How Supplementing With NMN Can Increase NAD levels, Energy, Reduce Inflammation, And Improve Insulin Resistance with Dr. Andrew Salzman

Coming up on this episode of the Doctor's Pharmacy.

There are inflammatory changes that are chronic or subacute where NAD is actually regulating the amount of inflammation in the cell and that has a whole effect on the development of injury to our tissues, cancer development, lack of healing. Hi everyone, it's Dr. Mark.

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And now let's get back to this week's episode of the Doctor's Pharmacy. Welcome to the Doctor's Pharmacy. I'm Dr. Mark Heimann. That's Pharmacy Within an F.A. Place for Conversations that Matter. And if you are curious about longevity, which I imagine many of you listening are, and you may have heard about something called NAD or NMN or NR or sirtuins or supplements that you can take to potentially extend your life and improve your health. You're gonna love this podcast because we have an expert today, Dr. Andrew Salzman, who's a physician and inventor, professor, he's a biomedical entrepreneur. He lives in Israel right now. He's received his medical degree from Harvard University and spent decades in drug discovery and development He's raised over $165 million in the NIH grants for research, which is astounding. That's a lot of money. It doesn't give away that much. In addition to 50 patents, Dr. Salzman is credited with a breakthrough discovery in how cells repair their DNA, which led to the first clinical application in the world for successfully treating breast cancer caused by mutations in BRCA1 and BRCA2 genes. So he's benefited so many people, millions of people have benefited from his discoveries in areas including mitochondrial health, gastrointestinal microbiome, the damage caused by inflammation and oxidative stress to human cells and DNA, autoimmune disease and cancer, all the things we.

Like to talk about on the Doctor's Pharmacy.

So welcome, Dr. Salzmann. Welcome. Thank you. Thank you very much for having me here today. Well, I'm really excited to talk to you because, you know, as many of you listening today know, I wrote a book called the Young Forever about how do we enhance our health span, increase the time we're healthy in our life, and potentially expand our lifespan. There's been so much research on this lately that has gone really deep into the understanding of the mechanisms of aging, we call the hallmarks of aging. In those hallmarks, there's a lot of data and information there. But there is something that's really important, which is how we regulate energy in our mitochondria, which is really the key energy producing units of our body. When we eat and we breathe, we produce energy called ATP. And in the mitochondria, that's where we do it. And it has to be functioning well. They have to be actually efficient, effective. And as we age, they decline in their number and their function, their efficiency. And that's kind of why we get old and slow and tired. So there's been an amazing compound that's been the subject of intense research. you might have heard about called NAD or nicotinamide adenine dinucleotide or something like that. It's a big fancy word and it's a driver of our health longevity in many ways. So can you tell us what is NAD? Why is it so key as a driver of our health longevity and just give people sort of a high level background about what we're going to be talking about today, which is mostly about NAD.

Okay, sure. So when the cell produces energy, it's actually a complex mechanism. It starts, of course, with the food we eat. and ultimately that fuel, that food that we ingest is changed and modulated until ultimately provides molecules of energy that the cells can use throughout the body. And NAD and the mitochondria are absolutely central to that process. When the sugar or protein or whatever we eat enters the cell, it enters into various pathways and in these pathways, the food stuff, which typically as an example might be glucose, is then modified and cut and shaped and NAD plays a critical role in this process. There are three separate sequential processes in the cell which produce the ATP and in each one of these NAD is generated to a certain extent and without that NAD we ultimately cannot finish this sequence, this cycle, which leads to ATP. So NAD is sort of the agent that goes from the food to the final product, which is ATP, which we can use. In the absence of NAD, you can't make ATP. So NAD is a central part of life. As we age and as we have various processes that reduce NAD, we are putting a number of factors in this process. For example, we can't make ATP as well. So when you're 20 years old and you're running down the field with a football, you've got a lot of NAD and a lot of ATP. When you're 60 years old, you start to notice quite a difference, of course. And look at the muscle of a 60 year old or of an 80 year old, because when we're 80, we're still doing a lot of stuff today. But what you're going to see is there are fewer mitochondria, these powerhouses of energy, there are fewer of them. That's a problem. But within each individual one, they're not making enough NAD. And of course, they're not making enough ATP. Now, if you're a couch potato, you're sitting there and you're watching the seven o'clock news, you're probably not going to notice that. But if you try to run up the stairs carrying some groceries or, God forbid, run down the football field at the age of 70 or 80, you don't have the capacity to ramp up and generate the NAD and ATP that would be required to be competitive with a youngster. So we start to feel it as we get older. Now, in the overall picture, this NAD deficiency is much more than just energy, although energy, let's start with that discussion because that's the key point. but there are other things that I will come to which show the broad effect of having lower NAD. So it's not just energy, but focusing on energy. We now know in humans that with time, with age, every year it's a little less NAD available to us. We know in animal models if we artificially suppress the amount of NAD, those animals can't perform as well. And we have even more data which show that if we supplement and restore and bring back the levels of NAD to where they were when we were younger, we can do a lot more. So NAD is a critical factor in our energy. Now, what's interesting recently is that this whole story of NAD has been tied into other mechanisms and other pathways in the cell that we didn't realize. For example, we now know that NAD is involved in inflammation. It's involved in pain. And as we get older, we're all feeling a little bit more painful, and we're also having loads of inflammation. We have more inflammatory diseases. So this deficit of NAD as we age is really causing a broad effect on our health.

Yeah, it's so important because, you know, I think as we're sort of unpacking the science of aging and longevity, which really has been neglected for way too long in medicine, we're understanding that there are underlying pathways that are in the body that are designed to repair, regenerate, renew, heal, and optimize our health. We just screw them up by how we live, what we eat, how we don't move, stress for under environmental toxins all mess up these ancient survival pathways. And there's thousands of genes that regulate the process of actually healing, repair, rejuvenation, and renewal. And we see these decline as we age, but at any age it's possible to actually activate these pathways and reverse that process. So, NAD seems to be really a key part of the story. And, one of the hallmarks of aging that I talked about in the book, and it's really an important one, I think probably the most important, is the deregulated nutrient sensing, in which there are four key pathways that are sensing your nutrient environment, mTOR, AMPK, sirtuins, and insulin signaling pathways. And, NAD works specifically on the sirtuins, to stimulate sirtuins when there's low energy states, right? So can you explain what NAD does in the process of helping us to regulate the sirtuins, what the sirtuins do, and why that's so important in longevity and aging? Because I think people need to understand the science behind why everybody's talking about NAD and NMN and NR and all these compounds that sort of have nice alphabet soup, but what the hell do they do and how do they work in the body on these ancient preserved pathways that can be activated to optimize our health.

