Latest / Wellness by Designs - Practitioner Podcast / Exploring the Role of Nicotinamide Riboside in Fertility with Belinda Kirkpatrick

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Exploring the Role of Nicotinamide Riboside in Fertility with Belinda Kirkpatrick · Wellness by Designs - Practitioner Podcast

• 0:12
  Speaker 1: Welcome to Wellness by Designs.
• 0:14
  Speaker 1: I'm your host, andrew Whitfield-Cook, and joining us today is Belinda Kirkpatrick, a naturopath and nutritionist who specialises in fertility management, and we're going to be discussing today the benefits and uses of nicotinamide riboside, or NR.
• 0:29
  Speaker 1: Welcome to Wellness by Designs, belinda.
• 0:32
  Speaker 1: How are you going?
• 0:33
  Speaker 2: Well, thank you, Andrew.
• 0:34
  Speaker 2: Thank you so much for having me.
• 0:37
  Speaker 1: Thank you so much for your time today.
• 0:38
  Speaker 1: So I guess, to start off, really, what is NR?
• 0:43
  Speaker 1: And, by the way, we're always going to say NR, everybody shortens it but it's nicotinamide, so the non-flush form of B3, combined with ribos, riboside, so nicotinamide, riboside, but we're going to say NR, we'll always default.
• 0:57
  Speaker 1: So what exactly is NR and why is it used in fertility?
• 1:05
  Speaker 2: Yeah, nr you're right, we never actually say the word is one of my favourite supplements.
• 1:09
  Speaker 2: So NR is a precursor for NAD+ or nicotinamide adenine dinucleotide, and that's a compound naturally produced in the body.
• 1:20
  Speaker 2: Now this NAD plus is essential for processes things like I energy production, dna repair, gene expression, and the levels decline as we age.
• 1:30
  Speaker 2: So it's been looked at a lot as sort of like an anti-aging thing.
• 1:34
  Speaker 2: So we've got it in bucket loads when we're young and full of energy and it starts to decline in our 30s and beyond.
• 1:40
  Speaker 2: So NR that we're talking about today is a precursor for this NAD, which is super essential and it's known to boost NAD levels.
• 1:50
  Speaker 2: So in my practice I'm using NR a lot to address, like age-related ovarian fertility issues you know, guys, I guess, like you know, maintaining and improving egg quality.
• 2:05
  Speaker 1: Okay, could you just explain for us why, as a naturopath and nutritionist, you choose NR over NMN, which is nicotine mononucleotide NMN?
• 2:18
  Speaker 1: We always do that to produce NADH or NAD+.
• 2:22
  Speaker 1: What's the benefits of NR over NMN?
• 2:28
  Speaker 2: It's such a good question and it's such a confusing thing, and I've done so many deep dives kind of down into it, because it's like why are we not, if we want NAD+, why are we not just using NAD?
• 2:38
  Speaker 2: And then we've also got the NMN form or the nicotinamide mononucleotide or the NR.
• 2:44
  Speaker 2: So when we're looking at NAD, it is very unstable, it's degraded very quickly in light, whereas NR is more stable, and then NMN is kind of closer structurally to NAD.
• 3:01
  Speaker 2: What we want to finish with.
• 3:02
  Speaker 2: However, both NMN and NAD are quite big molecules and they find it quite difficult to cross into the cell.
• 3:06
  Speaker 2: So if you take NMN, it's actually converted back to NR before going into the cell to then become NAD.
• 3:14
  Speaker 2: So I guess it's like an extra metabolic step that some people may do easily and some people don't.
• 3:19
  Speaker 2: So the NR form, like you said, is the non-flushing form, so it's basically the closest instruction to NAD, but while still being able to cross into the cells and being converted back into NAD, and it's been shown to raise cellular NAD levels significantly.
• 3:39
  Speaker 1: I think this is one of the issues we've always got to be cognizant of, and that is that when we're talking about a molecule that'sant of, and that is that when we're talking about a molecule that's in the cells, is that relevant for oral supplementation of that molecule?
• 3:50
  Speaker 1: Because we've got a whole digestive process first, past metabolism, it's going to be taken into the liver, processed and then taken to the cells or the target organs, if you like, to be used there.
• 4:01
  Speaker 1: So taking it orally in the mouth doesn't necessarily mean that it gets to the target organ or target cells in that form or in that dose.
• 4:12
  Speaker 1: So we've got to.
• 4:13
  Speaker 1: There's a few relevant steps we've got to think about right.
• 4:17
  Speaker 2: Absolutely, and the less steps that we need to take, then we're not then relying on somebody's you know personal sort of genetic ability to actually convert things back and back.
• 4:28
  Speaker 2: So the more I guess steps that there are, the more places there could be issues.
• 4:34
  Speaker 1: Yeah, that's a really good point you make actually about genetic ability, because, you know, often we find these are the people, for instance, p5p, these are the people that have issues with phosphorylation and dephosphorylation and so, in some people, maybe with liver assaults or, you know, chronic fatigue for instance.
• 4:55
  Speaker 1: These are the people that tend not to be able to use pyridoxine hydrochloride and they sometimes do better with P5P, whereas most people can convert pyridoxine hydrochloride no problem.
• 5:07
  Speaker 1: Do you find that, with your use in practice, that there's a certain population that NR is better suited for?
• 5:17
  Speaker 2: It's a great question because absolutely in so many other in other complex formats, I pretty much just use that solely because we know that it is the most easily absorbed form um.
• 5:29
  Speaker 2: So there probably are genetic snip tests and all these sorts of things you can probably have a look at.
• 5:34
  Speaker 2: I actually haven't done that dive down into that um, just knowing that.
• 5:38
  Speaker 2: I guess that the nr actually does go into the cell pretty easily, um and get converted into nad.
• 5:44
  Speaker 2: So I think there will always be patient subgroups that do that more effectively than others.
• 5:50
  Speaker 2: But yeah, I'm basically just using the NR form, to be honest.
• 5:56
  Speaker 1: Yeah, cool.
