July 17, 2025 • 42 mins
Is Cellular Energy the Key to Fertility Over 35?
In this insightful episode of Wellness by Designs, naturopath and nutritionist Belinda Kirkpatrick explores how supporting our cells' energy systems may hold the key to optimising fertility, particularly for women over 35. At the heart of the discussion is nicotinamide riboside (NR), a cutting-edge nutrient that acts as a precursor to NAD+, the essential molecule powering mitochondrial function, DNA repair and healthy gene expression. As NAD+ levels naturally decline with age—starting as early as our 30s—so too can egg and sperm quality. Belinda explains how NR effectively raises cellular NAD+ levels by easily crossing cell membranes, unlike other forms that must convert before entering cells.
Belinda shares practical guidance on how she uses NR in fertility treatment plans, highlighting typical doses ranging from 250 to 1000 mg daily depending on age and egg quality markers. Importantly, she explains that NR can be taken right up until egg collection during IVF without interfering with medications, making it a valuable option for those navigating assisted reproductive cycles. She also reveals her "top three" supplements for fertility support—NR, ubiquinol and NAC—describing how they work synergistically to enhance egg quality and overall reproductive health.
Beyond supplements, the episode dives into lifestyle strategies to support NAD+ levels naturally, from eating protein-rich foods that provide tryptophan precursors to understanding how sun exposure can deplete NAD+, while practices like infrared sauna therapy may help boost it. With her trademark blend of scientific detail and compassionate, practical advice, Belinda offers an evidence-informed roadmap for anyone seeking to optimise their reproductive potential—whether they're undergoing treatment or simply planning ahead. For those ready to explore how cellular health underpins fertility, this conversation provides an essential guide to the latest research and integrative strategies.
Connect with Belinda: Naturopath in Sydney - Belinda Kirkpatrick Naturopathy & Nutrition
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Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Speaker 1 (00:12):
Welcome to Wellness by Designs.
I'm your host, andrewWhitfield-Cook, and joining us
today is Belinda Kirkpatrick, anaturopath and nutritionist who
specialises in fertilitymanagement, and we're going to
be discussing today the benefitsand uses of nicotinamide
riboside, or NR.
Welcome to Wellness by Designs,belinda.
How are you going?
Speaker 2 (00:33):
Well, thank you, Andrew.
Thank you so much for having me.
Speaker 1 (00:37):
Thank you so much for your time today.
So I guess, to start off,really, what is NR?
And, by the way, we're alwaysgoing to say NR, everybody
shortens it but it'snicotinamide, so the non-flush
form of B3, combined with ribos,riboside, so nicotinamide,
riboside, but we're going to sayNR, we'll always default.
(00:57):
So what exactly is NR and whyis it used in fertility?
Speaker 2 (01:05):
Yeah, nr you're right , we never actually say the word
is one of my favouritesupplements.
So NR is a precursor for NAD+or nicotinamide adenine
dinucleotide, and that's acompound naturally produced in
the body.
Now this NAD plus is essentialfor processes things like I
energy production, dna repair,gene expression, and the levels
(01:29):
decline as we age.
So it's been looked at a lot assort of like an anti-aging
thing.
So we've got it in bucket loadswhen we're young and full of
energy and it starts to declinein our 30s and beyond.
So NR that we're talking abouttoday is a precursor for this
NAD, which is super essentialand it's known to boost NAD
levels.
(01:50):
So in my practice I'm using NRa lot to address, like
age-related ovarian fertilityissues you know, guys, I guess,
like you know, maintaining andimproving egg quality.
Speaker 1 (02:05):
Okay, could you just explain for us why, as a
naturopath and nutritionist, youchoose NR over NMN, which is
nicotine mononucleotide NMN?
We always do that to produceNADH or NAD+.
What's the benefits of NR overNMN?
Speaker 2 (02:28):
It's such a good question and it's such a
confusing thing, and I've doneso many deep dives kind of down
into it, because it's like whyare we not, if we want NAD+, why
are we not just using NAD?
And then we've also got the NMNform or the nicotinamide
mononucleotide or the NR.
So when we're looking at NAD,it is very unstable, it's
(02:49):
degraded very quickly in light,whereas NR is more stable, and
then NMN is kind of closerstructurally to NAD.
What we want to finish with.
However, both NMN and NAD arequite big molecules and they
find it quite difficult to crossinto the cell.
So if you take NMN, it'sactually converted back to NR
(03:10):
before going into the cell tothen become NAD.
So I guess it's like an extrametabolic step that some people
may do easily and some peopledon't.
So the NR form, like you said,is the non-flushing form, so
it's basically the closestinstruction to NAD, but while
still being able to cross intothe cells and being converted
(03:31):
back into NAD, and it's beenshown to raise cellular NAD
levels significantly.
Speaker 1 (03:39):
I think this is one of the issues we've always got
to be cognizant of, and that isthat when we're talking about a
molecule that'sant of, and thatis that when we're talking about
a molecule that's in the cells,is that relevant for oral
supplementation of that molecule?
Because we've got a wholedigestive process first, past
metabolism, it's going to betaken into the liver, processed
and then taken to the cells orthe target organs, if you like,
(04:00):
to be used there.
So taking it orally in themouth doesn't necessarily mean
that it gets to the target organor target cells in that form or
in that dose.
So we've got to.
There's a few relevant stepswe've got to think about right.
Speaker 2 (04:17):
Absolutely, and the less steps that we need to take,
then we're not then relying onsomebody's you know personal
sort of genetic ability toactually convert things back and
back.
So the more I guess steps thatthere are, the more places there
could be issues.
Speaker 1 (04:34):
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 phosphorylationand dephosphorylation and so,
in some people, maybe with liverassaults or, you know, chronic
fatigue for instance.
