Most of us probably still cringe any time we hear someone say “COVID-19.” However, we also envision classic physical symptoms such as fever, cough, shortness of breath, and fatigue. As we move past the climax (hopefully!) of the global pandemic experience, the focus of health and science efforts has shifted away from symptoms of COVID to COVID recovery and methods that lead to rapid results. Interestingly, a critical coenzyme involved in metabolic processes called NAD+ might just hold the key to a swift, and complete, COVID recovery.
Beyond the observable cold and flu-like symptoms, COVID-19 is also associated with mitochondrial dysfunction and metabolic abnormalities. These abnormalities often occur when there is a nicotinamide adenine dinucleotide (NAD+) deficiency. Some experts suggest cellular depletion of NAD+ is a contributing factor to COVID-19 mortality. In other words, individuals with lower NAD+ levels–older adults, individuals with increased risk of comorbidities such as heart disease, diabetes, obesity, etc.–suffer more COVID fatalities. But, if we know lower NAD+ levels typically indicate more severe COVID responses, is it possible to improve or strengthen patient outcomes by increasing NAD+? The science seems to suggest the short answer is: yes.
How NAD+ Affects Immunity
There is growing consensus about the correlation between healthy individuals and higher levels of NAD+; similarly, scientists continue to agree that older individuals and/or people with common comorbidities, such as diabetes or cardiovascular disease, display significantly lower NAD+ levels. Research continues to explore NAD+ as a potential therapy for neurodegenerative diseases such as forms of dementia, Parkinson’s, and Huntington's disease. It has also been explored as a potential agent for cancer therapies and cancer treatment. Even mental health and mood enhancement experts are considering ways NAD+ might benefit patients suffering from depression and anxiety disorders.
Although there is still much to learn about the relationship between NAD+ and modern medicine, recent studies have found viral infections, specifically COVID-19, are responsible for depleting NAD+ stores. This is significant for a variety of reasons. Not only does this discovery further demonstrate the impact and importance of maintaining higher levels of NAD+ in the body, but it also provides evidence of other potential interventions to improve COVID-19 recovery (including Long Covid) and health outcomes.
NAD+ and COVID-19
Researchers have completed several studies exploring the effects of NAD+ precursors as a means to improve patient recovery from COVID-19. By restoring metabolic function through administration of combined metabolic activators, scientists were able to significantly improve rapid, symptom-free recovery rates. Some of the most recent findings earlier this year (2022) also show that higher NAD+ levels actually promote antiviral defense and lessen inflammation. Because viral infections further deplete NAD, the patient becomes more susceptible to illness and respiratory infection. When NAD+ levels improve, there is also a substantial improvement in patients’ cellular energy in order to respond to viral attacks. Many NAD+-dependent enzymes, including members of the sirtuin and poly-ADP-ribose polymerase (PARP) families, display potent antiviral activities. Sirtuins regulate metabolic network functions and PARPs help repair our DNA when it is damaged. With NAD+ as a crucial part of so many essential processes, our body is more resilient and ready to fight unwanted intruders. For this reason, there is ongoing research and exploratory treatments concentrating on NAD+ as a means to increase antiviral response.
NAD+ and Long COVID
Post-Acute COVID syndrome (PACS), or Long COVID, is the term used to describe persisting symptoms experienced by patients recovering from COVID. Most patients with a mild COVID experience will recover within 7-10 days, but patients with Long COVID will continue to suffer persistent clinical symptoms, long past their initial “recovery.” Symptoms include extreme fatigue, insomnia, “brain fog,” shortness of breath, aches, chest pain, and even digestive issues. Ongoing research suggests approximately 31-69% of COVID-19 patients suffer from Long COVID. The reason NAD+ infusion might help with Long-COVID is because the virus directs infected cells to increase the synthesis of enzymes that consume NAD+, which typically provide NAD+ to where the body needs it most (in this case, fighting off the virus).
Experts hypothesize that utilizing intravenous NAD+ therapy could improve mitochondrial dysfunction, thereby enhancing patients’ cellular ability to repair and protect the body. When patients are infected with the COVID-19 virus, oxidative stress on the mitochondria leads to mitochondrial dysfunction, which can induce DNA and tissue damage. These processes reduce NAD+ which results in disruption of cellular energy production and increased disease susceptibility. Less NAD+ means repair-associated enzymes are less likely to initiate antiviral pathways in response to damage caused by viruses.
Just as the world continues to learn about COVID itself, scientists continue to learn about PACS/Long COVID in order to develop best practices for prevention and treatment. Intravenous NAD+ infusion therapy is the gold standard of treatment compared to other methods because it provides high concentrations of NAD+ directly into the bloodstream. Many enzymes and proteins, like those involved in antiviral responses, depend on NAD+ to carry out their essential functions. By getting NAD+ into the bloodstream, it can begin impacting cellular processes more rapidly.
So, what’s the main takeaway here? In a nutshell, NAD+ can improve COVID recovery by (1) restoring and enhancing metabolic and mitochondrial function, and (2) increasing antiviral defenses and suppressing inflammation. NAD+ treatments have been shown to improve the body’s response to certain diseases, so it is not surprising that NAD+ might also work to improve COVID recovery, especially Long-COVID.
Scientists and immunologists continue to find evidence of the natural, functional power of NAD+. Although we might still cringe at the mention of “the virus,” perhaps we can be hopeful at the prospect of new treatments and healthcare successes through NAD+.
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