IS NMN GOOD FOR YOU?
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Episode 232:
Show Notes
Episode 232:
Transcript
Dr Mary Barson (0:04) Hello, my lovely friends. I am Dr Mary Barson.
Dr Lucy Burns (0:09) And I'm Dr Lucy Burns. We are doctors and weight management and metabolic health experts.
Both (0:16) And this is the Real Health and Weight Loss podcast!
Dr Lucy Burns (0:17) Good morning gorgeous ones, how are you this morning? Dr Lucy here of course with an episode of Real Health and Weight Loss and joined with my absolute superstar colleague, Dr Mary. Good morning Miss, how are you this morning?
Dr Mary Barson (00:30) Good, I am good this morning. Busy, busy, busy, busy. It's winding up to Christmas and there are rehearsals and concerts and recitals and charity events and school expos and lots of work to try and get organised before Christmas. And then there's lots of just trying to organise holidays and Christmas and I feel busy but happy, I think.
Dr Lucy Burns (00:56) Good. Yeah. It is funny isn't it that there is always this sort of mad Christmas rush about everything? You know, it is one day of the year but it seems to be like this marker day for many things. You know, people want to get their house cleaned by Christmas or everything needs to be done by Christmas.
Dr Mary Barson (01:16) I once spoke to, it's all very strange, but to a stonemason. I can remember many years ago when my lovely, my great uncle passed away and I was a teenager but I went along with dad to the stonemason to sort of organise his grave head. And it was the end of the year and the stonemason said, look do you need it by Christmas? Dad was like, no, that's okay. And he goes, oh good, because we have a Christmas rush. And I was like, do you? He was like, yeah. Like people suddenly go, oh goodness, I didn't organise that for Auntie Maeve. And so yeah, there's like a Christmas rush even on that, bless it. So yes, it is just a time when we make ourselves busy.
Dr Lucy Burns (01:53) Indeed. Indeed. Well, this week we are diving back into the world of supplements and this particular supplement, we have been asked multiple times in multiple forums about it. So we thought we'd do a big episode on it. And the supplement is, it's hard to pronounce.
Dr Mary Barson (02:17) Nicotinamide mononucleotide. What are you talking about? Nicotinamide mononucleotide, it's easy. Even the shortening of NMN. I find that harder, NMN. NMN. NMN. Not the rapper. Not the rapper. We're talking about NMN, yep.
Dr Lucy Burns (02:36) NMN, nicotinamide mononucleotide. Correct, yes. Excellent. So this supplement has burst onto the scene in many, many industries and with all sorts of claims and promises. And so we thought we'd have a look into them and see, you know, sort out the fact from the fiction and, you know, maybe just give you some clues on some marketing mischief around it. So, Miss I thought, you know, you being the biochemist, if you could perhaps lead the way and just explain a little bit, because again, NMN, you know, no one's heard of it. It's not like, you know, vitamin C, we've all heard of that. We're over that vitamin C. Yeah, you bet. Yeah. Yeah. NMN, tell us about it.