Well, there are a number of different pathways that are both immediate and intermediate and then long term. And NAD seems to be playing an important role in all three of them. So in the most acute situation where you have an acute stress, where you've lost function or you've lost blood flow, like in a myocardial ischemia where you have a heart condition or in a stroke where you've suddenly lost blood flow to your brain, these are instantaneous problems. These are immediate problems. And those settings, NAD plays the dominating role because it is regulating the ability of the cell to survive in an environment where oxygen's been suddenly removed. So we can classify a whole bunch of conditions that are instantaneous that we have to deal with, and that involves PARP, which we'll come back to later, but there are pathways that NAD is regulating or is a substrate for, which we must have for an acute problem. So those are the acute instant problems. There are inflammatory changes that are chronic or subacute where NAD is actually regulating the amount of inflammation in the cell. And that has a whole effect on the development of injury to our tissues, cancer development, a lot of a lack of healing. So when we look at processes like diabetes, metabolic disease, liver disease, and there where there's colitis, where there's chronic inflammation, as we age, that is also very important with NAD. As we get into the longer term changes, we're talking about genetic changes or regulation of genes, and I think this is where you were coming at. And in sirtuins and PARP are presently known to regulate a lot of the different upregulated or downregulated expression of key genes. So in the case of sirtuins, for example, NAD is a necessary cofactor. they don't function without the presence of NAD or they function a lot less. They modulate genetic transcription so they can upregulate and depress various genetic changes which become important in aging and disease. In the case of PARP, our own.

Research showed- Can you just define what PARP is? Because I think most people have never heard of that before.

Yeah, PARP is actually the most abundant protein in our nucleus. It is a protein that sits within the nucleus, which is the center of the cell where all the genetic material is housed. And there it is responsible for ensuring that the DNA is in good health. So DNA is a very long, long molecule, and it can be influenced or impacted by oxidants. We're always exposed to oxygen. We're in an oxygen breathing environment, and we have defenses against those oxidants, but some of them slip through. and when they do so, they can go right into the nucleus of our cell and they can actually alter our DNA. So our genes can actually be damaged after we're born by some kind of oxidant stress and they're damaged in very different ways. But one of the most important ways is called a nick, where the oxidant into the cell and it actually cuts like a scissors. one DNA strands. We have two strands, double helix. But if you cut one of them, it's called a single strand break. And this is a very damaging effect on the cell. If it accumulates, it can cause cancer. So we have all kinds of mechanisms in the cell to make sure that when we have damage to our genetic material, it's. It's rapidly repaired. And part is the key enzyme that does that. It's a key enzyme.

And that's mediated through NAD.

Well, when HARP recognizes, when the enzyme is recognizing that there's a break, it grabs onto that break, it holds on for deer life, and then it pulls in NAD around it and makes a long chain of that NAD, which helps do the repair. So you, which is a good thing. So if, because you want to keep your DNA repaired. and if you have enough NAD, you can affect the repair and your cells stay in good shape. You're not allowing the DNA to be damaged. So having NAD around chronically is very good. We know that animals that are deficient in PARP, we can actually make animals now that don't have the enzyme. These are genetic mice and they are much more prone to cancer. So having a constant way to repair your DNA as you get older, is absolutely essential and PARP is the enzyme that takes care of that. So NAD is absolutely essential to having healthy PARP, having sirtuins operate at the right level and causing the up-regulation and down-regulation of various genes so that we stay balanced. And as we lose NAD, this balance falls apart and we start to see dysfunctional gene expression. We start to see injury to various tissues which can kind of cascade as we age. So NAD plays the critical role and maintaining that NAD level all the time becomes more and more of a challenge as we get old because we're starting.

At a lower point. Yeah, so NAD levels decline with age. But what's really interesting about what you're saying is that the body gets maybe 100,000 little nicks to its DNA every day, right? That by a thousand cuts, but the body has its own built-in repair system. like a repair truck that goes out. And this part is a key part of this repair system. And the NAD is also involved in actually activating the sirtuins, which are part of this repair system. Is that fair to say?

I think most people don't recognize that to be in health, it's not just a matter of the body doing a lot of good things to keep itself. It's the defense. The body is on defense, like a football team. And in the case of defending ourselves against oxidant stress and injury, the body has a host of mechanisms and all of those are important. It's like losing, you know, somebody in the front, the tackle or something in a football team. If you don't have a good defense, you don't need a lot of offense to win, to get in trouble. So the defense, what are the defenses in the cell? How does the cell protect itself all the time? Well, first of all, we have evolved mechanisms to take care of these oxidants directly. We have antioxidant enzymes actually sitting throughout the cell, around the nucleus, and inside the nucleus. And those enzymes, when they see an oxidant, they come right in on it and they remove it. But in order for them to do that, they have to have ammunition, if you will, to defuse the oxidant. And what is that ammunition? It's a special molecule called glutathione. to neutralize and take out this oxidant stress. So glutathione, it's the weapon they're using. Well, where does glutathione come from? It comes from a process in the cell which is completely dependent on NAD. So if you have NAD in the cell, you cannot produce glutathione. And these enzymes, they may be there, but they can't work. So NAD is absolutely essential to protecting ourselves from the oxidants, the very oxidants themselves. Okay, so we have antioxidants. That's the first line of defense. It's immediate, very fast, very effective most of the time.

Now, so that's fascinating that NAD actually boosts the enzymes in the cell that actually can make glutathione, right?

Every cell in the body has to make glutathione or it perishes. And within the cell, there is a special donor, electron donor called NADPH. which builds the glutathione. And this molecule, NADPH is absolutely essential to us and it comes from NAD. So without NAD being around, we cannot defend ourselves from immediate threats in the oxidative sphere. Beyond that, if one of these oxidants slips through the line, it's running towards the quarterback. Okay, so the front line failed. There has to be a defense, right? Something there to protect that quarterback. And in that case, the next line of defense would be this repair mechanism. So the injuries happen, the quarterback got hit, but he has to get back up again fast and keep working. The cell has mechanisms built within it to repair the damage that's occurred. And PARP would be a classic example of that. So NEDD is at every stage. It's the initial stage on the front line preventing the rusher coming in, and then it's back farther, if there's injury that's happened, it's there to heal. When NAD levels fall, none of these things are there and the whole cell starts to run into trouble. And eventually, if it spirals out of control and it cannot recover, that's when the cell dies or perishes. For example, I'll give you a classic example. Someone has chest pain and they find out they're having a heart attack, so they're not getting enough blood flow into their heart. The muscle of the heart is suffering. It's ischemic. so that is an immediate threat to the viability of the heart itself. There's all these oxidants flooding in right now. Glutathione is right there, NAD is doing everything it can to get there, but if the NAD levels are not sufficient, the glutathione levels fall, and now the injury goes one step further to the DNA. You get the fix, then PARP is activated. NAD rushes in, tries to help there. all of these things are good and they can keep you from having a full-blown heart attack. But if at any point the NAD levels go too low, that's it. And at that point, the ATP cannot be produced, the glutathione is not made, and you have cell death. That is an infarction where the. The tissue is actually died. It's necrotic, and it won't recover. And this is. This is the most severe situation.

