Nicotinamide Adenine Dinucleotide

NAD+ is a critical coenzyme involved in cellular energy metabolism, DNA repair, and aging-related pathways. NAD+ levels decline with age, driving interest in supplementation for anti-aging. However, oral NAD+ itself has very poor bioavailability - PRECURSORS like NR (nicotinamide riboside) and NMN (nicotinamide mononucleotide) are generally preferred. NO GRADED OUTCOMES for direct NAD+ supplementation. Most NAD+ research actually uses precursors. Research on aging benefits is ongoing but preliminary.

Quick Answer

What it is

NAD+ is a critical coenzyme involved in cellular energy metabolism, DNA repair, and aging-related pathways. NAD+ levels decline with age, driving interest in supplementation for anti-aging.

Key findings

  • Grade C: Cellular NAD+ Levels
  • Grade D: Cardiac Remodeling and Heart Function
  • Grade D: Systemic Inflammation

Safety

  • Preclinical evidence and reviews indicate NAD+ homeostasis is disrupted in failing hearts and that NAD+ supplementation may prevent adverse cardiac remodeling by improving mitochondrial redox state (Mericskay, 2016; Pei et al., 2022).
ℹ️ Quick Facts: Nicotinamide Adenine Dinucleotide

Quick Facts: Nicotinamide Adenine Dinucleotide

  • Best Evidence:Grade C
  • Conditions Studied:4
  • Research Outcomes:10
  • Key Effect:Aging & Longevity
Outcomes by grade:
A0
B0
C1
D9
4 conditions · 10 outcomes

Detailed Outcomes

|
C
Cellular NAD+ Levels
Multiple small human trials demonstrate that NAD+ precursors (NR, NMN) reliably raise blood and tissue NAD+ levels. In a pharmacokinetic study of 12 healthy subjects, single-dose oral NR produced up to 2.7-fold increases in blood NAD+ (Trammell et al., 2016). Similar NAD+ elevations were confirmed in aged skeletal muscle (Elhassan et al., 2019) and in the brains of Parkinson's patients (Brakedal et al., 2022). Note: direct oral NAD+ has poor bioavailability; most evidence uses precursors NR or NMN.
moderateImproves
D
Systemic Inflammation
Reduced inflammatory markers were observed across multiple human and animal studies. In aged men, NR reduced circulating inflammatory cytokines (Elhassan et al., 2019). In Parkinson's patients, NR lowered inflammatory markers in serum and CSF (Brakedal et al., 2022). NAD+ metabolism modulates immune response, T cell function, and inflammaging pathways (Navarro et al., 2022). Evidence is consistent but from small, heterogeneous studies.
smallImproves
D
Skeletal Muscle NAD+ Metabolome and Anti-inflammatory Markers
A double-blind, placebo-controlled crossover RCT in 12 aged men showed that 1g daily NR for 21 days augmented the skeletal muscle NAD+ metabolome and induced transcriptomic anti-inflammatory signatures, with reduced circulating inflammatory cytokines (Elhassan et al., 2019). In prediabetic women, NMN also upregulated muscle remodeling genes (Yoshino et al., 2021). Evidence limited to two small trials.
smallWorsens
D
Cardiac Remodeling and Heart Function
Preclinical evidence and reviews indicate NAD+ homeostasis is disrupted in failing hearts and that NAD+ supplementation may prevent adverse cardiac remodeling by improving mitochondrial redox state (Mericskay, 2016; Pei et al., 2022). The Nampt/NAD axis has been shown to suppress atrial fibrillation by modulating calcium handling in cellular models (Shan et al., 2020). No human cardiac trials have been completed.
smallImproves
D
Neuroinflammation in Alzheimer's Disease Models
In transgenic Alzheimer's mouse models, 5-month NR supplementation reduced microglial activation, suppressed NLRP3 inflammasome, decreased DNA damage and cellular senescence, and improved cognitive function and synaptic plasticity via the cGAS-STING pathway (Hou et al., 2021). Additional preclinical and review evidence supports NAD+ precursors for neurodegeneration, but no human trials have tested cognitive endpoints in Alzheimer's patients.
moderateImproves
D
Muscle Insulin Sensitivity
A double-blind, placebo-controlled RCT of 25 postmenopausal prediabetic women found that 10 weeks of NMN supplementation (250 mg/day) increased skeletal muscle insulin signaling (AKT, mTOR phosphorylation) and glucose disposal (Yoshino et al., 2021, Science). Impaired NAD+ metabolism in diabetic tissues provides mechanistic support (Okabe et al., 2020), but this is a single small trial.
smallImproves
D
Age-Related Oocyte Quality and Female Fertility
Two independent rodent studies demonstrated that NMN supplementation restored oocyte quality during reproductive aging. Bertoldo et al. (2020) showed NAD+ repletion rescued fertility in aged mice, improving ovulation rates and embryo development. Miao et al. (2020) confirmed NMN reversed age-related oocyte decline by restoring mitochondrial function and reducing ROS. No human studies have been conducted.
moderateImproves
D
Anti-Tumor Immune Response
In preclinical cancer models, NAD+ supplementation enhanced T cell tumor-killing capacity by rescuing defective NAMPT transcription in tumor-infiltrating T cells, improving glycolysis and ATP production in CAR-T and anti-PD1 models (Wang et al., 2021). Cancer cells also show heightened NAD+ dependency, suggesting dual therapeutic potential (Griffiths et al., 2020). All evidence is preclinical.
smallImproves
D
Parkinson's Disease Biomarkers
The NADPARK phase I RCT in 30 newly diagnosed, treatment-naive Parkinson's patients found that NR supplementation was well-tolerated, significantly increased brain NAD+ levels, altered cerebral metabolism, upregulated mitochondrial and cellular repair genes, and reduced inflammatory markers in serum and cerebrospinal fluid (Brakedal et al., 2022). However, clinical motor outcomes were not a primary endpoint and larger trials are needed.
smallImproves
D
Obesity and Metabolic Health (Animal Models)
In rodent models, NR supplementation enhanced oxidative metabolism, activated SIRT1 and SIRT3, increased energy expenditure, reduced cholesterol, and protected against high-fat diet-induced obesity and metabolic abnormalities (Cantó et al., 2012). Reviews confirm NAD+-boosting molecules improve metabolic regulation in animal models (Rajman et al., 2018). No human obesity trials have been conducted.
moderateImproves

