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The general policy of the Supplement Sciences site is to avoid discussions of supplement therapies that are not well documented in the peer-reviewed literature. However, this article is an exception to the rule, in that it will discuss anecdotes and speculation that NAD+ precursors such as niacin, NMN, or NR may be helpful in alcohol recovery. We will show how this line of reasoning might be supported by research supporting the use of high-dose IV administration of NAD+. While the expense and lack of availability may prevent many from being able to access this therapy, NAD+ precursors may provide benefit. Bill W. believed strongly that high-dose niacin helped friends recover from alcohol addiction. Read more of this fascinating history.
Bill Wilson, the founder of Alcoholics Anonymous worked hard to get 3000 mg high-dose niacin or nicotinamide adopted as a part of AA. This was blocked by physicians who believed at that time in the 1960s that there was the potential for health risks.
Mixed messages still exist on the safety of niacin. Niacin does, in fact, have a tolerable upper limit set at 28-41 mg/day, presumably based on flushing reactions. Niacin’s safety and its potential for liver injury is also discussed in NIH literature [NBK548176], which states, “The recommended dosage for hyperlipidemia is 1 to 6 grams daily, starting at low doses (100 mg three times daily) and increasing at weekly intervals based upon tolerance and effect.” Meanwhile, Canadian psychiatrist, Abram Hoffer, studied niacin doses of 3000 mg on many, many of his own patients over the course of decades in his work with people who had schizophrenia.
“Since Elvehjem et al. reported a cure for canine pellagra dogs using nicotinic acid amide (known as nicotinamide) in 1938 , nicotinamide (NAM) at doses far above those required as a vitamin (e.g., 500–3000 mg) has been applied to various diseases and conditions.”[PMC7277745]
Bill W. and His Fight To Add Niacin to Alcoholics Anonymous
In the summer of 1935, a movement was started when Bill Wilson, known as Bill W., and Dr. Bob started the first Alcoholics Anonymous (AA) group. Over the years, this support group would prove to be a lifeline for countless people grappling with alcoholism.
However, despite the success of AA in helping Bill W. address his alcoholism, it had little effect on his persistent depression and anxiety. Furthermore, it wasn’t a universally effective solution for all. In search of answers, Bill W. attended a parapsychology conference in New York City in 1960, where he was introduced to niacin researcher Abram Hoffer by the renowned British writer, Aldous Huxley.
Hoffer told Wilson about an innovative treatment for alcoholism and schizophrenia – niacin therapy. Using Vitamin B3, or niacin, they had achieved promising results. Wilson decided to try it himself, beginning a daily intake of 3 grams of niacin. Within just two weeks, his lifelong battle with depression and anxiety had significantly eased. Wilson was thrilled with this simple and effective solution and recommended vitamin therapy to his AA friends and acquaintances in the celebrity world. The results, in his eyes, were striking.
Wilson approached the physicians of AA, who were also members due to their own struggles with alcoholism. But, the International Organization of AA was less than receptive, saying that Wilson, without a medical license, should not be promoting any form of vitamin treatment.
Wilson devoted the final eleven years of his life to championing niacin therapy as a supplementary treatment for alcoholics in AA groups. Despite producing three informative booklets [*] for AA physicians, his efforts largely went unheeded. When asked about his legacy before his passing, Bill Wilson said he would like to be remembered for his promotion of niacin therapy, even more so than his founding of Alcoholics Anonymous. His statement emphasizes his belief in the transformative potential of this seemingly simple vitamin therapy.
Research Lacking Despite Anecdotes
Although Bill W. and many others believed strongly in the mood improvements that were possible with niacin, there does not appear to be any published research on the use of high-dose niacin for alcohol or addiction recovery. However, there is research to support the use of intravenous NAD+ therapy.
Relating Niacinamide, NAD+ Precursors, and NAD+
Nicotinamide adenine dinucleotide (NAD) is found in all living cells and plays a critical role in energy production as well as genetic repair processes. NAD levels decline as people age and this decrease in NAD is associated with age-related physiological changes. The image below shows how niacin in the form of nicotinamide (NAM) relates to NMN (nicotinamide mononucleotide) and NR (nicotinamide riboside). All of these NAD+ precursors are available as dietary supplements. NAD+ is only available as an intravenous therapy.
