NADH supplement health benefit, side effects 5 mg 10 mg and 20 mg tablets, which medical conditions is this nutrient used for?
April 13 2019 by
Ray Sahelian, M.D.

NADH, which stands for nicotinamide adenine dinucleotide, is an activated form of the B vitamin niacin. I remember my high school biology class where I first tried to learn the complicated Krebs cycle and how energy in the form of ATP was derived from sugars, amino acids, and fats. I recall coming across NADH, the coenzyme that helps in this complicated process of energy extraction. I never thought that someday it would be available as a supplement.

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There is declined mitochondrial functions and altered NAD homeostasis that accompany the normal aging process.

Alzheimer's disease, dementia - no benefit
J Neural Transm (Vienna). 2000. No evidence for cognitive improvement from oral nicotinamide adenine dinucleotide (NADH) in dementia. Reduced nicotinamide adenine dinucleotide (NADH) is advertised as an over-the-counter product or dietary supplement to treat Alzheimer's disease. We performed a 3-month open-label study with oral 10 mg/day NADH with 25 patients with mild to moderate dementia of the Alzheimer, vascular, and fronto-temporal types in addition to their current cholinomimetic drug medication. In 19 patients who completed the study, we found no evidence for any cognitive effect as defined by established psychometric tests. We conclude that NADH is unlikely to achieve cognitive improvements, and present theoretical arguments against an effectiveness of this compound in dementia disorders.

Making energy
The body, just like a car, needs fuel. Our primary source of fuel is through fats, proteins, and carbohydrates in our diet. After digestion in the stomach, foodstuffs are absorbed into the blood and circulate to various tissues and cells where they are broken down into even smaller particles. One of these is a two-carbon molecule known as acetyl. Enzymes help break down these fats, proteins, and carbohydrates into acetyl and they then help extract the final energy from acetyl. Enzymes also need helpers, and these helpers are called coenzymes. Most of the coenzymes are partly made from vitamins, such as vitamins E, C, lipoate, and riboflavin (vitamin B2). NADH, known as nicotinamide adenine dinucleotide, is a coenzyme, partly made from nicotinamide (vitamin B3).
   NADH, through a series of reactions with acetyl and oxygen, is able to produce energy. This energy is in the form of ATP (adenosine triphosphate). Therefore, a good supply optimizes energy production in the body. Another function is its ability to help transform an amino acid called tyrosine into the important brain chemical dopamine. Dopamine is involved in mood, energy, sexual drive, concentration, memory and muscle movement.
   NADH is normally found in meat, fish, and poultry. The content of in fruits and vegetables is minimal.

The claims and promotions
NADH was introduced to the US health market in 1995. There are claims that it can improve memory, athletic performance, slows the aging process, and is helpful in a variety of conditions including Alzheimer's disease, Parkinson's disease, chronic fatigue syndrome, depression, and overall lack of energy.
   A small number of short term studies done with an oral form of NADH have shown slight to moderate benefits in regards to depression, Parkinson’s disease and Alzheimer’s disease. An eight-week double blind study done at Georgetown University Medical Center found thirty percent of patients with chronic fatigue syndrome to benefit from 10 mg of NADH compared to eight percent of the controls. Birkmayer Laboratories of Vienna, Austria who organized all of these studies, are also involved in promoting their trademarked NADH product.

Fatigue and tiredness, chronic fatigue syndrome
Rev Clin Esp. 2010. Nicotinamide adenine dinucleotide (NADH) in patients with chronic fatigue syndrome. Nicotinamide adenine dinucleotide (NADH) may be depleted in chronic fatigue syndrome (SFC). The purpose of the study was to evaluate the efficacy of supplementation with NADH in these patients. A double blind, placebo controlled, 3 month long clinical trial was conducted. The patients were randomized to oral NADH oral 20mg or placebo during the first two months. Administration of oral NADH was associated to a decrease in anxiety and maximum heart rate, after a stress test in patients with CFS. On the contrary, this treatment did not modify other clinical variables and the global functional performance.

