Camilla Thompson has tried it in just about every form: pills, powder, a liquid compounded by her pharmacist. Not the intravenous injections or jabs, though – yet. It is “completely and utterly life-changing”, she says.
“My brain, it was like all these different parts lit up. I just felt I could do so much more. And I really do credit NAD for it.”
NAD – Nicotinamide adenine dinucleotide – is having a moment. The molecule is under serious study as a treatment for the ravages of ageing. Youth, in a pill.
Several in-human clinical trials are under way; we will soon know if it can be a real medicine.
But in the lightly-regulated world of complementary medicine, it’s already being used to treat a cornucopia of diseases. Thompson, a self-described “biohacker”, uses it for a brain and energy boost. Others turn to it for brain fog, poor sleep, dull skin and even drug addiction. Main street chemists have recently started to stock it.
Dr Scott Allison delivers NAD injections at his Brisbane-based cosmetic medicine clinic. “People just feel subjectively a lot better, and we see improvements in their skin and other biomarkers,” Allison said.
But NAD is years away from regulatory approval as a drug. Without good human data, some researchers are deeply sceptical and worried about the molecule’s safety.
“As a clinical physician, I would never recommend something like that,” said Professor Luigi Fontana, who heads a research group on healthy ageing at the University of Sydney. “We have very preliminary data in humans, mostly negative.”
Hope in a pill
Excitement about NAD was ignited in part by Australian longevity researcher Professor David Sinclair, whose team showed in 2017 the molecule played a role in repairing DNA.
DNA repair mechanisms decline as we age, as do NAD levels. By boosting NAD levels in old mice, their cells “were indistinguishable from the young mice”, Sinclair said at the time. Raising NAD levels was also linked in animals to improving the function of mitochondria, the cellular machines that produce our energy.
In 2017, Sinclair predicted a safe and effective anti-ageing drug could be on shelves within just five years.
But proving a molecule can actually extend human lifespan “is probably the longest, most-expensive trial you can imagine, by definition”, says Dr Lindsay Wu, head of the Laboratory for Ageing Research at the University of NSW.
Instead, researchers are targeting diseases of ageing: memory loss, hearing loss, kidney disease, high blood pressure, insulin sensitivity.
Wu has co-founded two companies, one of which is trialling NAD for mitochondrial disease and the other for fertility. “In humans, the first sign of biological ageing is female infertility, which occurs at this startlingly young age,” he says.
In a paper published earlier this year, Wu showed boosting NAD prevented chemotherapy-caused infertility in mice – possibly by protecting the metabolism of the egg cell.
But negative results are accumulating too. Multiple trials have found NAD supplementation has no effect on mitochondrial function in humans.
It wouldn’t be the first time an anti-ageing compound fell short of the hype. Promising research on resveratrol, a compound found in red wine, led British biotechnology company GlaxoSmithKline to pour $US720 million into research in 2007. Only two years later GSK killed the research program after safety concerns emerged.
Safety questions now circle NAD as well. This year, a paper in Nature Medicine linked high levels of NAD metabolites with an increased risk of heart attacks. And Australia’s drug regulator last year received a report from a doctor linking a heart attack to a patient’s use of an NAD supplement.
That underscores the need to wait for high-quality human clinical trial data before taking it, says Wu, especially because some NAD supplements on the market “don’t contain what’s written on the front of the bottle”.
“There are a tonne of clinical trials reporting really promising results,” he says. “But hang onto your money for now.”