Intravenous NAD+ Therapy For Addiction
In recent years, IV NAD (Nicotinamide Adenine Dinucleotide) therapy has gained attention as a potential treatment for addiction. This therapy involves administering NAD intravenously, and it is based on the premise that NAD plays a crucial role in cellular energy production and DNA repair. Research suggests that addiction may deplete NAD levels in the body, contributing to withdrawal symptoms and cravings.
Impaired energy metabolism has been reported in the brains of subjects addicted to substances. IV NAD therapy aims to replenish these depleted NAD levels, potentially reducing the severity of withdrawal symptoms and cravings. While the exact mechanisms are still being studied, it is proposed that NAD therapy may support the restoration of damaged neurotransmitter pathways and aid in the recovery process. Although promising, further research will be needed to fully understand the effectiveness and long-term outcomes of IV NAD therapy for addiction treatment. People considering this therapy need to consult with healthcare professionals and addiction specialists to determine its suitability for their specific needs. [PMC7278809]
NAD-dependent enzymes can influence major signalling processes associated with the neurobiology of addiction. These studies implicate raising intracellular NAD+ levels as a potential target for managing and treating addictive behaviour and reducing cravings and withdrawal symptoms in patients with food addiction and/or substance abuse.Sobriety and Satiety: Is NAD+ the Answer? [PMC7278809]
Dietary Supplement Options For Raising NAD+
While it hasn’t been studied, it could be theorized that any of the precursors that raise NAD+ levels might be helpful for alcohol or addiction recovery in a similar way to IV NAD+ therapy. The NAD+ pathway in the image below shows clearly how Niacin/nicotinamide, NMN, and NR relate to NAD+. To focus in on a small part of the pathway from the above image, it can be seen that there are three readily available supplement options for raising NAD+ levels:
- High dose niacin/nicotinamide supplement
- Nicotinamide Riboside (NR)
- Nicotinamide Mononucleotide (NMN)
Are NMN, NR, and Niacin Safe?
Nicotinamide mononucleotide (NMN), nicotinamide riboside (NR), and niacin are generally considered safe for most people when taken in appropriate doses. These compounds are forms of vitamin B3 and play vital roles in cellular processes, including energy metabolism and DNA repair. Studies have shown that at recommended doses, they are well-tolerated with minimal side effects. Niacin, a well-known B3 vitamin, has a long history of use with a well-established safety profile. Similarly, NR and NMN, newer to the market, have also shown a good safety record in early research. It’s important to note that while these supplements are safe for most, they may interact with certain medications or pre-existing health conditions.
Medication Interactions with NAD precursors
For NMN and NR, interactions are less well-defined due to their relatively recent emergence and lesser extent of research and the field of supplement interaction with medications is evolving, and it’s essential for individuals to consult healthcare providers before starting any new supplement, especially if they are on existing medication regimens. However, there are some general considerations:
- Cholesterol-lowering Drugs: Niacin can interact with statins, potentially increasing the risk of muscle problems. It can also affect the efficacy of cholesterol-lowering medications like bile acid sequestrants.
- Diabetes Medications: Niacin can affect blood sugar levels, which might necessitate adjustments in diabetes medications.
- Blood Pressure Medications: Niacin may potentiate the effects of drugs that lower blood pressure, leading to an increased risk of hypotension.
- Anticoagulants or Antiplatelet Drugs: There’s a potential for increased bleeding risk when niacin is taken with anticoagulants like warfarin or antiplatelet drugs.
- Alcohol and Liver Stressing Drugs: Since niacin can affect liver function, combining it with alcohol or other medications that stress the liver could increase the risk of liver damage.
Supplement Interactions with NAD Precursors
Potential supplement interactions involving Niacin, Nicotinamide Riboside (NR), and Nicotinamide Mononucleotide (NMN) primarily relate to their shared role in the NAD+ pathway and their individual effects on the body. Here are some considerations:
- Vitamin B Complex: Niacin, NR, and NMN are all forms of Vitamin B3. Taking them alongside a Vitamin B complex could lead to an excessive intake of B3, which might increase the risk of side effects associated with high B3 intake, like flushing or gastrointestinal discomfort.
- Other NAD+ Precursors: Taking NR or NMN alongside other NAD+ precursors, like nicotinamide, might not be beneficial as they compete for the same pathway in the body.