So.

So NAD is playing a role at every level, trying to protect us from that chronic stress and then acute stresses like. stroke and heart attack.

Yeah. I mean, what you point out is so important because so many of the diseases of Aging, like heart disease, cancer, diabetes, dementia, those are just way Downstream from all these mechanisms that go wrong that we can influence. And that's what scientists are now talking about. If we address the underlying root causes of Aging, the Hallmarks of Aging, which NAD in part does a lot of, we can actually do a huge job in preventing and even reversing some of these diseases. And that's what's so exciting to me. I think we, like, are reaching a turning point in healthcare and medicine where we're understanding that the root causes.

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Week'S episode of the Doctor's Pharmacy. What's really interesting, I want to unpack this a little bit because you basically said that we need NAD, which helps us create energy in the cell, but also is involved in regulating antioxidant status. It's involved in DNA repair and our epigenetic programming. But it also has all these cross-purpose actions. When you activate sirtuins, which NAD does, one of the main actions of NAD is to activate the family of sirtuins. These signaling proteins, they work on many of the other pathways that relate to aging, for example, mTOR, which is regulating your protein synthesis and inhibiting and regulating autophagy. So it helps inhibiting mTOR and helps stimulate the cell cleaning and repair recycling called autophagy. It reduces inflammation by inhibiting a big transcription factor that turns on all the cytokines in your cells called NF kappa B. It activates FOXO, which is another regulator of antioxidants in your cells. It helps to reduce oxidative stress by the mechanisms you mentioned of increasing glutathione, but it also activates another family of transcription factors called FOXO. which increases antioxidant enzymes that are built into our system. It can help reduce cancer by activating the tumor suppressor gene called P53. It helps your mitochondria make new mitochondria and improves the efficiency. It helps improve insulin sensitivity. It activates AMPK. It regulates our circadian rhythms and clocks. So, it's such a multifunctional substance. You think you take a drug for one pathway. I'm taking a cholesterol drug for lowering my cholesterol, blood pressure drugs for lowering my blood pressure. But the beauty of these natural compounds that are our body's own medicines is that they work across the board on all these different pathways. And there are many redundancies in the system so that it's not the only thing that regulates these pathways. But that's what I think makes NAD so powerful. What are your thoughts on how all these things connect and how NAD has these multiple functions?

I think 30 or 40 years ago when I was in medical school, We went from class to class and we learned about different diseases.

Yeah, me too.

We had a rheumatoid class, we had a stroke class, and we were told that there are these diseases that people just get, right? I mean, suddenly a Parkinson's disease or suddenly you have diabetes. And so we would study diseases, and this is sort of how the specialties develop, right? But I think it's come full circle because what we really understand is that it is, there's really one fundamental disease, which is called aging. And then these other manifestations which we see, which we call diseases. Oh, I have Parkinson's disease, but no, you don't. What you really have is a sequential accumulated process of aging that has dysfunction across multiple pathways connected to each other. And then we suddenly have what we, oh, you know, we're 65 and now we we have diabetes. Well, where did that come from? But it's not just like a hit or miss thing. It is a sequential process. And as you get older and as this aging process inevitably drives forward, all of these mechanisms are at risk. And eventually one of them or more of them becomes a disease that we can categorize and call a disease. But really, it's a generalized process. And NAD is at the epicenter.

Of all process.

So one different way to think about disease management, I mean, yes, we need diabetologists, we need all these good people who do all these good things, but fundamentally, we need to slow and arrest or reverse this overriding, inexorable aging process that is starting to degrade all of these different pathways together. And so the search is on now for more broad spectrum or more fundamental approaches than just disease specific ones. And as we look at NAD story, what better candidate could there be than something that underlies energetics, pain, inflammation, immune response, DNA repair, tissue repair, signaling and all of the, I mean, this is a fundamental currency, right?

Insulin sensitivity, all that, right?

Right, I mean, like we have currently, like we carry a dollar bill in our pocket, we can buy many, many things, but they all go back to you better have that dollar bill. So NAD is a fundamental driver of all of these processes. And you just mentioned many mechanisms, but there are many others that we don't even know about yet. I mean, over in our research, we're looking at new pain pathways that are related to NAD. We didn't even know about this until recently. There's a whole of pain related problems that have to do with NAD deficiency. Recently, there's been a whole lot of research on prostaglandins and inflammation from NAD deficiency. We didn't know that. So all of these separate things that we talked about and that we see in our patients, they're starting to come together to a final comment or final initiating pathway. And we better understand that pathway and then learn how to manipulate it, how to help it, how to restore it. and that's where my interest is in.

Well, I tell you, I'm barely able to sit in my chair right now and not jump up and down and scream hello, hooray, yay. Finally, somebody's getting it. Because I've been singing this tune for a long time. And when you start to look at systems biology and network medicine, what we call functional medicine, it speaks exactly what you're talking about. The diseases are just leaves on the trees. We need to go to the roots in and the trunk of what's really going on with their biology. And it has to do with exactly this thing that you're talking about, which is this dysregulated function that accumulates over age that we can actually intervene with and create health. And then all these diseases either would prevent them or they go away or get reversed. So that's, that's what's so beautiful about our kind of understanding of longevity science. Now it's sort of peeling back the layers and people are going, wait a minute, aging is a disease. These are processes we can treat. There's a way to think about this differently. The diseases aren't all these separate things. They're all connected by these common roots. and it has to do with everything you're talking about. And so when you look at NAD, the mechanism of action, it does so many different things from DNA repair to the activation of sirtuins to increasing energy production in the cell to lengthening our telomeres which shorten to making new brain cells and making new brain connections, reducing inflammation, boosting mitochondrial function, improving insulin resistance and exercise performance. It's really quite remarkable. I remember David Sinclair told me about a study where They had a mouse treadmill that only goes to like, I don't know, one or two kilometers. And they never saw anybody like mouse go longer than that. And then when they gave them NMN, the thing just kind of broke the treadmill because it was like, went three kilometers or something.

