NAD Therapy Offers Anti-Aging Possibilities for Patient Care

A renewed search for longevity has left many patients and integrative practitioners desperate to find innovative interventions to prolong health span. Gaining popularity is a new therapy that some say may help slow the process of aging and revitalize the body, nicotinamide adenine dinucleotide (NAD).

“People ask me all the time, what is the one thing I would do to optimize health and performance? It's NAD therapy,” said Craig Koniver, MD, cofounder of Koniver Wellness in Charleston, SC. “It is nothing short of transformational for most people. We say it's a magical molecule, but that's only because we've observed it.”

A molecule found in all living organisms, NAD contributes to hundreds of metabolic functions in the body including cell division, DNA repair, and ATP production, according to Andrew Wong, MD, an integrative primary care doctor in Bethesda, Md.

Vitamin precursors of NAD have long been used orally to help with nutritional deficiencies and various ailments. Today, practitioners like Koniver and Wong are using NAD intravenously to help with anti-aging and improve overall health. According to Koniver, after NAD therapy, patients report feeling more energized and rested, creative, happy, alert, and less stressed.

“A patient recently walked out of my office after receiving NAD therapy and said it was the best he has felt in 10 years, and maybe the best he has ever felt,” Koniver said.

NAD and Anti-Aging

Every cell in the body is powered exclusively by two molecules through the Krebs cycle: NAD and flavin adenine dinucleotide (FAD), according to Mikhail Kogan, MD, medical director at George Washington Center for Integrative Medicine Kogan where he offers NAD therapy. “And if you don’t produce enough of those, you die,” he said.

NAD is one of the most important nutrients for mitochondria, which produce cellular energy, Koniver explained. In addition to age, he said a decline in mitochondrial function has also been associated with several chronic conditions. “NAD gets those mitochondria back online and working better so we can make energy to not only live a productive and meaningful life,” he said, “but help prevent the big bad diagnoses of cancer, heart disease, diabetes, neurodegenerative disease, and whatnot.”

In addition, NAD increases sirtuins, a family of proteins that regulate cellular health and play key roles in staying biologically young, said Wong. Consequently, low NAD levels are associated with the aging process, contributing to a loss of pluripotent stem cells and immunosenescence.

Aging, Kogan said, is generally the process of declining cellular and mitochondria function. With aging comes a slow progressive decline in the production of NAD. However, NAD levels are also influenced by outside factors.

According to Wong, low oxygen, systemic inflammation, metabolic syndrome, overeating, and alcohol consumption will all decrease NAD. Excessive sun exposure from UV radiation will decrease NAD in the skin, Wong said.  

Increasing NAD Through Supplementation

There are two forms of NAD therapy, oral supplementation and intravenous (IV) therapy. According to Koniver, IV therapy is the more effective method because it allows for a direct administration of NAD.

The oral administration is really an NAD precursor," said Koniver. “They aren’t technically NAD, rather they are compounds called nicotinamide riboside (NR) or nicotinamide mononucleotide (NMN) that within the body convert to NAD.” 

Oral NAD does not get absorbed, said Kogan. “You cannot simply buy any NAD product and expect any reasonable absorption because it's getting disassembled. So, you have to either take NMN or NR.”

At his clinic, Koniver does a loading dose of NAD, stacking the treatments over a short period of time, usually five treatments in 10 days. “That gets most people caught back up and then from there, on average, people do a maintenance dose of one treatment per month,” he said.

The average dose at Koniver’s clinic is 750 milligrams. “Other clinics will use less like 250 milligrams or 500 milligrams, and some will use more. But we found that 750 milligrams is the sweet spot,” he said. Patients, he said, usually feel the effects of the NAD instantly, adding that an estimated 95 percent of his patients respond positively to the therapy.

Kogan usually starts his patients at 125 milligrams. He said dosing is different from patient to patient, but he rarely gives more than 750 mg. NAD therapy is one of the most expensive IV therapies offered at Kogan’s clinic and oftentimes people can’t afford to do it for a long time. “We give them a couple of days of the IV and then we will switch them to a sublingual liposomal form,” he said.

