Episode 101
NAD The Molecule of Life — and the Hype
🧬 NAD: The Molecule of Life — and the Hype
How a lab coenzyme became the latest anti-aging obsession
What We Mean by Longevity and Healthspan
When people talk about longevity, they usually mean how long we live.
But healthspan — the years we live well — matters far more.
That’s the time before disease steals our energy, mobility, and independence.
Modern medicine has already doubled our lifespan in the last century.
Now the goal is to extend the healthy part — without falling for pseudoscience along the way.
When Marketing Meets Medicine
Longevity has become a booming business.
Some gurus, like Dr. Eric Topol, do real science.
Others, like Peter Attia, sell access: $150 000 per patient for lab tests, a VO₂ max treadmill run, and a few “optimized” workouts.
He’s also an investor in AG1 — the influencer’s green drink of choice.
Andrew Huberman promotes similar ideas under studio lights bright enough to sterilize a petri dish.
Both are clever, credentialed, and caught between data and drama.
Then there’s Dr. David Sinclair, who helped discover how cells age — and then helped turn that discovery into a supplement empire.
His company tried to patent NMN, an NAD precursor, as a drug.
The FDA briefly removed NMN from the supplement market, sending Reddit into meltdown.
It’s back now, but the episode showed how quickly science slides into sales.
And finally, we have the shirtless salesmen:
Paul Saladino, who went from carnivore crusader to “fruit influencer.”
Liver King, whose real secret wasn’t liver — it was injectable.
And Gary Brecka, who claims to predict your death date (for a fee).
These are subscription services disguised as sages.
What NAD Actually Is
Nicotinamide adenine dinucleotide (NAD⁺) is a molecule found in every living cell.
It helps convert food into energy and repair DNA.
As we age, NAD levels fall — metabolism slows and damage builds up.
So scientists asked: If we raise NAD again, can we slow aging?
In mice, the answer looks promising.
NAD precursors like nicotinamide riboside (NR) and nicotinamide mononucleotide (NMN) increase average lifespan by 5–15 percent and improve energy, insulin sensitivity, and activity.
That’s great for mice — but we don’t live in cages or eat lab chow.
Can You Get NAD from Food?
Not directly — but your body makes NAD from dietary precursors:
tryptophan and niacin (vitamin B₃).
You’ll find them in fish, poultry, beans, milk, and whole grains — basically, a Mediterranean-style diet.
So before spending $90 on capsules, you can spend $9 at the farmers' market.
What the Human Studies Show
Human trials of NR or NMN (usually 500–2000 mg per day for 6–12 weeks) show they are safe and well-tolerated.
They modestly raise NAD levels and sometimes improve lipid profiles and blood pressure.
But the effects are small and inconsistent, especially in healthy adults.
NAD precursors do not reverse aging.
They don’t prevent heart attacks or extend lifespan in people — at least, not yet.
NAD vs Statins: A Reality Check
Meta-analyses show NAD precursors, especially niacin, can lower LDL (“bad”) cholesterol by about 8–12 percent.
That’s fine, but compare it to rosuvastatin (Crestor):
DoseAverage LDL Reduction5 mg≈ 45 %10 mg≈ 52 %20 mg≈ 55 %40 mg≈ 63 %
That’s the difference between “interesting biochemistry” and “fewer funerals.”
So NAD may nudge your cholesterol; statins save lives.
Who Might Benefit
Older adults with metabolic syndrome, prediabetes, or early neurodegenerative disease could see modest improvements in inflammation or blood lipids.
Younger, healthier people mostly see lighter wallets.
No serious drug interactions have been documented, though theoretical ones exist with some chemotherapy or DNA-repair drugs.
As always, talk to your doctor before combining anything with prescription therapy.
Food Before Pharma
The best way to support NAD and longevity is still food, sleep, and movement.
A Mediterranean diet rich in legumes, vegetables, olive oil, and fish fuels NAD pathways naturally — and has proven benefits for heart and brain health.
No influencer code required.
A Note from the Galley
We’ll explore all of this — diet, longevity, and a little wine science — on next summer’s Mediterranean Longevity Cruise.
World-class physicians, scientists, and chefs will join me for ten days of evidence-based indulgence.
It’ll cost less than a Peter Attia consult — and no one will force you to drink AG1.
(For the record, I still do. It’s gentle on my stomach, but I’m hunting for less bougie vitamins.)
The Takeaway
Boosting NAD may someday help extend healthspan, but for now, the best evidence still supports:
- Eat Mediterranean-style food.
- Move daily.
- Sleep enough.
