The Top 7 NAD+ Benefits

NAD+ is the oxidized form of nicotinamide adenine dinucleotide (NAD), a coenzyme form of vitamin B3. NAD+ is found in every cell in the body where it supports the activity of myriad enzymes and, along with its reduced form NADH, participates in redox reactions (i.e., reactions where there is transfer of electrons) with essential roles in cellular function. NAD+ is a cofactor for enzymes involved in cellular energy metabolism and helps transfer the energy extracted from nutrients (as electrons) to the production of cellular energy as adenosine triphosphate (ATP). NAD+ also has a key role in maintaining redox homeostasis and balanced levels of cellular oxidants and is a co-substrate for enzymes involved in key cell signaling pathways essential for cellular health [1,2]. 

How the Body Produces NAD+

NAD+  is continuously synthesized, metabolized, and recycled in the cell through different pathways. The de novo synthesis pathway converts the amino acid L-tryptophan to NAD+ by building a niacin molecule anew. De novo synthesis starts with tryptophan and, through a series of reactions known as the kynurenine pathway, converts it into quinolinic acid. The next step converts quinolinic acid to a niacin-containing molecule called nicotinic acid mononucleotide (NAMN). NAMN is also an intermediate of another pathway of NAD+ production called Preiss-Handler pathway, which starts with the conversion of a niacin molecule into NAMN and with which the de novo pathway converges at this point. NAMN produced by both pathways then flows through the Preiss-Handler pathway and is converted into nicotinic acid adenine dinucleotide (NAAD), which, in the final step, is converted to NAD+ [3,4].

An additional pathway of NAD+ production called the salvage pathway starts with the conversion of nicotinamide to nicotinamide mononucleotide (NMN), which is then converted into NAD+. This pathway recycles (or salvages) nicotinamide produced as a byproduct in NAD+-consuming reactions back to NAD+ (but it can also metabolize nicotinamide obtained from the diet). NAD+ is then available again to be used in NAD+-consuming reactions [3,4].

NAD+ Production Declines With Age

As we age, the balance between NAD+ use and synthesis can shift, and NAD+ consumption can exceed the ability of cells to produce or recycle NAD+. As a result, NAD+ levels in cells and tissues decline, which helps to drive many of the cellular changes that drive the aging process and age-related physiological decline [1,5–7]. 

Low NAD+ levels can impact mitochondrial function and cellular energy production and consequently affect cellular growth and repair processes. NAD+ depletion can also destabilize cellular redox balance and allow for an oxidative cellular environment to develop, which can promote oxidative stress and damage cellular molecules and structures. Furthermore, it can compromise mitochondrial quality and DNA repair [1,8]. 

This reduction in NAD+ availability plays a key part in the decline of cellular and tissue function and in age-related physiological decline. Low NAD+ levels have been linked to several age-related features, including cognitive decline, poorer muscle function, and poorer cardiac, metabolic, liver, and kidney health [1,8].

What Are the Top 7 Benefits of NAD+ Boosting?

Maintaining adequate levels of NAD+ is crucial for maintaining good health. Boosting NAD+ levels can potentially support the many cellular processes in which NAD+ is involved. Because NAD+ depletion underlies or accelerates many features of aging, restoring NAD+ levels may help to slow down or even reverse cellular changes. Boosting NAD+ levels can support cellular metabolism and energy production, redox balance, DNA repair, and mitochondrial health, helping to preserve cellular and tissue function as we age [1]. 

Mitochondrial Function

Although the generation of cell energy is the main function of mitochondria, it is not the only one: they make steroid hormones, regulate calcium levels in the cell, contribute to immune responses and signaling, and play a key part in cell survival and cell death pathways, for example. They are crucial for the health of every tissue and organ in the human body. 

NAD+ depletion compromises mitochondrial function. Consequently, it compromises cellular metabolism and cell energy production, enhances the production of reactive oxygen species (ROS), and triggers signaling pathways that can lead to cell death. These changes lead to a progressive deterioration of cell and tissue function that can accelerate the aging process [4,57].