Dr Mary Barson (03:24) Nicotinamide mononucleotide, NMN. It's something that we all naturally make in ourselves. All of our cells make it and it's a precursor to a really important substance that we need to make called nicotinamide adenine dinucleotide. We're going to call it NAD+, N-A-D for short, NAD+. When you write it, it has to have a little plus sign on it because of biochemistry, but we're just calling it NAD+, people. So that's what we mean. So NAD+. NAD+ is vital, it's got a coenzyme. It's a vital coenzyme, and it's called a coenzyme because it makes our enzymes work. It's like their friend and helps them along, holds their hand and makes them work in a huge number of cellular processes that are involved in our metabolism and in our energy production. So NAD+ is vital for all kinds of things to make us work well, to make us be able to burn our fuel, to use our food. And if we don't have enough NAD+, and if our NAD+ levels aren't functioning properly, all kinds of things can go wrong. One thing that NAD+ does as well is it's really important in getting rid of our reactive oxygen species. You've heard about, you know, oxidative stress and oxidation. So we need to have NAD+ to be able to deal with that. We need NAD+ to be able to repair our DNA from little changes. So having enough NAD+ around is really important to prevent age-related diseases and cancer keep our cells healthy and be able to reproduce and use our energy effectively. So that's really important. And we do know that NAD+ naturally declines with age. And we do know that certain illnesses like type 2 diabetes are associated with lower levels of NAD+. So it's drawn a lot of attention to this signaling pathway to NAD+ from the pharmaceutical industry, from longevity researchers. Is there something that we can do? How can we get NAD+ to work better? Because it's hypothesised that if NAD+'s functioning better, then we won't get as many age-related diseases. And perhaps we will be able to manage our fuel better. We won't get as many metabolic diseases, of which type 2 diabetes and obesity are some of those metabolic diseases. And coming back to nicotinamide mononucleotide or the MNM. NMN, not NMN. See, I find it easy. And it's not M&Ms. It's not M&Ms. NMN. This has really been heavily investigated. Supplementing with NMN has been heavily investigated as a potential strategy to increase NAD+ levels improve cellular health and to help mitigate the potential effects of aging. And there have been some studies, really intensive studies looking at animals. And then more recently, some short-term studies looking at humans. And then a whole lot of companies have jumped on this and started marketing NMN supplements to us with great vigour. It's hitting people's Facebook ad feeds, and we're getting lots of questions pinging around that NMN supplementation is the answer to obesity. It's the answer to aging. What do you think, Dr Mary? What do you think, Dr Lucy? So today we're going to tell you what we think.
Dr Lucy Burns (07:02) Indeed. And I think one of the things is to think, first of all, about the phrase aging. So aging means different things to different people and anti-aging, again, different things to different people. So what are your thoughts on it, Miss? When you hear the word aging, what do you think?
Dr Mary Barson (07:24) I reckon there are two things. There's just getting older, just chronologically getting older, which actually I think logically most of us want because we don't want to die early. We want to live. We want to live. And then there are the deleterious effects of aging, the age-related disease, the age-related debility, the age-related decline. We don't want the decline and the disease and the debility, but we probably do want to get older. So what we want is to say, well, as we get older.
Dr Lucy Burns (07:55) I think that's really important that we do, that we know that getting older should not be seen as this huge negative that it is. And there's, again, I mean, we could talk on and on about the youth washing that goes on, that getting old is bad and that being young is good, all of that sort of stuff. So there's that in there, but yes, you're right. Definitely chronologically getting older is a good thing because, you know, my pop used to say, there's only two options. You're either getting older or you're dead. Which one do you want? That's all right. So, yeah. So yes, we're accepting that getting older is normal. You know, again, my thoughts are most definitely we need to change the narrative around that in, certainly in Western society where, you know, old is used as a slur, as being stupid, as being silly, as being an, oh, you know, you're just an old woman, as being, you know, fuddly, all the things. Old is not the problem. It's, I think, some of the things that come, as you said, come with getting older. But what we're seeing now, again, is that they're coming younger. You know, type 2 diabetes used to be, as you said, age-related, except people are now getting it in their 30s and 40s. So it's not actually age, necessarily age-related. It's more lifestyle-related.
Dr Mary Barson (09:32) And we're in this interesting time in the history of our species where, you know, we've largely, not completely, but largely eliminated death from communicable diseases like infections, and we're living longer than we ever have. But we are not necessarily living healthier than we ever have. So I like the idea of not just looking at people's lifespan but looking at your health span. So you want to slow down the effects, the more deleterious effects of chronic disease while still living longer. And, you know, it is proposed that MNN supplementation does that.
Dr Lucy Burns (10:20) Indeed, indeed. Interestingly, I did a talk not that long ago to a group of businesswomen and we're talking to them about this concept that we work really hard, all of us, whether you're a woman or a man, work hard because we want to retire and gallivant around on, you know, your moped or hike the Andes or whatever you want to do when you've got time in retirement. But interestingly, yes, you know, we are living longer, but the health span has decreased. And the average now of people that debilitating chronic disease right at the end, the average is 11 years, which means there are some people who have a hell of a lot longer. So they might have 20 years of, you know, debilitating chronic disease before they die. Because there are plenty of, you know, we know there's plenty of people who go, oh my God, Fred was 93 and then he just dropped dead. It's like, yeah, well, that's what we all want, isn't it? You want to be great, and healthy. Oh, Fred was riding his bike yesterday and then he just died in his sleep. You think, yay, Fred, that's what you want. But yes, so you're right. So we're all fearful of frailty and being sick when we're old rather than the actual getting old. Yes.