The secret now, or the trick now, that once we've recognized this is how do we get NAD levels back up? How do we preserve them? How do we preserve people who are reasonably healthy? and give them optimal performance? And how do we help people who have low NAD who are in trouble and get them back to a reasonable level? So to do that requires, like any medicine, it means giving something to somebody that they're missing. So there's several ways that initially people started giving NAD. It made sense. You have low NAD, give the person NAD. The problem with that is that NAD is a chemical or a molecule that's made inside cells. And it's so valuable and so important to the cell itself that the cell is very clever and it embeds within NAD, it changes the molecule in such a way that it can't leak out. It's precious. And so NAD has been designed to stay inside the cell. And if you give a person NAD, it won't fall out of the cell once it's there, but the big problem is it won't get into the cell. So if you have a lot of NAD, that's great. It's all floating around doing all this stuff, but in order for it to work, it needs to be inside the cell. Now getting NAD into a cell is no mean feat because you've got a problem there. It's designed not to cross cell membranes. So what do you do? so you see all these health products out there, you know, take NAD, take this pill, it's got a lot of NAD, but the problem is, yes, you can get it into the body, but you can't get it where it needs to go, which is inside the cell.

Interesting.

But created the interest in other ways to boost NAD. So what people did is they said, well, where does NAD come from naturally? Yeah. How does the body make NAD? Well, it turns out that there are two steps along the way. first, there's something called NMN, and then there's something called NR, and then there's something called NAD. And so they thought, well, if we give the molecule before you get to NAD, that can cross the cell membrane more successfully. It can cross the gut. When you swallow it, there are all of these good things that could happen. Maybe if you took a precursor, an earlier step. So you'll see all these products now that have something called NR. Right, so nicotinamide riboside. Yeah. There are studies and cell studies and human studies looking at NR and it seems to do good things. First of all, it gets in a little bit better than NAD, but more importantly and significantly, you can see the NAD levels go up in the cell when you take NR. So that was a good thing. And then people went out to the ultimate step, which was to give NMN. and they ask, is this a good way to deliver NAD? Will this, will this do it? First of all, when you swallow a pill with NMN, it crosses into the body a lot better than NAD and NR. And that's because the body has created a special shuttle in the cell that recognizes NMN when it's outside and provides a lovely tunnel, if you will, for it right through the membrane and end up on the inside of the cell. So the body has neared a way for NMN to get in there. And of course, once it's in the cell, that's great, because then it can be sliced up and form NAD and all is good. And that's been shown. So we now believe that the most efficient way to deliver NAD is actually not NAD itself, but it's in the form of NMN. And that's why our focus has been to use NMN to make these necessary changes to boost NAD.

Interesting. Now, just to kind of loop back for a minute before we want to get into the delivery forms and what it does and so forth, do you know why NAD levels decrease as we age? Is this inevitable? Is there a way to prevent it? Can we naturally increase them? Is there any understanding about how that may work?

No, there really isn't a lot understood on that.

Okay, good. I thought I missed it, but I thought maybe you knew because you're the expert expert, I'm like.

Let'S just go, let's talk about where it's actually made. The first part is when you take sugar, and again, glucose is a good example, and that is broken down by glycolysis, and there you get something that's spun out. The next part is a cycle called the Krebs cycle, and in that you take what comes out of glycolysis and you whiz it around with all these different enzymes and you make more NAD. And then the last step, is where it enters the mitochondria, which is the powerhouse of the cell, the ATP unit, if you will, of the cell. Mitochondria, the NAD is grabbed ahold of, and it is used to fuel the production of ATP, which is the ultimate thing which comes out of the mitochondria. So those are the three different things. If I had to guesstimate where the deficit lies, it's almost surely in the last one. So we don't think that as you age, you lose glycolysis and you lose the Krebs cycle. We think the mitochondria are really the point where with aging we start to see this degradation. It's not just, first of all, it's in the number of mitochondria. Let's take a professional basketball player and they run up and down the court for 60 minutes. They're not even sweating. how on earth would that be? If you take the muscle out of someone like Michael Jordan, you will be astonished what you see under a microscope. It's not normal at all.

The number of mitochondria can jump over the rim.

And I'd imagine the amount of mitochondria in that muscle. So, when he takes a quiet breath, he's producing so much more energy than I could ever even imagine. That's why he can run up and down the court for 60 minutes because he's just loaded with these mitochondria bulging out everywhere in the muscle cell. Then take the same guy, and he's now 75, and he's still working out, still doing his thing. If you look at the number of mitochondria in his cell at that age, it's fewer. Now, why is that? Well, in the last five years, we've learned a lot about what controls the number of mitochondria in your cell. There's actually a pathway that tells us, tells the body how to make or when to make or how many to make of these mitochondria. So we now know that one of the stimuli, for example, is low oxygen tension. So if you were to exercise, you're using up your oxygen very quickly and the muscle is in a state where it doesn't have enough. It's hungry. And that is a powerful stimulus to make new mitochondria. that's why a guy who's 75 who works out every day, he will actually create new mitochondria. Whereas someone who's a couch potato, he has no stimulus and so you won't see those mitochondria being formed. So the aging process diminishes our mitochondria and that's probably, can't say for sure, but this is probably the prime reason that NAD levels fall with age. It's pure mitochondria.

Yeah, that makes sense. That's interesting because you look at some therapies that are used for longevity, for example, they're like hypoxia therapies. And so, when you look at Vilcabamba in Ecuador, they live a long time because they live at 17,000 feet. Maybe it's because of that. Or maybe when you use this technology called the Cell Gym, which essentially takes you up to Mount Everest and then back down, it makes you hypoxic. It activates your mitochondrial production. Or, when you use these hypoxia masks that athletes do, or when they go to the altitude to go train for running a marathon, they'll run it you know, 7,000 feet when they're going to run it on a thousand during the race because it actually helps them build more mitochondria. So, it's really all about little tricks and building muscle through strength training, through the right amount of protein, through actually using some of these compounds like NMN can actually help to maintain and actually activate mitochondrial biogenesis making new ones and mitochondrial bioreenergetics, which is the efficiency through which we make energy in ourselves, right? Is that fair to say?

I think there's so many serious athletes who exercise at elevated altitude for that reason and it provides them, well, I mean, you'd get the same thing, I suppose, if you're doing a lot of activity even at sea level, but being at an elevated altitude forces you into this domain where you're already stressing your system with hypoxia and athletes who train at an elevated altitude and then come down. are in far better shape, right? So they have a lot more loading of mitochondrial, we call it mitochondrial biogenesis. And that's just, we now know how the hypoxia is actually influencing the creation of new mitochondria. We know the molecular pathway. We know the molecules involved. And those, they haven't yet, but those will become drug targets.

So useful hypoxia factor, things like that.