• 5:56
  Speaker 1: And so talking about fertility, because these people are crying out, they spend thousands, they go through months and months and years and years of anguish.
• 6:06
  Speaker 1: Can you explain the function of NR in fertility management in both females and males?
• 6:15
  Speaker 2: Yeah, yeah, absolutely.
• 6:16
  Speaker 2: So I think it is really important to note that, like a lot of the research that we're basing this data on does come from predominantly mice you know a lot of them are animal studies.
• 6:26
  Speaker 2: There is research in humans that's ongoing we're basing this data on does come from predominantly mice.
• 6:29
  Speaker 2: You know a lot of them are animal studies.
• 6:30
  Speaker 2: There is research in humans that's ongoing.
• 6:31
  Speaker 2: There's the ENHANCE study here in Sydney that's looking at the effects of NR supplementation, you know, in the IVF cycle and equality and all that kind of stuff that is still kind of ongoing.
• 6:39
  Speaker 2: So a lot of the research is using, you know, aged mice and things like that.
• 6:45
  Speaker 2: But I think that the research in humans will become more and more Certainly clinically.
• 6:51
  Speaker 2: I've been using it for many years and really noticing a huge difference with it.
• 6:58
  Speaker 2: So NR has kind of a few roles in infertility.
• 7:00
  Speaker 2: Most importantly, I think, for lots of our patients is basically this overall improvement in quality, so it can improve the quality of eggs.
• 7:10
  Speaker 2: It basically works by enhancing mitochondrial function and we know that the egg donates the mitochondria to the embryo.
• 7:17
  Speaker 2: So really important that mitochondrial health of the egg is really important.
• 7:21
  Speaker 2: As we age that mitochondria often doesn't function as well, so enhancing mitochondrial function, reducing oxidative stress and then helping to maintain sort of normal chromosomal structure.
• 7:33
  Speaker 2: Nad also activates these enzymes called sirtuins, and if you work in fertility sort of these sirtuins are kind of like you know big enzymes there and they're basically involved in DNA repair.
• 7:45
  Speaker 2: So that can then help to boost, like egg and sperm as well, integrity.
• 7:50
  Speaker 2: So we're really wanting to boost that sirtuin pathway without getting too technical, because I'm actually not a super technical kind of person, but you know there's also in the cells.
• 8:01
  Speaker 2: We've got this thing called another enzyme called CD38.
• 8:04
  Speaker 2: Now this enzyme basically is the primary NAD plus consuming enzyme in the ovaries.
• 8:10
  Speaker 2: So it gets higher, it expresses more activity with age which contributes to these declining NAD levels, follicle depletion, reduced fertility.
• 8:20
  Speaker 2: So the NR supplementation can't stop this CD38 from, you know, increasing with age.
• 8:27
  Speaker 2: That just happens.
• 8:28
  Speaker 2: Maybe there's something else I don't know about that does that.
• 8:31
  Speaker 2: But it basically can elevate these ovarian NAD plus levels which then helps to kind of mitigate the kind of consequences, I guess, of this sort of CD38 driven depletion.
• 8:44
  Speaker 2: So it really is kind of getting a little bit technical there, but it's actually kind of helping to reduce something or it's helping to balance something that is causing egg and ovarian ageing.
• 8:57
  Speaker 1: Can I ask about dose?
• 8:59
  Speaker 1: So do you find that as we age, for instance, that the dose of NR has to be escalated?
• 9:05
  Speaker 1: Do you find, maybe, certain conditions, certain types?
• 9:09
  Speaker 1: Of aberrations with oocytes.
• 9:11
  Speaker 1: That NR is that you use different doses for.
• 9:17
  Speaker 2: I certainly do use a higher dose in sort of, I guess, what they would call poor responders, so basically people who either don't respond well to IVF cycles, and that's where we can sort of really see egg quality is really in that assisted reproductive setting.
• 9:33
  Speaker 2: Do you know what I mean Like?
• 9:34
  Speaker 2: I mean, as women get older when they're trying, naturally we definitely assume that there's an egg quality component there once people start to get over 38, 40, 42.
• 9:45
  Speaker 2: You know Lots of my patients are over 41, 42, 43, 44.
• 9:49
  Speaker 2: So we know that egg quality probably isn't going to be amazing then.
• 9:53
  Speaker 2: So I will often use the higher doses at that point If they've been doing IVF and we can see the specialist or the embryologist kind of giving feedback about egg quality or the eggs aren't.
• 10:07
  Speaker 2: You know that sort of fertilization to day three embryo is very egg quality driven.
• 10:12
  Speaker 2: So if we're not seeing kind of much movement in that embryo progression from day one to three, I will often kind of increase the dose as well.
• 10:20
  Speaker 2: So, you know, depending on where they are and how old they are and things like that, I think, because we can't measure egg quality, we kind of essentially we start off with a bit of a stab in the dark, based on their history and their age, and then, if they are moving into the assisted reproductive sort of IVF world, we get a lot more information um on that.
• 10:43
  Speaker 2: So yeah, I definitely will um use higher doses in people with sort of seemingly poorer egg quality right god.
• 10:53
  Speaker 1: And and what about its use?
• 10:55
  Speaker 1: Um, as well, a metabolic balancer and and as an anti-inflammatory, like I've heard of its use in polycystic ovarian syndrome.
• 11:05
  Speaker 2: The other thing too, just with the egg quality, because I think that's something that people are like super interested in.
• 11:12
  Speaker 2: It also can also, researchers showed, increase and stimulate ovarian follicle growth.
• 11:16
  Speaker 2: So really important.
• 11:17
  Speaker 2: There are some animal studies that I love as well that shows that the NR increases the proportion of embryos reaching those advanced developmental stages, so day five and beyond.
• 11:29
  Speaker 2: So, giving you know, I guess, better IVF outcomes and also, in mice, increased life birth rate.
• 11:36
  Speaker 2: So you know, it really does seem to kind of really give a lot of health to that egg.
