In last week’s post, I outlined what NAD+ is; how it declines with age and the role that plays in aging; how it can be boosted with healthier lifestyle habits; how it can also be boosted with IV infusions or by taking the oral supplements NMN or NR; and why these supplements have generated tremendous interest in recent years.
But I also explained that, at this point in time, I do not recommend supplementing with NAD+, NMN, or NR. (Needless to say, I do recommend exercise and a healthy diet, both of which have been shown to raise NAD+ levels).
Pictured: Sir Arthur Harden, Nobel Laureate and discoverer of NAD+
I have not yet spent a lot of time on this blog discussing supplements, because I think the focus of good health should be the basics: healthy diet, exercise, good sleep, stress management, and the avoidance of toxic substances such as drugs, tobacco, and excessive alcohol.
This is not to say that supplements don’t have a role, but as a category they suffer from a number of problems. They often are not backed by large and robust studies. The studies that do exist tend to be funded by companies who stand to profit from the supplement, thus introducing the same conflict of interest that “big pharma” is often guilty of with prescription medications. They are not well regulated, so even if “substance X” is truly safe and terrific for your health, you have little guarantee when you purchase “substance X” that you are actually getting “substance X”, unless you make sure to purchase from a reputable place like FullScripts (linked here in case you are interested). And supplements can give people a false sense of security – “I take a multivitamin, and therefore I don’t need to worry about eating healthfully,” or “I take creatine, so I don’t need to actually do a workout” are foolish and potentially dangerous ideas.
With that said, I get asked about this topic a LOT, so I’m going to start periodically reviewing various supplements.
First up in today’s post: NAD+ (and the supplements which help to raise NAD+, namely NMN and NR), which a number of patients have asked me about in the past few months. This is a long and complicated topic and I had to do a lot of research to get up to speed on it, so I am going to break this post into two separate parts, one today and one a week from now. But first let me just give the punchline for those of you who don’t want to read my long ramblings:
I’ve discussed in a few prior posts (for example here and here) the potential downsides of doing too much testing in medicine. This is an important topic, and one that can be difficult to discuss. Patients – quite reasonably – want to feel that their doctors are listening to them, and running all reasonable medical tests to prevent, diagnose, and treat disease. Any discussion of how medical testing can sometimes actually be detrimental to your health can therefore risk coming off as being callous and uncaring. “What do you mean I shouldn’t be tested for disease x?,” a patient may think. “Don’t you want me to know if I have it or not?” Unfortunately it’s not so simple.
I’m going to take a holiday break from posting on this blog over the next few weeks. But before doing so, I’d like to share a few parting thoughts as we wrap up the year.
A few patients have recently asked me about “liquid biopsy” tests. These are a new frontier of testing in which a single blood sample is analysed for evidence of multiple types of cancer. The idea is to analyze a single blood sample and – ideally – receive reassurance. However if you got an abnormal result, you’d then be referred for further testing to either confirm or exclude a diagnosis of cancer. This is much the same process as our current prostate cancer screening program in which a man has a PSA test as part of his annual physical to indicate the possibility of prostate cancer and then, in the event of an abnormal result, is referred for further workup (e.g. a prostate MRI or biopsy) to determine if he in fact does have cancer, or if he simply has a “false positive.” However, unlike with a PSA – which checks only for prostate cancer – a “liquid biopsy” would be able to test for dozens of different types of cancer at once.
It’s wonderful to imagine a (not so distant) future in which a blood test at your annual physical can screen you for virtually every known type of cancer (including ones for which we currently have no good tools for early detection such as brain, pancreas, or ovarian) and either give you reassurance that you are cancer free, or conversely pick up a cancer in the very earliest stages and offer a much better chance for cure.
There are a number of such tests under development (the GALLERI test from Grail, and CANCERGUARD from the makers of Cologuard are two of the better known ones), and, as you can imagine, these are igniting great interest in both doctors and patients. And while none of these tests are yet to be FDA approved – nor to be covered by any type of insurance – a few are now commercially available for those who can pay out of pocket for them. Not surprisingly then, a few patients have asked me recently whether these are worth having.
I recently came across a paper that was published almost ten years ago (2017) but which I think is highly relevant and very interesting. But before I get into it, let me give a bit of context.