Antioxid Redox Signal. 2015. Does oral coenzyme Q10 plus NADH supplementation improve fatigue and biochemical parameters in chronic fatigue syndrome? Chronic fatigue syndrome (CFS) is a chronic and extremely debilitating illness characterized by prolonged fatigue and multiple symptoms with unknown cause, diagnostic test, or universally effective treatment. Inflammation, oxidative stress, mitochondrial dysfunction, and CoQ10 deficiency have been well documented in CFS. We conducted an 8-week, randomized, double-blind placebo-controlled trial to evaluate the benefits of oral CoQ10 (200 mg/day) plus NADH (20 mg/day) supplementation on fatigue and biochemical parameters in 73 Spanish CFS patients. A significant improvement of fatigue showing a reduction in fatigue impact scale total score was reported in treated group versus placebo. In addition, a recovery of the biochemical parameters was also reported. NAD+/NADH, CoQ10, ATP and citrate synthase were significantly higher, and lipoperoxides were significantly lower in blood mononuclear cells of the treated group. These observations lead to the hypothesis that the oral CoQ10 plus NADH supplementation could confer potential therapeutic benefits on fatigue and biochemical parameters in CFS. Larger sample trials are warranted to confirm these findings.

Jet lag benefit?
Stabilized NADH ENADA improves jet lag-induced cognitive performance deficit
Wien Med Wochenschr. 2002.
Current remedies for jet lag (phototherapy, melatonin, stimulant, and sedative medications) are limited in efficacy and practicality. The efficacy of a stabilized, sublingual form of reduced nicotinamide adenine dinucleotide (NADH, ENADAlert, Menuco Corp.) as a countermeasure for jet lag was examined. Because NADH increases cellular production of ATP and facilitates dopamine synthesis, it may counteract the effects of jet lag on cognitive functioning and sleepiness. Thirty-five healthy, employed subjects participated in this double-blind, placebo-controlled study. Training and baseline testing were conducted on the West Coast before subjects flew overnight to the East Coast, where they would experience a 3-hour time difference. Upon arrival, individuals were randomly assigned to received either 20 mg of sublingual stabilized NADH or identical placebo tablets. All participants completed computer-administered tests (including Cog Screen) to assess changes in cognitive functioning, mood, and sleepiness in the morning and afternoon. Jet lag resulted in increased sleepiness for over half the participants and deterioration of cognitive functioning for approximately one third. The morning following the flight, subjects experienced lapses of attention in addition to disruptions in working memory, divided attention, and visual perceptual speed. Individuals who received NADH performed significantly better on cognitive test measures and reported less sleepiness compared with those who received placebo. No adverse effects were observed with ENADA  NADH treatment. Stabilized ENADA NADH significantly reduced jet lag-induced negative cognitive effects and sleepiness, was easily administered, and was found to have no side effects. NADH dehydrogenase and NAD.

Dr. Sahelian's Experience, testimonial
Does NADH really improve energy, concentration, and mood? I have taken it on numerous occasions. Within an hour or two of swallowing a pill on an empty stomach in the morning, I notice an increase in alertness, wellbeing, vitality, visual clarity, and sexual interest. The effects last most of the day. However, I develop a tolerance to NADH if I take it regularly. I understand NADH is available as 2.5 mg, 5 mg, 10 mg, and recently as 20 mg. I don't think the 10 mg and certainly the NADH 20 mg supplements are useful, they may cause fatigue after a few days of use rather than enhancing energy. Too much of a good thing is not so good.

NADH side effects, caution, risk, testimonials
Reports of NADH side effects from the use of 2.5 mg are rare. Higher dosages can sometimes lead to insomnia, anxiety, fatigue, and overstimulation. George, a 42 year-old lawyer from Philadelphia says, “I like the 2.5 mg dose because of the alertness it provides. However, when I take 5 mg or more, it makes me too stimulated, almost with a panicky feeling.” As more individuals start taking this nutrient, we may come across additional reports of NADH side effects. The risk of NADH adverse reactions increase when this supplement is combined with other stimulants. A few patients have found that high dosages used daily for prolonged periods led to mood swings, anxiety, and sleeplessness which resolved when the NADH was stopped. I do not recommend its use on a daily basis for prolonged periods until we learn more details about its effects when used daily for months and years.
   One user noticed that NADH helped her chronic fatigue, but things didn’t go well when she stopped. Betty, a 36 year-old homemaker from Houston, says, “I have chronic fatigue syndrome (CFS) and was taking 10 mg of NADH daily. I know it really helped my energy level and mood. But I began to have stomach upset from it and stopped for a few days. I then fell quickly into a very bad CFS "crash," the worst one in months.” I recommended that Betty only take 2.5 mg of NADH every other day. I don’t think we should rely on one nutrient to solve CFS.

I have been taking a NADH supplement daily for a week and it has caused me insomnia.
    When sleeping problems occur this means a lower dosage is appropriate or the product needs to be taken less frequently.

