Lessons in Longevity: Debunking NAD and Cellular Health with Dr. Tiffany Libby of Niagen Bioscience

0:01Hey guys, welcome back to Skin Anarchy. Today's episode is very special because a lot of you have been asking about supplements especially NAD supplements and trying to understand their science and understand how does this fit fit in skin and how do you have been a lot of skin and so much of skin and so much of skin you guys to Dr. Tiffany Libby who is truly an extraordinary dermatologist. She's certified and has so many accomplishments under her belt and so I'm so excited Dr. Libby to host you and to talk about Neogen Bioscience. So welcome to the show. Thank you so much for having me. Yeah I'm excited to dive in and learn more about you.

0:48You know you have such an impressive background and I mean you've really seen this very deep dive level of science you know especially from the dermatology side. So I'd really love to get to know more about you and your interest in obviously dermatology, but then the longevity space as well. If you can kind of give us maybe a walk down memory lane a little bit. Yeah, absolutely. So my current role, I'm the director of Mohs Surgery, which is really a specialized way to move skin cancer. And I'm a dermatologist specializing in cosmetics and lasers at Brown University Health. So I really love that I get to do really the procedural side of things, but I'm having very varied conversations with people who are dealing with high burdens of skin cancer at all aspects of their life.

1:31We're seeing patients come in as early as in their 30s with skin cancer and helping them manage that and then well into their 90s. So something that we know we'll be dealing with chronically. And then dealing with cosmetic patients who have a very different... They're coming in and they don't necessarily need to, right? They're looking to feel better, to look better and improve and kind of have these conversations. And they want to do it on a holistic level. So I feel like the longevity space has been very interesting to me. I think when I think about when it first started for me, that interest, it kind of brings me back to my childhood.

2:07I grew up in a medical household. My dad's a urologist. And from a young age, medicine really felt like home to me. I really saw the responsibility, that desire to constantly be learning, putting in those long hours. And that was always really deeply fulfilling to me and figuring out how you can help your patients in every aspect live long, healthier lives. And then when I was really young, my mother was diagnosed with an acute onset autoimmune disease. And she had almost passed from that. So high-dose prednisone saved her life, but at a big cost, permanently damaging her adrenal system. And she's lived with these long-term consequences since.

2:45And yes, she's surviving, but we talk about lifespan and how that differs from healthspan. Is she really thriving? She kind of put off a lot of these things that she wanted to do later in her life, enjoying freedom, travel, enjoying being active with us as kids. And now with her grandkids, she's not able to do that. So you kind of think about, makes you think about these things earlier on, because most of us don't think about longevity when we're young and healthy, right? We think about it when things have happened to us and we're thinking about, oh, how can we dial things back or how can we chase that fountain of youth and what can we be doing now?

3:23And I think this is a really exciting time to be in science because we can actually do things. And where we're learning so much, the space is constantly evolving and there are actionable things that we could actually incorporate into our lifestyles now. yeah no it's so fascinating what you're saying because i think that really kind of hits on you know i think a lot of people's interest in longevity you said it wonderfully where we don't really think about it we don't you know engage in like i guess interventional options you know before early on especially not in like our 30s or even early 40s and then you know all of a sudden something happens and we're like oh wait a minute you know i need to think about this so that's very fascinating to me that you brought that up because i think when i think of any supplement, I think that's where we are.

4:11You know what I mean? As a supplement industry is that people are coming to this realization and understanding that the body might need some help at this point, you know? And so I guess my question really is for you, like, how do we, I mean, also I'm curious as also being in healthcare myself, like, how do you manage that expectation with patients, right? When they come in and they're like, well, now I want to learn all of a sudden about NAD supplements or any supplement or anything that they can do to intervene. I mean, where do you think that balance is between like treating someone and then also educating them on these kinds of interventions and these kinds of like, you know, preventative measures that we could be taking?

4:48Yeah. I mean, that's, those are all great points. I feel like there's so much to dive into here. And I think just to wrap up even on that note, I think it's a systemic problem, right? Of our U.S. healthcare system. We're really a treatment-based healthcare system. We don't invest much in our preventative healthcare services. And we see that in every aspect and how that plays out, you know, where we're more of a specialist dominated healthcare system versus the only quarter of our U.S. physicians are in preventative or primary care roles. And we spend less than 10 % of our healthcare spending is on prevention.

