NAD Shots and Supplements for Aging

I get asked about NAD supplements. NAD is essential for mitochondrial functions, part of the Krebs cycle. And there's a lot of popularity of NAD injections and NAD supplements. And I'm just going to go over our approach to NAD supplementation. Who might consider taking it, what form and when you should start taking it. So NAD is essential for proper metabolism, proper metabolic function, proper metabolic mitochondrial function, and it's a critical component of this ATP metabolic pathway. And our NAD levels decline as we age. So somebody 50 has less NAD available than somebody 30. And NAD is popularized as an anti aging compound because it appears to have a positive effect on the gene pathway called Sirtuin SIRT1. So Sirtuin is silent inflammatory regulator. Pathway is when turned on, it seems to slow down or mitigate the the effects of aging. And when it's not active, we theoretically age faster. And this has led to the race to figure out how do we supplement nad, what's the best form. Now there's numerous ways to get NAD levels raised and this is all some kind of a B vitamin complex derivative. So there's many different ways to think about it. But we really want to have a higher NAD level, reduced NAD level in our bloodstream for it to be effective. And it's kind of hard to absorb it when you eat it. So this has led to people using NAD injections. So there's NAD clinics where they do infusions of nad. It's something that has to go very slow IV because it makes you feel really terrible when you're getting the injection. They kind of have pressure on your body, feels really heavy, it's an odd feeling. So you have to run it over a few hours, it makes it inconvenient. And there's oral forms of nad. I've tried various ones, but the one that has the most promise right now is called nmn. I'm gonna use the letters versus the terms because it's confusing, but NMN is a precursor to, and it is likely the most favorable precursor to NAD and the most bioavailable meaning when you eat it, you absorb it. You can take it as a powder, into a drink or as a tablet. It is considered a vitamin historically. But recently the FDA has reclassified it as an investigational new drug which has led to some companies like Amazon not carrying NMN anymore. But you can still buy it through various manufacturers. And the reason it's reclassified is there's a company that is led by David Sinclair, he's kind of a famous Harvard scientist that want to turn this into a drug that they can sell to people if they can prove that it does in fact have some impacts on some component of aging. And it may be something like better physical performance or less frailty, because aging is not clearly defined by the fda. And the FDA would not today approve any drug to reduce aging because they do not recognize aging as a disease. We'd have to have some workaround to get it FDA approved. But it is under study as an investigational new drug. And about a year ago, about a year and a half ago, the FDA put pressure on manufacturers to stop making this vitamin that's been available for over a decade so that the drug companies could be able to have a monopoly on it. And that's how this works. But you can still buy it in the United States. So NMN supplements typically is 1 gram a day, potentially 2 grams a day, to raise your level to the NAD level of somebody before 35. And that goes back to who should be considered taking it. I'm not giving this as medical advice. I'm saying in general, this is the approach is that when you're 30, you have plenty of NAD in your body, and taking NAD probably does nothing. And when you're 70, you have a fraction as much NAD as you did when you were 35. So this is the person that might consider consider supplementation at that age versus at a younger age. And the typical dose is 1 to 2 grams per day. Generally speaking, when people do nad, they might feel like they feel something different afterwards. But actually, with most things that make you healthier, you don't really feel much different. Because when we're unhealthy, we remember what it felt like to be healthier. And as we age, we remember what it felt like to be younger. So I'm doing things that make myself more youthful. My heart age is younger than I am. My brain age is younger. My genetic age is younger. I still feel about the same because I don't feel old, even though I'm getting older. And you don't really feel something when you're taking a vitamin. May there's some exceptions to that. A B 12 shots. I'm taking people energy, so there's vitamin C. I don't think you'll be able to judge the effect of NAD by how you feel. Now, there is an NAD blood test that you could do to see where your level's at. They're not widely available. You can talk to your doctor about finding somebody to do an NAD blood test to see if you're low, if it's low, then you can talk to your doctor about supplementing NAD in some form, either NAD supplement or NMN supplementation. As far as the NAD injections, I'm not currently recommending that to our patients because there's no evidence that works better than oral supplementation. And it is very much kind of a pain to do because you have to put an IV in to run it very, very slowly because it has significant side effects if it's run too fast. So, and I have tried it myself