Dr Mary Barson (11:46) Yeah, that's right. And, you know, there are, there are lots of actionable steps we can take to give ourselves the best chance to have a longer health span and to improve our health and to prolong our health. And I think that that is a, at some level, that is a deep sort of visceral desire for many people. And that's why, you know, marketing comes. There's a market there, essentially, there's a market, there's a market there to which it is being marketed. And I think that it's important to have a little bit of savviness and to put on your sceptical hat, you know, put your sceptical hat on over your open mind and balance that open-mindedness with that healthy scepticism and to navigate the best path forward for you. So we could go into NMN a little bit more and talk about, I guess, I suppose the current state of science should be like, or like in what I mean by that is sort of the current state of evidence.
Dr Lucy Burns (12:54) Yeah, I think that's a great place to start because so the reason that we're doing this episode again, as we mentioned, we get, we get asked a lot and Mary run an episode called Doctor in Your Pocket every Monday for our Momentum members and they can bring anything, any questions. And we get all sorts of questions, which is where we had the hops, the matured hops extract. And then we've had this NMN and yeah, looking at the science is absolutely critical because when you look up NMN, NMN, first of all, the first Google search, there are lists of supplement companies that sell it. So I did a bit of a click on the website and then when you click on the website, they will usually as part of their marketing list publications, which makes sense. Why wouldn't you? I mean, you know, if you're trying to sell something, you want to give it some validity. So yeah, Miss, take us through some of those publications and they're unlike MH, unlike the hops thing, there are actually quite a few studies on it.
Dr Mary Barson (14:17) There is, yeah. It's been a hot topic of research for a long time now, about a decade really. So as is usually the case when we sort of start researching a new potential therapeutic target, the research is on animals. So there are lots of studies looking at mice and fruit flies and they showed some potential benefits for metabolic health and anti-aging effects in those model organisms that we call them in the science world. And then much, much, much more recently, like really only in the last four years or so, there is starting to become some human research. And that's really where I put so much more of my energy into because showing that something is metabolically important in mice does not mean that it'll be metabolically important in humans. It's an important first step, but it doesn't necessarily translate. And since we deal with humans and we deal with sort of, you know, the clinical day-to-day reality of people's lives, that's where I focus my energy. So there is some promising short-term research and emphasis on the short-term that MNM supplementation could be useful for improving mitochondrial functioning cellular defense and metabolic health. There was a study in 2020 looking at healthy post-menopausal women. It was just for 10 weeks and it showed that it increased their muscle insulin sensitivity in their muscle, but interestingly didn't actually have any change on their liver fat or their body fat or other aspects, but you know, it was promising. It was quite a low dose 250 milligrams a day. There's a study in 2021 in healthy men showing that it improved their aerobic capacity to a modest degree. There are some more newer studies looking at various other aspects and a study earlier on that looked at just proof safety actually got a group of healthy men to take 500 milligrams for several weeks and they didn't see any adverse effects, didn't see any issues with it. But again, this is all really kind of short-term. So that's broad brushstrokes as of like the positive aspects, but there are some potential negative aspects that might be inferred from that data. Lucy, you were telling me about one.