5:24So I think the supplement industry is just very interesting because yes, people are coming to it, hopefully to want to get ahead of things, but also because they're looking for a fix. And I have many thoughts on this because I'm always looking at things from a holistic perspective. And I think we, in this, you know, in this world, everyone wants that quick fix. And this is not, there's no, there's no fountain of youth. I think that there's, yes, there are these amazing NAD supplements that we're going to get into today, but it's a lot of it are the things that we've known for a long time, decreasing stress, eating well, exercising, being active, you know, decreasing that inflammation.

6:02So, and having good sleep, I feel like these are things that we were trying to find ways around that, but I feel like we have to incorporate a lot of those foundational truths. And then we can also build on that. So I, you know, just like when I have conversations with my patients, hey, if we're not going to invest in good sunscreen use and be diligent about it and reapply and apply the correct amount, then what are you doing having the rest of these conversations and chasing these treatments? So especially when it comes to conditions like melasma, I have to let them know that there's no real cure.

6:32We kind of have to be aggressive with prevention. And if you can't promise you will, we will be. And we don't want to be spending all that money on the treatment side of things. And for NAD, this is definitely a buzzword right now. I'm getting a lot of people asking me about this. And we have, you know, we have a, this is already ingrained in what we do in dermatology and I'll get into that as well. But NAD, as we know, is, you know, really critical for increasing cellular energy. So, you know, when we're explaining this to patients, you know, they hear about this, like, can you tell me more about NAD?

7:05You know, what, what is this? And I kind of explain it as an analogy. You know, I like to use analogies and I say, think about your mitochondria because some people have heard about that mitochondria word you know and that's a cellular organelle you know in all of our working cells like 99 of our working metabolically active cells mitochondria is present and it produces it's like the powerhouse the power plant keeps the lights on in our cells and it keeps them functioning optimally it produces cellular energy so maybe fuel you want to think of it that way atp and in order for that process us to occur and produce ATP, we need NAD.

7:48So NAD is really critical to making sure we produce cellular energy. And then another big part is cellular repair, because things are always happening to us and we're always kind of defending and repairing. So we want to optimize those processes as well, because when those processes are not optimized, that's when things can go awry and we're not able to fix and stop some of those negative consequences. So I like to think about NAD that way. And what's fascinating to me is that just like all good things that decline as we age, NAD levels also decline as we age. Actually, they drop by 65 % between the ages of 30 and 70.

8:30So think about all these cells that require NAD to produce cellular energy. Now they're no longer functioning as optimally as they can be. And that's a big problem, right? So I think that's one aspect of this whole, how do we optimize our own health? How do we allow our cells to function to the best of their abilities? And these are cells that we're talking about that produce not just collagen and elastin, but for our skin structure, but also help repair DNA damage at the surface level of our skin. Because our skin is constantly battling UV radiation that's causing UV-induced DNA damage, and then that eventually leads to skin cancer.

9:12So there's so much that's happening, and it all starts at the cellular level. So I think this is a fascinating time to be able to make changes at the cellular level. Absolutely. No, I think it's really fascinating, the whole movement around NAD, because I'm not going to lie. At first, I was very, very skeptical about it because I come from a very heavy cell biology background. And so for me, when I think about anything going inside of a cell and then acting and then working within that normal cellular machinery, I know there's a lot that needs to happen for that to occur. So like that's where I think I get lost in this world of like if we supplement our cells, they're going to incorporate that molecule and then utilize it in the normal machinery.

9:52So what is the role here of like the biotech being utilized by Niogen that is allowing for NAD to actually be utilized by cells? So I love that you brought that up because I think as scientists, right, we're always led, we're always, we always lead with skepticism. And that's the way it should be. We should always be like, hey, I don't believe this. I want to make sure, like convince me that this works. And that's sort of how I, you know, even when I was, I told True Niagen when I started working with them, I was approached by many different supplement companies for hair and various things. And I said no to them all.