(04:55):
These are the people that tendnot to be able to use pyridoxine
hydrochloride and theysometimes do better with P5P,
whereas most people can convertpyridoxine hydrochloride no
problem.
Do you find that, with your usein practice, that there's a
certain population that NR isbetter suited for?
Speaker 2 (05:17):
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 itis the most easily absorbed form
um.
So there probably are geneticsnip tests and all these sorts
of things you can probably havea look at.
I actually haven't done thatdive down into that um, just
(05:38):
knowing that.
I guess that the nr actuallydoes go into the cell pretty
easily, um and get convertedinto nad.
So I think there will always bepatient subgroups that do that
more effectively than others.
But yeah, I'm basically justusing the NR form, to be honest.
Speaker 1 (05:56):
Yeah, cool.
And so talking about fertility,because these people are crying
out, they spend thousands, theygo through months and months
and years and years of anguish.
Can you explain the function ofNR in fertility management in
both females and males?
Speaker 2 (06:15):
Yeah, yeah, absolutely.
So I think it is reallyimportant to note that, like a
lot of the research that we'rebasing this data on does come
from predominantly mice you knowa lot of them are animal
studies.
There is research in humansthat's ongoing we're basing this
data on does come frompredominantly mice.
You know a lot of them areanimal studies.
There is research in humansthat's ongoing.
There's the ENHANCE study herein Sydney that's looking at the
effects of NR supplementation,you know, in the IVF cycle and
(06:36):
equality and all that kind ofstuff that is still kind of
ongoing.
So a lot of the research isusing, you know, aged mice and
things like that.
But I think that the researchin humans will become more and
more Certainly clinically.
I've been using it for manyyears and really noticing a huge
difference with it.
(06:58):
So NR has kind of a few roles ininfertility.
Most importantly, I think, forlots of our patients is
basically this overallimprovement in quality, so it
can improve the quality of eggs.
It basically works by enhancingmitochondrial function and we
know that the egg donates themitochondria to the embryo.
So really important thatmitochondrial health of the egg
(07:20):
is really important.
As we age that mitochondriaoften doesn't function as well,
so enhancing mitochondrialfunction, reducing oxidative
stress and then helping tomaintain sort of normal
chromosomal structure.
Nad also activates theseenzymes called sirtuins, and if
you work in fertility sort ofthese sirtuins are kind of like
(07:41):
you know big enzymes there andthey're basically involved in
DNA repair.
So that can then help to boost,like egg and sperm as well,
integrity.
So we're really wanting toboost that sirtuin pathway
without getting too technical,because I'm actually not a super
technical kind of person, butyou know there's also in the
cells.
We've got this thing calledanother enzyme called CD38.
(08:04):
Now this enzyme basically isthe primary NAD plus consuming
enzyme in the ovaries.
So it gets higher, it expressesmore activity with age which
contributes to these decliningNAD levels, follicle depletion,
reduced fertility.
So the NR supplementation can'tstop this CD38 from, you know,
(08:26):
increasing with age.
That just happens.
Maybe there's something else Idon't know about that does that.
But it basically can elevatethese ovarian NAD plus levels
which then helps to kind ofmitigate the kind of
consequences, I guess, of thissort of CD38 driven depletion.
So it really is kind of gettinga little bit technical there,
(08:47):
but it's actually kind ofhelping to reduce something or
it's helping to balancesomething that is causing egg
and ovarian ageing.
Speaker 1 (08:57):
Can I ask about dose?
So do you find that as we age,for instance, that the dose of
NR has to be escalated?
Do you find, maybe, certainconditions, certain types?
Of aberrations with oocytes.
That NR is that you usedifferent doses for.
Speaker 2 (09:17):
I certainly do use a higher dose in sort of, I guess,
what they would call poorresponders, so basically people
who either don't respond well toIVF cycles, and that's where we
can sort of really see eggquality is really in that
assisted reproductive setting.
Do you know what I mean Like?
I mean, as women get older whenthey're trying, naturally we
(09:38):
definitely assume that there'san egg quality component there
once people start to get over 38, 40, 42.
You know Lots of my patientsare over 41, 42, 43, 44.
So we know that egg qualityprobably isn't going to be
amazing then.
So I will often use the higherdoses at that point If they've
(09:58):
been doing IVF and we can seethe specialist or the
embryologist kind of givingfeedback about egg quality or
the eggs aren't.
You know that sort offertilization to day three
embryo is very egg qualitydriven.
So if we're not seeing kind ofmuch movement in that embryo
progression from day one tothree, I will often kind of
(10:19):
increase the dose as well.
So, you know, depending onwhere they are and how old they
are and things like that, Ithink, because we can't measure
egg quality, we kind ofessentially we start off with a
bit of a stab in the dark, basedon their history and their age,
and then, if they are movinginto the assisted reproductive
sort of IVF world, we get a lotmore information um on that.
(10:43):
So yeah, I definitely will umuse higher doses in people with
sort of seemingly poorer eggquality right god.
Speaker 1 (10:53):
And and what about its use?
Um, as well, a metabolicbalancer and and as an
anti-inflammatory, like I'veheard of its use in polycystic
ovarian syndrome.
Speaker 2 (11:05):
The other thing too, just with the egg quality,
because I think that's somethingthat people are like super
interested in.
It also can also, researchersshowed, increase and stimulate
ovarian follicle growth.
So really important.
There are some animal studiesthat I love as well that shows
that the NR increases theproportion of embryos reaching
(11:26):
those advanced developmentalstages, so day five and beyond.
So, giving you know, I guess,better IVF outcomes and also, in
mice, increased life birth rate.
So you know, it really doesseem to kind of really give a
lot of health to that egg.
You know, I guess getting thatreproductive potential sort of
protected but like and all theway through Anyway, I just
thought of, you know, I guess,getting that reproductive
potential sort of protected andall the way through Anyway, I
(11:47):
just sort of, you know, thoughtI'd throw that in there With
PCOS.
