Joey Wahler (Host): They're gaining popularity, so we're discussing NAD+ supplements. Our guest is Courtney Neil. She's an advanced practice registered nurse and family nurse practitioner with Wickenburg Clinics Community Hospital and Clinics. This is WickCare Talks. Thanks for joining us. I'm Joey Wahler. Hi there, Courtney. Welcome.

Courtney Neal, APRN, FNP-C: Good morning.

Host: Great to have you aboard. So first, in a nutshell, what are NAD+ supplements and why are they becoming so popular lately?

Courtney Neal, APRN, FNP-C: So, NAD is a molecule that is in every cell of the body. It actually stands for nicotinamide adenine dinucleotide, which is why we call it NAD. I think it's becoming more popular because we're learning so much more about it, and people talk about what works for them and it works.

Host: And I see I made a great move by leaving the breakdown of the acronym to the expert here. So, how does NAD+ function in the body and why is it so important for our cellular health?

Courtney Neal, APRN, FNP-C: So being in every cell of the body, it's responsible for just about every process biologically in the human body. But to put it in a nutshell, and make it in the simplest terms possible, it's responsible for cell division. So, it causes our cells to divide very rapidly. And when the cells open up, mitochondria open up and they release ATP. ATP is what our bodies use for energy. So, one of the biggest benefits that patient's see is immediately they get a huge uptick in their energy production.

Host: It seems as though in recent years so many people are looking for that extra energy more than ever trying whatever they can get their hands on, whether it's an energy drink or now NAD+ supplements, right?

Courtney Neal, APRN, FNP-C: Absolutely. It's better to go with the natural sources, so I don't recommend the energy drinks by any means. I get that they have a place, but going with supplementation for things that are already inherent to the body is much more beneficial.

Host: So when you say that in terms of the benefits, what recent studies or evidence is there to highlight those benefits of NAD+?

Courtney Neal, APRN, FNP-C: There's millions of publications out there that anyone can search. We've been researching NAD since 1906. And it started gaining more popularity in 1936 as they started to discover that it really is involved in every cellular process in the body. So, anything from fatigue to muscle recovery-- it's great for athletes-- to cognition, improving brain fog and memory. It is neuroprotective against Alzheimer's and Parkinson's. It's involved in regulating metabolism and circadian rhythms. So, it really just is kind of a one-thing-does-it-all.

Host: So when you mentioned there for one thing, athletic recovery, this is huge for a number of reasons for people that are active. It helps for you to be able to work out better and longer. Perhaps it helps for you to, if you have to lay off for a while, kind of bounce back faster and pick up where you left off, right? How would it therefore compare NAD+ that is with something like creatine, which many people take for the same reason?

Courtney Neal, APRN, FNP-C: They do take for the same reason. NAD actually helps the muscles to recover faster. So, it's actually more beneficial for people that are endurance training, so your long distance runners and people that are lifting really heavy. So, it's very, very popular amongst athletes. I use it myself. I work out six days a week and I lift very heavy. So, I take it immediately after my workout, and I use creatine as well. So, NAD is one of those things that it's just an kind of an adjunct that you would add on to whatever your normal stack is.

Host: Let's, on the other hand, talk for a moment about those that aren't real athletic. Maybe they're active just in terms of going for a walk or doing lighter things to keep healthy, et cetera. How would it benefit that?

Courtney Neal, APRN, FNP-C: In all the same ways that it would benefit an athlete. The NAD that we have in our bodies decreases in production as we age. So, right about the time that we turn 40, it decreases by half. So, that's kind of why we start aging at 40. You know, you get out of bed on your 40th birthday and everything starts to crack, and all of a sudden your vision's blurry and you know, you have all these ailments that you never had before. That's because of NAD deficiency. So as we start to increase that in the body and we reintroduce it, it encourages our own natural production to increase. So even for people that are aging, that they may have joint issues, so really walking in the neighborhood is all that they're capable of doing, it will help them to recover faster as well.

Host: So, one thing that I love about tackling this topic with you here is the fact that it seems compared to some other things, like creatine, like protein powders and protein shakes, et cetera, it seems like we haven't heard a whole lot about NAD+. We talked about it gaining in popularity. Why now do you think? Why is it coming more to the forefront?

Courtney Neal, APRN, FNP-C: That's an interesting question, and I ask myself that quite regularly because I have seen a massive uptick in how many people are coming and seeking me out just for natural medicine. I think that people are starting to take control of their health. They're starting to be more involved in their health, and they want an option that isn't western medicine. They want to know what they can do every single day to increase their longevity and to give them more energy so that they can be active in their life.

Host: Yeah. And I guess, along with that, a big part is the fact that people are living longer than ever. You know, recently Dick Van Dyke was getting an award and he was up at the podium receiving it and said, you know, "If I knew I was going to live this long, I would've taken better care of myself."

Courtney Neal, APRN, FNP-C: Absolutely. Absolutely. I tell people all the time, I have that conversation with patients. Every day, you're given two things in this life. One is health and one is time. Invest in your health, and it'll buy you more time every single day.

Host: Very nice words to live by, for sure. So, how about common side effects or risks associated with taking these particular supplements?