• 11:40
  Speaker 2: You know, I guess getting that reproductive potential sort of protected but like and all the way through Anyway, I just thought of, you know, I guess, getting that reproductive potential sort of protected and all the way through Anyway, I just sort of, you know, thought I'd throw that in there With PCOS.
• 11:52
  Speaker 2: I've sort of started using it a little bit for PCOS, look, mostly in the setting of fertility and PCOS, but I can see where it is starting to kind of show some promise in sort of managing PCOS.
• 12:06
  Speaker 2: You know, even people who aren't necessarily trying to conceive.
• 12:11
  Speaker 2: It does work as an anti-inflammatory.
• 12:13
  Speaker 2: It reduces that oxidative stress, so that's kind of, you know, reducing inflammation there, increasing again the mitochondrial health I talked about before, increasing again the mitochondrial health I talked about before and it also does a few things you know.
• 12:30
  Speaker 2: Basically, you know helping with the cellular metabolism, you know increasing ATP function.
• 12:33
  Speaker 2: So a polycystic ovary is generally a pretty inflamed ovary.
• 12:35
  Speaker 2: So you know there's lots going on there and there's generally a level of inflammation.
• 12:39
  Speaker 2: So really, you know, reducing those ROS, or reactive oxygen species, can really help to reduce any cellular damage that's been caused by inflammation.
• 12:50
  Speaker 2: It also, too, helps to reduce ovarian fibrosis or these fibrosis associated genes, and that's going back to that sort of activation of that CERT1, cert3 kind of pathway.
• 13:02
  Speaker 2: So really, enhancing ovulation and reducing fibrosis, reducing inflammation, you know really is working on a part of PCOS.
• 13:13
  Speaker 1: Yeah, sure, and obviously alongside other therapies like myo-inositol, exercise, weight loss, blah, blah, blah yeah.
• 13:20
  Speaker 2: Yeah depending on what's going on testosterone inflammation, you know insulin resistance.
• 13:27
  Speaker 2: So as a part of a treatment, I can absolutely see where that's going to play a role.
• 13:33
  Speaker 1: Yeah, sure, and what about?
• 13:36
  Speaker 1: You were mentioning the IVF sort of process previously.
• 13:40
  Speaker 1: If we think about temporal dosing like when can you?
• 13:46
  Speaker 1: And are there any times where you shouldn't use NR?
• 13:51
  Speaker 1: With regards to the IVF cycle or the IVF process, yeah, when do you use it?
• 13:58
  Speaker 1: When do you hold back?
• 14:00
  Speaker 2: I use it all the way up until an egg collection.
• 14:03
  Speaker 2: So it's not something that is going to be contraindicated with IVF medications, which is fantastic.
• 14:09
  Speaker 2: It doesn't, you know, increase estrogen, like sometimes ubiquinol at very high doses, cancer.
• 14:14
  Speaker 2: Sometimes we drop back, you know, ubiquinol dose sort of in that sort of IVF cycle.
• 14:18
  Speaker 2: So you know I'm using NR like all the way up until, kind of egg collection.
• 14:22
  Speaker 2: Now you know they sort of say you know what gets you pregnant, keeps you pregnant.
• 14:29
  Speaker 2: So you know I'll often drop the dose back and actually use it for a little bit longer after that in certain women, depending on, you know, sort of oxidative stress, inflammation.
• 14:36
  Speaker 2: But yeah, so it's not.
• 14:38
  Speaker 2: You know it's not shown to affect implantation, which is obviously a good thing, so you can be using it kind of all the way through.
• 14:47
  Speaker 2: But that real, I guess yeah, you don't have to be sort of stopping it before they start their IVF stimulation medication, which is great.
• 14:56
  Speaker 1: Gotcha.
• 14:57
  Speaker 2: I'm just going to segue.
• 14:58
  Speaker 1: Yeah, in that enhanced study.
• 15:02
  Speaker 2: they're actually using it.
• 15:03
  Speaker 2: It's only six weeks, you know, I think it probably does need to be longer, but hopefully that's the beginning of many studies.
• 15:09
  Speaker 2: But they use that all the way up until egg retrieval or their trigger injection.
• 15:15
  Speaker 2: So yeah, that sort of gives you a lot of confidence too that you know IVF doctors are running a trial and actually kind of using it up until egg retrieval.
• 15:26
  Speaker 1: Gotcha, tell us a little bit more about this ENHANCE study.
• 15:32
  Speaker 2: Yeah, so it's a study that they're doing.
• 15:36
  Speaker 2: I think they're doing from memory.
• 15:38
  Speaker 2: I think it's like 250 milligrams, which is a low dose, and 1,000 milligrams daily and it's six weeks up until egg retrieval.
• 15:49
  Speaker 2: So I guess that's kind of four weeks before they start their stimulation and then they say sort of two weeks during stimulation, which some of them won't get to two weeks.
• 15:58
  Speaker 2: So you know, I mean, look, you know, yay for any studies you know like, because it's so hard to get research, particularly in these patient groups, right.
• 16:07
  Speaker 2: I mean I'm not part of it at all.
• 16:08
  Speaker 2: But I'm guessing if you say to somebody, would you like to be part of the study, you might have this.
• 16:13
  Speaker 2: You know this nutrient that has been shown to well that we think might help egg quality, or you could have the placebo.
• 16:20
  Speaker 2: I'm going to guess a certain big chunk of them jump out of the study and go and take it anyway.
• 16:25
  Speaker 2: But I mean, I don't know.
• 16:26
  Speaker 2: So I'm guessing it's probably hard to get kind of big studies.
• 16:30
  Speaker 2: I would like love there to be a study that was taking it for at least three months.
• 16:34
  Speaker 2: But you know, the start of anything is amazing and often then, obviously, if there's some promise shown there, like there are in the you know mice and animal trials they've been doing for a long time.
• 16:46
  Speaker 1: Hopefully, then they, then it gets to be, you know, bigger and longer and yeah yeah, but you know, I know this happens rarely and wouldn't it be great if this did.
• 16:56
  Speaker 1: But I have heard of trials that were stopped early because the results were so dramatic, so blindingly dramatic for people, that it was unethical to continue taking the placebo it would be amazing.