before. Try everything. I gave myself a subcutaneous shot and for like an hour. I feel terrible. I've done a slow IV push, which you don't really feel much from it. The oral NAD is something that I take daily. It's a NMN form. I take a gram a day and my workout drink and I've got a supply of it. Worried about it not being available anymore. I've heard from the current company trying to make it into a drug that you should freeze it if it's going to be sitting there for a long time. So you buy a couple of your supply and put in the freezer, make it more stable and take it out, you know, the month before you're going to use it. But the jury's out on whether or not this is really going to be an effective drug. These, some of these things have been hyped before. Resveratrol was kind of pushed by the same doctor. He was actually featured on the Wall Street Journal recently in the front page as being sort of. They kind of made like he was a quack. The statue Sinclair, he's definitely not a quack. He's a brilliant man. Met him personally and I've followed his work. He maybe over emphasizes what things can do because he is very. I think he's very enthusiastic. I think he's very, very legitimate and genuine. But he's the doctor behind the NMN, the scientist behind the NMN. He's not a medical doctor, he's a PhD. And this will be potentially a very expensive drug in the future, but something we could theoretically take now to impact aging. We think about these drugs affect aging. How do you measure aging? And I talked about this in other podcasts and blogs before. There's not a perfect way to measure it and we have disagreement on what exactly is aging besides a chronolog number? The way I've approached this is I look at several aspects that you're going to measure against other people of your own chronological age. So one would be your biological age on blood work. And there's a few companies that do this one is Function Health, that I've done that myself. And one of them is called Inner Circle, then that one myself. And these are looking at various chemistries that are very simple chemistries and say how do you compare to other people in your age group? And are you more associated with people younger than you or older than you? So that's a good general way. And it's not perfect, certainly imperfect about debate about whether or not this is valid. I'd say it's definitely imperfect, but it is valid. If your blood work looks like a person much older than you, probably should take some attention. If your blood work looks like somebody much younger than you, probably do a lot of the right things. There is epigenetic age and telomere age. So telomere age, these little ends on your DNA that say that you're potentially losing portion of your DNA faster or slower. And there's epigenetic age, which is these little things called methyl groups put on part of your DNA. They're keeping track of your aging. So those are ways we measure aging. Again, imperfect. And we don't really know the exact clinical implications if you become younger than when you started measuring it. But we do know that people that are going to die prematurely have an older epigenetic age than their peers. If you were to live longer, have a younger epigenetic age, and that's pretty well known. Then we have things like your physical performance, VO2 max, which is a measure of cardiac output strength, bone density, cardiac age, which can be measured by CIMT, CaroTid Intima Media thickness test with ultrasound that can tell you how old are your is your cardiovascular system versus your peers and your same sex and race and neuro. Quantitative aging, which is a measurement of your brain age. Again, it's just a volumetric measurement comparing it to other people. So if you are thinking about NMN or other similar anti aging compounds, it's probably not a bad idea to get some baseline testing done so you can see where you're at. And even before doing supplementation, you'll see a functional health provider that can walk you through things you should do personally for your health, be it diet and exercise and basic supplements, maybe even some drug therapy to optimize your current health. Before we start jumping on to supplements that have no definitive evidence of effectiveness, they're not known yet. Once they are known, they become a drug. That's one thing that happens. If something does in fact reduce aging, the FDA will declare it a drug and make it make it a prescription only right now the government and the FDA does not have a way to measure aging so there is a study right now called the TAME trial that's aiming to set some standards for what aging really is. For the FDA that's not done yet. Who knows if that'll be fruitful or not but we will see. So NAD supplementations I'm saying that there's probably some promise to it. I'm doing it myself. I don't routinely recommend this but when people are doing anti aging with us we do recommend that and I'm not recommending it as a across the board but I'm saying something you should maybe look into NMN orally seems to be the most bioavailability bioavailable NAD injectables probably not necessary. I'm not saying not to do I'm the same it's probably not necessary. Oral is probably sufficient and it does work on a genetic pathway that has a positive effect on aging. Thank you.