Courtney Neal, APRN, FNP-C: So, the side effects will vary depending on the route of administration. There are multiple ways that you can take NAD. There are just oral supplements, so pills and tablets. Those will go through the digestive system, and your gut is a big filter. So when you take it orally, you really only get about 18 to 20% of the bioavailability of the supplement that you're taking, and that increases over time. It kind of builds up in the body. So, you don't really have the immediate effects when you take an oral pill as opposed to taking it in IV form or injection form. So, a lot of the athletes are taking it in IV form because they can get a much larger amount, like 1,000 mg all at once, which is not very comfortable. So unless you've done it before, I don't recommend it. I actually inject a hundred milligrams five times a week myself. So when you take it either IM or IV, there is a kind of an instant flushing effect, where you really feel that rapid cell division occur. Your muscles feel a little bit heavy. Sometimes there's a little bit of nausea. And rapid heart rate is a very common side effect. It lasts really for about five to seven minutes, and then just a massive burst of energy that's incredible.

Host: Gotcha. Now, you mentioned there what you recommend. Speaking of which, who exactly should patient's consult when considering NAD+ supplements? Is it a choice someone discusses with their primary care doctor or a specialist like you?

Courtney Neal, APRN, FNP-C: They would. Not all PCPs are the same, so they would want to seek out somebody that has a lot of knowledge in homeopathy and natural medicine. They could speak with a naturopath, certainly. And there's tons and tons of research online about it. So, they should look at it and they should really see how it's going to benefit their life, but they should absolutely talk to their PCP or a naturopath.

Host: When you mentioned it being administered intravenously, so typically for the average person, how often would that occur?

Courtney Neal, APRN, FNP-C: Usually, about once a month, unless they're an athlete that's, you know, in like CrossFit games, we would go and do that after every performance, if you will. And they would do that two or three days in a row. But if you're not at that level, and you just really want to maximize the benefits for anti-aging or protecting your cognitive status, anything like that, once a month would probably be perfectly fine.

Host: How about some technological advancements that have improved NAD+ supplementation?

Courtney Neal, APRN, FNP-C: Technically speaking, you know, IV administration, there's so many routes of administration for this supplement now that people are really able to tailor it to their own individual needs. The kind of creation of liposomal NAD or liposomal supplements entirely has been really beneficial in maximizing the benefits of it really. So, that's where it's kind of wrapped in like a little fat bubble, if you will. And so, it's protected against the digestive enzymes in the stomach So, it doesn't break down as much as it would like a tablet or a capsule. So, you get to maximize the benefits and you really get a hundred percent of that bioavailability.

Host: Gotcha. Couple of other things. When we talk about things like having more energy, recovering faster, losing weight, it seems like there's no real one answer to make those things happen. It's usually part of a bigger picture plan, right? People would like to think it's one and done in terms of that scenario. But therefore, how do NAD+ supplements fit into a broader treatment plan for whether it's aging or metabolic issues, et cetera?

Courtney Neal, APRN, FNP-C: Well, any supplement that you take for any reason should be combined with exercise and proper diet. The days of us getting all of the minerals and nutrients that we need out of our foods are gone. As soon as we industrialized and started mass producing, we kind of stripped our soil of all of the nutrients that we need in the human body. So, this is why the supplement industry has really taken off and is bringing in $8 to $9 billion a year, because we have to supplement to get all of the micronutrients the body needs on a daily basis.

Host: You've done such a great job, Courtney, of breaking it all down for us in detail. Going forward, what's the most important thing would you say overall for our audience to remember about NAD+ supplements? What's job one if they want to get started with this?

Courtney Neal, APRN, FNP-C: Talk to your PCP. PCP or naturopath, whoever you go to for health advice, talk to them. Make sure that you are the right candidate for it and they can help you decide what route of administration is best for you, whether it's IV or IM, or oral pills, whatever. Not all of them are the same. So, most people will find the prettiest bottle and the one with the best marketing and they'll go after that one. And it doesn't mean that it's the best supplement. So, we have knowledge of all of the different supplement companies that are out there, and we know which ones are the purest, and the ones that we like the best. So, we will put together a plan for our patient's that includes diet and lifestyle, of course. Nobody wants to hear that, because everybody wants, you know, the one answer, like you said, the one thing. It's not just one thing. It really does boil down to how you live your life and how you treat your body.

Host: Finally, in summary here, Courtney, talk to us please about how important it is to take these supplements, particularly at the beginning under the supervision of medical pros that know what it's all about, like yourself. These things I think people tend to maybe presume can't be as dangerous as "drugs," but they can be if not taken properly, right?

Courtney Neal, APRN, FNP-C: Absolutely. And there are supplements out there that do interact with medications, that there are people that are not a good candidate. Pregnant women, for instance, wouldn't be a good candidate for this right away. People with heart disease or certain heart issues wouldn't be the right candidate. And it's really important for them to take this under medical supervision. So, that's why it's so critical to include your PCP and to always be able to tell us what supplements you're taking. It does matter.

Host: Yeah. As we discussed doing this, if you do do it, it's still only one piece in a much bigger puzzle of trying to live a healthier life. Well, folks, we trust you are now more familiar with NAD+ supplements. Courtney, keep up all your great work. It's really something, as we said, that's getting much more attention these days, rightfully so. Thanks so much again.

Courtney Neal, APRN, FNP-C: Thank you.

Host: Absolutely. And for more information, please visit wickhosp.com/wickcaretalks. That's W-I-C-K-H-O-S-P.com/W-I-C-K-C-A-R-E-T-A-L-K-S. If you found this podcast helpful, please do share it on your social media and thanks again for being part of WickCare Talks from Wickenburg Community Hospital and Clinics.