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Your body needs NAD to function, but can it make you stronger?
Nicotinamide adenine dinucleotide (NAD) is necessary for energy production within our cells. It’s also critical for various body processes, including fitness and optimal skeletal muscle growth and development. Yet, NAD levels decline with age and some supplements that claim to enhance NAD levels may actually lead to a decrease in exercise performance. In this article, I’ll share how you can enhance your exercise performance while supporting optimal NAD and ATP levels in your cells.
To understand exactly why NAD is so important for fitness and skeletal muscle growth and development, we need to first understand adenosine triphosphate or ATP. ATP is a molecule produced in the mitochondria of our cells. It provides the energy that fuels each of the biological processes that take place within our bodies. If our bodies are cars, then ATP is like gas—nothing is happening without it. Our bodies produce ATP from components of the foods we eat, such as glucose and fatty acids. Skeletal muscle requires a lot of energy and is, therefore, a major consumer of glucose and fatty acids. In order to metabolize these components into ATP and use it as energy, our muscles need NAD. This is why NAD’s role in energy production is so vital. Without adequate NAD, our bodies wouldn’t be able to produce sufficient ATP. 
NAD is critical for fitness, strength training, and optimal skeletal muscle growth and development. As we grow older, however, our NAD levels tend to decline. This is one of the reasons why it often becomes increasingly difficult to maintain muscle mass as we age. Lower NAD levels have a negative effect on muscle health, while higher NAD levels support optimal muscle health.[1]
That said, research has demonstrated an increase in tissue NAD levels after supplementation with NAD precursors, which are molecules that are converted into NAD within the body. These NAD precursors include niacinamide (NAM) and nicotinamide riboside (NR).[3] [4] [5] [6] [7] But don’t run out and buy all of the bottles just yet. In 2016 and 2018 a team of researchers conducted two studies on animals to identify the effect of popular NAD precursor nicotinamide riboside (NR) on exercise performance.[8] [9] At the end of the studies, researchers found that NR actually led to the animals performing more poorly on swim tests, instead of increasing exercise performance as they had expected.
Why would this happen? The process of our bodies producing NAD leads to a shift in the cellular environment. This environmental shift leads to an increase in the production of free radicals within our bodies. Free radicals are unstable molecules. They are typically kept in balance by antioxidants, but they can damage our cells if they go unchecked. This imbalance between free radicals and antioxidants is known as oxidative stress. In the study referenced, taking NR led to both an increase in free radical formation and a decrease in key antioxidant enzymes that typically combat free radical damage and oxidative stress.[10] Now, I want to point out that some increased free radical formation isn’t necessarily a bad thing. Free radicals actually play critical roles in wound healing, immune system health, and other body functions.[11] [12] Our bodies have antioxidant systems in place that help neutralize excess free radicals and prevent them from wreaking havoc on the body. However, when the increase in free radicals destabilizes the balance between pro-oxidants and antioxidants, our cell health is jeopardized. This was the case for the animals in this study who were administered nicotinamide riboside. The researchers who conducted these two studies hypothesized that NR’s negative effect on exercise performance may have been due to the shift in the balance of free radicals and antioxidants and the increased oxidative stress that came about as a result.
So, if animal studies on nicotinamide riboside suggest that it may have a negative effect on exercise performance, how can you increase NAD without sacrificing any of its benefits? Enter D-ribose. D-ribose is a critically important sugar molecule and building block for ribonucleic acid (RNA), a molecule that helps convert the genetic information in our DNA into proteins. D-ribose plays an important role in exercise performance. In fact, this molecule has been demonstrated to enhance recovery in ATP levels.[13] 
People who supplemented with D-ribose also felt that they were less tired after high-intensity training and had lower blood levels of creatine kinase, an enzyme that serves as a marker for muscle damage within the body. Furthermore, D-ribose has antioxidant effects on the body and may reduce the formation of free radicals.[14] Because it has been demonstrated to provide cellular protection in times of oxidative stress, taking D-ribose along with a precursor like niacinamide (NAM) that effectively increases NAD levels may help support optimal NAD and ATP levels which in turn may boost exercise performance and support optimal skeletal muscle health.