- Manage stress.
- See your doctor before your supplement dealer.
That’s how you live longer and better — no silver bullet, just science and common sense.
References
Effects of NAD+ Precursor Supplementation on Glucose and Lipid Metabolism in Humans: A Meta-Analysis. Zhong O, Wang J, Tan Y, Lei X, Tang Z. Nutrition & Metabolism. 2022;19(1):20. doi:10.1186/s12986-022-00653-9.
2 Niacin: An Old Lipid Drug in a New NAD+ Dress. Romani M, Hofer DC, Katsyuba E, Auwerx J. Journal of Lipid Research. 2019;60(4):741-746. doi:10.1194/jlr.S092007.
3.Nicotinamide Adenine Dinucleotide in Aging Biology: Potential Applications and Many Unknowns. Bhasin S, Seals D, Migaud M, Musi N, Baur JA. Endocrine Reviews. 2023;44(6):1047-1073. doi:10.1210/endrev/bnad019.
4. Crestor. FDA Drug Label. Food and Drug Administration Updated date: 2024-07-31
Transcript
>> Dr. Terry Simpson: Hey, welcome back to 4Q. Today we are launching a
Speaker:new series about longevity and health span. Now,
Speaker:longevity is easy to measure because there's a
Speaker:date on every tombstone. But health span is
Speaker:different. Healthspan we define as the time when
Speaker:you're healthy, mobile, curious, and capable
Speaker:before disease or aging slows you down. That's the
Speaker:part we want to stretch out, because living longer
Speaker:isn't the same as living well. Now, the moment you
Speaker:step into the world of longevity, you meet a
Speaker:parade of gurus, pouters, and podcasts. There's
Speaker:some serious scientists in the field, like the
Speaker:founder of the whole field, Leonard Hayflick, who
Speaker:recently died at age 93. He was the one who
Speaker:defined cellular aging in the first place. Or Dr.
Speaker:Eric Topol, who actually advance his medicine. But
Speaker:then there are those who have turned longevity
Speaker:into a luxury brand. Take Peter Attia. In his many
Speaker:iterations of himself, he finally settled on
Speaker:building an empire where he can charge $150,000 or
Speaker:more for a patient to become a patient of his. And
Speaker:what do you get for that? You get a handful of
Speaker:basic lab tests. You get a VO2 max run. You get to
Speaker:hike with him with a rucksack, a weighted
Speaker:backpack. You learn a few yoga poses, and you get
Speaker:some lectures about how you should sleep better.
Speaker:Some of this you can get from your local primary
Speaker:care doctor and a local gym for about 30 bucks a
Speaker:month and copay. So remember, this is a man who
Speaker:never finished a surgical residency, but
Speaker:billionaires pay him because they can. He
Speaker:positioned himself exceedingly well. The man who
Speaker:has gone from being all pro keto to let's do all
Speaker:the exercise we can. By the way, he's also an
Speaker:investor in something called AG1, that bright
Speaker:green drink sold as nutrition in a scoop. And of
Speaker:course, there's Andrew Huberman. He is another AG1
Speaker:investor. He podcasts between studio lights that
Speaker:are bright enough to give you a tan, and he seems
Speaker:to always wear black. Now, both of these guys are
Speaker:smart, they are accomplished, but let's be honest,
Speaker:they live where marketing meets medicine. And
Speaker:sometimes the marketing wins. There's the other
Speaker:longevity star. You've probably heard of Dr. David
Speaker:Sinclair. He's a Harvard professor, and he turns
Speaker:something called nad, which is a supplement
Speaker:almost, into a religion. And the precursor
Speaker:molecules, these are initials you're going to
Speaker:hear. Nmn, M and nr. They sound like secret
Speaker:passwords to eternal health. You know David
Speaker:Sinclair's early work on aging and sirtuins? It
Speaker:was brilliant. But somewhere between Harvard and
Speaker:Hollywood, the science and the sales pitch,
Speaker:started to share a toothbrush. He even formed a
Speaker:company. And he tried to patent NMN as a drug.
Speaker:Now, when you try and patent a supplement as a
Speaker:drug, the FDA does what they would always do. They
Speaker:pulled it from the supplement market. Now this
Speaker:sparked all of these rhettic panics and these
Speaker:headlines that the government was hiding. The
Speaker:fountain of youth. You can buy NMN now. But that
Speaker:fiasco showed just how thin the line is between
Speaker:research and retail and, and how desperate people
Speaker:are for that fountain of youth. Now, no longevity
Speaker:carnival would be complete without the shirtless
Speaker:salesmen of supplements and scams, the ones who
Speaker:promise eternal youth. Everything from protein
Speaker:powder and ancestral vibes. Take Paul Saladino.
