This article was previously published on February 15, 2021 and has been updated with new information.
The tendency is to lose muscle as you age, a condition known as sarcopenia. If you don’t do anything to stop it, you can expect to lose about 15% of your muscle mass between the ages of 30 and 80.1 An estimated 10 to 25% of seniors under 70 have sarcopenia, and even half of those over 80 have it.2
Forced bed rest, for example due to hospitalization, can also have dramatic effects on your muscle mass, even when you are younger. According to a 2015 review3 Extreme Physiology & Medicine allows you to lose 5.2% of your muscle mass in the first two weeks of bed rest. By day 23, you can have lost up to 10% of your quadriceps muscle mass.
Strong muscles are not only a prerequisite for mobility, balance and the ability to live independently, but muscle reserves also increase your chances of survival4th in the event of illness or hospitalization. Since muscles are lost much more easily and faster than they are built, it is of the utmost importance to find ways to continuously develop and maintain your muscle mass.
The crucial role of NAD +
As reported by Science Daily,5 Scientists recently discovered that Alzheimer’s-like protein aggregates underlie the muscle breakdown commonly seen in old age and that nicotinamide adenine dinucleotide (NAD +) is essential in combating this condition.
Your study,6th published in the journal Cell Reports, showed that protein aggregates (amyloid) can be blocked by increasing the level of NAD +, a biomolecule that is also essential for the maintenance of mitochondrial function.
It has been found that higher NAD + levels activate the mitochondrial defense systems and restore muscle function. Aggregated proteins have long been believed to contribute to brain aging, and this study proves that aggregated proteins also contribute to muscle aging.
“The most prominent part of these protein aggregates is beta-amyloid, just like in the amyloid plaques in the brains of patients with Alzheimer’s disease.” said Johan Auwerx from EPFL’s School of Life Sciences. “These abnormal proteotoxic aggregates could serve as new biomarkers for the aging process beyond the brain and muscles.”
The study suggests that NAD + homeostasis is required to maintain proteostasis, the regulation of protein formation, folding, transport, and degradation. It turns out that increasing NAD + later in life reduces amyloidosis (the accumulation of amyloid) and mitochondrial dysfunction.
The importance of NAD + for healthy muscle function is also described in “Sarcopenia and Muscle Aging: A Brief Overview”.7th published in the journal Endocrinology and Metabolism. The paper highlights:
“… recent findings describing important pathophysiological phenotypes of this disease, including changes in muscle fiber types, mitochondrial function, nicotinamide-adenine-dinucleotide (NAD +) metabolism, myokines and gut microbiota, in aged muscles versus young muscles or healthy aged muscles. “
As indicated by the Cell Report study, this paper on endocrinology and metabolism highlights the link between sarcopenia and mitochondrial dysfunction in both skeletal muscle and motor neurons.
It has been found that people with sarcopenia have both reduced mitochondrial oxidative capacity and inhibited NAD + biosynthesis, and several studies have suggested that mitochondrial dysfunction in your neurons actually drives the development of sarcopenia.8th
What is NAD +?
NAD + is a substrate for a number of important enzymes, including poly (ADP-ribose) polymerase (PARP) and sirtuin 1 (SIRT1), known as a classic longevity protein. NAD + is also essential in metabolic processes such as the formation of ATP in your mitochondria. It accepts and releases electrons and is used in oxidation-reduction reactions in the mitochondrial electron transport chain.
Interestingly, scientists have observed that NAD + levels in most tissues decrease over time and are generally associated with aging and therefore play an important role in many age-related diseases.
According to the Endocrinology and Metabolism Paper9 Researchers have shown that when the NAD + recovery pathways are disrupted in muscles, mitochondrial dysfunction and decreased muscle mass occur.
NAD + enhancing molecules such as nicotinamide riboside (NR), nicotinamide mononucleotide (NMN), nicotinamide (a form of vitamin B3 or niacin) and nicotinic acid (niacin) have been shown to protect against age-related muscle diseases.
How to Increase NAD +
Of the four, NMN is my personal favorite because it activates the NAD + salvage pathway. As explained by Siim Land in an interview I conducted with him that also highlights the importance of NAD + in COVID-19:
“Much of the NAD that your body produces is recycled through the recycling route. Very little (less than 1%) of this will come from food, especially tryptophan or niacin. The easiest way to prevent your NAD from being lost is to get older or immunocompromised to encourage the escape route. “
I previously recommended using NR over NMN but have changed my mindset since then. In the past, NR was considered superior because no NMN transporter – which is needed to get into the cells – was detected. We now know that there is one such transporter that gives NMN the edge as it is also a more direct NAD + precursor.