Dr Lucy Burns (16:48) Yeah. And there was, I also thought it was interesting that there's again, a particular supplement company that's got its 15 trials listed as being evidence of the efficacy of their product. One of the trials in particular was on healthy people, only again, 250 milligrams, which is a small dose. And when you click on the trial, the conclusion is that it increased your insulin levels post-prandioly, so after food. So when we eat, when they compare the people without the supplement and the people with the supplement, well, the people who took the supplement had higher insulin levels after eating. And my brain goes, well, I don't want that. Like, honestly, why would you want that? The only people that would want that are people with insulin dysfunction, you know, at sort of the tail end of their type 2 diabetes, who are really trying to get their pancreas to work a bit better. But the majority of us- Squeeze every drop of insulin out of it. Yeah. We don't want higher insulin post-prandioly. Why would we want that? And then I thought, well, isn't it interesting then that they're linking this study to their supplement? So two things occurred to me either, they don't actually understand metabolic health and where insulin fits into it all, or they know that most people don't click on the studies and that the people that do, most people can't read them because they're hard to understand.
Dr Mary Barson (18:28) They're totally hard. They're totally hard. It's a totally different language than they've written in science.
Dr Lucy Burns (18:33) Yeah, absolutely.
Dr Mary Barson (18:35) You highlight a really good point here that there are potential risks of MNN supplementation. Although the short-term safety data in humans is encouraging, there seems to be minimal adverse effects reported in these clinical trials. There are some really, there are some potential risks that, well, there could be risks that we don't know about long-term. We don't know. And these medications are only going to work while you take them. That's the other thing. You have to be on them to get the benefit. Some theoretical concerns from the preclinical studies are that we just don't know what kind of metabolic imbalances there could be from prolonged and excessive NAD+ production. If we're going to push up our NAD+ continually, we don't actually know necessarily what the metabolic consequences will be. They might be okay. They might be disastrous. And there are also some theoretical concerns about cancer growth. So NAD+ does lots of things. It's really important, but it's essential for cellular growth and it's increasing the amount of NAD+ you've got in your cells and in your bloodstream. It could potentially promote the growth of pre-existing cancer cells. And our body's got sort of mechanisms and safety mechanisms to try and prevent and fight off cancer. One of these includes this process called senescence, which is like programmed cell death. When a cell starts to go a bit wrong, a bit awry, there's some DNA mutations in there that could be leading it to be precancerous. One thing that our body can do is that cells can kind of commit planned suicide, senescence, like, well, there's something wrong with me. I'm out. I'm going to do an honourable suicide. And it's possible that having just extra NAD+ floating around could disrupt that process. It has not been confirmed in human studies, but it is a significant concern. So, I mean, there's just a lot of unclear, the risks are unclear due to lack of extended human studies, which I think is really important to note. Absolutely.
Dr Lucy Burns (20:38) And in fact, when we're talking about the studies, the studies are sort of eight weeks, like they're not even a year or two years. Like, you know, people are often talking, you know, concerns to say with medications like the injectable weight loss drugs, the GLP-1 receptor agonists and saying, well, we don't have any long-term safety data. We've at least got a couple of years. These, this one was, there's nothing more than eight weeks like it's really short. And it is very clear that the, you know, supplements only work, as you said, while you're taking them. And interestingly, again, the supplement industries, you know, a bazillion dollar, trillion dollars, I don't know, lots of million dollars industry that is largely unregulated, that can, you know, make claims that even the pharmaceutical companies can't necessarily. So I know there are lots of people out there who are really angry about big pharma, but I think, well, what about the big supplement, whatever you call that? It's, it's, you know, I would say it's worse.
Dr Mary Barson (21:58) Yeah. I mean, especially if they're sort of, they're classed as a food and not a drug, that the rules are different for them. So yeah, yeah. You got to keep your healthy scepticism hat, you know, firmly pulled on over your head here. And I think a great way to sort of, tie up this whole conversation would be to talk about that NMN is it's a natural product that we make ourselves. And NAD+ is a natural product that we make ourselves. And yes, it can decline. This decline is associated with disease states and aging, but there are natural ways that you can boost your own NMN and NAD+ production without supplementation. And there's going to have way more benefits beyond even just that they're going to be one of our favourite words, pleiotropic. Pleiotropic, I love that word. I do love that word. So I can, what do you reckon Lucy, we can talk about ways in which you can naturally boost your own NAD+ production.
