What is NMN?

NMN (Nicotinamide Mononucleotide) is a coenzyme that functions within the body and is a type of vitamin derived from Vitamin B3.

Originally an essential component for maintaining life, it naturally exists in a certain amount within our bodies.

Inside the body, NMN is converted into a coenzyme called NAD+ (Nicotinamide Adenine Dinucleotide), and it is this NAD+ that exerts various physiological effects.

NMN Naturally Exists in the Body

NMN and the NAD+ converted from it are extremely crucial substances for our vital activities. For this reason, our bodies are equipped with functions to synthesize NAD+. This includes pathways such as synthesizing NAD+ using tryptophan (an essential amino acid) as a raw material, and pathways that recycle the metabolites of NAD+ used in biological reactions.

However, the amount of NAD+ in the body gradually decreases with age, dropping to as much as half of its peak level by our 40s. This decline is believed to be caused by a combination of the following factors:

• Decreased NAD+ synthesis
• Increased NAD+ consumption
• A combination of both

Main Functions of NAD+

Promotion of Energy Production

The cells that make up our bodies contain organelles called mitochondria, which generate the energy required for daily vital activities. NAD+ is an essential component for the proper functioning of enzymes within these mitochondria. If NAD+ is deficient, the energy production pathway halts, which cuts off the very supply of energy to the body.

Regulation of Sleep and Circadian Rhythms

Our body clock is influenced by changes in NAD+ concentration. A deficiency in NAD+ can affect the expression of genes that regulate the body's sleep-activity cycles (circadian rhythms), which has been linked to variations in sleep quality.

Involvement in Energy Metabolism

By supporting energy production in the mitochondria, NAD+ positively influences the body's overall energy metabolism, which is expected to help build and maintain a healthy body.

Hydration and Comfort Around the Eyes (Research Examples)

Near the eyelids and eyelashes, there are oil-secreting glands called meibomian glands. With every blink, oil is secreted from these glands. However, as we age, meibomian gland function declines, making dry eye symptoms more likely to appear due to a lack of oil. Some clinical studies suggest that increasing NAD+ levels has a positive effect on meibomian gland dysfunction, demonstrating its usefulness in improving eye hydration and reducing discomfort.

Research on Glucose Metabolism (Basic Research Stage)

In experiments using model mice with glucose metabolism imbalances caused by lifestyle factors, it has been reported that the amount of NAD+ is involved in GLP-1 production in the intestinal tract of mice fed a high-fat diet. Therefore, keeping up NAD+ levels in the body is a promising area of future research for its potential role in managing glucose metabolism.

Maintaining Joint Cartilage Health

In basic research, it has been reported that a portion of the sirtuin genes activated by NAD+ is involved in the differentiation and proliferation of chondrocytes (cartilage cells) within joints, potentially suppressing cartilage degeneration. In experiments with mice lacking this sirtuin gene, the development of articular cartilage was significantly inhibited, and the incidence of joint-deforming issues increased. Consequently, its connection to maintaining joint health is currently being studied.

 Research on Muscle and Motor Function (Basic Research Stage)

In experiments using aged mice whose mitochondrial gene expression had declined due to aging, research reports show that administering NAD+ precursors supported the function of stem cells within muscle tissue, positively impacting motor function.

 Research on Brain and Nerve Functions (Basic Research Stage)

In experiments targeting model mice with recognized cognitive decline, data has been gathered on how the administration of NAD+ precursors changes the amount of NAD+ in the cerebral cortex and affects beta-amyloid proteins—the substance considered a primary cause of cognitive decline. This is drawing significant attention in future prevention and care research within the neurological field.

Methods of Administering NMN

Currently, the primary methods used are oral administration through NMN-containing supplements or systemic administration via intravenous infusion.

Time for Effects to Appear After NMN Infusion

The time it takes to experience results varies depending on the intended effect. Currently, many patients choose this treatment to relieve fatigue. While reducing fatigue and overall perception varies by individual, many patients report a noticeable reduction in the sluggishness they had been feeling, often starting around the day after the infusion. Some individuals also experience a refreshed feeling and better hydration around their eyes immediately after the treatment. However, how and when effects appear cannot be generalized, as it depends on your physical condition.

NMN is Excluded from Doping Regulations

NMN is excluded from doping regulations regardless of how it is administered. Therefore, individuals who engage in sports can receive the treatment at any time without worrying about timing.

Aging Care Expected from NMN

When searching for NMN, you will often see it introduced alongside phrases such as "aging care," "rejuvenation," and "anti-aging."

Because the sirtuin genes induced by NMN are involved in repairing the DNA of aging cells, it has garnered attention from the perspective of suppressing cellular aging and managing aging care.

In reality, a definitive consensus regarding the relationship between sirtuin genes and cellular aging has not yet been established among researchers, making it a difficult point to state conclusively. Furthermore, as you can see, some of the NAD+ benefits listed above remain confined to animal testing, meaning that the explicit effects of NAD+ within the human body are still at the research stage.

So, how should we view the anti-aging effects of NAD+?

My current perspective is as follows:

The Relationship Between NMN and Aging Care

It is easy to imagine that NMN—which naturally exists in the body and decreases with age—is closely intertwined with our aging process.

One of the beneficial effects of NAD+ is its ability to promote energy production within the mitochondria. The energy substances created by mitochondria are required in every facet of our biological activities, including cell production and repair, as well as muscle contraction.

By maintaining the amount of NAD+ in the body, energy production proceeds smoothly, supporting you in healthily continuing daily exercise and activities. Consistent exercise helps maintain muscle mass and bone health, making it easier to manage body fat. We believe that maintaining these healthy lifestyle habits ultimately leads to vibrant, youthful daily living.