I am occasionally hit with CFS (I am MTHFR homozygous C677T) but get it under control an I'm very active and still working professionally. I recently took Co-E1 10mg NADH for 2 days in a row and the anxiety (and just out-of-sorts feeling) was overwhelming. I stopped, and I suggest that 10mg is far too much for some people. I'm not likely to try it again for a while, and only at extremely low doses if I do try it.

NAD+ versus NADH supplements
Q. I couldn’t find any info about NAD+. What’s the difference between NADH and NAD+? Does it help to block cancer in the liver? I have cirrhosis and a carrier of Hep B for years, doing well.
   A. I cannot find human studies on NAD+ supplement benefits. At this point I am not certain which form is preferable.

Cell. 2007. Nutrient-sensitive mitochondrial NAD+ levels dictate cell survival.

Is Enada a way of processing NADH and not a synonym? I looked on the label and in the product description and nowhere was the word Enada used. So -- is Co-E1 an Enada NADH?
    The company that makes ENADA nadh was bought out, and the new owners are still using the name but now they have added a new name CoE1. Both Co-! and Enada are the same exact product.

Interactions with medications
Are you aware of the existence of any interactions with the antipsychotic Seroquel as well as Lithium Carbonate?
   Negative or positive interactions depend on dosages and the overall health of the person. I have not seen such studies with these combinations.

Does NADH interact with levothyroxine, thyroid hormone?
   Much depends on the dosages used.

I would like to know, if it's safe to take NADH while taking blood pressure medication.
   It depends on which medication it is, the dosage, the health of the patient, and the amount of the supplement. Generally low dosages should not interfere.

Research and clinical trials
Antioxidant activity of NADH and its analogue--an in vitro study.
J Biochem Mol Biol. 2004.
The antioxidant activities of NADH was evaluated in vitro. These results indicate that NADH can inhibit lipid peroxidation despite being hydrophilic. Nevertheless, membrane penetration is an important factor and limits its antioxidant activity.

Treatment of Alzheimer's disease with stabilized oral nicotinamide adenine dinucleotide: a randomized, double-blind study.
Drugs Exp Clin Res. 2004.
This study was designed to evaluate the effect of stabilized oral reduced nicotinamide adenine dinucleotide on cognitive functioning in patients with Alzheimer's disease (AD). NADH is a coenzyme that plays a key role in cellular energy production and stimulates dopamine production. In previous trials NADH has been shown to improve cognitive functioning in patients with Parkinson's disease, depression and AD. The present trial was a randomized, placebo-controlled, matched-pairs, double-blind, 6-month clinical study. Patients with probable AD were randomized to receive either stabilized oral NADH (10 mg/day) or placebo. Twelve pairs of subjects were matched for age and baseline total score on the Mattis Dementia Rating Scale (MDRS). After 6 months of treatment, subjects treated with NADH showed no evidence of progressive cognitive deterioration and had significantly higher total scores on the MDRS compared with subjects treated with placebo. Analysis of MDRS subscales revealed significantly better performance by NADH subjects on measures of verbal fluency, visual-constructional ability and a trend to better performance on a measure of abstract verbal reasoning. There were no differences between groups in measures of attention, memory, or in clinician ratings of dementia severity. Consistent with earlier studies, the present findings support NADH as a treatment for AD.

Distributor information
Birkmayer USA, the largest distributor of NADH tablets in the USA and the world, has released a new formula which has Chlorophyll in all NADH size tablets – 2.5mg , 5.0mg and the 10mg. Birkmayer USA markets NADH as ‘CO-E1 NADH’ as NADH is co-enzyme #1 and is vital in the support of the energy system of the body.
“By combining both NADH and Chlorophyll we have a truly brilliant and real product to help many people, and we are truly excited to be able to provide this product” said Rachel Chandler, the Manager of Birkmayer USA.
   Dr. Sahelian says: I really don't know why chlorophyll was chosen. Not that chlorophyll is a bad supplement, it may have some health benefits, but I really don't see the rational for combining NADH and chlorophyll. It's a puzzle to me.