10:25True, True Niagen sent me over all of their clinical studies. They've done over 40 human clinical studies. They have an external research branch that they have a patented nicotinamide riboside. And I'll get into why that is the best way to boost NAD levels. But they have a patented ingredient called Niagen, which is being used independently by Harvard, Mayo Clinic, by a lot of premier institutions and organizations in order to do research on cardiovascular disease, Alzheimer's, long COVID, inflammatory diseases. So they're investing a lot and their product has been vetted and has been heavily studied in its ability to actually increase NAD levels in the cell.

11:07And I think, you know, when we think about NAD, then there's other players that people also hear about, like NMN, NR. They're like, what is all that? Like it's all that soup, right? Right. So, and I feel like when you think about NAD, I mean, we've heard about it because we've taken Biochem back in our medical school days and Krebs cycle and ATP, but a lot of it's, you know, they just hear NAD and they think I need to get NAD into my body. How do I do that? But that's not the right way to think about it because NAD, as you know, is a large charged molecule that does not enter cellular membranes.

11:42So you actually need the precursor to NAD and that precursor. There are multiples of them. And the most well-studied one is nicotinamide riboside, which is their patent ingredient, true niagen's patent ingredient, which they call niagen. That one actually can enter into cells and then has been shown to boost NAD levels. And by taking 1 ,000 milligrams daily, over three weeks, has been shown to boost those NAD levels by 150%. So that's very meaningful. What's interesting is NMN, which is also very buzzy, that needs to be converted to NR before it can enter cells. So it needs an extra step. And it also relies on another enzyme in order to be converted to it.

12:24So if you have low bioavailability of that enzyme, you're not going to get as much of the NR. So NR is really the one that we want to be focused on. And that translates into increased NAD levels. And I think you bring up a great point. How do we know what's being told to us is actually happening? And true Neutrogen has really taken it upon themselves to perform all these clinical studies to demonstrate that not just in vitro, but in vivo, this is being shown. All right. That's very fascinating. And that's really why I asked you because exactly, you know, there's so many brands right now. I mean, literally NAD came out and everybody had a supplement, you know what I mean?

13:06It was like everybody, everywhere you look and it's like, for the longest time, like I said earlier, like I was just kind of like overwhelmed, you know, as both a consumer and also from the healthcare side. I was like, this doesn't even make sense. You know, like, what are we doing? And I'm sure a lot of people agree, your mind goes to toxicity, right? It goes towards the other side of things. Because if you put things in your body that are not made like, you know, what you're explaining is very, very, that's rare to see that in a supplement brand, you know, but I'm talking about the, when people don't do that homework, and they just give you these supplements, and then you're flooding your body with it, that There's a whole other side for all of our listeners, which is the toxicology side.

13:43And that's very, very important to understand. And so when you guys are shopping, these are the kind of things you should really hone in on. Because there can be a lot of damage that can happen. You are so right. Because even as a physician, I mean, I'm thinking about it from a skincare perspective. Patients come in, what should I buy? They're overwhelmed with what they see on the skincare aisles, right? There's tons of stuff out there. They don't know. But this is even more critical. This is what you're putting into your body. And this is, as I'm sure you have a very widely educated base here, but the supplement industry is not regulated.

14:15So we don't know those claims. What they're saying is in the formulation, you don't know if that's true. We don't know if there's extra stuff in there. We don't know what the percentage of that is. And that's really frightening for consumers. And that's why I was always very hesitant to get involved in the supplement space. But what I've really come to love about this company, True Niagen, is that they've taken that very seriously. They recognize that there's very little regulation, not even by the government's fault. They don't even have the ability to provide this kind of oversight because the industry is so large.

14:44They can't even do this kind of independent testing. So what TrueNiogen has done is they've taken it into their own hands. And you can go into their website and you can see they've tested, they've done independent testing of some of the competitors' brands and their own. And they've done third-party testing just to say, hey, we love that second opinion. We're like, hey, then let's get more testing. Let's vet. And the more evidence we see, the more we can trust. We want to be able to trust what we're using. Just like we want to be able to trust our doctors when they're telling us advice. We want to be able to trust that what we're taking is doing what it's actually saying it's going to do.