Dr. Janelle Louis is a licensed naturopathic doctor who specializes in helping people with childhood trauma overcome the chronic health concerns they are at increased risk for developing, including mental health conditions, reproductive concerns, autoimmune diseases, and metabolic syndrome. Dr. Louis is committed to ensuring that her patients live their healthiest lives in the present in spite of their difficult pasts. Resources: [1] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5840929/ [2] https://www.ncbi.nlm.nih.gov/pubmed/16802695 [3] https://www.ncbi.nlm.nih.gov/pubmed/28417163 [4] Xue, YQ, Increasing NAD level by D-ribose and its combinations. PCT/US2019/031889 patent pending [5] https://www.ncbi.nlm.nih.gov/pubmed/27721479 [6] https://www.ncbi.nlm.nih.gov/pubmed/29599478 [7] https://patents.google.com/patent/US20140031299A1/en [8] https://jissn.biomedcentral.com/articles/10.1186/s12970-016-0143-x [9] https://www.ncbi.nlm.nih.gov/pubmed/30007015 [10] https://www.ncbi.nlm.nih.gov/pubmed/30007015 [11] https://www.ncbi.nlm.nih.gov/pubmed/25313960 [12] https://www.ncbi.nlm.nih.gov/pubmed/10807157 [13] https://jissn.biomedcentral.com/articles/10.1186/s12970-017-0205-8 [14] https://www.ncbi.nlm.nih.gov/pubmed/22891990
What is NAD and why is it important for fitness?
To understand exactly why NAD is so important for fitness and skeletal muscle growth and development, we need to first understand adenosine triphosphate or ATP. ATP is a molecule produced in the mitochondria of our cells. It provides the energy that fuels each of the biological processes that take place within our bodies. If our bodies are cars, then ATP is like gas—nothing is happening without it. Our bodies produce ATP from components of the foods we eat, such as glucose and fatty acids. Skeletal muscle requires a lot of energy and is, therefore, a major consumer of glucose and fatty acids. In order to metabolize these components into ATP and use it as energy, our muscles need NAD. This is why NAD’s role in energy production is so vital. Without adequate NAD, our bodies wouldn’t be able to produce sufficient ATP. NAD is critical for fitness, strength training, and optimal skeletal muscle growth and development. As we grow older, however, our NAD levels tend to decline. This is one of the reasons why it often becomes increasingly difficult to maintain muscle mass as we age. Lower NAD levels have a negative effect on muscle health, while higher NAD levels support optimal muscle health.[1]
Some popular NAD supplements worsen exercise performance
As we age, if our goal is fitness and peak performance, it is critical that we give our bodies—and especially our muscles—the things that they need. This includes adequate NAD. However research has not been able to demonstrate an increase in tissue NAD levels after supplementing with NAD molecules directly.[2] That said, research has demonstrated an increase in tissue NAD levels after supplementation with NAD precursors, which are molecules that are converted into NAD within the body. These NAD precursors include niacinamide (NAM) and nicotinamide riboside (NR).[3] [4] [5] [6] [7] But don’t run out and buy all of the bottles just yet. In 2016 and 2018 a team of researchers conducted two studies on animals to identify the effect of popular NAD precursor nicotinamide riboside (NR) on exercise performance.[8] [9] At the end of the studies, researchers found that NR actually led to the animals performing more poorly on swim tests, instead of increasing exercise performance as they had expected.
Why would NR decrease exercise performance?