Preclinical studies have shown that boosting NAD+ levels can support mitochondrial function, metabolism, and abundance, enhance oxidative metabolism and ATP production, and promote the expression of enzymes controlling key metabolic pathways, including glycolysis and the citric acid cycle [9,10]. In old mice, NAD+ boosting restored mitochondrial function and cellular energy production to levels of young mice [11]. 

Healthy Aging

NAD+ has been linked to most of the 12 hallmarks of aging, either as a cause or a consequence (sometimes both). For example, an age-related decrease in NAD+ contributes not only to the decline of mitochondrial function, but also to genomic instability, epigenetic modifications, disabled autophagy, and cellular senescence [1,2]. 

Studies with aged animals have shown that restoration of NAD+ levels mitigates many age-related changes by enhancing mitochondrial function and energy metabolism, promoting DNA repair, and modulating cellular senescence [12,13]. 

Muscle Function Support

Muscle function declines with aging due to losses in muscle mass, strength, and regeneration. Muscle activity requires a constant supply of cellular energy, which is dependent on NAD+ availability and healthy mitochondrial function. With aging, NAD+ depletion affects muscle metabolism, mitochondrial fitness, and ATP production, leading to poorer muscle function and muscle weakening. Low NAD+ and poorer mitochondrial function also contribute to an accumulation of reactive oxygen species that promote oxidative stress and affect muscle health. Poor mitochondrial function also contributes to muscle stem cell senescence, which can impair muscle regeneration [8,14]. 

Healthy muscle function is associated with NAD+ availability [15]. Boosting NAD+ levels in muscles may help to maintain muscle function as we age by preserving mitochondrial function, stem cell function, and the regenerative capacity of muscles [8,14,16,17]. In humans, boosting NAD+ supported mitochondrial biogenesis in muscles [18], muscle remodeling in overweight women [19], and enhanced physical performance in healthy middle-aged and older adults [20–22]. 

Cardiovascular Function Support

The heart is a muscle that, like skeletal muscles, requires a constant supply of ATP to maintain its activity, and consequently, keep us alive. NAD+ depletion with aging can impair cardiac mitochondrial activity and cell energy production, DNA repair, and redox balance, resulting in a progressive weakening of cardiac muscle function [8,23–25]. Preclinical studies have shown that boosting NAD+ levels in the heart may help to support cardiac muscle metabolism and function and maintain heart muscle health and strength as we age [8,16,17,23,26,27]. 

NAD+ can also support vascular health. In preclinical studies, boosting NAD+ mitigated age-related changes in endothelial function and reduced oxidative stress [28]. NAD+ boosting has been shown to support the angiogenic capacity of endothelial cells, i.e., their capacity to generate new blood vessels from existing ones [29]. NAD+ boosting restored capillary density in muscles of old mice [30] and supported cerebral blood flow by promoting endothelial vasodilation [31].

Metabolic Health and Weight Management

NAD+ levels can influence the activity of several enzymes in mitochondrial cell energy-production pathways and cell signaling pathways that modulate metabolic function. Therefore, it can have a tremendous impact on cellular bioenergetics and metabolic health. Accordingly, low NAD+ levels have been linked to metabolic health decline [2].

In preclinical research, boosting NAD+ levels improved mitochondrial function and energy metabolism in the liver, one of our key metabolic organs [10,32]. Studies in aged animals showed that boosting NAD+ mitigates age-associated physiological decline by enhancing mitochondrial function and energy metabolism and supporting healthy insulin sensitivity and glucose tolerance [33–35].

In humans, boosting NAD+ has shown mixed results for metabolic health support. This may be due to circadian rhythms to blood NAD+ levels [36–38]. A preclinical study has demonstrated that the time of day determines the efficacy of NAD+ treatment for diet-induced poor metabolic function: boosting NAD+ before the active phase in obese male mice ameliorated metabolic markers including body weight, glucose and insulin tolerance, hepatic immune signaling, and nutrient sensing pathways. However, raising NAD+ immediately before the rest phase compromised these responses [39]. 

Cognitive Function Support

Mitochondrial function in neurons is an important contributor to age-related cognitive health [40].  Age-related decreases in NAD+ in the brain can affect neural mitochondrial quality, function, and metabolism, impairing the production of the vast amounts of cellular energy the brain requires to function optimally. Low NAD+ levels can also affect neural redox balance and promote oxidative stress in neurons, compromise neuronal stress responses and DNA repair, impair neuronal calcium homeostasis, and affect neuronal communication and synaptic plasticity [41]. 