• 17:08
  Speaker 1: Wouldn't it be great if that was the case.
• 17:10
  Speaker 1: That would be awesome.
• 17:10
  Speaker 1: It's amazing.
• 17:12
  Speaker 2: And it is so hard, I guess with naturopathy, isn't it?
• 17:14
  Speaker 2: Because it's often like sometimes we get these single nutrients or these single, you know coenzymes that are just amazing and show improvement and things like that, but there's always so many other things kind of going on that you're like, you know, we know that protein is so important for kind of egg quality.
• 17:30
  Speaker 2: You know, we know that, you know like.
• 17:34
  Speaker 2: So I guess, like diet and lifestyle and everything, even if it's not with other supplements, you know, I mean it would be amazing to kind of be able to sort of capture all that together.
• 17:43
  Speaker 2: But yeah, you're right, I mean mean, gosh, if you could go.
• 17:52
  Speaker 2: Yeah, a thousand milligrams for six weeks before showed any improvement, and then you went on to a bigger study that did it for longer or added in something I think you know.
• 17:55
  Speaker 2: I can't imagine that you wouldn't see it, because I see it in clinic all the time yeah, yeah, I.
• 18:01
  Speaker 1: I guess the danger is wanting a nutrient to be a drug, you know, because drugs are very powerful agents which block or upregulate things dramatically, often with attendant side effects.
• 18:13
  Speaker 1: Nutrients are things that we've evolved to handle, so it's a little bit of a different ballgame, it's hard to ask someone over a short period of time yeah, I don't know if it shows the group, but you know, like I mean how you choose that.
• 18:27
  Speaker 2: Like, are there other issues?
• 18:28
  Speaker 2: Is it just anyone doing it?
• 18:30
  Speaker 2: You know, was it?
• 18:31
  Speaker 2: People had sperm issues as well, but like they may as well take this to improving.
• 18:35
  Speaker 2: I mean I actually don't know those details, so maybe maybe that's all you know um fine-tuned out in the study, but um yeah so?
• 18:44
  Speaker 1: so we've mainly spoken about egg for egg quality so far.
• 18:48
  Speaker 1: What about sperm quality?
• 18:50
  Speaker 1: What about males?
• 18:52
  Speaker 2: yeah, so it is.
• 18:53
  Speaker 2: It is good.
• 18:54
  Speaker 2: I mean, in that same sort of way, it is good for sperm quality as well.
• 18:57
  Speaker 2: So a lot of the um, a lot of the research that we use for egg quality and also kind of sperm quality is based on anti-aging research, right.
• 19:07
  Speaker 2: You know the amount of my patients who you know on ubiquinol and they're on resveratrol or they're on nicotinamide, riboside and all these kind of you know beautiful antioxidants that we've got, and then, once they're pregnant, they're kind of like oh yeah like my husband wants to kind of buy those now is it, is it okay for him to, for him to take them, like all the guys in the gym or he's listened to some cubanman podcast or you know.
• 19:30
  Speaker 2: So it's like it's really.
• 19:32
  Speaker 2: It makes you realize, like you know, they're like what he's got, you've got nr.
• 19:36
  Speaker 2: Like my husband's asking me why I've got this type of thing, because it really is so much the bulk in that anti-aging, you know, kind of research.
• 19:43
  Speaker 2: So men and women like you know a lot of our, a lot of the issues is this sort of, you know, dna damage.
• 19:49
  Speaker 2: You know poor mitochondrial kind of health, inflammation, aging eggs, aging sperm, so you know anything that does kind of, you know, boost the sort of health of the egg and help with DNA repair, which is such a thing as we kind of age.
• 20:06
  Speaker 2: Um, it definitely does play a role there.
• 20:08
  Speaker 2: So I don't know that there's as much research on it as yet, but I think it's yet the next, the next ubiquinol, if it's not already right.
• 20:18
  Speaker 1: isn't it funny that it took going to the gym to to start men to uh to realize that there was a function for these anti-ageing nutrients.
• 20:26
  Speaker 1: I think that's funny.
• 20:26
  Speaker 1: Yeah, yeah, yeah.
• 20:28
  Speaker 1: And you also mentioned ubiquinol.
• 20:31
  Speaker 1: So we may as well cover off on that because, like I can remember, ruth Trickey was like the first, let's say, fertility specialist who really grasped the use of this, and I remember her saying, on the basis of one small trial, she started to use it and then it just became mandatory, it became just general approach.
• 20:53
  Speaker 1: So take us through ubiquinol while we're there.
• 20:56
  Speaker 1: What dose do you use?
• 20:57
  Speaker 1: When do you use it?
• 20:59
  Speaker 1: Are there times when you don't?
• 21:00
  Speaker 1: You mentioned some times you might pull back, and both males and females for two.
• 21:06
  Speaker 1: Yeah, yeah.
• 21:07
  Speaker 2: So I do tend to use ubiquinol, um the more active version of kind of coq10 um.
• 21:12
  Speaker 2: You do tend to kind of get what you pay for, in that sense.
• 21:15
  Speaker 2: And again, going back to our conversation about um, you know like how people can kind of break it down and convert it um, is it not?
• 21:22
  Speaker 2: Everybody converts protein into ubiquinol actually quite a small proportion, um.
• 21:27
  Speaker 2: So I do tend to kind of go upstream and and go with ubiquinol.
• 21:32
  Speaker 2: So, again, depending on their age and history and and ivf history and what have you, but like the dose that sort of sits well in most of the research is about 600 milligrams a day, which is a pretty decent dose in terms of cost, right, like I mean ubiquinol, I mean the same with nr.
• 21:52
  Speaker 2: They're beautiful in the sense that they fit into a nice little teeny tiny capsule and they're swallowed easily and digestion feels great.
• 21:59
  Speaker 2: And you know they're not sort of your b vitamins and they're not your.
• 22:03
  Speaker 2: You know taking four or six fish oil a day, so like they're, but they're, they're not sort of your B vitamins and they're not your.