15:18So I really respect that the company takes it seriously and unfortunately has to spend funds of its own in order to help police the arena, if you will, because shockingly, they found that many of those supplements, like you said, don't carry the amounts or don't even can sometimes even contain the ingredients that they're saying they contain on their bodies. Yeah. No, I mean, I'm glad they're doing that though. Honestly, I think that's important to set an example in this industry with that, because at the end of the day, and this is generally my opinion about supplements is like, if you're going to make a supplement, you need to put the money behind testing it.

15:56You know, You've got to do that because if you don't, then you're exactly what you're saying. The FDA is not doing anything about this stuff. There's a lot of doctors right now. I saw one very, very famous podcaster. He's a physician, and he was talking about how he believes more in the pharmaceutical industry than he does the supplement industry. I see that point, but at the same time, there's an argument to be made where it's like, well, the FDA is not doing jack about this. You know what I mean? They're not coming out and saying we're going to regulate it. So at the end of the day, what do you do?

16:26You're still going to have products, but you have to put some responsibility on those brands and say, okay, you're coming out with a product, now test it and show us that you tested it. You know, show us the data. And the fact that, you know, TrueNiogen is saying that, yes, we are testing our products. You know, we're not going to just be out here and not give you that information. That's huge. I think that goes a very, very long way and it sets a really good example for this industry. So, yeah. Yeah, I really applaud that. with me too, because I think with skincare, you know, again, there's also so many brands out there.

16:56And I think the ones I feel responsibility when I am working with brands on advisory side or promoting it or recommending it to patients, even, you know, for me, it's something, is this something I would use? Is it something that I know is going to help, or at least I can help them understand how much it will help, you know? So, and that's really helpful when they've done those studies. And we're not talking about like, you know, patient satisfaction studies or We're talking about real studies where they're doing things that they can actually measure. Is it actually increasing the skin moisture content?

17:26Is it actually increasing these essential skin barrier lipids? So we want to know, have actual metrics that are objective. Let's dive into that because a lot of our audience, obviously, we want to learn most about skin health and that. So you just mentioned a couple just now, but like overall, what are the actual like results that we can expect if we're using an NAD supplement regularly and sticking to it? I think it depends like what kind of NAD supplement first of all, right? So I think what we've sort of alluded to here is that they're not all created equal. And, you know, I think NAD is so buzzy that NR kind of gets lost in that.

18:06But really NR, the Niagen, which is the patented NR, is going to be that precursor you're looking for to boost those NAD levels. And it'll depend on the amount that you're taking. So if you're taking 100 milligrams daily over three weeks, you'll increase your levels by around 20 some percent. That's what the studies show. 1 ,000 milligrams will increase it by 150. And really the maximum daily you can take recommended is 2 ,000. but what's also exciting is the brand just launched a true niagen beauty supplement and that one is a hundred milligrams so it's meant to be as like a booster to be added with you know one of the other main products like the age better or the clinical strength which age better is 300 milligrams clinical strength is 500 milligram capsules and it's meant to specifically have these skin healthy ingredients like astaxanthin, which has potent antioxidant and anti-inflammatory capabilities.

19:05It's a carotenoid and it helps to reduce oxidative stress and inflammation and has measurably been shown to help improve skin moisture content and skin elasticity. It also is formulated with biotin, hyaluronic acid, grapeseed extract, vitamin E as well. So these are all ingredients that are helpful to support optimal skin barrier health, help improve skin elasticity and collagen production. So, you know, I think this is, it's great sort of thinking about beauty from within, you know, we are off. It's meant to complement your skincare routine, meant to complement everything else that you're doing.

19:43But I always like this layered approach, you know, when you can tackle something from multiple aspects, you know, that you're going to come to that solution more quickly and more effectively. Yeah, no, I love that. And it's actually, that's solid. I mean, those are some of the major things we're looking for when it comes to just, I guess, as consumers, you know, wanting more resilient skin, right? And so I think that's huge. And, you know, I want to ask you this from the longevity side as well, because we are hearing so much about mitochondria these days. You had brought it up briefly, you know, earlier, and the whole idea of mitochondrial health, I think, is finally and rightfully so taking, you know, set our stage.

20:24And so when it comes to the mitochondria, what is it that you think consumers should understand about true mitochondrial health, longevity, resilience? Like, what is it that matters when it comes to that? And how does NR play a role? Yeah. So mitochondria, these are the cellular engines of our cells. So when we think of our skin, you know, I know we recognize our skin as such a dynamic organ. It is really a super specialized organ that is sort of constantly defending. It's our interface with the outside world, you know. So it is constantly protecting us from all the external aggressors, which we know well, UV radiation, which is responsible for 90 % signs of skin aging, right?