I've sort of started using it alittle bit for PCOS, look,
mostly in the setting offertility and PCOS, but I can
see where it is starting to kindof show some promise in sort of
managing PCOS.
You know, even people whoaren't necessarily trying to
(12:09):
conceive.
It does work as ananti-inflammatory.
It reduces that oxidativestress, so that's kind of, you
know, reducing inflammationthere, increasing again the
mitochondrial health I talkedabout before, increasing again
the mitochondrial health Italked about before and it also
does a few things you know.
(12:30):
Basically, you know helpingwith the cellular metabolism,
you know increasing ATP function.
So a polycystic ovary isgenerally a pretty inflamed
ovary.
So you know there's lots goingon there and there's generally a
level of inflammation.
So really, you know, reducingthose ROS, or reactive oxygen
species, can really help toreduce any cellular damage
that's been caused byinflammation.
It also, too, helps to reduceovarian fibrosis or these
(12:55):
fibrosis associated genes, andthat's going back to that sort
of activation of that CERT1,cert3 kind of pathway.
So really, enhancing ovulationand reducing fibrosis, reducing
inflammation, you know really isworking on a part of PCOS.
Speaker 1 (13:13):
Yeah, sure, and obviously alongside other
therapies like myo-inositol,exercise, weight loss, blah,
blah, blah yeah.
Speaker 2 (13:20):
Yeah depending on what's going on testosterone
inflammation, you know insulinresistance.
So as a part of a treatment, Ican absolutely see where that's
going to play a role.
Speaker 1 (13:33):
Yeah, sure, and what about?
You were mentioning the IVFsort of process previously.
If we think about temporaldosing like when can you?
And are there any times whereyou shouldn't use NR?
With regards to the IVF cycleor the IVF process, yeah, when
(13:58):
do you use it?
When do you hold back?
Speaker 2 (14:00):
I use it all the way up until an egg collection.
So it's not something that isgoing to be contraindicated with
IVF medications, which isfantastic.
It doesn't, you know, increaseestrogen, like sometimes
ubiquinol at very high doses,cancer.
Sometimes we drop back, youknow, ubiquinol dose sort of in
that sort of IVF cycle.
So you know I'm using NR likeall the way up until, kind of
(14:21):
egg collection.
Now you know they sort of sayyou know what gets you pregnant,
keeps you pregnant.
So you know I'll often drop thedose back and actually use it
for a little bit longer afterthat in certain women, depending
on, you know, sort of oxidativestress, inflammation.
But yeah, so it's not.
You know it's not shown toaffect implantation, which is
(14:43):
obviously a good thing, so youcan be using it kind of all the
way through.
But that real, I guess yeah, youdon't have to be sort of
stopping it before they starttheir IVF stimulation medication
, which is great.
Speaker 1 (14:56):
Gotcha.
Speaker 2 (14:57):
I'm just going to segue.
Speaker 1 (14:58):
Yeah, in that enhanced study.
Speaker 2 (15:02):
they're actually using it.
It's only six weeks, you know,I think it probably does need to
be longer, but hopefully that'sthe beginning of many studies.
But they use that all the wayup until egg retrieval or their
trigger injection.
So yeah, that sort of gives youa lot of confidence too that
you know IVF doctors are runninga trial and actually kind of
(15:22):
using it up until egg retrieval.
Speaker 1 (15:26):
Gotcha, tell us a little bit more about this
ENHANCE study.
Speaker 2 (15:32):
Yeah, so it's a study that they're doing.
I think they're doing frommemory.
I think it's like 250milligrams, which is a low dose,
and 1,000 milligrams daily andit's six weeks up until egg
retrieval.
So I guess that's kind of fourweeks before they start their
stimulation and then they saysort of two weeks during
(15:55):
stimulation, which some of themwon't get to two weeks.
So you know, I mean, look, youknow, yay for any studies you
know like, because it's so hardto get research, particularly in
these patient groups, right.
I mean I'm not part of it atall.
But I'm guessing if you say tosomebody, would you like to be
part of the study, you mighthave this.
You know this nutrient that hasbeen shown to well that we
(16:17):
think might help egg quality, oryou could have the placebo.
I'm going to guess a certainbig chunk of them jump out of
the study and go and take itanyway.
But I mean, I don't know.
So I'm guessing it's probablyhard to get kind of big studies.
I would like love there to be astudy that was taking it for at
least three months.
But you know, the start ofanything is amazing and often
(16:38):
then, obviously, if there's somepromise shown there, like there
are in the you know mice andanimal trials they've been doing
for a long time.
Speaker 1 (16:46):
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 itbe great if this did.
But I have heard of trials thatwere stopped early because the
results were so dramatic, soblindingly dramatic for people,
that it was unethical tocontinue taking the placebo it
(17:08):
would be amazing.
Wouldn't it be great if thatwas the case.
That would be awesome.
It's amazing.
Speaker 2 (17:12):
And it is so hard, I guess with naturopathy, isn't it
?
Because it's often likesometimes we get these single
nutrients or these single, youknow coenzymes that are just
amazing and show improvement andthings like that, but there's
always so many other things kindof going on that you're like,
you know, we know that proteinis so important for kind of egg
quality.
You know, we know that, youknow like.
(17:34):
So I guess, like diet andlifestyle and everything, even
if it's not with othersupplements, you know, I mean it
would be amazing to kind of beable to sort of capture all that
together.
But yeah, you're right, I meanmean, gosh, if you could go.
Yeah, a thousand milligrams forsix weeks before showed any
improvement, and then you wenton to a bigger study that did it
for longer or added insomething I think you know.
(17:55):
I can't imagine that youwouldn't see it, because I see
it in clinic all the time yeah,yeah, I.