• 22:06
  Speaker 2: You know taking four or six fish oil a day.
• 22:06
  Speaker 2: So like they're, but they're expensive, right.
• 22:08
  Speaker 2: So it's like a little.
• 22:09
  Speaker 2: It's like gold in a little.
• 22:10
  Speaker 2: It's like gold in a little capsule.
• 22:12
  Speaker 2: So sometimes you know you are trying to kind of choose and sometimes you know you really want to, I guess, use better doses of less things rather than sort of spreading yourself too thin.
• 22:24
  Speaker 2: The amount of people that come, having read whatever sort of certain books that are great for getting people started on their egg health journey, that are taking, you know, ubiquinol and have been taking it for a long time off the internet or whatever, just kind of self-prescribed, it's quite amazing, without knowing what the issue is.
• 22:45
  Speaker 2: And is it the dose?
• 22:45
  Speaker 2: Is it the amount?
• 22:45
  Speaker 2: Is it whatever's in there?
• 22:45
  Speaker 2: Is it how?
• 22:46
  Speaker 2: It's quite amazing, without knowing what the issue is, and is it the dose?
• 22:47
  Speaker 2: Is it the amount?
• 22:47
  Speaker 2: Is it whatever's in there?
• 22:48
  Speaker 2: Is it how it's processed?
• 22:49
  Speaker 2: But they'll be like.
• 22:50
  Speaker 2: You know, I've been doing ubiquinol for kind of ages and you're like, can you just give me a few months on a different type and or dose?
• 22:56
  Speaker 2: You know, um, and they do get better results, as we mentioned before.
• 23:00
  Speaker 2: They're obviously doing lots of other things as well, um, but but it is important.
• 23:04
  Speaker 2: So if that was sort of younger, as in like maybe under 38, maybe I'd just do 300 milligrams of ubiquinol right, you know particularly if they'll just try naturally.
• 23:15
  Speaker 2: But if anybody's going into the ibf setting, I'm like, even if it's their first attempt and they're, you know, 37, even if there's not a known reason and it's a suspected egg quality, ie doesn't look like implantation failures, sperm looks fine.
• 23:30
  Speaker 2: We don't kind of know.
• 23:32
  Speaker 2: I will use that 600, if we can financially for three or four months beforehand and it's a really big consideration because you want to work with your patients and I would rather I was.
• 23:44
  Speaker 2: Sometimes I write one to two, because the ones that I use are 300s, and they say what do you mean one to two?
• 23:49
  Speaker 2: And I'm like if you're feeling rich today, you could have two, but if you're just like feeling normal, go with the one.
• 23:55
  Speaker 2: So even though I like them and you know their weight is higher, their BMI is higher, if they're over sort of 90 kilos, I mean you know the research is saying give them 900.
• 24:05
  Speaker 2: I rarely use that.
• 24:10
  Speaker 2: Again, I'd want to see real bang for my buck.
• 24:14
  Speaker 2: You know like I'd be extra disappointed if the quality wasn't as good.
• 24:17
  Speaker 2: So there definitely will be some people that are open to that.
• 24:20
  Speaker 2: But I think these are all things that you've got to assess your patient as a human, as an individual, and really prescribe personalized medicine.
• 24:30
  Speaker 1: Yeah, I love what you're saying there, belinda, about.
• 24:32
  Speaker 1: You know, if you've got a higher BMI you're going to have to use higher doses of things.
• 24:37
  Speaker 1: You've then got to choose your best bang for buck.
• 24:39
  Speaker 1: But the issue is the BMI and I get the fight, you know, I get the struggle, I understand it, but without addressing that BMI, without addressing lean muscle mass versus fat mass, then you just you're always hooked into higher dosage of nutrients because of the inflammatory nature of adipose tissue.
• 25:04
  Speaker 2: Yeah, and it's a really tough one.
• 25:06
  Speaker 2: You know all my patients are racing against the clock, you know, I mean I don't have the luxury really of seeing the 32 year old who wants to conceive next year although.
• 25:15
  Speaker 2: I did have one this week and I was like oh, your preconception bless.
• 25:18
  Speaker 2: I'm so happy.
• 25:19
  Speaker 2: You know I generally have.
• 25:21
  Speaker 2: You know, we've done five cycles.
• 25:23
  Speaker 2: I'm about to turn 41.
• 25:25
  Speaker 2: You know, this is my weight, this is my life, and so we are you know kind of trying to fast track things a lot.
• 25:34
  Speaker 1: Yeah, Can I just sort of delve on one of those impeders Is that a word?
• 25:42
  Speaker 1: One of those blocks, those roadblocks, yeah, the roadblocks to success.
• 25:48
  Speaker 1: And you know you're mentioning people who've gone through five cycles.
• 25:52
  Speaker 1: You know that emotional agony, the incredible stress that and I will say this mainly women, but not only women, couples certainly put themselves through or are put through uh, stress.
• 26:06
  Speaker 1: So, if, if, can we just talk a little bit about what else you use with regards to using nr for for fertility management with egg and or sperm quality?
• 26:19
  Speaker 1: Perhaps ubiquinol?
• 26:21
  Speaker 1: Um, if it's relevant, what else do you use and when?
• 26:27
  Speaker 2: um, yeah, great question, yeah, so I'd like to think that it's an impossible answer.
• 26:32
  Speaker 2: I'm going to answer, don't worry.
• 26:33
  Speaker 2: I'd like to think it's an impossible answer because I'm you know, I'm tailoring it.
• 26:37
  Speaker 2: You know it is sort of individualized kind of medicine and we need to fix up.
• 26:42
  Speaker 2: You know, nutrient deficiencies, things like vitamin D my gosh, the amount of people that are on high doses of vitamin D because it's just so related into egg quality, implantation, immune, everything.
• 26:53
  Speaker 2: So you know that's definitely kind of looked at.
• 26:55
  Speaker 2: Fish oils and good quality essential fatty acids are really important.
• 27:01
  Speaker 2: When we're looking at antioxidants, it's so hard because how long is a piece of string?
