What are the recommendations for supplementing with Nicotinamide Adenine Dinucleotide (NAD)?

From the Guidelines

Supplementing with NAD+ precursors, such as nicotinamide riboside (NR) or nicotinamide mononucleotide (NMN), is generally recommended to support cellular energy production and overall metabolic health, rather than supplementing with NAD+ itself due to poor oral absorption. The most common precursors, NR and NMN, are typically dosed at 250-1000 mg daily for NR and 250-1200 mg daily for NMN, as seen in various studies 1. These supplements are best taken in the morning on an empty stomach to maximize absorption. Some key points to consider when supplementing with NAD+ precursors include:

• Starting with a lower dose and gradually increasing while monitoring for side effects, which may include flushing, nausea, fatigue, or headaches
• Ensuring adequate intake of B vitamins, particularly niacin (vitamin B3), as it plays a crucial role in NAD+ production, with a recommended daily intake of 14-16 mg/day for adults 1
• Considering lifestyle modifications that naturally support NAD+ levels, such as regular exercise, intermittent fasting, and limiting alcohol consumption
• Consulting with a healthcare provider before beginning supplementation, especially if you have existing health conditions or take medications, as NAD+ precursors may interact with certain medications or affect existing health conditions, and upper intake levels (ULs) for nicotinic acid and nicotinamide should be considered to avoid adverse effects 1.

From the Research

Recommendations for Supplementing with Nicotinamide Adenine Dinucleotide (NAD)

• The use of NAD+ precursors, such as nicotinamide riboside (NR) and nicotinamide mononucleotide (NMN), has been proposed as a strategy for improving cardiovascular and other physiological functions with aging in humans 2, 3.
• Chronic supplementation with NR is well tolerated and effectively stimulates NAD+ metabolism in healthy middle-aged and older adults 2.
• The oral administration of NAD+ precursors, such as NR and NMN, is safe and significantly increases NAD+ levels in humans 3, 4.
• NAD+ supplementation has been shown to have beneficial effects on various physiological functions, including reducing blood pressure and arterial stiffness, improving muscle insulin sensitivity, and enhancing quality of life 2, 5, 6.
• However, the efficacy of NAD+ precursors is lower than expected from preclinical studies, and further research is needed to determine the optimal method of raising NAD levels and identifying target conditions 3, 5.
• Common side effects associated with NAD+ supplementation include muscle pain, nervous disorders, fatigue, sleep disturbance, and headaches, but these are generally not serious and do not pose a significant risk to health 6.

Key Considerations

• The identification of the contribution of host-gut microbiota interactions to NR and NMN metabolism has added complexity to NAD+ metabolism, and further research is needed to optimize the effects of NAD+ supplementation 3.
• Methods of delivering NAD+ precursors to target organs or tissues may be necessary to increase the outcomes of clinical trials 3.
• Comparison of pharmacological methods of raising NAD levels to physiological means, such as exercise programs and dietary interventions, is also necessary to determine the most effective approach 5.