Hypoxia induction factor, HIF, responds to low oxygen environment. But, what would happen if you had a drug that could turn that on? I wonder if that's how blood restriction exercise works.

Is it some blood flow restriction where you put, let's say, a blood pressure cuff equivalent on your arms or legs, and then you weight train at much lower levels, but you get far more exhaustion sooner and it actually increases muscle synthesis better than regular string training, which is really interesting.

Sure. Yeah, it's the same mechanism. And I think that we can do that through being active by exercising. And ultimately, I think there will be nutrients that stimulate mitochondrial biogenesis. There should be research going on both in the pharmaceutical space, but also in the natural health food space.

Yeah, for sure.

Things that we can eat on our own or drugs that we can take perhaps. but we can change our lifestyle through what we eat if we can identify diets that potentiate HIF and other factors that turn on mitochondria. And I think that's a wonderful area of research.

Amazing. So we're going to go into the forms of mitochondrial support with NMN and NR and talk about the differences. But before I do, I want to talk about a few other topics related to NAD, which has to do with sleep. It seems like there's a benefit to sleep as well, which I think I've never heard about. And there's a new study that came out that basically found that people who were part of this study and took cannabidiol had better sleep duration, better deep sleep, better REM sleep, and reported better overall improvement in sleep quality. Can you comment on how that would work? I don't understand the mechanism.

Well, I think there are two aspects there. First of all, there's the control of sleep. We know that that sleep deficiency leads to a loss of energetics, loss of focus, a loss of peak performance. So some of that has to do, of course, with the brain in terms of it going through the processes that it needs to. But also we know that sleep is a systemic phenomenon and it allows muscles, really all of our tissues, to recover during the day. So NMN, and this is an early area of research, if NMN can potentiate better sleep, that's going to translate in a better systemic response. You're more rested and you've had a better chance to recover. So there's that effect at the central level with NMN on the sleep process. And some of that may have to do with regulation of sleep centers. We know, for example, that sleep is highly regulated by metabolites that have to do with energy. The main driver of sleep is adenosine. And adenosine is accumulating during the day as we're thinking and we're doing all of these things. Little by little, we're breaking down ATP because the brain uses ATP in a way that no other organ does. The brain is consuming a vast quantity of ATP way out of proportion to everything, including our muscles. The brain is an ATP consumer. huge amount of. I think that's 25% of the energy in your body is in your brain.

So.

So that a prime area where you can't keep up and you can't by the end of the day, by nine o'clock or 10 o'clock at night, it is well documented that you have not been able to regenerate all of the ATP you've used. There's always a continuous deficit from the moment you wake up. you are not keeping up. Nine or 10 or 11 o'clock at night, you have wasted enough ATP that you cannot regenerate that the end product that, which is the adenosine, the final breakdown product, has accumulated. And adenosine is what causes drowsiness and ultimately sleep. I mean, ultimately you.

So does NAD improve and adenosine production? Is that what you're saying?

So you, you, the NAD is responsible for taking the adenosine that's forming during the day and driving it back and, and getting rid of it and keeping it low by pushing it back to ATP. Adenosine is used to make ATP. So when you have ATP, it breaks down to ADP and then to AMP, and then the AMP is broken down to adenosine.

Oh, adenosine. Oh, gosh, I can't believe I just got that adenosine monophosphate, adenosine triphosphate. Yeah, that's ATP, AMP, okay. Adenosine, right?

Of course, yeah. I've never put that together. If you looked at the brain at six in the morning, what is there? It's ATP, everything's fine. You wake up, you feel good. You can conquer the world. By four or five in the afternoon, you've already got adenosine there. Some people even take naps as they get older. By the time it's 10 or 11 o'clock at night, your ATP levels are low and your adenosine levels are super high, and adenosine directly influences the, it's a part of the brain in the midbrain, which controls your arousal, how awake you are, and the adenosine directly causes you to feel sleepy. When you're driving down the road in the morning and you can hardly keep awake, your brain is flooded with adenosine, very dangerous to drive. And so what you need is to do one of two things. Either get rid of the adenosine, which is called sleep, is the best way to do that. Or you can take a drug which blocks the adenosine from binding to its receptor. So even though you're swimming in adenosine, you can block the adenosine from activating the adenosine receptor. And I would say that 99% of the American public does this every day because it's called coffee.

Coffee, coffee.

So some people even have a problem in the morning and get going to work. You know, they get up and they drink two cups of coffee and it's really unnecessary, frankly, because you don't have much adenosine at six in the morning. If you good night's sleep, that is. Now, if you haven't had a good night's sleep, you haven't had time to remove all the adenosine and you need your coffee at six in the morning to block it. The better thing to do is to get some good sleep. But if you want to stay awake and alert and bright-eyed and bushy-tailed, people drink coffee. It's a natural adenosine blocker. So that is the whole adenosine story. Now, NAD is there in the brain to take adenosine and turn it back to ATP. So if we had sufficient NAD around, we would be able to go through the day with a whole lot more energy and a lack of sleep.

And then when we want, we do sleep, it improves the quality of our sleep.

Yes, because it's helping us to get rid of the adenosine. Sleep is about many things. Fundamentally, we've got to get rid of the adenosine that accumulates during our day. That's our job.

Got it. Interesting. All right. So, okay, next question has to do with a research paper that came out in mice. It got a lot of play, which basically got everybody in a kerfuffle, which is that NMN NAD causes cancer. Can you speak to that study, the challenges with it, what's true? Because you are an expert in cancer. A lot of your research has been on cancer. You know this stuff inside out. So can you unpack this for us and help us either understand why there's a problem or why there's not a problem?

Well, look, it's one lab that's very focused on this. God bless them, but they're doing the Lord's work looking at this. But still, it's one lab, but it hasn't disseminated to other labs which have shown this. Okay, let's take this guy and give him all the credit in the world that he's doing a good job. Let's walk through those. If you give NMN in cells that you have the potential to actually stimulate tumorogenesis. Well, what he later shows, and it wasn't discussed initially, is that it's not the NAD levels that are causing the, it's not the NMN that's causing the cancer per se, it's that he created artificially a very unusual metabolic scenario. He dumped a bucket of NMN into the cells and there was so much NMN that it overwhelmed the NAD. So you had a ratio of NMN very, very high and NAD was normal, but the ratio was crazy, crazily in favor of NMN. And that can't happen. And later studies have shown that if you have very low NAD and very high NMN, yes, that has the potential for causing tumorigenesis. But can that really happen? No. Normally, if you ingest NMN, it doesn't hang around and mind its own business. It's converted to NAD. That's what happens to NMN. It's not just saying hello, I'm here. It is rapidly transformed because it's a precursor into NAD. So you don't get this wild abnormal ratio of high NMN, low NAD. It's not going to happen in nature. Now, maybe he speculated there could be people with a genetic defect where they can't convert NMN to NAD. I don't know. I mean, in theory, yes, you could have someone with this condition, but I haven't seen it identified yet. So under normal conditions where NMN is converted to NAD, I don't think that scenario can ever play out. It was an interesting lab trick, if you will. It's good to learn new things, knowledge is power.