• 27:06
  Speaker 2: and people come saying oh this and this and this and this and this and this and this and this and whatever and sort of you know maybe brands that aren't necessarily amazing, who knows or doses and we have to rein it all in.
• 27:16
  Speaker 2: But you know, definitely, look, ubiquinol, nac and NR would be in my stable of.
• 27:25
  Speaker 2: You know, older women, ivf support, egg quality, you know, anti-inflammatory, mitochondrial health they would be probably in my top three if I had to choose.
• 27:36
  Speaker 2: And the IVF doctors who refer to me and or suggest things to patients a lot of them, that's in the top three also.
• 27:45
  Speaker 2: I mean, obviously we're looking at folate and methylation, you know, do they need different types of folate?
• 27:51
  Speaker 2: B12, super important Sometimes.
• 27:53
  Speaker 2: Riboflavin is your little missing link.
• 27:55
  Speaker 2: B2, you know, particularly in older women.
• 27:59
  Speaker 2: Lipoic acid in older women oh my gosh, the list goes on, doesn't it?
• 28:06
  Speaker 2: So inositol sometimes, you know, we do have insulin resistance a lot.
• 28:11
  Speaker 2: And you know, particularly, if you expand your definition of insulin resistance to be above eight instead of above 10 or 20 um, you're suddenly using it a whole lot more um.
• 28:26
  Speaker 2: So it's, you know, and that's what I mean by being very individualized.
• 28:30
  Speaker 2: You do need to look at a patient's kind of whole health and and whole health picture and then not forget our beautiful basis of, of diet and lifestyle.
• 28:39
  Speaker 2: But but diet, you know, um, it's, it's, it's so important and the difference that I see.
• 28:46
  Speaker 2: And if my patients, if I was just had my science hat on and my patients weren't these beautiful humans who just deserve, deserve to have this success, I would go hey, can we just get you protein adequate for three months and do a cycle and see what happens?
• 29:06
  Speaker 2: You know, but of course I'm popping in all the antioxidants and nutrients and and things like that at the same time, because I just want them to have the absolute kind of best chance of things working.
• 29:16
  Speaker 2: But I would say I would say four months of protein rich diet, you're going to get a huge increase in success in certain populations.
• 29:29
  Speaker 1: I love what you said then and forgive me, this is my brain going back to mitochondrial health but I loved what you said.
• 29:35
  Speaker 1: I just picked up that you'd spoke about riboflavin b2.
• 29:38
  Speaker 1: So if we think about nr being the b3 and riboflavin being the b2, they're the two main feeders not the only, but the two main feeders to the electron transfer chain fad nad, nadh+.
• 29:54
  Speaker 2: So it's really like I love just being we very rarely All the friends when we go to the go-to, don't they All the friends?
• 30:02
  Speaker 2: All the bees are like this you know they're all so important B6, b9, folate, you know B12.
• 30:08
  Speaker 1: It's like it's just a bee fest and what's in thets is usually not enough for these people yeah, but but very rarely do I hear a practitioner mention riboflavin specifically, so I love how your mind channels into these certain nutrients to target them.
• 30:27
  Speaker 1: Can I ask Belinda about herbs?
• 30:30
  Speaker 1: Are there any herbs that you favour?
• 30:33
  Speaker 1: Perhaps even you know inter-cycle to maybe help manage stressful situations, or any other herbs that you might help with, even fertility?
• 30:46
  Speaker 2: Yep, look, I love my herbs as well.
• 30:48
  Speaker 2: I think we all do, or anybody who works with herbs loves herbs.
• 30:52
  Speaker 2: So I don't tend to use them in the IVF cycle.
• 30:56
  Speaker 2: I'm a big believer in you know.
• 30:58
  Speaker 2: If you're doing IVF you know.
• 31:00
  Speaker 2: We just don't know those interactions and of course there's some that would be fine to use through the cycle.
• 31:08
  Speaker 2: I tend to just make everybody happy.
• 31:10
  Speaker 2: All the doctors that I work with know that I'm not going to use herbs in a cycle.
• 31:13
  Speaker 2: So they'll always just say when my patients say to them, oh, belinda's prescribed stuff, they're now just like fine and they don't even look at it, which is great.
• 31:22
  Speaker 2: I don't care if they do, but they often don't know the brand names and what have you.
• 31:25
  Speaker 2: So we've got a trust thing going that I'm not going to use herbs in a cycle if they're in charge they're in charge you know, um pre-cycle, though it depends on what we're working on.
• 31:36
  Speaker 2: So patients who we know are going into the IVF setting I don't care if their cycle's perfect.
• 31:41
  Speaker 2: To be honest, beforehand, you know, sometimes I say like you know, it's like you know, if the walls of the house that you're moving into aren't amazing but you're going to paint anyway, let's not worry about not getting the house because the walls aren't great.
• 31:53
  Speaker 2: So those people might be people who are going to IVF because of um, that the partner might have had a vasectomy or there's um, they're using donor sperm or there's a reason that they're not going to conceive naturally.
• 32:06
  Speaker 2: So it's not like we're kind of trying to get natural conception going by getting the cycle perfect for those people.
• 32:11
  Speaker 2: Sure, we're often working on the luteal phase.
• 32:14
  Speaker 2: You know Vitex kind of, you know, probably has to be, I think, a favourite of everybody's.
• 32:19
  Speaker 2: I'm loving saffron for kind of premenstrual mood stuff.
• 32:22
  Speaker 2: I mean, not so much sort of cycle regulation, you know, in terms of stress, like withania ashwagandha oh you know who doesn't love a bit of that, I do.
• 32:34
  Speaker 2: Look, stress impacts everything, right, I'm a very big believer in helping my patients not to be stressed about being stressed.
• 32:46
  Speaker 2: So I'm pretty big on.
• 32:48
  Speaker 2: I don't want you to be stressed, because nobody wants to be stressed and that it feels horrible to feel stressed, but please don't worry about it affecting your cycle.
