Peter Attia's Foundational Perspective on Longevity
Dr. Peter Attia, a physician specializing in the extension of healthspan and lifespan, approaches longevity with a clear and hierarchical framework. He posits that foundational health behaviors—including exercise, quality sleep, and emotional well-being—are the most critical determinants of long-term health. For Attia, more advanced interventions, like supplements and targeted therapies, should be considered only after these pillars are firmly in place. This perspective strongly influences what does Peter Attia say about NAD+, a topic he has discussed extensively on his podcast, The Drive, and in his book, Outlive.
The Role of NAD+ and Its Age-Related Decline
Attia acknowledges that NAD+ (nicotinamide adenine dinucleotide) is a ubiquitous and vital coenzyme present in every living cell, crucial for hundreds of metabolic reactions, including energy production within the mitochondria and DNA repair. He agrees with the established fact that NAD+ levels precipitously decline with age. A major reason for this drop is believed to be increased DNA damage over time, which increases the cellular demand for NAD+ to activate DNA-repairing proteins called sirtuins. This decline is often linked to the general decrease in cellular function and energy experienced during aging.
Attia's Skepticism on Geroprotective Claims
Despite the mechanistic rationale for NAD+ supplementation, what does Peter Attia say about NAD+'s geroprotective effects? He expresses significant skepticism that merely boosting NAD+ levels via supplements will translate to meaningful healthspan or lifespan improvements in humans. His caution is rooted in several key observations:
- Lack of Robust Human Data: Attia points to the surprisingly limited and often low-quality human data available for NAD+ supplements. He notes that the few studies conducted often have small sample sizes and show clinically insignificant effects on health markers.
- ITP Study Results: He frequently references the Interventions Testing Program (ITP), a highly rigorous longevity research program in mice. When the ITP tested the NAD+ precursor nicotinamide riboside (NR), it found no benefit for lifespan or healthspan, even at high doses.
- Anecdotal vs. Evidentiary Thinking: Attia warns against the “cottage industry” and commercialization that has outpaced the science, highlighting how the hype surrounding NAD+ is mostly “noise”. He cautions against mistaking potential mechanisms for proven benefits.
Comparison of NAD+ Strategies: Attia's View
To understand Attia's perspective, it is useful to compare his view of the different NAD+ boosting strategies with foundational health practices. This table illustrates his prioritization.
| Strategy | Description | Peter Attia's Viewpoint | Evidence Level (per Attia) |
|---|---|---|---|
| Foundational Behaviors | Sleep hygiene, exercise, nutrition, emotional health | Most critical determinant of health and longevity. Must be prioritized. | High (Extensive, robust evidence) |
| Oral Precursors (NR/NMN) | Supplementation with nicotinamide riboside or nicotinamide mononucleotide | Commercially driven debate. Evidence for geroprotection is weak and effects are likely minor. Does not take them himself. | Low (Human trials show small, insignificant effects) |
| Intravenous (IV) NAD+ | Direct infusion of NAD+ into the bloodstream | Expensive, uncomfortable, and likely ineffective for raising intracellular NAD+. Not recommended. | Very low (Intracellular efficacy is questionable) |
| Targeted Interventions | Pharmaceutical molecules for specific disease pathways (e.g., rapamycin for mTOR) | Can be useful for addressing specific disease processes, but secondary to foundational health behaviors. | Higher (Some promising animal data and human studies) |
The NMN vs. NR Debate: Commercial Noise
Attia believes the intense commercial debate over which precursor, NMN or NR, is superior is largely irrelevant from a scientific perspective. He and others argue that once NMN enters the cell, a phosphate group is cleaved off, leaving NR to enter the salvage pathway to produce NAD+. While some claim marginal differences in bioavailability, Attia considers these nuances minor compared to the overall lack of compelling evidence for a significant longevity benefit. He has stated he does not take either supplement himself.
Intravenous (IV) NAD+ Infusions
The most extreme and costly method of boosting NAD+ is via intravenous infusions. Attia and expert guests, like Dr. Eric Verdin, have strongly advised against this approach. Key reasons include:
- Inefficient Cellular Entry: NAD+ is too large to effectively enter cells directly. During infusion, much of it is broken down into simpler, cheaper forms like nicotinamide.
- High Cost, Low Benefit: IV infusions can be hundreds of dollars per session, yet provide little physiological benefit beyond what can be achieved with cheaper supplements or lifestyle changes.
- Potential Side Effects: Attia himself has reported uncomfortable side effects, such as chest pressure and cramps, during infusions.
Intriguing, but Unproven, Hints in Research
While largely skeptical of the longevity claims, Attia acknowledges that some research areas surrounding NAD+ are intriguing. For instance, he points to preliminary hints that NAD+ or its precursors may play a role in reducing the risk of certain skin cancers, like basal and squamous cell carcinoma. However, he emphasizes that such findings are preliminary and require replication before they can be considered reliable. He remains open to the possibility that more targeted and robust research will clarify the role of NAD+ in specific disease contexts in the future.
Prioritizing Foundational Health Habits
In summary, Attia's stance on NAD+ is not a dismissal of the molecule itself, but a critique of the premature and unsubstantiated claims surrounding its supplementation. He argues that the focus on expensive supplements like NMN, NR, and IV infusions distracts from the most important work of longevity: consistently practicing foundational health habits. Instead of buying into the marketing hype, he advises focusing on evidence-based practices that provide the greatest return on investment for healthspan and lifespan. For a more detailed analysis, see his article on the topic at peterattiamd.com.
Conclusion
Ultimately, what does Peter Attia say about NAD+? He presents a scientifically cautious yet open-minded perspective. While acknowledging the crucial physiological role of NAD+ and its age-related decline, he sees little compelling evidence for its use as a geroprotective supplement for healthy humans today. His message is clear: prioritize foundational, proven health behaviors before getting sidetracked by expensive supplements with minimal human data. The path to a longer, healthier life lies primarily in the steering of one's own ship, not in the promises of a quick-fix pill.