It's not a long-term therapy, Kogan explained. Since the body is constantly making NAD, the boost from intravenous therapy is relatively short-lived. “But it's often enough to move patients through their acute problems, allowing time for other therapies to begin to work better,” he said.

Risks of NAD Supplementation

NAD supplementation can be a double-edged sword, according to Wong. While NAD, or its precursors when given in supplemental form may improve cognition, energy, immune strength, and metabolic health overall, he said, there is also a concern that if cancer cells are present, those cells may utilize NAD for use themselves.

“It's not that NAD has been shown to cause cancer, but if the cancer is already there, it may aid its growth or survival,” said Wong. “In my opinion supplementation of NAD should be targeted for a specific purpose in selected individuals, for a limited period of time.”

If it’s done inappropriately, NAD IV therapy can be very problematic, said Kogan. Pushed too fast, the therapy can cause severe tachycardia to the point where people can go into heart failure or a heart attack instantly. This, he said, is a major side effect and part of the reason why NAD IV therapy is so labor intensive and expensive. The rate of the administration must be very slow to be safe, sometimes taking up to six hours.

“It has to be done very carefully,” Kogan said. “We monitor heartrate continuously throughout the session, checking the pulse every 15 to 30 minutes.”

Kogan advised that patients with a history of heart disease should avoid IV NAD therapy, or at least consult their cardiologist before trying the therapy.

“If somebody for example, is on the beta block or they have a heart failure or they have a history of heart disease or a heart attack, they can have very serious cardiac complications,” he said. “For those patients, often we would just limit their treatments to the sublingual NMN [nicotinamide mononucleotide] and NR [nicotinamide riboside].”

Koniver said there are also mild side effects during the actual therapy. People often describe symptoms of stomach cramping, chest pressure, and feeling overwhelmed or agitated during the treatment. Koniver believes these side effects are a result of the NAD helping with cleanup of the cells as well as the DNA damage that happens throughout someone’s lifetime.

“I describe it as cellular fitness,” said Koniver. “I tell people it’s just like a difficult workout. You know, you're huffing and puffing, you're short of breath. It's a grueling process, but you hang in there for what comes after because you want to look better and feel better.”

Diet and Lifestyle Interventions to Increase NAD

“In my opinion the best way to increase NAD is through nutrition and lifestyle,” said Wong. Increasing NAD through lifestyle is considered safe to continue long-term for most people, and unlike intravenous therapy, he said, it has generally been shown to be helpful for cancer prevention.

NAD production is regulated through genetic factors as well as nutrigenomics factors, so things that you eat influence how your energy is produced, said Kogan.

Foods containing apigenin, like parsley and chamomile, or quercetin, like onions, dill, skins of red apples, can inhibit CD38, a multifunctional enzyme which contributes to age-related NAD decline, and thus may lead to an increase in NAD, said Wong. “Other good foods to increase NAD include fish, mushrooms, green vegetables,” he said.

Wong also suggested exercise, specifically interval training, to maintain or increase muscle mass and help raise NAD within muscle tissues. In addition, he recommended intermittent fasting for at least 12 hours, calorie restriction, ketosis, fermented foods, and saunas.

There seems to be an element of NAD metabolism that's affected by the circadian rhythm, Koniver said. Quality sleep and getting natural rhythms more in line with the sun sunrising and setting will help increase NAD, he said. Getting consistent amounts of protein in the diet may help increase NAD as well. However, Koniver said there are many factors preventing NAD from increasing, that diet and lifestyle aren’t always enough to make people feel better.

“I’m a really big fan of NAD IV therapy, and that’s because I’ve seen what it can do,” he said. “We're still in the very early phases of NAD and people's understanding of it, probably the first inning. And certainly, there’s more to learn, but it's an exciting tool.”