• 32:56
  Speaker 2: From my sort of understanding, unless it's like severe, acute stress, then it's likely the thought would affect your hormones, shut down ovulation, make you disappear, kind of stress which some people look.
• 33:09
  Speaker 2: Definitely that can happen, but it's not most of the stress that our patients are under.
• 33:14
  Speaker 2: I mean, I always say to them like you're special, but you're not that special like you.
• 33:18
  Speaker 2: You know like it's like if, if this level of stress not that I'm rating it was you know it was related to infertility, nobody would have a baby.
• 33:26
  Speaker 2: You know it's all for I think people fall pregnant in war zone, in prison, horrifically, in assault situations, you know.
• 33:33
  Speaker 2: So that whole like you need to be positive and you need to be relaxed and things.
• 33:37
  Speaker 2: It definitely helps 100%, right for sure it helps.
• 33:41
  Speaker 2: You know Everything's better when we're less stressed.
• 33:45
  Speaker 2: But adding that onto their plate, you know, if you're stressed and someone says don't be stressed, when did that ever work?
• 33:54
  Speaker 1: yeah, yeah.
• 33:55
  Speaker 1: But I love that practical point there about don't get stressed, about being stressed, because everybody has stress, um, and women want to hold women want to.
• 34:06
  Speaker 2: What women want to have done something wrong.
• 34:09
  Speaker 2: Let's call it so that they can fix it next time, you know.
• 34:12
  Speaker 2: So, that way.
• 34:13
  Speaker 2: Then you know, was it because they exercised too hard?
• 34:16
  Speaker 2: They got hot at the beach, they?
• 34:18
  Speaker 2: I mean, the questions are you know, I'm like it's not what you're doing.
• 34:22
  Speaker 2: We're trying to kind of improve certain parameters.
• 34:26
  Speaker 2: I mean, you know, I always say like I'm gaslighting my own profession, right?
• 34:29
  Speaker 2: you know, it's not what you're doing, but everything you should do, all these things you know.
• 34:35
  Speaker 2: So we're definitely wanting to improve the bits that we can improve on and the way that I kind of look at stress like, yes, I do use herbs in between cycles for stress.
• 34:41
  Speaker 2: For sure is, let's try to balance the effect of stress on your body by.
• 34:48
  Speaker 2: Would you like exercise?
• 34:49
  Speaker 2: Do you like time in nature?
• 34:51
  Speaker 2: Can you go for a walk without your phone?
• 34:52
  Speaker 2: Could you have a cup of tea outside in the morning before you start the day?
• 34:56
  Speaker 2: You know, we find some pockets of moments in time that they can slide into their day, that they feel.
• 35:04
  Speaker 2: Do you know what?
• 35:05
  Speaker 2: Yeah, I could sit outside and have a cup of herbal tea without my phone for five minutes.
• 35:09
  Speaker 2: Great.
• 35:10
  Speaker 1: Do that.
• 35:11
  Speaker 2: So we balance the effect of stress on the body by creating some joy and downtime.
• 35:17
  Speaker 2: Yeah, that's my philosophy anyway.
• 35:20
  Speaker 2: It doesn't matter, I love it.
• 35:22
  Speaker 1: I love it Creating joy and downtime.
• 35:24
  Speaker 1: You mentioned diets before.
• 35:27
  Speaker 1: Let's dive into that a little bit.
• 35:29
  Speaker 1: And are there any dietary interventions, even dietary choices, sort of approaches, which will increase NADH plus levels?
• 35:42
  Speaker 2: Yeah, so, yes, so not easily, right, you know it's not like, oh, you don't need to do the supplement anymore because you ate an avocado or a bit of fish or whatever it is.
• 35:49
  Speaker 2: You know to do the supplement anymore because you ate an avocado or a bit of fish or whatever it is.
• 35:51
  Speaker 2: You know so.
• 35:52
  Speaker 2: But we certainly want to, I guess, like fluff out what we're doing by having that dietary base there.
• 35:59
  Speaker 2: And you know people really like to know what to eat.
• 36:03
  Speaker 2: You know, just healthy whole foods just doesn't make them happy.
• 36:07
  Speaker 2: You know they need to hear individual foods, but anyway, so things that are vitamin B rich foods, so things like avocado and fish, peanuts, leafy greens, eggs, mushrooms, I think, are kind of in that list as well.
• 36:21
  Speaker 2: So those are good.
• 36:23
  Speaker 2: The body can also convert some tryptophan, which is an amino acid from protein, into NAD.
• 36:30
  Speaker 2: So I guess tryptophan could be also considered a bit of a dietary source of NAD.
• 36:34
  Speaker 2: So, again, you know cheese and chicken and turkey and egg whites and pumpkin seeds, and this is great because, as I said, protein, we know is one of the major macron nutrients needed for egg quality.
• 36:45
  Speaker 2: So we're getting double whammy here on a few things, which is great here on a few things.
• 36:51
  Speaker 2: Which is great, our fermented foods.
• 36:53
  Speaker 2: They can also contain small amounts of NAD.
• 36:56
  Speaker 2: It'll also improve, I guess, your healthy microbiome in the gut which helps to absorb nutrients.
• 37:01
  Speaker 2: So I think they say like yogurt and kefir have some amounts of NAD, but things like sauerkraut and kimchi rank much higher.
• 37:10
  Speaker 2: But again, you know, it's like eating some lentils for iron, like you know.
• 37:17
  Speaker 2: I mean it's not going to get you to high doses diet alone, but it can boost what's there.
• 37:23
  Speaker 1: I think, personally, I must have a histamine deficiency because I love like I'll just eat sauerkraut and kimchi.
• 37:29
  Speaker 1: I just love them If anything happens.
• 37:33
  Speaker 2: I mean, touch every piece of wood to my.
• 37:35
  Speaker 2: You know I don't like to prescribe the histamine diet, but unfortunately it does have to happen.
• 37:39
  Speaker 2: Sometimes I'm like if it's yummy, it's high in histamine, like it's everything I want to eat.
• 37:46
  Speaker 1: Yep, yep, I will sit down.