Yeah, so what you're saying basically is he created conditions that would never happen in the living organism in the test tube that actually could never be replicated. It might potentially cause cancer. So in a mouse. So we're so far away from this being actually a viable scenario for humans.

That you don't think it's an issue. Yeah, not right now. Now, I think we should continue to all do research and that's a good thing. I'm in favor of research.

I'll vote for that. Not worried right now about that. Now, what was really also interesting on the positive side was it was a really interesting clinical trial on NMN that was in humans because we've done a lot of research in animals and David Sinclair and those guys, Len Guarente did a lot of work on sirtuins and found resveratrol could extend a life by a third of rodents by taking this compound that stimulated sirtuins, which was what NAD does. But it turns out that humans are important to study too. So, we need to study not just yeast and mice and so forth. And there was a clinical trial in a man that I thought was pretty impressive that I thought would talking about both the safety, the efficacy, and what it did in people who were middle-aged. It was a double-blind, randomized, multi-center, placebo-controlled, dose-dependent clinical trial, which is the highest level of research you can do. Can you tell us about that study.

What it showed, what take homes were? I thought it was pretty impressive, actually. Well, what they're looking at there is basically the energy capacity of people, and in particular, the ability to walk, bow distances and they were able to show that there was a longer capacity to be functional. So you had more energy. And they looked at energy balance and they looked at insulin sensitivity and other things. And all of these things seemed to line up to tell a story that it was working. So although it's a small study, I mean, it's not a giant study and we know- Sure, 80 people, right? That's right. Yeah, it wasn't 80 or 800 people and it was a small number. and therefore the differences that are identified you can question statistically about if they're there to really write home about. But I think, you know, being in the right direction is positive. There have been a number of small studies like this and there was the six-minute walk test has been looked at and people can walk further, which is a holistic way of looking at the energy. Those are all positive, but I would caution the audience that all of these studies are still somewhat small. And I don't think we're there yet where we can conclusively say that NMN is going to be has been proven to engender more energy. In animals, yes, it would appear in humans. We also have evidence in cardiac function in humans. that the cardiac function is better, particularly in congestive heart failure. So there have been some studies, but as I say, they're early and we shouldn't jump to the conclusion that it's been proven. I think the pace of research will definitely increase and the quality of research. One of the problems with and NAD in terms of research is that it has not been yet driven into the classic pharmaceutical space. and these are very expensive, especially if they're- and right now the motivation to carry out a large randomized double-blinded placebo-controlled trial, which can cost millions of dollars, definitely, and it hasn't been there yet because the pharmaceutical companies don't own NMN. So when you invest $5, $10, $50 million in a study, you better believe or you must believe that you've got something that you own so that at the end of that, your evidence, your data leads to financial outcome, which means you can sell it exclusively. That won't happen, although there's one company in the US that's trying exactly to do that, to patent its exclusivity.

Yeah, I see that.

But this is the reason that NAD and NR and NMN have not enjoyed the large scale studies that you would need in order to exclusively, and it's a problem with all natural products.

And it was a promising study because I thought that, you know, they reversed biological age, they improved six-minute walking, they helped improve what we call SF-36, which is subjective quality of life. And these were people who were taking a, didn't know whether they were taking a placebo or the compound. So it was really well designed. But I think you're right, it was a small study. We needed to get more data.

I spent a lot of time in my life at the FDA. You know, we have all these fancy tests that people do and the audience may be that, but at the end of the day, and it's fascinating, you know, I was sitting there at the FDA and I was telling them all about these biochemical advantages of this and that. And the guy looks at me and says, I just have just a simple question. Can Mrs. Jones carry a bag of groceries up the stairs? better or not. That's it. Because if she can't, all of this doesn't count for much. And the six minute walk is a test where they take a person and they're on a treadmill. They say walk and walk as much as you can for six minutes. And we're going to keep track of how far you went. So if you could walk 200 feet in six minutes, You're hurting. But if you can, you know, like a mile, this means your health is great, right? Because everything is integrated, your cardiac function, your respiratory function, your metabolic status, your NAD.

Dr. Well, that would be a run. A six-minute mile would be a run. I wasn't able to do that when.

I was very young. But that's the point. That six-minute walk is really critical understanding the overall promise of a drug like NAD or NMN that can create and boost up the intracellular NAD levels. That's why in that study of all the things that I was impressed with more than the others was the fact that they could— Dr. Dean P. Was the walk. You can't fake that.

Dr. Dr. Dean P. That's great. Now let's talk about the practical application because there are people who recommend NR and there's companies that produce NR. there's companies that are making NMN, you can get NAD sublingually, like through liposomal forms, you can get subcutaneous NAD, intravenous NAD. And I'd like to have you take us through what's the pros and cons of each. One of the things I wanted to bring up was triggered by what you said earlier, is that NAD given as a compound can't get in the cells very well. And I had one experience with a patient, I read this in other studies, who had Parkinson's and we gave her IV NAD and her tremor went away, not permanently, but for the short time she had more energy and she perked up, was able to walk better. I was like, holy cow, this is impressive. But that would lead me to think that actually giving intravenous NAD can get it in the cell. So can you talk about sort of these different forms and the pros and cons and whether I'm just making this up about this woman or if there's actually something to that.

Not black and white. I don't want to say that giving NAD cannot enter cells, period. That's not correct. But it is impeded. It's not efficiently taken up. Now, having said that, there are hundreds of different cell types, and it might be that certain cells have such a quenching thirst for NAD that maybe they've evolved shuttle mechanisms for NAD. You're talking about Parkinson's disease, and that's a disease which ultimately is regulated by a very tiny but very important tissue.

Mitochondria.

And who knows, maybe those cells in the basal ganglia have a better ability to suck in NAD that other cells. So, I don't know. That's never been studied.

But it is a mitochondrial disease. Parkinson's is a mitochondrial disease. That's why I think it may be effective.