Speaker 1 (18:01):
I guess the danger is wanting a nutrient to be a drug
, you know, because drugs arevery powerful agents which block
or upregulate thingsdramatically, often with
attendant side effects.
Nutrients are things that we'veevolved to handle, so it's a
little bit of a differentballgame, it's hard to ask
someone over a short period oftime yeah, I don't know if it
(18:24):
shows the group, but you know,like I mean how you choose that.
Speaker 2 (18:27):
Like, are there other issues?
Is it just anyone doing it?
You know, was it?
People had sperm issues as well, but like they may as well take
this to improving.
I mean I actually don't knowthose details, so maybe maybe
that's all you know umfine-tuned out in the study, but
um yeah so?
Speaker 1 (18:44):
so we've mainly spoken about egg for egg quality
so far.
What about sperm quality?
What about males?
Speaker 2 (18:52):
yeah, so it is.
It is good.
I mean, in that same sort ofway, it is good for sperm
quality as well.
So a lot of the um, a lot ofthe research that we use for egg
quality and also kind of spermquality is based on anti-aging
research, right.
You know the amount of mypatients who you know on
ubiquinol and they're onresveratrol or they're on
(19:13):
nicotinamide, riboside and allthese kind of you know beautiful
antioxidants that we've got,and then, once they're pregnant,
they're kind of like oh yeahlike my husband wants to kind of
buy those now is it, is it okayfor him to, for him to take
them, like all the guys in thegym or he's listened to some
cubanman podcast or you know.
So it's like it's really.
It makes you realize, like youknow, they're like what he's got
(19:35):
, you've got nr.
Like my husband's asking me whyI've got this type of thing,
because it really is so much thebulk in that anti-aging, you
know, kind of research.
So men and women like you knowa lot of our, a lot of the
issues is this sort of, you know, dna damage.
You know poor mitochondrialkind of health, inflammation,
aging eggs, aging sperm, so youknow anything that does kind of,
(19:57):
you know, boost the sort ofhealth of the egg and help with
DNA repair, which is such athing as we kind of age.
Um, it definitely does play arole there.
So I don't know that there's asmuch research on it as yet, but
I think it's yet the next, thenext ubiquinol, if it's not
already right.
Speaker 1 (20:18):
isn't it funny that it took going to the gym to to
start men to uh to realize thatthere was a function for these
anti-ageing nutrients.
I think that's funny.
Yeah, yeah, yeah.
And you also mentionedubiquinol.
So we may as well cover off onthat because, like I can
remember, ruth Trickey was likethe first, let's say, fertility
(20:39):
specialist who really graspedthe use of this, and I remember
her saying, on the basis of onesmall trial, she started to use
it and then it just becamemandatory, it became just
general approach.
So take us through ubiquinolwhile we're there.
What dose do you use?
When do you use it?
Are there times when you don't?
(21:00):
You mentioned some times youmight pull back, and both males
and females for two.
Yeah, yeah.
Speaker 2 (21:07):
So I do tend to use ubiquinol, um the more active
version of kind of coq10 um.
You do tend to kind of get whatyou pay for, in that sense.
And again, going back to ourconversation about um, you know
like how people can kind ofbreak it down and convert it um,
is it not?
Everybody converts protein intoubiquinol actually quite a
small proportion, um.
(21:27):
So I do tend to kind of goupstream and and go with
ubiquinol.
So, again, depending on theirage and history and and ivf
history and what have you, butlike the dose that sort of sits
well in most of the research isabout 600 milligrams a day,
which is a pretty decent dose interms of cost, right, like I
(21:50):
mean ubiquinol, I mean the samewith nr.
They're beautiful in the sensethat they fit into a nice little
teeny tiny capsule and they'reswallowed easily and digestion
feels great.
And you know they're not sortof your b vitamins and they're
not your.
You know taking four or sixfish oil a day, so like they're,
but they're, they're not sortof your B vitamins and they're
not your.
You know taking four or sixfish oil a day.
So like they're, but they'reexpensive, right.
So it's like a little.
It's like gold in a little.
(22:10):
It's like gold in a littlecapsule.
So sometimes you know you aretrying to kind of choose and
sometimes you know you reallywant to, I guess, use better
doses of less things rather thansort of spreading yourself too
thin.
The amount of people that come,having read whatever sort of
certain books that are great forgetting people started on their
egg health journey, that aretaking, you know, ubiquinol and
(22:34):
have been taking it for a longtime off the internet or
whatever, just kind ofself-prescribed, it's quite
amazing, without knowing whatthe issue is.
And is it the dose?
Is it the amount?
Is it whatever's in there?
Is it how?
It's quite amazing, withoutknowing what the issue is, and
is it the dose?
Is it the amount?
Is it whatever's in there?
Is it how it's processed?
But they'll be like.
You know, I've been doingubiquinol for kind of ages and
you're like, can you just giveme a few months on a different
(22:55):
type and or dose?
You know, um, and they do getbetter results, as we mentioned
before.
They're obviously doing lots ofother things as well, um, but
but it is important.
So if that was sort of younger,as in like maybe under 38,
maybe I'd just do 300 milligramsof ubiquinol right, you know
particularly if they'll just trynaturally.
(23:15):
But if anybody's going into theibf setting, I'm like, even if
it's their first attempt andthey're, you know, 37, even if
there's not a known reason andit's a suspected egg quality, ie
doesn't look like implantationfailures, sperm looks fine.
We don't kind of know.
I will use that 600, if we canfinancially for three or four
(23:38):
months beforehand and it's areally big consideration because
you want to work with yourpatients and I would rather I
was.
Sometimes I write one to two,because the ones that I use are
300s, and they say what do youmean one to two?
