NAD+ for Chronic Fatigue and Fybromyalgia

Mar 11

Introduction

CDC, about 4 Million adult people are affected by fibromyalgia in the United States. The exact cause of fibromyalgia is not known, however, the factors that increase the risks of developing this disorder are:

Increasing age
Female gender
Stress
Frequent injuries
Obesity
Viral infections
Family history

Chronic Fatigue Syndrome (CFS) is a related disorder that shares many features with fibromyalgia. Although patients with Chronic Fatigue Syndrome do not appear ill but they are unable to perform their daily activities and have overwhelming fatigue. Symptoms are exacerbated by any activity and are improved with rest, so these patients are confined to the bed. According to a report about 836,000-2.5 Million people in the United States are suffering from Chronic Fatigue Syndrome and about 90% of the people are undiagnosed. It costs about 17-24 Billion Dollars in terms of medical bills and income lost. The disease is more common in females that are 40-60 years old. [1]

Chronic Fatigue Syndrome and Fibromyalgia are considered a different spectrum of the same entity. Evidence suggests that Increased oxidative stress, mitochondrial dysfunction, and disturbance in immune metabolism are responsible for producing many of the symptoms. [2]

Nicotinamide adenine dinucleotide (NAD+) is a coenzyme - derived from Niacin- that plays many important functions in our body. It controls metabolism, restores energy level, decreases inflammation, helps in COVID, repairs DNA, and activates anti-aging enzymes. To read more about the science of NAD+, click here.

Moreover, decreased level of NAD+ has been seen in patients with fibromyalgia and CFS. [3] If you want to know how you can boost your NAD+ levels naturally, check out this article.

How NAD+ Helps with Fibromyalgia & Chronic Fatigue Syndrome:

NAD+ acts through various mechanisms and some of which are still being investigated. Here are a few of the mechanisms by which NAD+ helps in CFS and fibromyalgia:

In every chronic condition including fibromyalgia and CFS, the function of the mitochondria is lost. As a result, the body is not able to synthesize energy, and the patient experience excessive fatigue. If routine replacement of the nutrients is provided then intractable fatigue can ensue. Supplementation with NAD+ can restore the function of the mitochondria and result in a marked improvement in fatigue and other symptoms. [4]
Another underlying pathology in Chronic Fatigue Syndrome and Fibromyalgia is increased oxidative stress that can damage every cell in the body. NAD+ decreases free radical formation through an enzyme called Sirtuin and helps in the symptoms caused by these.
NAD+ plays a key role in the formation of certain chemicals called neurotransmitters, for example, serotonin, dopamine, and norepinephrine. These neurotransmitters control the function of the brain and improve cognition, memory, mood, and fatigue.
NAD+ supplementation boosts our immunity and decreases the chances of getting infections that act as a starting point for making the body vulnerable to CFS and Fibromyalgia. To read about how NAD+ boost our immune system, check out this article on NAD and immunity.
Tryptophan is an essential amino acid is required for the synthesis of nicotinamide. Tryptophan and nicotinamide work together in a pathway called the “Kynurenine pathway”, which plays a vital role in the structural, inflammatory, and immune-modulatory functions of the body.

Research has demonstrated that tryptophan levels are depressed in patients with fibromyalgia. Another research has shown that the severity of the pain is inversely related to the blood level of tryptophan in patients with CFS. Similarly, patients with depression and fatigue also have a low level of tryptophan. [5, 6]

As Nicotinamide is synthesized from tryptophan, so supplementation with NAD+ prevents the decrease in tryptophan level and helps in symptoms of fibromyalgia and CFS.

Supporting Evidence:

Many studies and clinical trials have investigated the role of NAD+ in helping patients with CFS and fibromyalgia. Some of them are summarized below:

Researchers at the Georgetown University School of Medicine, Washington, D.C, USA studied the effect of oral NAD+ supplementation on patients with Chronic Fatigue Syndrome and demonstrated that oral NAD+ is very safe and no adverse effect was reported in the study. A significant improvement in symptoms of the patient with CFS (32%) was seen as compared to placebo (8%). [7]
Another research at the University of Puerto Rico School of Medicine demonstrated that NAD+ supplementation results in a dramatic reduction in the symptoms of the patients with CFS in the first three months. NAD+ supplementation also provided similar improvement in subsequent months as offered by the conventional therapy. [8]
Spanish scientist demonstrated that NAD+ level is depleted in patients with CFS and oral supplementation improve anxiety, fatigue and other symptoms of CFS. [9]
Another Clinical trial done showed that supplementation of NAD+ plus Coenzyme Q10 decreases fatigue, improves sleep and health-related quality of life in patients with chronic fatigue at 4 and 8 weeks follow-up. [10]

References

Institute of Medicine. 2015. Beyond Myalgic Encephalomyelitis/Chronic Fatigue Syndrome: Redefining an Illness. Washington, DC: The National Academies Press.https://doi.org/10.17226/19012.
Anderson G., Maes M. Mitochondria and immunity in chronic fatigue syndrome. Prog. Neuro-Psychopharmacol. Biol. Psychiatry. 2020;103:109976. DOI: 10.1016/j.pnpbp.2020.109976.
Castro-Marrero J., Cordero M.D., Saez-Francàs N., Jimenez-Gutierrez C., Aguilar-Montilla F.J., Aliste L., Alegre J. Could Mitochondrial Dysfunction Be a Differentiating Marker Between Chronic Fatigue Syndrome and Fibromyalgia? Antioxidants Redox Signal. 2013;19:1855–1860. DOI: 10.1089/ars.2013.5346
Nicolson GL. Mitochondrial dysfunction and chronic disease: treatment with natural supplements. Altern Ther Health Med. 2014;20 Suppl 1:18-25.
Bralley JA, Lord RS. Treatment of chronic fatigue syndrome with specific amino acid supplementation. J Appl Nutr 1994;46:74-78.
Yunus MB, Dailey JW, Aldag JC, et al. Plasma tryptophan and other amino acids in primary fibromyalgia: a controlled study. J Rheumatol 1992;19:90-94.
Forsyth LM, Preuss HG, MacDowell AL, Chiazze L Jr, Birkmayer GD, Bellanti JA. Therapeutic effects of oral NAD+H on the symptoms of patients with chronic fatigue syndrome. Ann Allergy Asthma Immunol. 1999;82(2):185-191. doi:10.1016/S1081-1206(10)62595-1
Santaella ML, Font I, Disdier OM. Comparison of oral nicotinamide adenine dinucleotide (NAD+H) versus conventional therapy for chronic fatigue syndrome. P R Health Sci J. 2004;23(2):89-93.
Alegre J, Rosés JM, Javierre C, Ruiz-Baqués A, Segundo MJ, de Sevilla TF. Nicotinamida adenina dinucleótido (NAD+H) en pacientes con síndrome de fatiga crónica [Nicotinamide adenine dinucleotide (NAD+H) in patients with chronic fatigue syndrome]. Rev Clin Esp. 2010;210(6):284-288. doi:10.1016/j.rce.2009.09.015
Castro-Marrero J, Segundo MJ, Lacasa M, Martinez-Martinez A, Sentañes RS, Alegre-Martin J. Effect of Dietary Coenzyme Q10 Plus NAD+H Supplementation on Fatigue Perception and Health-Related Quality of Life in Individuals with Myalgic Encephalomyelitis/Chronic Fatigue Syndrome: A Prospective, Randomized, Double-Blind, Placebo-Controlled Trial. Nutrients. 2021;13(8):2658. Published 2021 Jul 30. doi:10.3390/nu13082658