21:10So your brown spots, wrinkles, loss of radiance and sagging of skin. So it's responsible for 90 % of those signs of photoaging. And it's responsible for 80 to 90 % of skin cancer. So our skin is a highly dynamic organ. And there are a lot of different processes happening in it from skin regeneration, skin cell turnover, DNA repair processes, producing collagen and elastin, producing all of those ceramides, those barrier lipids, all of those healthy fats, the lipids in our skin barrier that help keep moisture content in and prevent dryness and help keep that microbiome stable. So there's a lot of things that are happening in the skin and all of them are mitochondria dependent, meaning that they're depending on these mitochondria to be functioning optimally.

22:04So if the mitochondria is not producing enough cellular energy because NAD levels are dropping, then all of those functions, as we can see, will decrease. And I think we're always quoting in beauty that we lose 1 % of starting in mid-20s, we lose 1 % of collagen in our skin per year. When women hit menopause, we start losing even more than that. That kind of number jumps up to 2 % per year. And not only that, but sebum production decreases. And that means skin is drier and the skin barrier health is now weakened and is no longer functioning as optimally as it can be. So there are a lot of things that are decreasing in the skin that are happening as a result of just aging and internal processes, let alone all the UV radiation that's sort of bombarding us and creating this constant battleground, if you will, on the skin.

22:55And we're relying on ourselves to be able to defend and sort of take up these free radicals. You know, we want these antioxidants. We want all of these processes to be functioning in unison to help, you know, keep all this damage at bay. But unfortunately, you know, these processes start declining because, you know, we have less cellular energy feeding it. And I think what's important is all of these things that we see downstream can actually be helped by an interesting, this almost like a singular pathway, you know, that's upstream and helps with prevention and is really tied to so many of these processes that are critical in maintaining not just skin barrier health, but, you know, reducing risk of developing skin cancer in the future and reducing signs of the photo aging.

23:42That's so interesting. I mean, I find that to be so fascinating on so many fronts because there's, I mean, I think at the end of the day, when it comes to longevity, most people, I think they assume that we're just talking about like reversing damage or like, you know, like, how can I like kind of take things like in the opposite direction, right? But then when you think about true preventative measures, like you're really actually priming yourself to age better, you know, and to really like do better as you keep going forward, you know? And so I I think that's a whole like mind shift, you know, that needs to take place, I guess, when we're approaching these kind of like interventions, because I don't know, like longevity is interesting for me, you know, right now, the whole space, like I think people are divided in the way that we view it and the way that we like what we expect, I guess you could say from it.

24:28So whether it's a supplement or, you know, you had brought up skincare earlier, even the longevity skincare that I'm seeing pop up, you know, all over the place, it becomes this idea or this hurdle of setting like true patient expectations around this stuff, you know, and, and figuring out like, what can you rightfully expect? And like, when it comes to your mitochondria, you're not going to reverse what's already happened. I mean, I think that's the thing that I, I get very stuck on that because I think a lot of the people, even the ones that chime into our podcasts or emails, they're always asking about how can I reverse the damage?

25:00How can I reverse this? How can I make things go back to how it was when I was 20? And it's like, you can't, there's no way to do that so you know that's why i asked you about that is you know why does mitochondrial health matter but no i want to actually ask you more about a little go a little deeper into biomarkers because you can't talk about longevity without talking about biomarkers and i think right now with all of those independent companies that are out like i know function health does this there's so many that are tracking almost every biomarker that you can think of you know, through blood.

25:33And so what are your thoughts on that in terms of like just biomarker studies and, you know, I guess how it ties into what TrueNiagen is doing and what we should know as patients, as consumers about what we can really rightfully, or, you know, I guess logically interpret from these kind of like, you know, tracking or this kind of like, you know, looking into our health, like constantly, like what should we really be looking at? This is fascinating because I've always been a strong believer of you don't test unless you can do something about it. And if you're going to test, you have to be prepared to interpret those tests and help guide on what to do next.