Well, Parkinson's It's a mitochondrial disease and it's also probably a disease in which the oxidant stress within certain select cells, these basal ganglia cells, it has been increased. And why it's been increased, you know, as anybody's guessed, the most recent research on Parkinson's that I've seen is really implicating tangles and what do you call it, precipitates from proteins from misfolding, very analogous to Alzheimer's, which is some new work that's come out with alpha-synuclein. And it's thought that these aggregates might impact the amount or way that oxidants are developed in cells. The whole cell starts to become a factory of oxidants and then injures itself. there are also Parkinson's patients who have fundamental deficits in handling oxidants. And so to get NAD into the cells of a Parkinson's patient might be, you know, it might be a very interesting way to look at that. We know that the model Parkinson's disease that are used today, the most important one being the rotenone model, which is from Emory University, Georgia, that is created by actually blocking the first protein, the first enzyme in the mitochondria. Yeah. In the transport chain. So, definitely Parkinson's is somehow related as an example of NAD failure because the cells are not generating. It's a deficit in the mitochondria. And what your observation, if it's correct, suggests that maybe in that particular disease, NAD might be good. But the advantages of NMN are that it is known, at least in the intestine, that there is a specific shuttle, or a shuttle is a protein that's present in the membrane of the intestinal cells, and it literally carries the molecule from the outside to the inside of the cell in a way that not happen. The cell that if it weren't for that, the. The NMN couldn't. The. The NAD or any. NMN. Without that shuttle, they can't get in.

Can't get in.

And that shuttle is like a smooth pathway that. That helps it across. So that's a reason from an oral perspective to suggest that NMN might be good. And those shuttles are within the body as well. It's not just on the intestine.

Yeah, but it's hard to get NAD because you have to take it intravenously or subcutaneously. And the beautiful thing about NMN and NR is that you can take them as supplements. So what's in between NR and NMN and why should we be more focused on NMN, which seems to be winning out the horse race?

The shuttle is specific for NMN. So even though NR is closer to NAD and it's easier to get into the cell, it doesn't have the advantage of a built-in shuttle that God designed to move that material from the outside to the inside. NMN is, first of all, NMN is a natural molecule, by the way. It's not just something we make NMN. And so this shuttle is there for a reason. It's to facilitate entry. And we're just leveraging that when we give it therapeutically. But that path, that shuttle is a fundamental issue. It changes the whole question about how do you get the stuff into the cells? that heretofore, NAD just doesn't cut it. Now, I do research with NAD and NR because there may be certain cells that function differently that we haven't examined. So we should continue that. And if you look at the literature, there's far more studies of NAD than NMN by many fold. So that was the beginning and it made sense. They knew NAD is important. Let's give it and see what happens. But I think the tide has changed and you'll see a lot more loading studies now where NMN loads the cell with NAD and that's going to be, there'll be a bevy of studies like that, clinical, animal and even cellular. You start to see a lot of that.

So you're saying that the NR doesn't have the same shuttle to get the medicine or the supplement or the ingredient into the cell as NMN, which has a specifically designed shuttle.

Yes.

Right? Okay, well, I wanted to talk about specifics and dosing and how we take it. There's a product called Wonder Feel Younger NMN or Younger NMN, which includes not just NMN but a bunch of other stuff. So, I'd love to talk about that product. I know you're involved with the company. I've been talking to them as well, advising them. Tell me why you think this is unique and different and what's important to know about it.

We began with the premise that NMN is important. NMN by itself is probably not the whole story because there are mechanisms within the cell that are very active as you age, as you have disease, and these are going to interfere with the benefits of NAD. We talked about that already, oxidant stress being the most important. So when you add NMN to a cell and you get NAD in there, it's good. to do it. It's going to increase the glutathione levels. It's going to mend all of the mechanisms, the defense I talked about. But you have a lot of offense, particularly as you get older. A lot going on in this. A lot of injury, a lot of oxygen stress. So to ourselves, well, let's build a front line, a defensive line that's more than just one guy. Let's build a whole defensive line. and with backups so that it's a team effort to suppress the damage of the aging cell. So we were not castigating or denigrating NMN in any way. It is the basis, as I said, it's the basis we're starting with, but we have supplemented that now with additional team players, each of which has their unique role and together as a team, in working in concert with each other, we think we will have a much more effective result. So we chose supplements to fill in the gaps, if you will, to make that front line, that defensive line. The first one was ergothioneine, again, natural molecule, as something that we ingest in our foodstuffs. And that has very powerful and quite specialized antioxidant features that have effects on inflammation and on cell survival, on antioxydants specifically. And so we put in and it's very well tolerated. I mean, another principle in this concoction was do no harm. So we did not want to create a model system where we had some good things in there, but carrying some toxicity risk. We wanted this to be very, very safe based on natural products. And, that's something that could, you know, rear its ugly head with some toxicity we hadn't thought about.

Ergothionine is like in oyster mushrooms and black beans and liver and stuff, right? So, it's found naturally in plants and animals.

Yes, we don't produce it. You don't make ergothionine. You obtain that from your environment by eating various food stuffs. so that's a good thing.

It's almost like a longevity vitamin, basically, right?

Yes. And there are companies out there that are marketing, not many, but their marketing ergothioneine is a standalone. And it makes sense that it would have benefit and that it could help with aging and help diminish a lot of the oxidant stress that, you know, we're prey to. Then we added resveratrol, which is a polyphenol, it's a simple molecule actually, is present in grapes, present in red wine for example, well known, and it is also sold on the market. You'll see lots of instances where people are out there advocating the use of resveratrol alone. It's a relatively weak antioxidant. It's not anywhere near as potent as the natural antioxidant mechanisms we have within the cell, but it is adjunctive. and it's helpful. I wouldn't recommend it much as a standalone because it's not that potent. But in concert, it has specific types of antioxidant defense, particularly in the cell membrane and lipids and various places in the cell. And people who drink red wine a lot.

You have to drink a lot.

It's known that the French, for example, are very enamored with red wine. And in fact that they're eating pastries and they have a lot of things that they shouldn't be eating so much of, their cardiac consequences are less than you would predict. And, one of the hypothesis that they're also drinking every meal with the big glass plural.

Maybe true. But, I wouldn't recommend drinking alcohol as a health strategy.