- Herbal Supplements: There may be a possibility that certain herbal supplements that impact energy metabolism, blood sugar, or lipid levels might have additive or conflicting effects when taken with NAD+ precursors.
- Minerals: High doses of minerals like zinc and copper can potentially interact with B vitamins, including niacin. The extent and significance of these interactions in the context of NR and NMN supplementation are not well-characterized.
- Antioxidants: There is some evidence to suggest that high doses of antioxidants might interfere with the cellular signaling roles of NAD+ precursors. However, this interaction is not fully understood and requires more research.
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Order Niacin Supplements
Flush Free Niacin (500 mg)
Manufacturer Description: Niacin is a water-soluble B Vitamin whose main role is to serve as a precursor for two essential biochemical coenzymes, NAD and NADP.* These two cofactors participate in virtually every aspect of energy production and other metabolic processes.* Niacin coenzymes help the cell use carbohydrates, fats, and proteins to produce energy and are critical for DNA replication and repair.* Inositol Hexanicotinate is a stable, non-flushing source of Niacin. This superior source of Niacin works to reduce the common “niacin-flush” associated with high-dose Niacin supplements.
Take 1 capsule daily as needed, preferably with a meal, or as directed by your healthcare practitioner.
Amount Per One Capsule Serving
Niacin … 500mg (B-3)(from 640mg of Inositol Hexanicotinate)
Inositol … 135mg (from 640mg of Inositol Hexanicotinate)
The optimal dosage of NMN for humans is still not well-established, and further research is needed to determine safe and effective dosages for specific health outcomes. The lowest effective dosage of NMN (Nicotinamide Mononucleotide) in studies can vary depending on the specific study and the desired outcome. However, some studies have suggested that even relatively low doses of NMN can have beneficial effects.
NMN was found to increase muscle insulin sensitivity in prediabetic women at a dose of 250 mg per day. [PMC8550608] The effects do seem to be dependent on dose with many people taking 500mg to 1000 mg per day for anti-aging benefits.
Avoid Fakes: 65% of NMN Supplements on The Major Online Marketplace Site
ProHealth Longevity published this article, in which they discuss their (2020-2021) investigation into adulterated and counterfeit NMN products sold on the major online marketplace site. They discovered that many of these products had fake Certificates of Authenticity and other documentation. Consumer Lab and other parties have now reported similar findings.
During their research, ProHealth Longevity found that more than half of the NMN products tested contained no NMN at all, while others had less than 80% purity. Some suppliers were selling low-cost vitamin B3 as NMN.
Consumer Lab tested the 21 NMN brands with the highest market share on this online marketplace and found that only three of the brands contained their claimed amounts of NMN. Consumer Lab notes that many of the products that contained virtually no NMN had hundreds or thousands of positive reviews on Amazon, raising questions about how those reviews were obtained.
These Are Trustworthy Sources For NMN
NMN (Nicotinamide mononucleotide)
Jarrow Formulas® Nicotinamide Mononucleotide (NMN) is an efficient precursor to the essential vitamin B3 metabolite, NAD+. NAD+ is essential to cellular energy production and mitochondrial function.* Levels of NAD+ decline with aging and high caloric intake, which can compromise mitochondrial function.* NAD+ is a required cofactor for sirtuins (SIRT), enzymes that promote healthy aging by regulating gene expression, DNA repair, mitochondrial biogenesis and energy metabolism.* Suggested Use: Take 1 to 2 tablets per day or as directed by your qualified healthcare professional.
Amount Per 1 Tablet Serving
NMN … 125mg (ß-Nicotinamide Mononucleotide)
NMN Powder or Capsules from Renue By Science
Renue By Science is one of a handful of trusted suppliers of NMN and a few of other anti-aging supplements. It offers NMN in the higher dosages (500-1000 mg) that many experts recommend.
When You Take NMN, You Need A Methylation Supplement
Supplementing with NMN increases NAD+ levels, which then break down into nicotinamide (Vitamin B3). This nicotinamide degradation can consume betaine (aka TMG), a key methyl donor. The reduced betaine levels could affect important processes like DNA methylation. So, if you’re taking NMN, adding a betaine supplement may help maintain your methylation health.