And I'm like if you're feelingrich today, you could have two,
but if you're just like feelingnormal, go with the one.
So even though I like them andyou know their weight is higher,
(23:58):
their BMI is higher, if they'reover sort of 90 kilos, I mean
you know the research is sayinggive them 900.
I rarely use that.
Again, I'd want to see realbang for my buck.
You know like I'd be extradisappointed if the quality
wasn't as good.
So there definitely will besome people that are open to
(24:20):
that.
But I think these are allthings that you've got to assess
your patient as a human, as anindividual, and really prescribe
personalized medicine.
Speaker 1 (24:30):
Yeah, I love what you're saying there, belinda,
about.
You know, if you've got ahigher BMI you're going to have
to use higher doses of things.
You've then got to choose yourbest bang for buck.
But the issue is the BMI and Iget the fight, you know, I get
the struggle, I understand it,but without addressing that BMI,
without addressing lean musclemass versus fat mass, then you
(24:56):
just you're always hooked intohigher dosage of nutrients
because of the inflammatorynature of adipose tissue.
Speaker 2 (25:04):
Yeah, and it's a really tough one.
You know all my patients areracing against the clock, you
know, I mean I don't have theluxury really of seeing the 32
year old who wants to conceivenext year although.
I did have one this week and Iwas like oh, your preconception
bless.
I'm so happy.
You know I generally have.
You know, we've done fivecycles.
I'm about to turn 41.
(25:25):
You know, this is my weight,this is my life, and so we are
you know kind of trying to fasttrack things a lot.
Speaker 1 (25:34):
Yeah, Can I just sort of delve on one of those
impeders Is that a word?
One of those blocks, thoseroadblocks, yeah, the roadblocks
to success.
And you know you're mentioningpeople who've gone through five
cycles.
You know that emotional agony,the incredible stress that and I
(25:57):
will say this mainly women, butnot only women, couples
certainly put themselves throughor are put through uh, stress.
So, if, if, can we just talk alittle bit about what else you
use with regards to using nr forfor fertility management with
(26:18):
egg and or sperm quality?
Perhaps ubiquinol?
Um, if it's relevant, what elsedo you use and when?
Speaker 2 (26:27):
um, yeah, great question, yeah, so I'd like to
think that it's an impossibleanswer.
I'm going to answer, don'tworry.
I'd like to think it's animpossible answer because I'm
you know, I'm tailoring it.
You know it is sort ofindividualized kind of medicine
and we need to fix up.
You know, nutrient deficiencies, things like vitamin D my gosh,
the amount of people that areon high doses of vitamin D
(26:49):
because it's just so relatedinto egg quality, implantation,
immune, everything.
So you know that's definitelykind of looked at.
Fish oils and good qualityessential fatty acids are really
important.
When we're looking atantioxidants, it's so hard
because how long is a piece ofstring?
and people come saying oh thisand this and this and this and
this and this and this and thisand whatever and sort of you
(27:11):
know maybe brands that aren'tnecessarily amazing, who knows
or doses and we have to rein itall in.
But you know, definitely, look,ubiquinol, nac and NR would be
in my stable of.
You know, older women, ivfsupport, egg quality, you know,
(27:31):
anti-inflammatory, mitochondrialhealth they would be probably
in my top three if I had tochoose.
And the IVF doctors who referto me and or suggest things to
patients a lot of them, that'sin the top three also.
I mean, obviously we're lookingat folate and methylation, you
know, do they need differenttypes of folate?
B12, super important Sometimes.
(27:53):
Riboflavin is your littlemissing link.
B2, you know, particularly inolder women.
Lipoic acid in older women ohmy gosh, the list goes on,
doesn't it?
So inositol sometimes, you know,we do have insulin resistance a
lot.
And you know, particularly, ifyou expand your definition of
(28:15):
insulin resistance to be aboveeight instead of above 10 or 20
um, you're suddenly using it awhole lot more um.
So it's, you know, and that'swhat I mean by being very
individualized.
You do need to look at apatient's kind of whole health
and and whole health picture andthen not forget our beautiful
(28:36):
basis of, of diet and lifestyle.
But but diet, you know, um,it's, it's, it's so important
and the difference that I see.
And if my patients, if I wasjust had my science hat on and
my patients weren't thesebeautiful humans who just
deserve, deserve to have thissuccess, I would go hey, can we
(29:00):
just get you protein adequatefor three months and do a cycle
and see what happens?
You know, but of course I'mpopping in all the antioxidants
and nutrients and and thingslike that at the same time,
because I just want them to havethe absolute kind of best
chance of things working.
But I would say I would sayfour months of protein rich diet
(29:23):
, you're going to get a hugeincrease in success in certain
populations.
Speaker 1 (29:29):
I love what you said then and forgive me, this is my
brain going back tomitochondrial health but I loved
what you said.
I just picked up that you'dspoke about riboflavin b2.
So if we think about nr beingthe b3 and riboflavin being the
b2, they're the two main feedersnot the only, but the two main
feeders to the electron transferchain fad nad, nadh+.
Speaker 2 (29:54):
So it's really like I love just being we very rarely
All the friends when we go tothe go-to, don't they All the
friends?
All the bees are like this youknow they're all so important B6
, b9, folate, you know B12.
Speaker 1 (30:08):
It's like it's just a bee fest and what's in thets is
usually not enough for thesepeople yeah, but but very rarely
do I hear a practitionermention riboflavin specifically,
so I love how your mindchannels into these certain
nutrients to target them.
Can I ask Belinda about herbs?
(30:30):
Are there any herbs that youfavour?
Perhaps even you knowinter-cycle to maybe help manage
stressful situations, or anyother herbs that you might help
with, even fertility?
Speaker 2 (30:46):
Yep, look, I love my herbs as well.
I think we all do, or anybodywho works with herbs loves herbs
.