Questions from a magazine reporter
Q. What is NAD and why is it so essential for health? About what percent of women would benefit from increasing their intake of NAD? Estimates are fine. Does the body's production of NAD decline with age? What other factors can contribute to a shortfall or low levels? What symptoms would low NAD levels cause? What percent of people who need more NAD don't know it, or attribute their symptoms to other causes? Is there a test that can diagnose people who need more NAD? How can people boost their NAD levels? If supplementing helps, what dose of nutrients? Are there foods? Lifestyle changes?
   A. Nicotinamide adenine dinucleotide (NAD) is a coenzyme present in the cells of our body in two forms, an oxidized and reduced form abbreviated as NAD and NADH. It has many important functions including energy production, DNA protection, and communication between cells. Levels decline with age. As we age many of our metabolic functions decline and it is not easy to isolate and determine what specifically happens by NAD reduction by itself but some animal studies indicate that higher levels may be important for longevity. There is no specific test that I am aware of that tests for levels of NAD in the body, and even if there were it is not easy to determine the levels within different cells and tissues of the body. One possible way to increase levels is to take the supplement NADH available over the counter in 2.5 mg, 5 mg, and 10 mg doses. Since long term studies are not available regarding safety of use, I suggest not taking such a supplement more than 3 days a week until we learn more.

Q. I have been taking 50 to 300mg of 5-HTP for about 2 months at bedtime to help my sleep and depression. It definitely improved my mood but I still felt tired and achy so I added 5 mg of NADH first thing in the morning to my regime for one week so far. I've had a few serious bouts of depression after adding the NADH but a lot more energy. I find it's better if I alternate between the two. Also, I've become very constipated after taking the 5-HTP.
Reading your website, and from experience of reducing the amount and consistency of 5-HTP, the grogginess is less. For your info, I found that taking 5-HTP actually increased my libido but that I've already become tolerant to that benefit. I find it relaxes me and reduces my negative thinking greatly. Reading your website, I'm pretty amazed at some of the horrific negative affects it has had on some people.

How soon does a NADH tablet have an effect after ingesting?
   I personally notice a sense of alertness and wellbeing within an hour or two of taking a tablet on an empty stomach in the morning. Most people notice the effects within hours.

Thanks so much for originally introducing me to NADH through your literature. I last took NADH 2 years ago. I am now trying to find the same form - 2.5mg NADH sublingual tablets. Do you know who manufactures it? (apparently, not Menuco). I'd prefer not to take the source naturals tablet, due to a very sensitive stomach -also, I had such a good prior experience with the sublingual. Thanks very much for your help, and I wish you continued success.
    You could do a google search for NADH 2.5 mg sublingual and find out, it is likely that there are many online stores that sell it.

I understand that Source Naturals NADH 20 mg is available. Do you think 20 mg is helpful?
    I don't see the need to take more than 5 or 10 mg of NADH supplement a few times a month. I'm concerned about side effects with a 20 mg dosage. Sometimes a lesser dosage of a supplement product works better than a higher dosage.

I am 72 years old and was having pretty difficult time hearing clearly for quite a while. My friend found me this article by you on hearing loss and NADH help forit. Instead of running for $5000 hearing aid i decided to try. Only 4 days back WOW what a change. I was myself amazed if i am making it in my head or it is real. I am experiencing so alive energy and improvement in hearing. I had been practicing singing my scales (Indian Music) since Jan.2013. I could hear the chords but not the in between notes clearly in my ears. But after 2 days of taking this NADH 5mg. one a day, third day as i sang the notes I could clearly hear all the notes in the same three strings of Tanpura (drone instrument looks like Sitar) i had been practicing so long. I could hardly hold my self down, Am so very very happy with this divine change that i can hear my swars (notes on the scale). This makes a sky and earth apart difference in progress of my vocal Indian classical music. Once again my heartfelt thanks for your article. One question how long can i take this tablet. I am taking only 5mg a day to begin with.
   A. As with many supplements whose long term use is not known well, it is preferable to take a break once in a while for a few days.

I am a doctor and compliment you on your informative website. I would appreciate an answer to the following question :What is the difference – apart the chemical composition – between NADH - nicotinamide adenine dinucleotide and nicotinamide riboside supplements ? I would assume they influence the same process(es) ?The recommended dosages with NAD are significantly lower than with NAR. Is this purely a matter of molecular weight relation or else ?Would you consider taking NADH without interruption a problem if one does not notice side effects ?
   A. I am not familiar with the riboside supplement. I prefer taking breaks from use even if there are not apparent side effects.

Q. Doc, i heard that you cannot get any benefit from ingesting NAD. Is intravenous the only way the body can utilize NAD?
   A. NAD+ is available over the counter, and so is NADH . I am not familiar with the research regarding NAD+ supplement use.


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Serving Size: 1 Tablet as needed
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  Amount per Serving % Daily Value*
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