Speaker:Hasn't seen a patient in years, discovered that
Speaker:fruit is good for you, even after declaring steak
Speaker:with salvation. Or the liver King, his erstwhile
Speaker:partner, who discovered that, well, his secret
Speaker:wasn't liver, but it was ever he was injecting.
Speaker:Then, of course, no claim would be complete
Speaker:without mentioning Gary Breca, the guy who says
Speaker:he's a human biologist, whatever that is, and can
Speaker:predict the date of your death. Of course, all you
Speaker:have to do is buy some of his fancy amino acids,
Speaker:his hydrogen water bottles, and all of his scams
Speaker:in between. Those people aren't scientists.
Speaker:They're basically services in human forms. Now
Speaker:here at 4Q, we're not selling miracle molecules or
Speaker:$150,000 wellness plans. We're bringing you the
Speaker:real science. What we know, what we don't, and how
Speaker:to tell the difference. Because understanding
Speaker:longevity shouldn't require six figure copay or a
Speaker:discount code. And as you will learn, you do not
Speaker:have to be a billionaire to learn about it and to
Speaker:implement it.
Speaker:But today, we're going to start with nad, which
Speaker:stands for nicotinamide adenine dinucleotide. This
Speaker:is the so called molecule of life. Now, does it
Speaker:actually work in humans? We're going to find out.
Speaker:I'm Dr. Terry Simpson, your chief medical
Speaker:explanationist, and this is Fork U Fork
Speaker:University, where we bust myths, make sense of the
Speaker:madness, and teach you a little bit about food and
Speaker:medicine. NAD is something that every freshman
Speaker:medical student learns in basic biochemistry about
Speaker:how the body works. It responsible for fueling
Speaker:energy production. It's in the Krebs cycle. It's
Speaker:responsible for DNA repair. And as we age, NAD
Speaker:levels drop, metabolism slows, inflammation rises,
Speaker:cells get sloppy, and blood, like Leonard Hayflick
Speaker:pointed out in the 1960s, senescent. So scientists
Speaker:ask the most obvious of all, can we top it up?
Speaker:Meaning can we Give external NAD or one of its
Speaker:precursors and kind of turn these cells back into
Speaker:powerhouses again, make those mitochondria shine.
Speaker:Well, it turns out in mice, the answer is yes.
Speaker:Boosting NAD in mice by using precursors such as
Speaker:NR or NMN extends the lifespan of the mice by 5 to
Speaker:15%. That translates to just a few months for a
Speaker:mouse. But if you're thinking about a human mouse,
Speaker:years in humans might work out to a couple of
Speaker:years. But in mice, we found that the mice moved
Speaker:better, they burned energy better, and as far as
Speaker:we could tell, they aged a little slower. But, uh,
Speaker:here's the catch. Human beings, we're not just
Speaker:mice with mortgages. Here's the thing. You cannot
Speaker:eat nad, but you can eat its precursors,
Speaker:tryptophan and niacin, which is vitamin B3. These
Speaker:are found in fish, poultry, beans, milk, and whole
Speaker:grains. Does this sound familiar? Yeah, we call
Speaker:that the Mediterranean diet. So before you drop 90
Speaker:to 100 bucks on a bottle of NMN or NR, maybe stop
Speaker:at the grocery store instead. The big supplement
Speaker:players, NR and NMN, can raise NAD levels and are
Speaker:generally safe up to about 2 grams a day. There's
Speaker:no major side effects beyond the occasional flush,
Speaker:but they don't reverse aging, and they don't
Speaker:replace real medicine. Now, a meta analysis shows
Speaker:that Some of these NAD precursors, especially
Speaker:niacin, can lower LDL cholesterol by about 8 to
Speaker:12%. That's a nice lab number, but let's compare
Speaker:that to, let's say, Crestor, which is
Speaker:rosuvastatin, which is the LDL lowering
Speaker:cholesterol agent. I use 5 milligrams, lowers
Speaker:cholesterol by about LDL cholesterol by 45%. 10
Speaker:milligrams, 52%, 20 milligrams. What? I take 55%,
Speaker:40 milligrams, same. So that's not a blip. That's
Speaker:the miracle of modern medicine. And no NAD
Speaker:supplement has ever been shown to prevent heart
Speaker:attacks or strokes. Statins have again and again
Speaker:shown that they can do that. Now, that's the
Speaker:difference between some interesting biochemistry
Speaker:and some actual medicine. But if we're looking at
Speaker:this, who might actually benefit from taking some
Speaker:form of nad? Well, maybe older adults with
Speaker:metabolic syndrome or prediabetes. The. Those
Speaker:small improvements in lipids or inflammation may
Speaker:be helpful. But imagine this. My bottle of Crestor
Speaker:cost me about 75 cents for a month. That bottle of
Speaker:NAD is going to be out 100 bucks a month, and the
Speaker:Crestor is going to do a little bit more for me.
