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So rapamycin, metformin, SGLT2i, and NAD+ precursors such as nicotinamide riboside?
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Out of curiosity, where can I read conclusive or highly suggestive research showing the benefits of supplementing with NAD+? I understand the theory, but I’d like to read some good outcome studies. I ask, because I’ve seen a lot of excitement about the potential, but I can’t seem to pin down concrete recommendtions based on results. TIA!
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I tend to agree that the jury is out on B3 vitaminers.
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I wonder the same. There’s confliction evidence and potential risk of harm: Nicotinamide riboside first alleviates symptoms but later downregulates dopamine metabolism in proteasome inhibition mouse model of Parkinson’s disease 2024
So for now I don’t supplement in NR. There are many ongoing trials in AD, PD, MS, ALS, heart failure, and ageing. Mostly in Norway. Results soon. So I’m okay to wait 
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What I think is clear about NR/NMN/other B3 vitaminers is that there is no good solid evidence for large dosing. There does need to be some basic level of supplementation. Whether NR or NMN is better than other B3 is also unclear.
There is an issue about the tryptophan pathways that perhaps lies behind this, however. And there may be people for whom supplementation is a good idea. However, it is not fixing a problem, but fixing symptoms.
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You’re probably right. The ongoing Norwegian trials are using very large doses: 1,000 to 3,000 mg/day.
Im still using B3/niacin in the hope of lowering my Lp(a). Seems it might depend on an Apo phenotype
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But my understanding is that while niacin lowers Lp(a) levels, there is no evidence that as a result, patients have better CVD outcomes. Back in the day before we had statins, niacin was used to control unfavorable lipid profiles, but the results were underwhelming. Meanwhile, statins actually raise Lp(a) levels, but ultimately still show CVD benefits. There have been several niacin trials, and none showed compelling results. Some early trials were argued to have been flawed, but subsequent ones still showed no real benefits even close to statins. The current consensus seems to be that niacin affects the lipid numbers in the right direction (including raising HDL), but that doesn’t seem to translate into actual clinical benefits, while having undesirable side effects.
At this point niacin has fallen out of favor with cardiologists, and there is no sign it’s ever coming back, given currently available therapeutic agents, and agents in the pipeline. As far as I can see, niacin for CV health is dead in the water. No?
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I received an email from Eight Sleep this week and found interesting, and out of character, to learn that Attia is involved with their new sleep supplement. From the guy who practically rolls his eyes when people ask about supplements
It seems fairly benign though.
Fyi:
Tryptophan
Tart cherry
Valerian root
Ashwaganda
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It was a lipidologist that recommended B3. But as you say my own reading of the literature suggests no meaningful CVD clinical benefit. Not worth the flushes then!
And from Andrew Steele:
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I think Dr. Attia has an issue with people using supplements just because he is using them. He has been clear that he changes his supplements based on evidence from his own testing a biochemical reactions. The concern is that what works him may not work for other people.
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