• 37:48
  Speaker 1: You know how they give you a tiny bowl of kimchi, normally with a Korean meal.
• 37:51
  Speaker 2: Oh, yeah, yeah, yeah, and I'm like no, no, no.
• 37:53
  Speaker 1: Big bowl, big bowl yeah yeah.
• 37:55
  Speaker 1: I've got my gut health.
• 37:58
  Speaker 1: Yeah, my wife looks at me with disgust, but anyway, can I ask about red flags?
• 38:06
  Speaker 1: Oh, sorry, you go.
• 38:07
  Speaker 2: The other thing I wanted to mention is sun exposure.
• 38:10
  Speaker 2: So, from a recovering sun addict no, I'm just a sun addict that knows that maybe that's good in some ways and not good in other ways.
• 38:18
  Speaker 2: So limiting sun exposure can also help to preserve some of your NAD levels.
• 38:24
  Speaker 2: So basically, like when you spend time in the sun, that direct sunlight on your skin hence why I'm taking NRA every day forces your body basically to use more nad plus to repair that cell damage from the uv rays.
• 38:37
  Speaker 2: So you know that doesn't mean don't go in the sun.
• 38:40
  Speaker 2: Please don't anybody get that message, because I actually would rather give you nad and vitamin d than I mean than vitamin d.
• 38:46
  Speaker 2: You know, um and or both.
• 38:48
  Speaker 2: But on the other side of that, heated things that aren't the sun like.
• 38:53
  Speaker 2: So your infrared saunas or, um, you know, hot tubs and things like that that raise your core body temperature, that can also increase nad production.
• 39:02
  Speaker 2: So you know, get some heat and and and I guess I don't know what I'm gonna say wear some sunscreen.
• 39:09
  Speaker 2: I don't know, look, I love.
• 39:10
  Speaker 2: Say worse than sunscreen, I don't know.
• 39:11
  Speaker 2: Look, I love the sun.
• 39:12
  Speaker 1: So you know but like, yeah, yeah, well, I mean Michael Hollick always says it sensible sun exposure.
• 39:17
  Speaker 1: It's not about burning your skin, it's about getting the appropriate amount of sun for your skin type to make adequate vitamin D.
• 39:26
  Speaker 1: And then stop it and then cover up, and then, if you wanted to put some sunscreen on or whatever, but don't go out, don't put the sunscreen on before you go outside, because you're not going to be making vitamin d yeah, yeah.
• 39:39
  Speaker 2: Well, if you're doing it's the middle of the day in the burning hot sun at the beach, fine, but you don't just put it on, but again like you said it's your skin type and things like that as well so you know, you've got all those things being sun exposure.
• 39:50
  Speaker 2: I mean we see it on skin, right.
• 39:52
  Speaker 1: I mean, like you know, that accelerated sort of ageing of the cells, you know, is basically like depleting your NAD stores, yeah, but that's really an interesting yeah, it's a really interesting point, though, about using NAD or NR to help to prevent the damage that might be caused by the excess sun exposure.
• 40:15
  Speaker 1: Obviously, the point is stop this excess sun exposure.
• 40:19
  Speaker 1: There's so much more that we could go into Belinda.
• 40:22
  Speaker 1: I just wish we had more time.
• 40:24
  Speaker 1: But look, I thank you so much for taking us through just some of the points of NR today.
• 40:32
  Speaker 1: We're always going to say it nicotinamide ribose.
• 40:34
  Speaker 1: That's it.
• 40:37
  Speaker 1: So I thank you so much for taking us through some of the most important points that we need to remember with regards to fertility today.
• 40:43
  Speaker 1: Obviously, people can learn a lot more from you.
• 40:46
  Speaker 1: I do have one more question, forgive me, I was going to ask this earlier Red flags.
• 40:50
  Speaker 1: So, with regards to nicotinamide, we were talking about tryptophan.
• 40:54
  Speaker 1: Um, I know this is going to be rare, but but those people who may suffer gout, for instance, do you have any other red flags or hesitations to nr yeah, um, I haven't come across any um and that's a little bit of the army.
• 41:13
  Speaker 2: So please don't um, please don't order self-prescribed, because belinda said that there wasn't any contraindications or red flags, um, but there's nothing that like comes up in my head that's like oh yeah, I've got to be careful of x when like with with nr.
• 41:25
  Speaker 2: So it seems to be pretty well tolerated.
• 41:28
  Speaker 2: Um, and there is an impatient subgroup that I'm not using it for.
• 41:32
  Speaker 2: Um, now that you've asked that, I'm obviously going to go and have to research that and you know, feel, feel terrible if there is.
• 41:37
  Speaker 2: But um, sorry, oops, sorry no we all learn something every day.
• 41:43
  Speaker 1: Well, I agree with you.
• 41:44
  Speaker 1: Um like nothing comes to mind except for gout.
• 41:48
  Speaker 2: Um, yeah, and, and even those is usually high, high dose yeah, I mean I and I guess you know my, my patient subgroup that I'm using it's.
• 41:57
  Speaker 2: It's not a very gouty population, so I haven't actually had the uh, even even the clinical experience to go.
• 42:04
  Speaker 1: Oh sorry oh, there you go a few but that that's confidence moving ahead, um.
• 42:12
  Speaker 1: But thank you so much.
• 42:13
  Speaker 1: Thank you so much for taking us through some of the more important points with regards to nr and fertility today.
• 42:19
  Speaker 1: I know there's a lot more to cover, but you've covered the most poignant points for people and practitioners patients and practitioners to move ahead with their therapy, um, safely and effectively.
• 42:30
  Speaker 1: Thank you so much for taking us through that today.
• 42:33
  Speaker 2: Thank you so much for the conversation and having me.
• 42:35
  Speaker 1: And thank you everyone for joining us today.
• 42:37
  Speaker 1: Obviously, you can find out the show notes to today's episode and the other podcasts on the Designs for Health website.
• 42:45
  Speaker 1: I'm Andrew Whitfield-Cook.
• 42:46
  Speaker 1: This is Wellness by Designs.