Peter Attia· MD
I do suspect it will do a better job than yeah and what we what we do have taking it back to the fatty liver what we do have is not you'll never see this in your day-to-day clinical life but what we do have a studies where we look at labeled tracers and that's what shows that in a random sampling Nash people you have a seventy-five percent decrease in able B secretion it doesn't matter what the april-b in the blood is you'd like to know why it's higher but you know that it's not because it's coming out of it's not secure and higher that's a great point right it can be longer residence time at the VLDL the LDL the low you know that's such a such a great point okay so speaking of tracers which just prompted me to think of another thing I wanted to talk with you about let's talk about the most sought-after discussed asked about supplement on the market today which are nad precursors mmm I know I know you've got some feelings on this I have pretty I have pretty strong feelings on this topic too I'm trying to think how we can frame this so let's take a step back well let's me do this for the listener who is contemplating whether or not they should turn the podcast off now or not because you've barely hung on to the biochemistry of choline and fatty liver disease most people have heard of NR nicotinamide right aside an ad as the sort of Fountain of Youth and if you've listened to other podcasts I've done specifically when I spoke with David Sinclair we talked a lot about sirtuins and the necessity of nad as a substrate to sirtuins what many of you have also probably heard of is there were a couple of companies out there that are making a very popular supplement one of them is called Elysium they make a supplement called basis the other was called chroma decks they make a supplement I think it's called true noggin if I'm right on that yeah I believe that basis takes nicotinamide Ryba side combines it with pterostilbene which is a sirtuin activator and that is their product and my recollection is that the true Nyugen folks are just giving nicotinamide right beside I don't know if they have a Sur to an activator in there but I could be wrong and it's probably not relevant unless you know the answer okay all right so the thinking goes as follows we have this little thing in our cells called mitochondria and they have all these little complexes and these complexes are basically used to generate reducing agents that move electrons to one side of a double membrane and it builds up a gradient and then that gradient allows us to make a bunch of ATP and that whole process is called oxidative phosphorylation the first of these complexes turns nad into NADH and uh pardon me NADH to nad so as the race as we age it has been postulated and maybe even observe that oh I don't know if it's been truly observed inside the mitochondria maybe it has that the ratio of nad to NADH goes down and if that's happening then you have presumably less nad with nad being an important substrate for sirtuins which do many things but primarily repair DNA damage it would seem that we would want more nad okay well they also have nad depletion because the sirtuins and the PARP switch is the other class of enzymes sort of using nad for the purpose of protecting DNA and telomeres and and all the things that are postulated to be important to aging and longevity they consume they're consuming the nad that's right absolutely which i think are two totally different things correct and there's another great example of it's hard to know why nad levels might be low is it low because of high consumption and high demand or is it low because of low so if you have if you're looking at the ratio of nad to NADH then I think that being in the overfed state is the thing that's the problem if you're talking about nad amount levels dropping then you're looking at consumption by the parts and circuits that are consuming it for the purpose of repair damage yeah so in an ideal world if you could wave a magic wand you would presumably want