Speaker:Now, there has been a hint of potential in
Speaker:patients with early Alzheimer's or Parkinson's
Speaker:disease, but that data is tiny and for all intents
Speaker:and purposes is statistically meaningless. Now, if
Speaker:you're young and healthy, the only thing NAD will
Speaker:reliably do is reduce your bank account. Safety
Speaker:wise, there have been no major interactions that
Speaker:have been found, although there are theoretical
Speaker:issues with certain anti cancer or DNA repair
Speaker:drugs. And even if your gut microbiome helps
Speaker:process NAD precursors, another reason to feed it
Speaker:well instead of flood it with pills, it may not
Speaker:actually help you that much. So what actually
Speaker:works NAD does drop. As we age, our cells enter
Speaker:into their cellular retirement. Or as Hayflick
Speaker:described it years ago, senescence. And whether
Speaker:topping NAD keeps them working longer is still
Speaker:really unknown. But what we do know is how to
Speaker:support your body's own NAD production on a plate,
Speaker:not in a capsule. The Mediterranean diet, which is
Speaker:rich in fish, legumes, olive oil, whole grains,
Speaker:naturally fuels the NAD pathway in your body and
Speaker:protects your heart in a dozen other ways. You
Speaker:don't need a subscription. You don't need a magic
Speaker:powder. You don't need this bougie price tag. You
Speaker:just need to eat better. Now, uh, here's the
Speaker:thing. If you want to learn a lot more about
Speaker:longevity the right way, we are going to actually
Speaker:work on, we're working on it now. A longevity
Speaker:cruise in the Mediterranean in the summer of 2026,
Speaker:next summer, maybe the second week of August. Our
Speaker:plan is to have world class physician, scientist,
Speaker:a food network chef with real conversations about
Speaker:living longer and better, all while sailing in the
Speaker:Mediterranean with shore excursions that will drop
Speaker:your socks off. You're not going to be fitted with
Speaker:a weighted rucksack. You're not going to have to
Speaker:pay a six figure fee. Um, unlike Peter Attia's
Speaker:program, this one includes shore excursions, wine
Speaker:and actual fun. And for the record, Yeah, I drink
Speaker:AG1, but. But not because I have an affiliate
Speaker:code. I don't get a kickback, I don't get stock on
Speaker:it. I just like how gentle it is on my stomach,
Speaker:which is why I take it. But I'm always looking for
Speaker:a less pricey, less bougie way to get in my
Speaker:vitamins. So come on. If you're interested, serve
Speaker:that time and consider about thinking about
Speaker:healthspan under the Tuscan sun, where we found 70
Speaker:years ago, people lived longer and lived better by
Speaker:eating simpler and developing immunity. This has
Speaker:been fork you, fork University researched and
Speaker:written by me, Dr. Terry Simpson, your chief
Speaker:medical explanationist. All things audio and
Speaker:editing were done by my friends at Simpler Media
Speaker:and the pod God himself who spent X amounts of
Speaker:time with me today and my new fancy equipment. For
Speaker:references and show notes, visit4q.com or
Speaker:YourDoctorsOrders.com or go to my
Speaker:substack@drsimpson.com now remember, I'm a board
Speaker:certified physician, but I am not your physician.
Speaker:If you have medical concerns, please see a real
Speaker:board certified doctor, not a chiropractor, not a
Speaker:wellness influencer. And please, you don't need to
Speaker:spend $150,000. This podcast is for education and
Speaker:entertainment, not personal medical advice. And
Speaker:until next time, stay curious, stay skeptical, and
Speaker:keep your diet Mediterranean. Have a great week,
Speaker:everyone.
Speaker:All right, Evo, we're getting old enough that our
Speaker:nad levels are dropping. I'm thinking that we
Speaker:should replace them. I just don't know how. More
Speaker:sunshine. An ocean. Happy? Uh, to hear your ideas.
Speaker:>> Speaker B: Well, I may be getting older, but I'm still
Speaker:perpetually 8 years old in my brain thinking about
Speaker:how my nads are dropping as I get older.