So I don't tend to use them inthe IVF cycle.
I'm a big believer in you know.
If you're doing IVF you know.
We just don't know thoseinteractions and of course
there's some that would be fineto use through the cycle.
(31:08):
I tend to just make everybodyhappy.
All the doctors that I workwith know that I'm not going to
use herbs in a cycle.
So they'll always just say whenmy 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.
I don't care if they do, butthey often don't know the brand
names and what have you.
So we've got a trust thinggoing that I'm not going to use
(31:28):
herbs in a cycle if they're incharge they're in charge you
know, um pre-cycle, though itdepends on what we're working on
.
So patients who we know aregoing into the IVF setting I
don't care if their cycle'sperfect.
To be honest, beforehand, youknow, sometimes I say like you
know, it's like you know, if thewalls of the house that you're
moving into aren't amazing butyou're going to paint anyway,
(31:50):
let's not worry about notgetting the house because the
walls aren't great.
So those people might be peoplewho are going to IVF because of
um, that the partner might havehad a vasectomy or there's um,
they're using donor sperm orthere's a reason that they're
not going to conceive naturally.
So it's not like we're kind oftrying to get natural conception
going by getting the cycleperfect for those people.
(32:11):
Sure, we're often working onthe luteal phase.
You know Vitex kind of, you know, probably has to be, I think, a
favourite of everybody's.
I'm loving saffron for kind ofpremenstrual mood stuff.
I mean, not so much sort ofcycle regulation, you know, in
terms of stress, like withaniaashwagandha oh you know who
(32:32):
doesn't love a bit of that, I do.
Look, stress impacts everything, right, I'm a very big believer
in helping my patients not tobe stressed about being stressed
.
So I'm pretty big on.
I don't want you to be stressed, because nobody wants to be
stressed and that it feelshorrible to feel stressed, but
(32:54):
please don't worry about itaffecting your cycle.
From my sort of understanding,unless it's like severe, acute
stress, then it's likely thethought would affect your
hormones, shut down ovulation,make you disappear, kind of
stress which some people look.
Definitely that can happen, butit's not most of the stress
that our patients are under.
(33:14):
I mean, I always say to themlike you're special, but you're
not that special like you.
You know like it's like if, ifthis level of stress not that
I'm rating it was you know itwas related to infertility,
nobody would have a baby.
You know it's all for I thinkpeople fall pregnant in war zone
, in prison, horrifically, inassault situations, you know.
So that whole like you need tobe positive and you need to be
(33:36):
relaxed and things.
It definitely helps 100%, rightfor sure it helps.
You know Everything's betterwhen we're less stressed.
But adding that onto theirplate, you know, if you're
stressed and someone says don'tbe stressed, when did that ever
work?
Speaker 1 (33:54):
yeah, yeah.
But I love that practical pointthere about don't get stressed,
about being stressed, becauseeverybody has stress, um, and
women want to hold women want to.
Speaker 2 (34:06):
What women want to have done something wrong.
Let's call it so that they canfix it next time, you know.
So, that way.
Then you know, was it becausethey exercised too hard?
They got hot at the beach, they?
I mean, the questions are youknow, I'm like it's not what
you're doing.
We're trying to kind of improvecertain parameters.
I mean, you know, I always saylike I'm gaslighting my own
(34:28):
profession, right?
you know, it's not what you'redoing, but everything you should
do, all these things you know.
So we're definitely wanting toimprove the bits that we can
improve on and the way that Ikind of look at stress like, yes
, I do use herbs in betweencycles for stress.
For sure is, let's try tobalance the effect of stress on
your body by.
Would you like exercise?
(34:49):
Do you like time in nature?
Can you go for a walk withoutyour phone?
Could you have a cup of teaoutside in the morning before
you start the day?
You know, we find some pocketsof moments in time that they can
slide into their day, that theyfeel.
Do you know what?
Yeah, I could sit outside andhave a cup of herbal tea without
my phone for five minutes.
Great.
Speaker 1 (35:10):
Do that.
Speaker 2 (35:11):
So we balance the effect of stress on the body by
creating some joy and downtime.
Yeah, that's my philosophyanyway.
It doesn't matter, I love it.
Speaker 1 (35:22):
I love it Creating joy and downtime.
You mentioned diets before.
Let's dive into that a littlebit.
And are there any dietaryinterventions, even dietary
choices, sort of approaches,which will increase NADH plus
levels?
Speaker 2 (35:42):
Yeah, so, yes, so not easily, right, you know it's
not like, oh, you don't need todo the supplement anymore
because you ate an avocado or abit of fish or whatever it is.
You know to do the supplementanymore because you ate an
avocado or a bit of fish orwhatever it is.
You know so.
But we certainly want to, Iguess, like fluff out what we're
doing by having that dietarybase there.
And you know people really liketo know what to eat.
(36:03):
You know, just healthy wholefoods just doesn't make them
happy.
You know they need to hearindividual foods, but anyway, so
things that are vitamin B richfoods, so things like avocado
and fish, peanuts, leafy greens,eggs, mushrooms, I think, are
kind of in that list as well.
So those are good.
(36:23):
The body can also convert sometryptophan, which is an amino
acid from protein, into NAD.
So I guess tryptophan could bealso considered a bit of a
dietary source of NAD.
So, again, you know cheese andchicken and turkey and egg
whites and pumpkin seeds, andthis is great because, as I said
, protein, we know is one of themajor macron nutrients needed
(36:44):
for egg quality.
So we're getting double whammyhere on a few things, which is
great here on a few things.
Which is great, our fermentedfoods.
They can also contain smallamounts of NAD.
It'll also improve, I guess,your healthy microbiome in the
gut which helps to absorbnutrients.
So I think they say like yogurtand kefir have some amounts of
(37:05):
NAD, but things like sauerkrautand kimchi rank much higher.