Why would this happen? The process of our bodies producing NAD leads to a shift in the cellular environment. This environmental shift leads to an increase in the production of free radicals within our bodies. Free radicals are unstable molecules. They are typically kept in balance by antioxidants, but they can damage our cells if they go unchecked. This imbalance between free radicals and antioxidants is known as oxidative stress. In the study referenced, taking NR led to both an increase in free radical formation and a decrease in key antioxidant enzymes that typically combat free radical damage and oxidative stress.[10] Now, I want to point out that some increased free radical formation isn’t necessarily a bad thing. Free radicals actually play critical roles in wound healing, immune system health, and other body functions.[11] [12] Our bodies have antioxidant systems in place that help neutralize excess free radicals and prevent them from wreaking havoc on the body. However, when the increase in free radicals destabilizes the balance between pro-oxidants and antioxidants, our cell health is jeopardized. This was the case for the animals in this study who were administered nicotinamide riboside. The researchers who conducted these two studies hypothesized that NR’s negative effect on exercise performance may have been due to the shift in the balance of free radicals and antioxidants and the increased oxidative stress that came about as a result.
How to enhance your workouts with NAD and ATP
So, if animal studies on nicotinamide riboside suggest that it may have a negative effect on exercise performance, how can you increase NAD without sacrificing any of its benefits? Enter D-ribose. D-ribose is a critically important sugar molecule and building block for ribonucleic acid (RNA), a molecule that helps convert the genetic information in our DNA into proteins. D-ribose plays an important role in exercise performance. In fact, this molecule has been demonstrated to enhance recovery in ATP levels.[13] People who supplemented with D-ribose also felt that they were less tired after high-intensity training and had lower blood levels of creatine kinase, an enzyme that serves as a marker for muscle damage within the body. Furthermore, D-ribose has antioxidant effects on the body and may reduce the formation of free radicals.[14] Because it has been demonstrated to provide cellular protection in times of oxidative stress, taking D-ribose along with a precursor like niacinamide (NAM) that effectively increases NAD levels may help support optimal NAD and ATP levels which in turn may boost exercise performance and support optimal skeletal muscle health.
Closing
In closing, our skeletal muscles require large amounts of ATP to function optimally. Adequate NAD levels are critical for optimal ATP production and peak exercise performance. NAD levels decline as we grow older. Therefore, without adequate NAD, it may be difficult to meet our fitness goals, especially as we age. When it comes to increasing NAD levels via oral supplementation, some NAD supplements simply haven’t been shown to increase NAD levels. Others have been demonstrated to increase tissue levels of NAD, but they may also lead to a decrease in exercise performance. This may be the result of imbalances in our bodies’ antioxidant systems that come about when we supplement with some NAD precursors. D-ribose is a critical molecule that has been shown to enhance exercise performance and to reduce oxidative stress. Taking NAD precursors like niacinamide (NAM) along with D-ribose may help increase NAD levels while enhancing exercise performance and ATP production.Dr. Janelle Louis is a licensed naturopathic doctor who specializes in helping people with childhood trauma overcome the chronic health concerns they are at increased risk for developing, including mental health conditions, reproductive concerns, autoimmune diseases, and metabolic syndrome. Dr. Louis is committed to ensuring that her patients live their healthiest lives in the present in spite of their difficult pasts. Resources: [1] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5840929/ [2] https://www.ncbi.nlm.nih.gov/pubmed/16802695 [3] https://www.ncbi.nlm.nih.gov/pubmed/28417163 [4] Xue, YQ, Increasing NAD level by D-ribose and its combinations. PCT/US2019/031889 patent pending [5] https://www.ncbi.nlm.nih.gov/pubmed/27721479 [6] https://www.ncbi.nlm.nih.gov/pubmed/29599478 [7] https://patents.google.com/patent/US20140031299A1/en [8] https://jissn.biomedcentral.com/articles/10.1186/s12970-016-0143-x [9] https://www.ncbi.nlm.nih.gov/pubmed/30007015 [10] https://www.ncbi.nlm.nih.gov/pubmed/30007015 [11] https://www.ncbi.nlm.nih.gov/pubmed/25313960 [12] https://www.ncbi.nlm.nih.gov/pubmed/10807157 [13] https://jissn.biomedcentral.com/articles/10.1186/s12970-017-0205-8 [14] https://www.ncbi.nlm.nih.gov/pubmed/22891990
