Introduction: Why NAD⁺ is so essential
Nicotinamide adenine dinucleotide (NAD⁺) is a vital coenzyme in every cell in the body. It is centrally involved in processes such as mitochondrial energy production (ATP production), DNA repair, cellular regeneration and epigenetic regulation. NAD⁺ levels fall with increasing age and under stress from infections, oxidative stress or intensive sporting activity - with far-reaching consequences for health and quality of life.
NAD⁺ - Loss with age - an underestimated risk factor
A low NAD⁺ status is not a harmless physiological finding of old age, but promotes the development of numerous chronic diseases. Age, viral reactivation, inflammation and oxidative stress are among the main causes of NAD⁺ loss. Restoring adequate NAD⁺ levels is therefore a central approach of modern longevity medicine.
Vitamin B3, Abraham Hoffer and the orthomolecular tradition
Vitamin B3 (niacin) already played a key role in the early phase of orthomolecular therapies. Abraham Hoffer, a pioneer of orthomolecular psychiatry, used it successfully to treat schizophrenic disorders. Today, vitamin B3 in the form of its modern derivatives such as nicotinamide riboside is experiencing a scientifically founded renaissance.
Nicotinamide riboside (NR): an efficient way to increase NAD⁺
Nicotinamide riboside (NR) is an innovative vitamin B3 derivative that can contribute particularly efficiently to increasing intracellular NAD⁺ levels. As a precursor, NR is converted into NAD⁺ in the liver and other tissues. This creates a synergistic effect: the combination of nicotinamide with ribose - a component of the ATP molecule - promotes mitochondrial function and energy supply. The renowned pharmacologist Uwe Gröber therefore describes NR as a „master regulator“ for NAD⁺.
Central functions of NAD⁺ - far more than just energy
1. cellular energy production
NAD⁺ is essential for the redox reactions in the mitochondria and for ATP production as part of the respiratory chain. NADH and NAD⁺ form a redox pair that enables electron transfer - without this process, cellular energy deficits and exhaustion occur.
2. activation of sirtuin longevity enzymes
Sirtuins (especially SIRT1) regulate ageing processes, DNA repair, metabolism and inflammatory processes. They are strictly NAD⁺-dependent. An increased NAD⁺ level increases sirtuin activity and thus cellular resistance to ageing, stress and metabolic dysregulation.
3. telomerase activation and telomere lengthening
Current studies show: NAD⁺ promotes the activity of telomerase, an enzyme that slows down the shortening of telomeres (age-related „wear and tear“ of chromosome ends). This is considered a cellular marker for healthy lifespan and longevity.
4. neuroprotection and cognitive health
NAD⁺ plays a central role in maintaining neuronal functions. It protects nerve cells from degeneration, particularly via SIRT1-mediated effects. In mouse models, NAD⁺ was able to significantly improve cognitive deficits in Alzheimer's disease. Preventive use therefore seems sensible.
5. DNA repair mechanisms through PARPs
NAD⁺ is an essential substrate for poly-ADP-ribose polymerases (PARPs), which recognize and repair DNA damage. Chronic NAD⁺ deficiency reduces this repair capacity and promotes degenerative and oncological diseases.
6. modulation of CD38 and chronic inflammation
CD38/CD157 are NAD⁺-consuming enzymes that are associated with ageing processes, tumor progression and immune modulation. Their excessive activity in aging and chronic stress accelerates NAD⁺ loss. Targeted regulation is the subject of current research.
Clinical applications of nicotinamide riboside
Targeted supplementation with nicotinamide riboside offers potential for:
- Fatigue syndrome, CFS and post-Covid/post-vac
- Chronic viral infections and immunomodulation
- Cognitive disorders, brain fog, Alzheimer's disease, Parkinson's disease
- Diabetes type 2 & metabolic syndrome
- Silent inflammation and oxidative stress
- Athletic performance enhancement & muscle function
- DNA protection & prevention of degenerative diseases
- Promotion of cellular apoptosis and epigenetics
- Telomere maintenance and longevity strategies
Conclusion: NAD⁺ as the molecular key to cell health
Nicotinamide riboside is a scientifically proven way of specifically increasing cellular NAD⁺ levels. The positive effects range from improved mitochondrial function and epigenetic regulation to preventive approaches for neurodegenerative diseases and ageing processes. NAD⁺ is not just an energy supplier - it is the key factor for cellular health, longevity and function-preserving ageing.
Literature and further information
Scientific sources:
- Verdin E. NAD⁺ in aging, metabolism, and neurodegeneration. Science. 2015;350(6265):1208–13.
- Rajman L, Chwalek K, Sinclair DA. Therapeutic Potential of NAD⁺-Boosting Molecules: The In Vivo Evidence. Cell Metab. 2018;27(3):529-47.
- Mills KF et al. Long-Term Administration of Nicotinamide Mononucleotide Mitigates Age-Associated Physiological Decline in Mice. Cell Metab. 2016;24(6):795-806
- Canto C, Menzies KJ, Auwerx J. NAD⁺ metabolism and the control of energy homeostasis: a balancing act between mitochondria and the nucleus. Cell Metab. 2015;22(1):31-53.
Publications by Dr. med. Andreas Bernhardt:
- NAD⁺ - Cell energy, aging and therapeutic options. www.gz-kapf.ch
- Post-Covid and mitochondrial dysfunction: NAD⁺ as a therapeutic option. www.wechselweise.net
- Telomere rejuvenation through NAD⁺ and sirtuins: The molecular fountain of youth. www.wechselweise.net
About Dr. med. Andreas Bernhardt:
Dr. Bernhardt is a specialist in general internal medicine with an international Training in endocrinology and better aging. He is a member of the Swiss Anti-Aging Society (SSAAMP) and the renowned Endocrine Society (Washington, D.C.). His focus is on bioidentical hormone therapy as part of a holistic longevity concept. As an expert on the German-speaking platform wechselweise.net he is committed to raising awareness in the DACH region about hormonal changes in men and women during the menopause - with the aim of promoting health and quality of life in the long term.