But again, you know, it's likeeating some lentils for iron,
like you know.
I mean it's not going to getyou to high doses diet alone,
but it can boost what's there.
Speaker 1 (37:23):
I think, personally, I must have a histamine
deficiency because I love likeI'll just eat sauerkraut and
kimchi.
I just love them If anythinghappens.
Speaker 2 (37:33):
I mean, touch every piece of wood to my.
You know I don't like toprescribe the histamine diet,
but unfortunately it does haveto happen.
Sometimes I'm like if it'syummy, it's high in histamine,
like it's everything I want toeat.
Speaker 1 (37:46):
Yep, yep, I will sit down.
You know how they give you atiny bowl of kimchi, normally
with a Korean meal.
Speaker 2 (37:51):
Oh, yeah, yeah, yeah, and I'm like no, no, no.
Speaker 1 (37:53):
Big bowl, big bowl yeah yeah.
I've got my gut health.
Yeah, my wife looks at me withdisgust, but anyway, can I ask
about red flags?
Oh, sorry, you go.
Speaker 2 (38:07):
The other thing I wanted to mention is sun
exposure.
So, from a recovering sunaddict no, I'm just a sun addict
that knows that maybe that'sgood in some ways and not good
in other ways.
So limiting sun exposure canalso help to preserve some of
your NAD levels.
So basically, like when youspend time in the sun, that
direct sunlight on your skinhence why I'm taking NRA every
(38:31):
day forces your body basicallyto use more nad plus to repair
that cell damage from the uvrays.
So you know that doesn't meandon't go in the sun.
Please don't anybody get thatmessage, because I actually
would rather give you nad andvitamin d than I mean than
vitamin d.
You know, um and or both.
But on the other side of that,heated things that aren't the
(38:52):
sun like.
So your infrared saunas or, um,you know, hot tubs and things
like that that raise your corebody temperature, that can also
increase nad production.
So you know, get some heat andand and I guess I don't know
what I'm gonna say wear somesunscreen.
I don't know, look, I love.
Say worse than sunscreen, Idon't know.
Look, I love the sun.
Speaker 1 (39:12):
So you know but like, yeah, yeah, well, I mean
Michael Hollick always says itsensible sun exposure.
It's not about burning yourskin, it's about getting the
appropriate amount of sun foryour skin type to make adequate
vitamin D.
And then stop it and then coverup, and then, if you wanted to
put some sunscreen on orwhatever, but don't go out,
(39:34):
don't put the sunscreen onbefore you go outside, because
you're not going to be makingvitamin d yeah, yeah.
Speaker 2 (39:39):
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 saidit's your skin type and things
like that as well so you know,you've got all those things
being sun exposure.
I mean we see it on skin, right.
Speaker 1 (39:52):
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'sreally an interesting yeah, it's
a really interesting point,though, about using NAD or NR to
help to prevent the damage thatmight be caused by the excess
(40:15):
sun exposure.
Obviously, the point is stopthis excess sun exposure.
There's so much more that wecould go into Belinda.
I just wish we had more time.
But look, I thank you so muchfor taking us through just some
of the points of NR today.
We're always going to say itnicotinamide ribose.
That's it.
(40:37):
So I thank you so much fortaking us through some of the
most important points that weneed to remember with regards to
fertility today.
Obviously, people can learn alot more from you.
I do have one more question,forgive me, I was going to ask
this earlier Red flags.
So, with regards tonicotinamide, we were talking
about tryptophan.
Um, I know this is going to berare, but but those people who
(40:58):
may suffer gout, for instance,do you have any other red flags
or hesitations to nr yeah, um, Ihaven't come across any um and
that's a little bit of the army.
Speaker 2 (41:13):
So please don't um, please don't order
self-prescribed, because belindasaid that there wasn't any
contraindications or red flags,um, but there's nothing that
like comes up in my head that'slike oh yeah, I've got to be
careful of x when like with withnr.
So it seems to be pretty welltolerated.
Um, and there is an impatientsubgroup that I'm not using it
for.
Um, now that you've asked that,I'm obviously going to go and
(41:34):
have to research that and youknow, feel, feel terrible if
there is.
But um, sorry, oops, sorry nowe all learn something every day
.
Speaker 1 (41:43):
Well, I agree with you.
Um like nothing comes to mindexcept for gout.
Speaker 2 (41:48):
Um, yeah, and, and even those is usually high, high
dose yeah, I mean I and I guessyou know my, my patient
subgroup that I'm using it's.
It's not a very goutypopulation, so I haven't
actually had the uh, even eventhe clinical experience to go.
Speaker 1 (42:04):
Oh sorry oh, there you go a few but that that's
confidence moving ahead, um.
But thank you so much.
Thank you so much for taking usthrough some of the more
important points with regards tonr and fertility today.
I know there's a lot more tocover, but you've covered the
most poignant points for peopleand practitioners patients and
(42:26):
practitioners to move ahead withtheir therapy, um, safely and
effectively.
Thank you so much for taking usthrough that today.
Speaker 2 (42:33):
Thank you so much for the conversation and having me.
Speaker 1 (42:35):
And thank you everyone for joining us today.
Obviously, you can find out theshow notes to today's episode
and the other podcasts on theDesigns for Health website.
I'm Andrew Whitfield-Cook.
This is Wellness by Designs.
Welcome to Wellness by Designs.
I'm your host, andrewWhitfield-Cook, and joining us
today is Belinda Kirkpatrick, anaturopath and nutritionist who
specialises in fertilitymanagement, and we're going to
be discussing today the benefitsand uses of nicotinamide
riboside, or NR.
Welcome to Wellness by Designs,belinda.
How are you going?
Speaker 2 (00:33):
Well, thank you, Andrew.
Thank you so much for having me.
