By Dr. Sandra Kaufmann, author of Why We Age and How to Stop It and the founder of The Kaufmann Anti-Aging Institute.

The search for the “fountain of youth” is as old as time itself. While we all know there’s no miracle pill to reverse aging, there are many steps we can take to get rid of our grey hairs, treat wrinkles, and ease the pain in our joints. 

Research shows the best way to understand what’s happening on the outside is to look within. 

What are the seven tenets of aging?

On a molecular level, organisms age because their cells age. Our bodies are a well-oiled machine, and as the various parts wear away and falter, so do we.

Understanding what happens on a cellular level is key to understanding aging. My protocol on aging organizes the various theories of cellular aging into seven categories, or tenets. The seven tenets are information systems (DNA), cellular energy, cellular pathways, quality control (cellular repair), immune system, individual cell aging, and waste management.

To age healthier, we must develop a wellness regimen to cater to these seven tenants. Besides a healthy diet and regular exercise, one promising and evidence-based approach to add to your wellness regime is  NAD+ supplementation. 

NAD+ and the aging process.

All of our cells rely on the coenzyme NAD+ to generate the energy they need to function at their best. Research shows that the NAD+ levels in our bodies decline by up to 50% between the ages of 40 and 60. 

The reduction in NAD+ as we age corresponds with a decline in our cell’s ability to produce energy and function properly. Other factors that may deplete NAD+ levels include metabolic stressors, such as overeating, sun exposure, sleep disruption, and alcohol consumption.

This natural decline may be at the heart of several tenets of aging. 

NAD+ and cellular energy.

NAD+ is essential to the production of cellular energy. NAD+ works alongside coenzyme Q10 and several enzymes in a cellular organelle called the mitochondria to produce the energy that powers your cells. Declines in NAD+ may reduce our cells’ ability to extract energy from food or regulate their metabolism, making cells less efficient and at greater risk of dysfunction. 

NAD+ and DNA integrity.

Another key tenet of aging is damage to our DNA, the instruction manual that tells each of our cells what to do.

Every day, our body will accumulate quadrillions of new mutations in our DNA. Much of this damage, called “oxidative damage,” is caused by our metabolism and can be accelerated by poor diet, lack of sleep, overdrinking, inflammation, and a sedentary lifestyle. 

NAD-dependent enzyme poly (ADP-ribose) polymerases (PARPs) regulate the cellular response to metabolic and physiological stressors, preventing the accumulation of oxidative damage. Without NAD+, our cells wouldn’t have functioning PARPs, which are essential for cellular defense. 

NAD+ and cellular repair.

Likewise, NAD+ is essential for repairing the damage caused by our environment and metabolism. Cell damage can cause cell cycle arrest, where duplication and division are placed on hold. Cells stuck on hold, or in “senescence,” are to blame for many aging symptoms.

Our cells must find a way to repair any damage before the cell cycle can resume. When DNA is damaged, our cells rely on NAD+ to help facilitate cellular repair processes by activating important NAD-dependent enzymes called sirtuins, which play an active role in cellular repair.

How can you boost your NAD+ levels to support cellular health?

The physical changes that you see in your body as you age reflect what’s happening within your cells. I recommend taking NAD+ boosters to improve your cellular energy, support cellular repair, and promote a healthy cellular metabolism.

A product that I personally recommend is Tru Niagen®, which is the most well-studied form of the NAD+ precursor nicotinamide riboside. Nicotinamide riboside is proven to safely increase the NAD+ levels by up to 40-50% with daily supplementation.

While some aspects of aging are outside our control, there are still many within our grasp. If we really want to improve the way we age, we have to work towards it every day. Start today by monitoring your diet and what you consume. 

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Dr. Sandra Kaufmann is the founder of The Kaufmann Anti-Aging Institute and the author of “Why We Age and How to Stop It.” After years of research and studying thousands of anti-aging substances, Dr. Kaufmann conceived the seven tenets of aging. Recently, Dr. Kaufmann launched My Protocol, an app that provides personalized regimen for users based on their particular aspects of aging and skin concerns.  

