The Importance Of NAD+ & Exactly How To Increase It
If you’ve ever walked down a supplement aisle in a health food store or scrolled through supplements on Amazon, you don’t need me to tell you that there are about a billion supplements in the world. It can be incredibly overwhelming, which is why I always suggest working with a functional medicine doctor to establish a supplement routine that is tailored to your needs.
That said, sometimes there’s a supplement that catches my interest and I want to share it with all of you.
One in particular that’s become increasingly popular over the last few years is NR, which is short for nicotinamide riboside (Try saying that ten times fast!). NR is a newly discovered form of B3 and among many other things, NR converts to something called NAD+ in the body.
Keep reading for everything you need to know about NAD+, what it does, and how to increase NAD+ levels in the body with or without a supplement.
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What is NAD+?
NAD+ stands for nicotinamide adenine dinucleotide and is a coenzyme, which means that it’s a compound that helps enzymes function properly. In the case of NAD+, it helps specifically with our mitochondria, the energy centers of our cells that are responsible for converting the nutrients we eat into fuel that our body can use to help us move, think, eat, and do the things we want to do! Beyond the mitochondria, NAD+ does a lot of things, but one important activity is helping sirtuins, a type of protein that helps regular cellular health, aging, and metabolism.
Like collagen and other important things in the body, NAD+ levels decrease as we age (1), which means sirtuin production is less supported. Researchers have long suspected that declining NAD+ levels are at least partly to blame for age-related diseases and decline, including a lag in energy levels. For example, in one 2018 study, researchers showed that when mice drank water with added NR, they had less DNA damage and an increased production of new neurons (2), which is great for cognition.
In other words, it’s pretty important to support NAD+ production as much as you can to keep your body functioning at optimal capacity, no matter what your age.
How do you increase NAD+?
Beyond NR supplements, there are a bunch of ways to increase NAD+ naturally, starting with foods that are rich in B vitamins.
1. Eat foods with NAD+ precursors
Our bodies mainly produce NAD+ by taking specific ingredients in food that are NAD+ precursors and transforming them into NAD+. Foods that are high in NAD+ precursors include:
- Milk (I recommend full-fat, organic, grass-fed milk)
- Chicken (I recommend always opting for organic, free-range chicken)
- Crimini mushrooms
- Green vegetables
2. Exercise regularly
Exercise positively benefits the mitochondria and NAD+ levels. For example, one study showed that older adults who take up exercise can restore NAD+ levels (3) in skeletal muscle.
3. Eat an anti-inflammatory diet
Declining NAD+ levels are further exacerbated by chronic inflammation, so adopting an anti-inflammatory diet — which is low in refined sugar and grains and high in healthy fats, leafy greens, and colorful fruits — is a great place to start. (For more about fending off chronic inflammation, check out my book The Inflammation Spectrum.)
4. Try intermittent fasting
Studies have shown that fasting leads to an increase in sirtuin levels (4), which explains many of its anti-aging and energy-boosting benefits.
5. Eat fermented foods
One of the byproducts of fermentation is NAD+, so fermented foods like kimchi, kombucha, sauerkraut, and kefir contain low levels of NAD+ and have a ton of other gut health benefits.
6. Limit alcohol
Studies have shown that NAD+ declines significantly during binge drinking (5). In the long term, this can cause liver injury because the enzymes that require NAD+ as a cofactor work to prevent organ injury and protect the liver.
Should you take an NR supplement?
If you’re incorporating plenty of NAD+ boosting practices into your routine but still want to try a supplement, I highly encourage trying one out! A supplement is probably the best way to know for sure if increasing your NAD+ levels will benefit you. NR supplements don’t come cheap, so if you’re young and healthy, you might want to just focus on NAD+ boosting activities. But if you’re struggling with low energy levels or are over 50 and noticing that you’re starting to feel a little more sluggish, you’re a particularly great candidate to give NR a try.
I always recommend adding one supplement at a time and mindfully paying attention to your energy levels, mood, sleep, and any other symptoms that may change. And remember to buy from a supplement company that lab tests their products for potency and purity, which means they check that there are no contaminants like microbes or heavy metals.
If you want to learn more about your own health case please check out our free health evaluation. We offer in person as well as phone and webcam consultations for people across the country and around the world.
- Schultz MB, Sinclair DA. Why NAD(+) Declines during Aging: It's Destroyed. Cell Metab. 2016;23(6):965-966. doi:10.1016/j.cmet.2016.05.022
- Compound prevents neurological damage, shows cognitive benefits in mouse model of Alzheimer’s disease. National Institutes of Health (NIH). Published February 6, 2018. Accessed September 22, 2020. https://www.nih.gov/news-events/news-releases/compound-repairs-neurological-damage-shows-cognitive-benefits-mouse-model-alzheimers-disease
- de Guia RM, Agerholm M, Nielsen TS, Consitt LA, Søgaard D, Helge JW, Larsen S, Brandauer J, Houmard JA, Treebak JT. Aerobic and resistance exercise training reverses age-dependent decline in NAD+ salvage capacity in human skeletal muscle. Physiol Rep. 2019 Jul;7(12):e14139. doi: 10.14814/phy2.14139. PMID: 31207144; PMCID: PMC6577427.
- Zhu Y, Yan Y, Gius DR, Vassilopoulos A. Metabolic regulation of Sirtuins upon fasting and the implication for cancer. Curr Opin Oncol. 2013;25(6):630-636. doi:10.1097/01.cco.0000432527.49984.a3
- French SW. Chronic alcohol binging injures the liver and other organs by reducing NAD+ levels required for sirtuin’s deacetylase activity. Experimental and Molecular Pathology. 2016;100(2):303-306. doi:10.1016/j.yexmp.2016.02.004
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BY DR. WILL COLE
Dr. Will Cole, IFMCP, DNM, DC, leading functional medicine expert, consults people around the world via webcam and locally in Pittsburgh. He received his doctorate from Southern California University of Health Sciences and post doctorate education and training in functional medicine and clinical nutrition. He specializes in clinically researching underlying factors of chronic disease and customizing a functional medicine approach for thyroid issues, autoimmune conditions, hormonal imbalances, digestive disorders, and brain problems. Dr. Cole was named one of the top 50 functional medicine and integrative doctors in the nation and is the best selling author of Ketotarian and The Inflammation Spectrum.
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