On the other hand, younger individuals naturally have abundant amounts of NAD+ in their bodies. Except for athletes who expend extreme amounts of energy during daily training, younger people may not significantly feel the effects of NMN administration. However, because the brain cannot utilize anything other than glucose as an energy source, it relies heavily on energy production from the mitochondria. In other words, we believe this treatment is highly favorable for professionals engaged in intense intellectual labor who are constantly required to focus and make rapid, flexible decisions.

Ingredients of NMN Infusion

Although NMN can be synthesized within the body, it is fundamentally a component derived from Vitamin B3. When synthesized as a commercial product, it is extracted and processed from sources such as edamame, broccoli, and avocados.

There Are Two Manufacturing Methods for NMN

The manufacturing methods for NMN are divided into the following two types:

Chemical Synthesis Method

This method involves reacting NAD+ precursors with chemical substances, followed by phosphorylating the synthesized NMN. It offers high productivity and has the advantage of keeping manufacturing costs low. However, because the alpha-NMN structure (which differs from the beta-NMN utilized within living organisms) may be included during the generation process, confirming the purity and structural makeup is critical.

Yeast Fermentation Method 

This method generates NMN by fermenting yeast strains, such as those found in beer or hops, alongside NAD+ precursors. It involves fewer chemical substances and allows for the efficient acquisition of beta-NMN, which is readily utilized by the body. The NMN used at our clinic is manufactured using this fermentation method.

Regarding NMN Dosage

The ideal daily intake is considered to be between 100 mg and 300 mg.

NMN is Effective When Taken in the Morning

Since it is known that the body's NAD+ synthesis increases during the day, taking NMN in the morning is recommended. Some opinions also suggest that oral intake on an empty stomach provides superior absorption rates.

Reasons for the Large Discrepancy in NMN Product Pricing

When researching NMN products, you will notice a massive price gap between relatively inexpensive options and extremely high-priced products.

Personally, I believe this is due to the following two factors：

1.Inexpensive products utilize the chemical synthesis method

Because chemical synthesis allows for the generation of large quantities of NMN at once, it is suited for mass production, allowing the product price to be set low. Conversely, it carries disadvantages such as the risk of harmful chemical substances or unutilizable alpha-NMN contaminating the refinement process.

2. Differences in quality control and purity

It has been pointed out that NMN products vary in quality and purity depending on the manufacturer and management system. Differences in raw material costs and product pricing arise based on whether the manufacturing process meets strict management standards (such as GMP certification) and whether thorough purity testing of the components is conducted.

Side Effects of NMN Infusion

To date, there have been no reports of serious side effects regarding NMN administration. Since it is administered via an IV drip, typical symptoms associated with infusions (such as pain or internal bruising at the injection site) may occur.

Same-Day Infusion is Available

Pre-treatment blood tests are not required. As a general rule, you can receive the infusion on the day of your visit and return home immediately afterward. The infusion takes approximately 30 minutes.

Frequency of NMN Infusion

There is no fixed rule regarding the frequency of NMN infusions. While it depends on the dosage, many patients receive the treatment roughly once a month.

【Important Information Regarding Self-Pay Medical Care】

This treatment is a self-pay care (uninsured treatment) that is not covered by Japanese public health insurance.

• Fee:
  NMN 300mg ¥65,000 (tax included)
• Standard Number of Treatments / Period:
  Approximately once a month (We will propose a plan tailored to your condition).
• Main Side Effects and Risks:
  Pain, redness, internal bruising, or vascular pain at the injection site may occur. In rare cases, allergic reactions may happen.

【Clarification of Unapproved Medicines, etc.】

The Nicotinamide Mononucleotide (NMN) preparation used in this treatment has not been approved under the Act on Securing Quality, Efficacy and Safety of Products Including Pharmaceuticals and Medical Devices (Pharmaceuticals and Medical Devices Act) in Japan.

【Clarification of the Procurement Route, etc.】

The NMN preparation used at our clinic is procured from a domestic manufacturer that meets appropriate manufacturing standards, under the responsibility of our clinic's physicians.

【Clarification of Approved Domestic Pharmaceuticals with Identical Components】

There are no other approved domestic pharmaceuticals in Japan that possess identical components or performance.

【Clarification of Information Regarding Safety, etc. in Other Countries】

There are no reports of serious side effects from this preparation in other countries, nor is it approved as a pharmaceutical product in any country. Although data is being gathered through clinical studies, unexpected risks may exist due to its status as an unapproved medicine.

How to Maximize the Effects of NMN Infusion

Once your mitochondrial function has been stimulated by NMN administration, we highly recommend incorporating exercise into your lifestyle. As you repeat the treatments, your body will gradually become more activated, enabling you to increase your exercise intensity while making it less likely to carry fatigue over to the next day. Furthermore, improvements in sleep quality will make it easier to engage in physical activity, entering a positive cycle where exercise continuously revitalizes your mitochondria.

For those wishing to receive NMN Infusion at NAG Orthopedics:
Please book your appointment using the link below.

Director of NAG Orthopedics: Yoshimasa Nagumo

Orthopedic Specialist & Sports Doctor

Dr. Nagumo initially built his career as a surgical oncologist specializing in orthopedic cancer treatment. Subsequently, he moved to the United States to engage in advanced research in the field of regenerative medicine.

It was during his time in the U.S. that a personal injury led him to realize the critical importance of sports medicine. Upon returning to Japan, he transitioned his focus to become a sports orthopedic surgeon.

Currently, he leads the "Athlete Support Program," which provides comprehensive medical support to athletes using a combination of blood analysis and cutting-edge regenerative medicine technologies.

[Click here for the program introduction page:https://nagseikei.jp/en/dr/]