NAD+ is an essential coenzyme that helps regulate and support our cells. But our NAD+ levels decline with age, and maintaining our NAD+ levels may play a role in helping to reduce the cellular effects of aging. 

Here’s a comprehensive guide on how to naturally increase your NAD+ levels. 

How does NAD+ work? 

Metabolism is how our cells extract energy from the food we eat. Not enough energy and a cell withers; too much energy stresses our cells. NAD+ helps strike a delicate balance with our cellular energy while activating many cellular repair processes to keep our cells in good shape. 

 Unfortunately, between aging and our often-unhealthy lifestyles today, most people experience a significant decline in NAD+ over the course of their life, according to Cell Metabolism. Scientists believe this decline may be a significant contributor to many age-related changes in the body. 

 The good news is that elevating NAD+ levels may help reduce these effects. A review published in the Translational Medicine of Aging discusses the potential health benefits of boosting NAD+ as we age. 

You can practice calorie restriction to elevate NAD+ levels.

As described in Scientific American, researchers found that those who eat less have more NAD+ in their bodies. Along with increasing NAD+, calorie-restriction was also shown to produce significant anti-aging effects in monkeys.

The metabolic process of breaking down our food can damage our cells and DNA by generating dangerous free radicals. NAD+ regulates and powers the enzymes that repair this damage. Eating fewer calories means less metabolic damage, resulting in less repair and less NAD+ depletion. Strategies such as calorie counting and intermittent fasting are calorie-restricting practices that can all increase NAD+.

It’s no surprise that, as discussed in Forbes, animals with slow metabolisms who don’t consume and process food nearly as quickly as we do, like tortoises or cold-water sharks, can live hundreds of years. However, humans still have a daily nutritional requirement that we have to meet. Taking calorie restriction to an extreme can become equally unhealthy. 

You can regularly exercise to elevate NAD+ levels.

As reported in Physiology Reports, another strategy for reversing age-related NAD+ decline is regular exercise.

In the process of extracting energy, muscle contraction activates enzymes that generate NAD+, which in turn helps muscle cells generate the energy they need to contract. This process is a positively reinforcing circular process, with NAD+ being an indicator of energy demand. 

As muscle contraction requires more fuel, it generates more NAD+, letting the body know to speed up metabolism and provide more fuel for the muscle. 

In particular, aerobic endurance training, like long-distance running, is the most efficient way to raise NAD+ because it forces your muscles to fight for every last drop of energy. 

You can help maintain NAD+ Levels by cutting out sun-tanning and alcohol.

Stressors on your cells, such as toxins or sunburn, require DNA repair that can deplete your NAD+ levels. In other words, lifestyle choices can help keep your cells healthy and NAD+ levels intact.

In the case of sun-exposure, The Conversation discusses how the sun’s harmful UV rays are a mutagen, meaning they can cause genetic mutations.

Avoiding sunburns with sunscreen is an excellent way to help prevent this damage. Still, it may also help maintain NAD+ levels as you spare your DNA repair mechanisms the extra work needed to combat UV radiation. 

Likewise, combatting stressors like processing alcohol in the liver can deplete NAD+ levels, as discussed in Hepatology Communications. Avoiding heavy drinking can help maintain your natural levels of NAD+.

You can increase NAD+ levels with vitamin B3.

Vitamin B3 is a common vitamin found in multivitamins that can elevate your NAD+ levels. A century ago, scientists realized that nutritional deficiencies in vitamin B3 caused a deadly disease called pellagra, and national efforts to enrich flour with vitamin B3 have saved thousands of lives since. 

Today, pellagra is no longer a pressing medical issue, but maintaining optimal NAD+ levels remains imperative for long-term health. 

Vitamin B3 comes in three forms: niacin, nicotinamide, and nicotinamide riboside. Niacin is the most common form of vitamin B3 and was used to fortify our flour during the pellagra epidemic. 

Other than niacin-enriched flour or cereals, you can find niacin in other foods like liver, chicken breast, tuna, and other animal-based proteins. Peanuts and avocado are also good sources for those who are going meatless. 