Research Citations (19)

The NADPARK study: A randomized phase I trial of nicotinamide riboside supplementation in Parkinson's disease.
(2022)
PMID: 35235774
Nicotinamide adenine dinucleotide metabolism in the immune response, autoimmunity and inflammageing.
(2022)
PMID: 33817782
Nicotinamide Adenine Dinucleotide in the Development and Treatment of Cardiac Remodeling and Aging.
(2022)
PMID: 35249481
NAD(+) supplementation reduces neuroinflammation and cell senescence in a transgenic mouse model of Alzheimer's disease via cGAS-STING.
(2021)
PMID: 34497121
NAD(+) supplement potentiates tumor-killing function by rescuing defective TUB-mediated NAMPT transcription in tumor-infiltrated T cells.
(2021)
PMID: 34380043
NAD(+) Repletion Rescues Female Fertility during Reproductive Aging.
(2020)
PMID: 32049001
Nicotinamide Mononucleotide Supplementation Reverses the Declining Quality of Maternally Aged Oocytes.
(2020)
PMID: 32755581
Nicotinamide adenine dinucleotide (NAD+): essential redox metabolite, co-substrate and an anti-cancer and anti-ageing therapeutic target.
(2020)
PMID: 32573651
Therapeutic potential of nicotinamide adenine dinucleotide (NAD).
(2020)
PMID: 32360833
Nicotinamide Phosphoribosyltransferase (Nampt)/Nicotinamide Adenine Dinucleotide (NAD) Axis Suppresses Atrial Fibrillation by Modulating the Calcium Handling Pathway.
(2020)
PMID: 32629939

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