That's what the French are doing. So, they're drinking a lot of red wine. So, that's resveratrol, a very interesting molecule, easy to purify and to add to the supplements and moderately effective. And, then the last one, I think is the most interesting one, which is hydroxytyrosol. And this came to me because, you know, I'm living in Israel right now and we're not too far from Greece and we have climate here and everywhere in Israel and Greece, you know, just covered, covered, covered with olive trees everywhere you look. That the Greek population that indulges in using special types of olive oil, which I'll come back to, has a lower incidence of a host of different diseases, Alzheimer's disease. And so, there is quite a lot of research in Athens, especially by some friends of mine there, some professors at the University of Athens, and they've identified the elements within the olive that are most effective in creating this antioxidant and anti-inflammatory effect. And there are different molecules, but most of these are polyphenols. And the most important one is this, this olipurin and. Yeah. And when you take people who are using a lot of olives in their diet, they tend to have the benefits from that. And what we now know, we know a couple things from this man's research there. All olive trees are the same, which I didn't know. So every orchard of olives is actually quite different. They're not the same. They're over 1,000 years studied. And when you do analysis in the olive from cultivar to cultivar, orchard to orchard, there are vast differences. Second thing, and so his research has identified orchards in Greece that are incredibly high, have incredibly high levels of these particular polyphenols. Second thing is that how you treat the olive has a dramatic effect on the survivability. Think an American factory that's processing millions of olives every day and all of that. And olive oil, you go to the shop and you buy olive oil. Unfortunately, the processes used there to get there have decimated the very most important molecules, these polyphenols, that it's oxidized them and they're not active. So in order to receive this benefit, you have to treat, you have to use virgin olive oil and from these special orchards and on and on and on. Now, most people can't find that olive oil in the store, but we know that the hydroxytyrosol is very special. in creating this effect. So, what we've done is take pure hydroxytyrosol, not olive oil, but the part of the olive oil that we care about, and that is what we've added together with the resveratrol, ergothionine, and the NMN.

Yeah, actually, I'm in Sardinia right now where I'm teaching a longevity retreat, and there's olive trees everywhere. And, it's interesting, they have wild olives sometimes. They actually hand-pick them and don't let them drop to the ground. they press them right away to make sure that the, and I would just olive all tasting and you can hear it, you can taste the different qualities of olive oil. And when you, you can actually taste that kind of polyphenol content because there's a little bit of acidic and bitter in the back of your tongue. So you're, you're absolutely right. These are powerful molecules in olives and olive oil. And I think that combination's great.

So I think, I think any last thoughts? So we're looking now in models where we explore these combinations to better tease out how the juxtaposition of these different players has an effect on these outcome endpoints and to try to understand how they're interacting with each other and supporting each other. But it's definitely a team effort approach. That was the concept biologically, to bring a team, an offensive line, defensive line, and then to put them together in the right fashion.

Well, it's like olive oil, red wine, and mushrooms. You kind of add that with NMN, and you get this product. It's a younger NMN, which I love. And what's interesting about this product also is the dose is high. A lot of the doses of NMN or NR out there are low. They're like 250 or if you take two, it's 500. But actually, clinically, it seems like the dose needs to be much more like 900 or 1,000 to get the most benefit. And this is actually done at a lower cost. I'm sort of surprised a lot of these products are really expensive, but this is actually a reasonable cost for that higher dose.

Well, there are reasons for the dose selection. Two reasons. Let me begin by saying always do no harm, right? So that's the place you begin at where you do not want to use a dose of a material that has the potential to harm. But the safety profile has been so unremarkable with NMN to date from people's experience and in animals, although there haven't been large formal toxicology studies, but the data out there suggests that this is a well tolerated ingredient. So therefore it makes sense to use more of it if there's why would there be a benefit? Because we know that certain pathways, particularly on inflammation, are very tightly related to the amount of NAD that will be there. So a small amount of NAD doesn't cut it. specific. There's a very special pathway in the cell regulating inflammation. This is a pathway, it's a fancy name called NF kappa B, but it's basically a pathway in there which turns on all our inflammatory genes at once. Like a symphony.

Yeah, that's what I was talking about.

The direct conductor lifting the baton and the whole orchestra plays it once. And so that's NF kappa B, that's the symphony conductor and when you turn that on, you get what's known as a cytokine release. And an extreme example, you get a cytokine storm. And we now all know that word because of the last few years with COVID That's why COVID patients die because this pathway is turned on incredibly all at once and you get this massive release of problem. NMN suppresses and NAD suppresses that pathway specifically. But you have to give enough of it to get there. So we specifically gave a high dose of NMN so we could suppress that pathway so that we could be sure that the mitochondria was enjoying a full benefit. So there was a very careful decision about elevating the amount of NMN to do that.

That'S great. Any other thoughts you have in conclusion about NMN, what we should be doing, how much we should be taking? I mean, basically the dose you're recommending is about 900 a day, right?

That's what's in there, yes, that's right. I recommend further research. I recommend research on how frequently to take it. We wanted to have it once a day if possible. People don't have time to take things, but we carefully, we need to better understand the pharmacokinetics, understand how long these things last, not just blood, but actually in the cell where they're going. That's the important thing. How much, whether they go to all the right tissues, how long they're there. We need to work on specific inflammatory and oxidant related conditions like Parkinson's and diabetes and arthritis and colitis to elucidate which clinical problem might be best served. We need to do more studies on aging, which is a very long, long study, but we need to do that.

I know I've started to take it and I think I've committed to it as part of my longevity regimen. Dr. Salzmann, thank you so much for being on the Dr. Salzmann's Pharmacy podcast and teaching us all about NMN. I think it's a really important topic. I think people just don't understand it well enough. You've done a great job of getting in the weeds and helping us understand why it's important, how it's critical to our health and aging itself. If anybody wants to learn more about it, you can read Dr. Salzmann's work online. Also, you can you can learn about this product he was talking about by going to getwonderfield.com, that's G-E-T-W-O-N-D-E-R-F-E-E-L-F-E-E-L.com and learn more about it and read reviews of science as well. It's a great product and I think your work is really important and I want to keep you going so we can learn more about how all this stuff works for us and actually advance treatment of aging itself, which is what we're talking about. if all of you have enjoyed this podcast, please share with your friends and family on social media. We're sure they'd like it. I'm sure they'd love to hear about this and learn more. I think I love this podcast. I've learned so much. Leave a comment. Maybe you tried NAD or NMN or NR or what's happened to you? How have you felt? I would love to hear from you. Subscribe wherever you got your podcast and we'll see you next week on the Doctor's Pharmacy.

Hey, everybody, it's Dr. Hyman. Thanks for tuning into the Doctor's Pharmacy. I hope you're loving this podcast. It's one of my favorite things to do and introducing you to all the experts that I know and I love and that I've learned so much from. And I want to tell you about something else I'm doing, which is called Mark's Picks. It's my weekly newsletter. And in it, I share my favorite stuff from foods to supplements to gadgets to tools to enhance your health. It's all the cool stuff that I use and that my team uses to optimize and enhance our health. And I'd love you to sign up for the weekly newsletter. I'll only send it to you once a week on Fridays. Nothing else, I promise. And all you have to do is go to DrHyman.com/picks to sign up. That's DrHyman.com/picks, P-I-C-K-S, and sign up for the newsletter and I'll share with you my favorite stuff that I use to enhance my health. and get healthier and better and live younger longer. Hi everyone, I hope you enjoyed this week's episode.

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