Consequently, NAD+ depletion can have significant detrimental effects on brain function and cognition. Replenishing NAD+ levels can help to mitigate these age-related changes and support the brain’s resilience as we age, helping to maintain healthy cognitive function [41]. 

Neuronal NAD+ replenishment has been shown to stimulate neuronal DNA repair, support mitochondrial metabolism, and improve mitochondrial quality via mitophagy [42–45]. In animal models, NAD+ boosting supported neuroprotective functions, helped to reduce neuronal death and synaptic loss, and supported synaptic plasticity and cognitive health [42,43,45–49]. Boosting NAD+ levels also supported cognitive function in aged mice by promoting cerebral blood flow [31].

Skin Appearance and Health Support

NAD+ has an important role in skin biology and health, but as in other tissues, its levels decline with age and contribute to skin aging. Restoring skin NAD+ pools can help to mitigate many of the age-related changes to which NAD+ decline contributes [50].

In studies in vitro, boosting NAD+ restored mitochondrial integrity in aged human fibroblasts [51]. Fibroblasts are the main cells of the dermis and are responsible for the production of structural molecules that provide elasticity and firmness to the skin. Boosting NAD+ also supported skin cells’ capacity to protect themselves from oxidative stress and environmental stressors, which are the main causes of skin aging [52–56].

In humans, supplementation with the NAD+ precursor nicotinamide supported uniform skin pigmentation [57]. Most human studies have boosted skin NAD+ levels using nicotinamide applied topically to the skin. These have shown that it can support skin appearance, lightness, uniform pigmentation, and elasticity [57–60]. 

How to Get More NAD+

Improve Your Diet

NAD+ is the coenzyme form of vitamin B3, which can be obtained from the diet in different forms. Niacin equivalents (or vitamin B3 equivalents) is a term used to describe all dietary molecules that can contribute to vitamin B3 status in the body, consequently supporting NAD+ production. These include nicotinamide, niacin, NMN, NR, and L-tryptophan. Niacin equivalents are found in all dietary animal, plant, and fungal foods (which also require NAD+ for life). Meat, eggs, fish, dairy, some vegetables, and whole grains are considered good sources of vitamin B3 [61].

What and how much we eat also influences NAD+ bioavailability by altering energy metabolism in mitochondria. A diet high in fat and/or sugar reduces NAD+, whereas calorie restriction increases NAD+ availability [38].

Practice Good Sleep Habits

NAD+ levels are regulated by circadian rhythms. The expression of the rate-limiting enzyme of the NAD+ salvage pathway is reduced by light and upregulated by darkness and night, meaning that NAD+ levels can be modified by sleeping time [36–38]. Practicing good sleep habits helps to support a healthy circadian rhythm of NAD+ production. 

Increase Physical Activity

Exercise or any kind of physical activity increases the demand for ATP, which in turn increases the NAD+/NADH ratio and stimulates an adaptive metabolic stress response. This leads to an increase in NAD+ availability by upregulating the salvage pathway [38]. Studies have shown that regular exercise can reverse the age-dependent decline in NAD+ salvage capacity in human skeletal muscle [62].

Take NAD+-Boosting Supplements

The NAD+ molecule is so important that cells evolved multiple ways to create it. Cells in some tissues rely preferably on one pathway, but other tissues may use different pathways of NAD+ production to varying extents to meet changing NAD+ needs. We developed Qualia NAD+ with this principle in mind. So rather than supporting only one pathway of NAD+ production, we support different ways to make it. This entails providing several substrates for NAD+ biosynthesis (NIAGEN® Nicotinamide Riboside, niacinamide, and niacin), as well as supporting rate-limiting steps in the different pathways. This has been our approach in designing Qualia NAD+. You can learn more about it in our article about the Qualia NAD+ Ingredients.*

*These statements have not been evaluated by the Food and Drug Administration. This product is not intended to diagnose, treat, cure, or prevent any disease.

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