As we age, NAD+ concentrations decline. It’s not fully understood why. Researchers hypothesize that the NAD+ recycling pathways lose functionality as we age or that we use more NAD+ for repair. Many scientists believe it is a combination of both.
To understand the complexity of NAD+ and aging, we have to introduce another important family of molecules, enzymes called sirtuins. One of our favourite aging experts, David Sinclair PhD, has done extensive research on the relationship between NAD+, aging and sirtuin activity. He is the one who discovered that the red wine molecule resveratrol increased sirtuin activity in a similar way to caloric restriction.
From a 2018 paper published by Alice Kane and David Sinclair:
“The sirtuin family… are thought to be responsible, in large part, for the cardiometabolic benefits of lean diets and exercise and when upregulated can delay key aspects of aging. SIRT1, for example, protects against a decline in vascular endothelial function, metabolic syndrome, ischemia-reperfusion injury, obesity, and cardiomyopathy, and SIRT3 is protective against dyslipidemia and ischemia-reperfusion injury. With increasing age, however, nicotinamide adenine dinucleotide levels and sirtuin activity steadily decrease, and the decline is further exacerbated by obesity and sedentary lifestyles. Activation of sirtuins or nicotinamide adenine dinucleotide repletion induces angiogenesis, insulin sensitivity, and other health benefits in a wide range of age-related cardiovascular and metabolic disease models.”
Because NAD+ is required for sirtuin activity, as NAD+ declines with aging, sirtuin activity declines as well, accelerating aging and reducing our body’s ability to generate energy, combat inflammation, repair tissue and fight infections.
If you want a deep-dive on this topic, read Sinclair’s new book, Lifespan, Why We Age and Why We Don’t Have To.
The Connection Between COVID-19 & NAD+
The body’s initial response to an infectious threat like COVID-19, known as innate immune activation, depends on NAD+. Viral infections deplete NAD+ because infections trigger a cellular defence cascade that results in increased NAD+ degradation to prevent the virus from taking over the cell. Significantly reduced NAD+ concentration has been shown in COVID-19 and some researchers think this is a major factor in why this virus is so deadly, especially to those with depleted NAD+ storage.
Considering the populations at the highest risk of perishing from COVID-19, this theory makes sense. Not only the elderly but those in a constant state of inflammation such as people managing hypertension, diabetes and obesity, all live with depleted NAD+ concentration. Now, more than ever, it’s critical that our bodies have the molecular resources to fight infection.
COVID-19 & NMN Case Study from the University of Chicago
A case study was published on April 22, 2020, by Dr. Robert Huizenga MD at the University of Chicago describing his response to a 55-year old woman who had been hospitalized with COVID-19 on March 16. Her condition continued to worsen and on day 13 she had obvious pneumonia, cytokine storm and extremely elevated hsCRP, a non-specific inflammatory marker.
Dr. Huizenga treated her with oral NMN, betaine and NaCl (known to reduce IL-6) and continued the zinc treatment she had been given prior. By day 15, her fever was alleviated and symptoms improved significantly. By day 17 she was discharged to go home. By day 23, she was asymptomatic.
Two other elderly patients were treated with the same “cocktail” and both experienced similar recoveries.
How to Increase NAD+
There are a handful of proven ways to increase NAD+. While niacin-containing foods such as beef, liver, poultry, anchovies, salmon, mushrooms, peas, potatoes and yeast can provide substrate for NAD+. However, it’s not possible to get enough niacin (Vitamin B3) in the diet to meet the high demand throughout the body. Instead, NAD+ recycling pathways are the primary source of NAD+. To increase NAD+, we need to use less or boost production. Here are effective ways to increase NAD+:
Fasting or caloric restriction has been shown to boost sirtuins and NAD+, leading to increased longevity and anti-aging effects. One of our favourite tools for fasting is Prolon FMD which has been shown to boost stem cell production and turn off aging and cancer pathways.
Aerobic and resistance exercise has been shown to reverse aging by increasing NAD+ production.