Dr Lucy Burns (23:04) Yep. So I loved what you mentioned earlier. You can, you're looking at ways to naturally increase your NAD+ and you're also looking at ways to naturally stop the degradation. And so by kind of attacking it at both ends, you then, you know, increase the pool in the middle. Yes. So yeah, again, so certainly, I mean, you know, how much we love the six S's, six S's for success. Certainly, five of those have evidence for either increasing NAD+ or stopping its degradation. And so, you know, again, start with our favourite S of sustenance. Yeah. You can get NAD+ in food. Now there's not a lot, okay. Compared to say supplementing. So the supplements are all looking at 250 to 500 up to 2000 milligrams is what the trials are on. So these are bigger numbers. But here's the thing we know. Food, the way in which we absorb nutrients is different. Food versus a tablet. So for example, we know that iron absorption is much more effective when it is, you know, combined in whole foods compared to taking an iron supplement tablet. We know this with lots of food. So whilst the dose in your food might look small, I would say the bioavailability is pretty good.
Dr Mary Barson (24:51) That's right. And the food synergy to all of the other nutrients that are there as well is going to help in ways that science probably can't even, you know, quantitate at this point in time. So yeah, food.
Dr Lucy Burns (25:04) Again, the foods that we know about are great for our low-carb lifestyle because they're all the foods that we, you know, already look at. So, you know, we've got veggies like, you know, broccoli and cabbage and cucumbers, like they're all good sources. Avocado, you know, most of us eat lots of avocado, beef and even milk. I mean, we're not big fans of lots of milk, but, you know, so there's plenty of just whole food, you know.
Dr Mary Barson (25:41) That's right. And you get the precursors that our bodies use to make the NMN. So tryptophan, the niacin, our bodies use that to make our own NMN. If we're getting a nice supply of real food, it's good. And coming up to Christmas, turkey is a pretty good source of tryptophan, just saying. So turkey, if you're into animal foods, that is a good one to boost up your tryptophan to therefore boost your own M&M production.
Dr Lucy Burns (26:06) Absolutely. And another way to increase your NMN as sort of part of that sustenance, I guess, is some fasting. So the benefits of fasting are way beyond just calorie restriction, which is what some people will try and convince you of. There's things that go on during that process. So, yeah, definitely our body will make its own NMN.
Dr Mary Barson (26:41) It turns on longevity pathways, the fasting sort of it activates pathways in our genes and in our mitochondria that turn on these longevity genes. And one of those is one of the pathways, the sirtuin pathway in particular, that helps us boost our own NAD+ production. So nurturing your body with some intermittent fasting is a great way to boost your NAD+ and have all those beautiful anti-aging metabolic health benefits.
Dr Lucy Burns (27:06) Absolutely. Now, exercise, again, is a word that can be very triggering for people. We've spoken about this. If you've used exercise as a punishment for food if people have told you you must exercise, if you've been flogged as a child to run around the oval when it was 35 degrees and you were hot. Yeah, that might have been me. There are many reasons for people to feel, have just a negative thought process on exercise. But we do know that moving your body increases your NAD+.
Dr Mary Barson (27:48) It does. Promoting that mitochondrial function, and metabolic health is a good way to increase your NAD+ synthesis. Do something you enjoy.
Dr Lucy Burns (27:56) Yes. Yeah. Look, you know, my brain, whenever I'm doing any, you know, and as we all know, my favourite thing to do is swimming. Well, it's not actually my favourite, but it's the thing I can do. So, you know, we've got to balance practicality. There's no point having my favourite being ice skating when I can't ice skate. Indeed. But what I do in there is I just keep reminding myself of all the things that are happening whilst I'm doing it. So, you know, my myokines are being activated, which is making, and improving my mood. And now I can add more NAD+. More NAD+. That's right. More NAD+, which is improving my longevity pathways, which is making me, you know, decreasing. So increasing the health span or decreasing the sick span at the end. Yes. Yes. Okay, Miss, what else have we got? So we've got sustenance, we've got, you know, movement or, you know, it doesn't have to be strength training necessarily in this one, but a movement one. And what are our other S's?