Adding betaine to your NMN supplementation routine can offer multiple benefits. Betaine, also known as Trimethylglycine (TMG), originally came from the beetroot plant. Betaine/TMG is a key player when it comes to donating methyl groups, which are essential for DNA methylation. The availability of methyl donors like betaine, methionine, and choline directly affects DNA methylation rates. Betaine also reduces inflammation by suppressing the activity of inflammatory markers like TNF-α, COX2, and NF-kB. [PMC9861325]
Although there is not enough research into the optimal dosage of betaine/TMG, many clinicians recommend TMG supplements be dosed in equal proportion to NMN, taking an equal number of milligrams of each.
Betaine TMG by BrainMD
Mood and Methyl Support* Betaine TMG provides betaine, also called trimethylglycine, which occurs naturally in the body and provides methyl groups that support genetic, epigenetic, and numerous metabolic life functions.* Betaine also can supplement the metabolic actions of SAMe (S-adenosylmethionine). Betaine TMG is a component of the comprehensive brain program developed by leading clinical neuroscientist Daniel Amen, MD. Enhances mood benefits of SAMe (S-adenosylmethionine)* Rich source of metabolically essential methyl groups* Supports metabolic recycling of homocysteine* Important protectant for cell water balance*
Suggested Use: Take 2 capsules daily between meals, to a maximum 6 capsules daily.
Amount Per 2 Capsule Serving
Betaine … 1000mg (Trimethylglycine)
TMG by Bio-Nutritional Formulas
TMG is a natural source of methyl groups. The process to detox homocysteine is called methylation, which depends on the presence of sufficient methyl donors. TMG donates one of its methyl groups to convert homocysteine to methionine, leaving beneficial Dimethylglycine (DMG) for energy support.*
Use 1 to 3 scoops (provided) daily with or between meals.
1 level scoop = 500mg
5 scoops = 1 teaspoon.
Order NR Supplements
NR is another option that can be used an NAD+ precursor.
TruNiagen 500 mg NR
Help drive cellular energy production and promote cellular repair with TRU NIAGEN® PRO 500. This supplement delivers the highest dose available today of NIAGEN® nicotinamide riboside (NR). With 500mg of NR in each capsule, it increases NAD+ by an estimated 80%.**
Available only through licensed healthcare professionals, TRU NIAGEN® PRO 500:
• Significantly increases NAD+*
• Supports ongoing mitochondrial health*
• Increases cellular energy production*
*These statements have not been evaluated by the Food and Drug Administration. This product is not intended to diagnose, treat, cure, or prevent any disease.
**Based on the dose-dependent clinical effects of 100, 300, and 1000 mg/day Niagen®
Adults take 1 capsule daily or as recommended by your healthcare professional
Amount Per 1 Capsule Serving
NIAGEN® … 500mg (nicotinamide riboside chloride)
To Sum It Up
The use of NAD precursors such as NR and NMN to elevate NAD levels may present a parallel to the benefits documented in IV NAD therapy in the context of recovery from alcoholism or drug addiction. This concept echoes the belief of Bill W., co-founder of Alcoholics Anonymous, in the potential of high-dose niacin to aid in addiction recovery.
By raising NAD+ levels in the body, these oral supplements could support cellular repair, improve energy metabolism, and aid in neurological function restoration, all of which are crucial in overcoming substance abuse. These supplements offer a valuable addition to a holistic recovery program, providing a more accessible and less costly option compared to IV therapy. Recovering from addiction requires a comprehensive approach encompassing medical, psychological, and social support. As research in this area progresses, NAD precursors, inspired in part by historical perspectives like those of Bill W., stand to possibly improve recovery and support sustained well-being.
This Article is Not a Substitute for Medical Advice
Dietary supplements are not designed to diagnose, treat, cure, or prevent any disease. The Supplement Sciences website seeks to provide comprehensive access to the most relevant supplement information along with convenient online ordering. We do not provide medical advice and cannot guarantee that every product suggested is completely without risk. Since each person is unique in their health history and medication use, it is important to discuss supplements with your personal physician. Specifically, pregnant women and individuals being treated for cancer or liver or kidney problems must consult their physician about every nutritional supplement they plan to take. People taking medications for the treatment of HIV or with a history of organ transplant must not take supplements without consulting with their physician.