Most of the NAD + precursor research is done with NR, and that used to be my first choice. However, as you can see from the above image, NMN is converted to NAD +, while NR must be converted to NMN first before it can be converted to NAD +.10 Therefore, it makes more sense to use NMN for NAD + augmentation.
The above picture also shows how niacin (NA) also finds its way to NAD +. Niacin is also a useful supplement for increasing NAD + levels. You just need to limit the dose to around 25 mg, which is mostly a dose low enough not to cause flushing. Higher doses are likely not as effective as NMN and exercise in producing NAD +.
The NMN transporter was discovered11,12th just before my interview with David Sinclair, Ph.D., a professor of genetics and co-director of the Paul F. Glenn Center for the Biology of Aging at Harvard Medical School. Interestingly, NMN is also Sinclair’s preferred NAD + precursor.
Sinclair is well known for bringing the importance of NAD + to the world with his experiments at MIT in the late 1990s that linked NAD + to sirtuin activation.
I believe one of the most effective ways to increase your NAD + levels is to use NMN in suppository form as this will largely avoid the methylation of the supplement. Other alternatives include subcutaneous or intranasal administration, all of which are more effective than oral supplements.
Unfortunately, NMN isn’t sold in suppository form, so you’ll need to get silicone candy molds and use coconut oil to act as a binder for the NMN. The suppositories would need to be refrigerated as coconut oil tends to melt at 75 degrees Fahrenheit. In addition, NMN is perishable, which is another reason to keep it refrigerated.
As for the other NAD + boosters, I don’t recommend using high-dose niacinamide, as high doses inhibit Sirt1, an important longevity protein. As mentioned above, low dose niacin (vitamin B3) of 25 mg can be used.
Low doses of niacin along with NMN in suppository form – both precursors to NAD + – are usually sufficient. As an added boon, increasing your NAD + appears to protect against severe COVID-19 as well. There are also NAD + supplements available, but the price tag can be prohibitive.
Lifestyle strategies can address the underlying cause of low NAD +
While supplements like NMN can certainly be helpful, when your NAD is low, it’s best to fix the underlying cause. The good news is that this can be achieved through simple lifestyle strategies like exercise, sauna bathing, fasting, realigning your circadian rhythm, and minimizing exposure to electromagnetic fields (EMF).
One of the reasons exercise, heat stress, and fasting all help fight low NAD + levels is because they are catabolic stressors that activate AMP protein kinase (AMPK). AMPK, in turn, activates an enzyme called NAMPT, which controls the NAD + escape route.
Blood flow restriction (BFR) exercise can be particularly beneficial in relation to exercise. It has been shown to naturally increase your NAD levels and is very safe for the elderly.
Your circadian rhythm, meanwhile, plays a role as it is controlled by longevity genes, the sirtuins, especially SIRT1. If your circadian rhythm is misaligned, sirtuins will not be expressed, which in turn will inhibit NAMPT and thereby cripple your NAD + escape route.
Oxidative stress and inflammation also deplete and deplete NAD +, and exercise, sauna, and fasting help reduce these. This means that less NAD + is used. So these strategies not only improve your NAD + production, but also reduce your body’s NAD + consumption. The end result is a higher NAD + baseline.
EMF exposure, which is the subject of my book “EMF * D”, is a common source of oxidative stress, so it increases your NAD + consumption as well. It does this by activating PARP, a DNA repair enzyme. Every time PARP is activated, it consumes 150 molecules of NAD +. Therefore, reducing your EMF exposure can also be an important strategy to maintain and protect your NAD + levels.
Your body also uses NAD + to detoxify alcohol. So if nighttime drinking is part of your routine, give it up. To learn more about how healthy lifestyle strategies like the ones mentioned here can improve your NAD + levels, see the paper “Recommendations for a Healthy Lifestyle: Do the Benefits Origine from NAD + Amount at the Cellular Level?” read through.13th
NAD + is a crucial antiaging component
In conclusion, increasing your NAD + levels and maintaining them high has many important health benefits, from helping mitochondrial function, which is critical to overall health and longevity, to protecting against severe COVID-19 and age-related ones Muscle loss.
The good news is that this can easily be achieved by implementing the healthy lifestyle strategies outlined above – exercise, sauna, fasting, and recalibrating your circadian rhythm – while avoiding things that are consuming your body of NAD +, like EMF- Exposure and excessive alcohol consumption. Additionally, supplements like NMN, along with normal doses of niacin, can help boost your NAD + in the short term.
Thank You For Reading!