Lack of energy, slower recovery after physical exertion, the feeling that you won't have enough strength to get through the day — experiences that many accept as an inevitable part of aging. But what if the roots of these changes lie not in chronological age, 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 aging process itself.

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 would simply stop [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 longevity genes

A special repair team operates in our cells — a family of proteins called sirtuins. They're often called longevity genes because they perform critically important functions:

• They repair DNA damage and thus protect genetic information from daily harm.
• They regulate inflammation and suppress chronic inflammatory processes that wear down our body.
• They regulate metabolism and help maintain healthy metabolic processes.

Most importantly, sirtuin activity is completely dependent on NAD+. When NAD+ levels are high, sirtuins are active and can effectively do their job. When NAD+ is lacking, their activity diminishes, allowing cellular damage to accumulate and accelerating aging processes [3].

The problem with natural NAD+ levels in our body is that they drop drastically over the years — it's believed that by middle age, levels decrease by roughly half [2].

How to increase 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 increase 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 booster 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 increase 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 increase NAD+ levels in the body, two main methods have become popular:

NAD+ IV drips (IV therapy). This is a quick way to get a large dose of NAD+ directly into the bloodstream. Such a method can be useful for achieving a rapid restorative effect. However, these procedures are expensive, 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 increasing NAD+ levels are short-term—there's still a lack of data on the effects of long-term use spanning decades.

Effects when dealing with cancer. There's a theoretical risk that increased NAD+ levels could promote the growth of existing cancer cells. For this reason, people with active forms of cancer should avoid these supplements and maintain cellular vitality with the help 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 health. The decrease in NAD+ levels with age is closely linked to aging processes. Nutritional supplementation with NAD+ precursors, such as nicotinamide riboside (NR), is a clinically validated method to increase the amount of this coenzyme in the body. It's designed to support normal energy metabolism and activate protective sirtuin mechanisms.

Nevertheless, NAD+ is not an elixir of youth. 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 health 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 in aging and disease. 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, the immune response, and cancer. Signal Transduction and Targeted Therapy.