However, niacin’s effectiveness is not as great as its counterparts in the vitamin B3 family. People also found that ingesting niacin in high doses can lead to uncomfortable flushing of the skin.  

You can take supplements to increase your NAD+.

It’s hard to know whether you elevate NAD+ effectively just by consuming enough vitamin B3 in your diet. Currently, the only way to measure NAD+ levels is with a blood test.

Also, most of the available vitamin B3 in our foods come in the form of niacin, one of the least efficient NAD+ boosters. 

Alternatively, the best way to increase NAD+ levels amongst the vitamin B3 family is by consuming nicotinamide riboside. A clinical study showed that nicotinamide riboside increased whole blood NAD+ by 40-50% in as little as two weeks. But it's quantities are only found in trace amounts in dairy milk and yeast, yielding far too small in quantity to make a significant impact.

Fortunately, nicotinamide riboside is available in synthetic form, mainly as Niagen®. Niagen® is the only form of nicotinamide riboside that has been successfully reviewed twice under the FDA’s New Dietary Ingredient Notification (NDIN) program and successfully notified to FDA as Generally Recognized As Safe (GRAS).

You can combine these strategies to increase your NAD+.

While raising NAD+ levels naturally is a worthwhile goal, NAD+ boosting supplements, like Niagen®, can help the process along by increasing cellular energy and supporting healthy aging. 

Moreover, research suggests that NAD-boosting strategies synergize with one another. According to a human trial from the American Journal of Clinical Nutrition, supplementing with nicotinamide riboside resulted in a minor improvement in body composition.

Making lifestyle changes around good diet and exercise, cutting out “bad” habits, and supplementing with an NAD+ boosting supplement can provide you with a multi-approach strategy to maintain your NAD+ levels for better aging. 

Vitamin B3 is as standard as your daily multivitamin, but this important micronutrient isn't as pedestrian as it sounds. 

Originally called niacin back at the turn of the twentieth century, vitamin B3 isn’t always clear and cut from a molecular or safety standpoint. Today, vitamin B3 takes on three different forms. We’ll discuss the differences between the three: niacin, nicotinamide, and nicotinamide riboside.

Niacin, the original vitamin B3. 

Vitamin B3 is most often associated with niacin, labeled almost synonymously in multivitamins. Niacin's roots are old, stretching back through history where it was used to treat a disease called pellagra, Italian for "rough skin." Spreading throughout the American South, pellagra patients suffered severe symptoms known as the "4 D's": dermatitis, diarrhea, dementia, and death. 

Pellagra continued to become an unmanageable problem until Dr. Joseph Goldberger traced pellagra to a dietary deficiency in vitamin B3 in 1926. Afterward, Goldberger's discovery led to the widespread supplementation of niacin as an effective treatment. Government mandates called for food groups like flour to be niacin-enriched in efforts to address the larger populace. 

Niacin as a treatment for high cholesterol.

Pellagra has become a thing of the past, but we've learned that niacin does a lot more, identified as a treatment for high cholesterol in the decades that followed.

As noted in the Mayo Clinic, doctors sometimes prescribe niacin to increase high-density lipoprotein (HDL) cholesterol, more colloquially known as the "good cholesterol." "Good cholesterol" functions to reduce low-density lipoprotein (LDL) cholesterol in the blood, also known as the "bad cholesterol", and its levels are associated with a lower risk for cardiovascular disease.

The CDC notes rising levels of "bad cholesterol" increase the risk of plaque formation in blood vessels. Plaque build-up and inflammation can make the vessels stiffer, causing high blood pressure. Niacin helps prevent this process by regulating how the liver produces cholesterol. 

Niacin may help kidney function.

Niacin has also been investigated for its role in supporting kidney function. When kidneys lose function, they don't get rid of enough phosphate, which then binds calcium and interferes with vital heart and muscle function. 

Niacin helps support cells under duress, such as kidney cells in chronic conditions. Research published in the Clinical Journal of the American Society of Nephrology shows that niacin promotes phosphate control in the kidneys. 

Niacin's side effects.

