Tru Niagen (Nicotinamide Riboside) Benefits
Tru Niagen (nicotinamide riboside) effectively increases NAD+ levels in the body, but current evidence shows limited clinically meaningful benefits for most health outcomes, with the strongest data supporting only modest effects on body composition and muscle metabolism in overweight adults. 1, 2, 3
Established Biochemical Effects
Nicotinamide riboside dose-dependently increases whole blood NAD+ levels by 22-142% depending on dose (100-1000 mg daily), with effects maintained throughout supplementation. 2
NAD+ is involved in over 400 enzymatic reactions, playing roles in energy metabolism, DNA repair, gene expression, and stress responses. 1, 4
Unlike nicotinic acid (another vitamin B3 form), nicotinamide riboside does not cause flushing, making it better tolerated. 1, 5
Documented Clinical Benefits
Body Composition (Strongest Evidence)
In overweight/obese adults, 1000 mg daily for 6 weeks increased fat-free body mass by 1.34% and elevated sleeping metabolic rate. 3
Skeletal muscle acetylcarnitine concentrations increased significantly (from 3025 to 4558 pmol/mg dry weight), suggesting enhanced muscle metabolic capacity. 3
Cardiovascular Effects (Under Investigation)
- A clinical trial is investigating whether 500 mg twice daily for 3 months reduces systolic blood pressure and arterial stiffness in adults over 50 years with elevated blood pressure (120-159 mmHg), but results are not yet published. 6
What Nicotinamide Riboside Does NOT Improve
Critical limitation: Despite increasing NAD+ levels, nicotinamide riboside showed no benefit for:
- Insulin sensitivity (no improvement in hyperinsulinemic-euglycemic clamp testing) 3
- Mitochondrial function (no changes in ex vivo or in vivo measurements) 3
- Hepatic or intramuscular fat accumulation 3
- Cardiac function or energy status 3
- Blood pressure (in the completed study) 3
- Inflammatory markers 3
- Overall energy metabolism 3
Safety Profile
The no observed adverse effect level (NOAEL) is 300 mg/kg/day in animal studies, with a lowest observed adverse effect level of 1000 mg/kg/day. 7
Human trials using 100-1000 mg daily for up to 8 weeks showed no significant adverse events, no flushing, and no elevation of LDL cholesterol. 2
The upper limit for nicotinamide (the class to which nicotinamide riboside belongs) is approximately 900 mg/day for adults based on safety data. 1
Target organs of toxicity at high doses in animal studies include liver, kidney, ovaries, and testes. 7
Practical Considerations
Standard dietary niacin recommendations (16 mg/day for adult males, 14 mg/day for adult females) can be met through fortified foods, meat, fish, nuts, and legumes—these provide NAD+ precursors without supplementation. 1
Age-related decline in cellular NAD+ levels has been documented, providing theoretical rationale for supplementation in older adults, though clinical benefits remain unproven. 1
Injectable NAD+ is not FDA-approved and has no established role in clinical practice; oral nicotinamide riboside is the only evidence-based route for NAD+ supplementation. 4
Bottom Line for Clinical Practice
The evidence shows nicotinamide riboside reliably increases NAD+ biomarkers but translates to minimal clinically significant benefits. The modest improvements in body composition and muscle acetylcarnitine metabolism in overweight adults represent the strongest documented effects. For patients seeking anti-aging or metabolic benefits, set realistic expectations: increasing NAD+ levels does not automatically improve the metabolic outcomes (insulin sensitivity, mitochondrial function, cardiovascular health) that matter most for morbidity and mortality. 3