want to look at the studies yourself, you can get into the weeds here.

Regardless of whether or not you choose to try a supplement, make sure you continue to focus on healthy lifestyle and habits. And always discuss over the counter medications and supplements with your PCP - as a direct access PCP, I now have the space to do these deeper dives. I love that I get to learn along with my patients, and become more informed when making recommendations in this regard!