Ageing is a complex process. I’ve been involved with the anti-ageing movement for over 20 years and there’s always been the search for the all-embracing phenomenon that is the prime cause of growing old which, when identified, can be targeted to simply prevent ageing.

We’re not quite there yet, and the huge question mark around whether we can ever come to that place is the fact that we have two competing camps in our bodies essentially propelled by the same resources.

We have healthy cells that increasingly weaken and de-energise as we age which we’d like to resurrect and reinvigorate so that we can regain our vitality. Then there are abnormal cells which can morph into cancer cells that are innervated by the same mechanisms allowing healthy cells to regain the mojo. Any program designed to repurpose ailing healthy cells is potentially vulnerable to being hijacked by cancer cells that are just as determined to survive and multiply. We need to be extremely careful that whatever all-powerful elixirs we enthusiastically consume to look and feel more youthful don’t germinate malevolent actors seeding our demise.

Nicotinamide adenine nucleotide, or NAD+, a molecule that has become the laser focus of research scientists as it appears to embody all the fundamental operations governing ageing, encapsulates this dilemma. NAD+ sits at the epicentre of energy production, DNA repair and the restriction of free radicals, chemicals that can cause irreparable damage when allowed to proliferate freely. Youthful cells are able to execute these key activities with exuberance, but as you get older your capacity to perform these functions diminishes, hence the relentless stumble towards decrepitude. Part of the reason for this is a dwindling supply of NAD+. Replenishing your stocks of this core chemical might be all you need to reverse ageing.

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There is a tonne of animal research which supports this. A number of diseases from Parkinson’s to Alzheimer’s, diabetes and obesity can all be overturned by topping up with NAD+. There is even evidence that food addictions which lead to weight gain can be treated by boosting NAD+ levels. If augmenting NAD+ has such wide-ranging benefits, while we are waiting for human trials to substantiate all the good work that’s been done on animals what can we do to provide our debilitated cells with more NAD+?

Boosting NAD+

One of the easiest ways to do this is by consuming more vitamin B3 or niacin, the principal vitamin used by the body to manufacture NAD+. Dietary sources of niacin include liver, chicken breast, salmon, tuna, peanuts, avocado and brown rice, suggesting that vegetarians aren’t going to have ready access to this indispensable nutrient. Pellagra, a disease caused by vitamin B3 deficiency which is characterised by the three Ds (dermatitis, diarrhoea and dementia, and in extreme cases the fourth D: death) is uncommon in the Western world. Aside from a vegetarian diet, excessive alcohol consumption can also deplete niacin reserves. Anyone suffering from loose bowels, poor memory or dermatitis might need to look no further than eating more foods that are rich in vitamin B3 to successfully palliate these disorders.

Two forms of vitamin B3 in supplement form, nicotinic acid and niacinamide, can also be deployed to produce more NAD+. Nicotinic acid also can be used to lower cholesterol and LDL (substances that are bad for the heart) while raising HDL (that prevents heart disease). Niacinamide is also utilised to help treat cancer. Unfortunately, nicotinic acid causes flushing which is often rather unpleasant, making it an unappealing resource for assembling extra NAD+.

There are two new supplements, nicotinamide mononucleotide and nicotinamide riboside, that have become the darlings of the commercial anti-ageing community for recharging NAD+. However, these have to be ingested in rather larger doses to achieve a significant effect. Taking 1000mg of nicotinamide riboside can increase NAD+, but most supplements only contain 100mg of this substance.

Another less sexy but more demanding way of increasing NAD+ is by fasting. It’s a practice that’s difficult to maintain, so for the less devoted regular exercise also increases NAD+.

The downside of boosting NAD+

As we alluded to earlier, in nature any molecule that has the power to do us a whole lot of good also has the potential to be harmful. When it comes to preserving healthy cells, NAD+ also has the ability to make cancer cells. The ageing of your cells, technically known as replicative senescence, is a time when your body makes less NAD+, and this was thought to reduce cancer risk.

However, recent research also indicates that eliminating senescent or ageing cells also decreases cancer risk, which makes NAD+’s relationship with cancer rather convoluted. Scientists have advised that we should increase NAD+ with precision, which probably means you should be measuring the NAD+ status of all your cells while at the same time identifying the presence of abnormal cells that can co-opt NAD+ in a disadvantageous fashion. This is a technology which has yet to become commercially available.