Dr Mary Barson (29:03) Sleep. You could even, I know it starts with a C, but circadian rhythm alignment is really good. Our NAD+ production is intricately tied to our circadian rhythms. So getting some sleep. Sleep is going to help support. So having a good regular sleep-wake cycle, getting some morning sunlight, avoiding light at night, going to bed on time, and getting enough sleep, that's going to support your NAD+ production. And it's also going to help prevent the increased NAD+ breakdown that you get with sleep deprivation. So it's a double whammy. You can make more and you burn less.
Dr Lucy Burns (29:46) And you touched on one of the other S's being sunlight. And again, it's, you know, the morning sun, not the middle of the day sun, middle of the day sun, we know is damaging to our skin and skin cancers and, you know, wrinkles and all of those things that the daylight sun does with oxidising. Whereas who has the morning sun has none of that. So you can be gallivanting out in the morning, you know, walking the dog, swimming in the pool, you're actually getting, you know, two for the price of one with your sunlight and your movement and your circadian rhythm. So your sleep's good. So, yeah, so sleep in the night, you know, again, we all need to sleep. So if you're working the night shift, you can't not sleep, but sleeping at night is so much better for you than sleeping in the day.
Dr Mary Barson (30:43) Yes. And also we may, it's not completely proven, but we may also be able to make NAD+ in our skin through sun-mediated pathways. Getting a little sun on your skin is also going to add that other little boost to your NAD+ production. So a bit of sun is good for you. Sunburn is bad, but up until being sunburned, some daily sun exposure is really good for you. And yes, that morning sun, is brilliant, brilliant for your circadian rhythms.
Dr Lucy Burns (31:10) Excellent. And then our last one, stress management. How does that affect your NAD+?
Dr Mary Barson (31:15) Chronic stress quite likely lowers your NAD+ levels, just all of the deleterious metabolic pathways that we get with chronic stress, increasing our oxidative stress and psychological stress causes physical stress. So it's not, it's not just like a black cloud that exists above your head as some existential thought bubble, the actual psychological, chronic psychological stress literally impairs our metabolism and our physiology, as we have discussed many times. And, and one of the ways in which it does it is it, is it decreases our NAD+ levels. So managing your stress, you know, we don't need desert islands. Don't need to run away to a desert island. Although that does sound nice. It's about like the practical doable things that you can do in your day-to-day life right here, right now, even though you've got Christmas and dance recitals and stressed out about having to do stage makeup on your 11-year-old girl really well, you can still, still take action to manage your stress.
Dr Lucy Burns (32:16) And it doesn't have to be perfect. And again, every time you stop, every time you, you, you know, do some meditation or listen to hypnosis, you can know that in the background, you're, you know, you're NAD+, boosting this NAD+.
Dr Mary Barson (32:31) Could be a new mantra. I boost my NAD+, I boost my NAD+.
Dr Lucy Burns (32:22) So as far as supplements go, guess there are two things I guess we want to wind up with. One is that there's not enough safety data on the long-term effects. Short-term, it does seem to have some potential benefits, but are they outweighed by these potential risks? We don't know. And do the benefits stay with you long-term? We don't know. The data's just not there. So I think given the expense of this product, and the fairly aggressive marketing around it, I'd probably give it a nay.
Dr Mary Barson (33:02) Yeah, I think for now, I got the balance of probability. I would give it a nay as well. But my open mind is there. My sceptical hat is on, but for now, it's a nay.
Dr Lucy Burns (33:09) Alright. It's a nay. Well, my lovelies, we're going to bring you next week a yay in our supplement world. So stay tuned for that. So we're not always doom and gloom. We're not always, but we do, as I said, we know that there is marketing mischief. It's not just around food. There it's now around supplements and we know what they're, you know, the pain points that they're targeting, the fears that they're targeting and they're, yeah, it's just, some of it's a little bit rubbish.
Dr Mary Barson (33:24) Yeah, that's that. See you later gorgeous ones.
Dr Lucy Burns (33:48) Alright, see you next week. Bye for now.
Dr Lucy Burns (34:06) The information shared on the Real Health and Weight Loss Podcast, including show notes and links, provides general information only. It is not a substitute, nor is it intended to provide individualised medical advice, diagnosis or treatment, nor can it be construed as such. Please consult your doctor for any medical concerns.