As noted by Healthline, niacin has an Achilles' heel: intense flushing. Although presumed harmless, the flushing attributes of niacin can be uncomfortable, causing redness, itchiness, and warmth of the skin. 

Usually, the flushing goes away as your body gets acclimated, but much of the enthusiasm around niacin dampened after learning of this unpleasant side effect.

Nicotinamide, niacin's younger brother.

Nicotinamide, sometimes known as niacinamide, acts similarly to niacin but has a different molecular structure. This subtle difference allows nicotinamide to bypass the step that causes niacin's annoying flushing, providing the benefits of vitamin B3 without making you self-conscious. 

Nicotinamide may help with acne.

Nicotinamide is being investigated in part for its potential to support skin health by controlling inflammation, an overactive response by the body’s immune system.

Acne is often caused by an overactive response of the immune system towards the skin’s natural bacteria. It is often presented as redness, warmth, swelling, crusting, and other symptoms of acne.

A review paper published in Dermatologic Therapy outlines how multiple studies have found nicotinamide to be an effective treatment for uncontrolled acne. While many dermatologists currently recommend nicotinamide, the data remains inconclusive, and large trials are required to assess efficacy.

Nicotinamide's side effects.

A review published in Diabetologia reports some people having GI symptoms when taking nicotinamide. The same publication reported that it might increase the risk of type II diabetes in high doses. 

Nicotinamide also may inhibit a unique class of protective enzymes called sirtuins. As reported in the Journal of Cell Science, sirtuins are essential to DNA repair and cell survival. Sirtuins, like many regulatory enzymes, help ensure that cells monitor and mend their DNA before they replicate. This process prevents cells from passing on mutated genes, akin to faulty instruction, possibly causing many cellular processes to go awry. 

Sirtuins regulate the rate at which our cells break down energy, maintain their machinery, and replicate, making them a popular target for longevity research. A review published in Biogerontology suggests that sirtuins may even extend lifespan in some animals. Unfortunately, nicotinamide seems to turn off sirtuins, which runs the risk of having a negative impact on cell health and survival.

A new take on vitamin B3: nicotinamide riboside. 

Nicotinamide riboside was first identified in the 1940s, but in the 2000s, scientists discovered it could raise a coenzyme called NAD+ far more efficiently than either niacin or nicotinamide. NAD+ is an essential molecule your body uses to regulate cellular metabolism, aging, and DNA repair. 

NAD+ and aging?

Promising research from a team of researchers at the University of New South Wales uncovered age-associated changes in NAD+ metabolism in humans. Their research showed that NAD+ levels decline by up to 50% between the ages of 40-60. 

The team found a strong negative correlation between NAD+ levels and age by observing NAD's role in fueling the mechanisms needed to combat oxidative stress, a significant contributor to age-associated changes in the body. 

Nicotinamide riboside and oxidative stress.

Besides inflammation and infection, many processes in our daily lives, such as the breakdown of food, can damage our DNA and cellular machinery. Our metabolism causes this damage in a process called “oxidative stress.” Repair enzymes utilize and deplete NAD+ to fix the damage and prevent permanent complications.

While aging decreases NAD+ levels naturally, other stressors such as sleep deprivation, a sedentary lifestyle, poor diet, and alcohol consumption can also deplete NAD+ levels. 

Nicotinamide riboside is the most efficient supplement to restore NAD+ levels that may become depleted from these everyday stressors.

Nicotinamide riboside's side effects.

Nicotinamide riboside is uniquely safe— it's been evaluated in 11 published human trials without any severe attributable side effects reported in clinical trials. 

However, there are several forms of nicotinamide riboside. Amongst them, Niagen® is the only patented form that has gone through the regulatory procedures to assess safety in key markets around the world.

Nicotinamide riboside: A promising way to raise NAD+. 

Nicotinamide riboside is the latest member of the B3 family. However, it does not have the same resume as niacin in terms of its use in treating high cholesterol or supporting kidney function. Also, it has not yet been investigated for helping with acne, as does nicotinamide.

Still, scientists find that nicotinamide riboside’s role as the most efficient NAD+ booster may be the most promising benefit that unlocks our understanding of cellular health as more research continues.