Maintaining consistent vitality, supporting smooth recovery after physical exertion, and sustaining endurance throughout a demanding day — these are goals we often associate with youth. But what if the roots of these changes lie not in chronological years, but in biochemical processes constantly occurring in every cell of the body?

Today, science is increasingly delving into cellular biochemistry and seeking answers to the question of what determines our vitality. One of the hottest topics is a molecule called NAD+, with discoveries that are changing our understanding of energy, resilience, and the natural progression of time.

In this article, we'll explain scientifically yet simply what NAD+ is and why the level of this molecule in the body is so important for our well-being.

Journey into the cell: what is NAD+?

Imagine your body as a huge city, and cells as individual buildings. For the city to function, each building needs electricity. In our cells, this energy (called ATP) is produced by tiny power plants—mitochondria. For mitochondria to work, they need fuel.

This is where NAD+ (nicotinamide adenine dinucleotide) comes in. It's one of the most important coenzymes, acting as a primary energy carrier. It takes energy from the food we eat and delivers it to the mitochondria. Here it's converted into fuel suitable for cells. Without NAD+, this essential process for every cell's vitality could not function optimally [1].

However, NAD+'s role is far more diverse. It also acts as an activator for other vitally important molecules that protect and maintain our cells.

Sirtuins — the fuel-hungry vitality proteins

A special maintenance team operates in our cells — a family of proteins called sirtuins. They're often referred to as vitality proteins because they perform critically important functions:

• They support DNA integrity and thus protect cells from daily oxidative stress.
• They support cellular balance and maintain normal physiological responses that keep our bodies resilient.
• They regulate metabolism and help maintain healthy metabolic processes.

Most importantly, sirtuin activity is completely dependent on NAD+. When NAD+ levels are optimal, sirtuins are active and can effectively do their job. When NAD+ levels naturally fluctuate, their activity can diminish, which may impact our long-term vitality [3].

A natural characteristic of NAD+ levels in our body is that they gradually evolve — it's observed that as the years pass, levels decrease by roughly half [2].

How to support optimal NAD+ levels?

Since the NAD+ molecule itself is too large to easily enter cells, scientists have developed NAD+ precursors — smaller molecules that our body can directly use for NAD+ production.

• Nicotinamide riboside (NR). This is a form of vitamin B3 that cells convert into NAD+ particularly efficiently. Many clinical studies have proven that NR supplements are safe and effectively support NAD+ concentration in the blood [4, 5]. Due to its solid scientific foundation, NR is approved as a safe dietary supplement ingredient in the EU.
• Nicotinamide mononucleotide (NMN). Although NMN is also an effective NAD+ precursor, it's important to know that in the European Union, NMN is not approved as a dietary supplement and its sale is restricted.
• Dihydronicotinamide mononucleotide (NMNH). This is a newer, reduced form of NMN. Early studies show that NMNH may be an even more effective NAD+ level supporter than NMN or NR, as cells absorb it more easily. However, research on this molecule is still in the early stages, mostly conducted on animals.
• Other forms. Although classic forms of vitamin B3 (niacin, niacinamide) can support NAD+ levels in the body, they have drawbacks — niacin often causes skin flushing (niacin flush), and very high doses of niacinamide can suppress sirtuin activity.

Strategies for maintaining NAD+ levels: IV drips vs. supplements

With the emergence of possibilities to support NAD+ levels in the body, two main methods have become popular:

NAD+ IV drips (IV therapy). This is a quick way to deliver a large dose of NAD+ directly into the bloodstream. Such a method can be useful for achieving rapid support. However, these procedures are expensive and require visiting a clinic where you must spend several hours. Moreover, the effect itself is short-term.

Oral NAD+ precursors (e.g., NR). Dietary supplements are designed for daily, long-term use. They work gradually, continuously supplying cells with the raw material needed for NAD+ production. This is a convenient and sustainable way to maintain stable NAD+ levels.

The optimal strategy may be combining these methods, using IV drips as an initial loading dose, while maintaining the NAD+ level achieved through drips by taking oral supplements with NR daily.

Potential risks and important considerations

Although NAD+ supplements are considered safe, science in this area is still developing. Therefore, it's important to pay attention to:

Lack of data on long-term effects. While theoretically, sirtuin activation seems like a logical and direct way that could help the body stay in good condition, most studies on supporting NAD+ levels are short-term—there's still a lack of data on the effects of continuous use spanning decades.

Effects on specific health conditions. There's a theoretical risk that elevated NAD+ levels could interact with certain cellular abnormalities. For this reason, people with serious underlying health conditions should avoid these supplements and maintain cellular vitality with the guidance of a physician [6].

Individuality of effects. As with any supplement, effects may vary depending on individual genetic and metabolic characteristics.

Summary

NAD+ is an essential coenzyme in our body, necessary for cellular energy and wellness. The natural change in NAD+ levels over time is closely linked to how our bodies progress. Nutritional supplementation with NAD+ precursors, such as nicotinamide riboside (NR), is a clinically validated method to support the amount of this coenzyme in the body. It's designed to promote normal energy-yielding metabolism and support protective sirtuin mechanisms.

Nevertheless, NAD+ is not a magic shortcut. Most important remain a balanced diet, regular physical activity, and a healthy lifestyle. NAD+ supplements should be just one of the tools in a holistic wellness strategy.

Scientific references

[1] Canto, C., & Auwerx, J. (2009). PGC-1alpha, SIRT1 and AMPK, an energy sensing network that controls energy expenditure. Current Opinion in Lipidology.

[2] Massudi, H., Grant, R., Braidy, N., Guest, J., Farnsworth, B., & Guillemin, G. J. (2012). Age-associated changes in oxidative stress and NAD+ metabolism in human tissue. PLoS ONE.

[3] Imai, S., & Guarente, L. (2014). NAD+ and sirtuins. Trends in Cell Biology.

[4] Trammell, S. A., et al. (2016). Nicotinamide riboside is a major NAD+ precursor vitamin in cow milk. The Journal of Nutrition.

[5] Martens, C. R., et al. (2018). Chronic nicotinamide riboside supplementation is well-tolerated and elevates NAD+ in healthy middle-aged and older adults. Nature Communications.

[6] Navas, L. E., & Carnero, A. (2021). NAD+ metabolism, stemness, and the immune response. Signal Transduction and Targeted Therapy.