Speaker 1 (00:37):
Thank you so much for your time today.
So I guess, to start off,really, what is NR?
And, by the way, we're alwaysgoing to say NR, everybody
shortens it but it'snicotinamide, so the non-flush
form of B3, combined with ribos,riboside, so nicotinamide,
riboside, but we're going to sayNR, we'll always default.
(00:57):
So what exactly is NR and whyis it used in fertility?
Speaker 2 (01:05):
Yeah, nr you're right , we never actually say the word
is one of my favouritesupplements.
So NR is a precursor for NAD+or nicotinamide adenine
dinucleotide, and that's acompound naturally produced in
the body.
Now this NAD plus is essentialfor processes things like I
energy production, dna repair,gene expression, and the levels
(01:29):
decline as we age.
So it's been looked at a lot assort of like an anti-aging
thing.
So we've got it in bucket loadswhen we're young and full of
energy and it starts to declinein our 30s and beyond.
So NR that we're talking abouttoday is a precursor for this
NAD, which is super essentialand it's known to boost NAD
levels.
(01:50):
So in my practice I'm using NRa lot to address, like
age-related ovarian fertilityissues you know, guys, I guess,
like you know, maintaining andimproving egg quality.
Speaker 1 (02:05):
Okay, could you just explain for us why, as a
naturopath and nutritionist, youchoose NR over NMN, which is
nicotine mononucleotide NMN?
We always do that to produceNADH or NAD+.
What's the benefits of NR overNMN?
Speaker 2 (02:28):
It's such a good question and it's such a
confusing thing, and I've doneso many deep dives kind of down
into it, because it's like whyare we not, if we want NAD+, why
are we not just using NAD?
And then we've also got the NMNform or the nicotinamide
mononucleotide or the NR.
So when we're looking at NAD,it is very unstable, it's
(02:49):
degraded very quickly in light,whereas NR is more stable, and
then NMN is kind of closerstructurally to NAD.
What we want to finish with.
However, both NMN and NAD arequite big molecules and they
find it quite difficult to crossinto the cell.
So if you take NMN, it'sactually converted back to NR
(03:10):
before going into the cell tothen become NAD.
So I guess it's like an extrametabolic step that some people
may do easily and some peopledon't.
So the NR form, like you said,is the non-flushing form, so
it's basically the closestinstruction to NAD, but while
still being able to cross intothe cells and being converted
(03:31):
back into NAD, and it's beenshown to raise cellular NAD
levels significantly.
Speaker 1 (03:39):
I think this is one of the issues we've always got
to be cognizant of, and that isthat when we're talking about a
molecule that'sant of, and thatis that when we're talking about
a molecule that's in the cells,is that relevant for oral
supplementation of that molecule?
Because we've got a wholedigestive process first, past
metabolism, it's going to betaken into the liver, processed
and then taken to the cells orthe target organs, if you like,
(04:00):
to be used there.
So taking it orally in themouth doesn't necessarily mean
that it gets to the target organor target cells in that form or
in that dose.
So we've got to.
There's a few relevant stepswe've got to think about right.
Speaker 2 (04:17):
Absolutely, and the less steps that we need to take,
then we're not then relying onsomebody's you know personal
sort of genetic ability toactually convert things back and
back.
So the more I guess steps thatthere are, the more places there
could be issues.
Speaker 1 (04:34):
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 phosphorylationand dephosphorylation and so,
in some people, maybe with liverassaults or, you know, chronic
fatigue for instance.
(04:55):
These are the people that tendnot to be able to use pyridoxine
hydrochloride and theysometimes do better with P5P,
whereas most people can convertpyridoxine hydrochloride no
problem.
Do you find that, with your usein practice, that there's a
certain population that NR isbetter suited for?
Speaker 2 (05:17):
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 itis the most easily absorbed form
um.
So there probably are geneticsnip tests and all these sorts
of things you can probably havea look at.
I actually haven't done thatdive down into that um, just
(05:38):
knowing that.
I guess that the nr actuallydoes go into the cell pretty
easily, um and get convertedinto nad.
So I think there will always bepatient subgroups that do that
more effectively than others.
But yeah, I'm basically justusing the NR form, to be honest.
Speaker 1 (05:56):
Yeah, cool.
And so talking about fertility,because these people are crying
out, they spend thousands, theygo through months and months
and years and years of anguish.
Can you explain the function ofNR in fertility management in
both females and males?
Speaker 2 (06:15):
Yeah, yeah, absolutely.
So I think it is reallyimportant to note that, like a
lot of the research that we'rebasing this data on does come
from predominantly mice you knowa lot of them are animal
studies.
There is research in humansthat's ongoing we're basing this
data on does come frompredominantly mice.
You know a lot of them areanimal studies.
There is research in humansthat's ongoing.
There's the ENHANCE study herein Sydney that's looking at the
effects of NR supplementation,you know, in the IVF cycle and
(06:36):
equality and all that kind ofstuff that is still kind of
ongoing.
So a lot of the research isusing, you know, aged mice and
things like that.
But I think that the researchin humans will become more and
more Certainly clinically.
I've been using it for manyyears and really noticing a huge
difference with it.
(06:58):
So NR has kind of a few roles ininfertility.
Most importantly, I think, forlots of our patients is
basically this overallimprovement in quality, so it
can improve the quality of eggs.
It basically works by enhancingmitochondrial function and we
know that the egg donates themitochondria to the embryo.
So really important thatmitochondrial health of the egg
(07:20):
is really important.
As we age that mitochondriaoften doesn't function as well,
so enhancing mitochondrialfunction, reducing oxidative
stress and then helping tomaintain sort of normal
chromosomal structure.
Nad also activates theseenzymes called sirtuins, and if
you work in fertility sort ofthese sirtuins are kind of like
(07:41):
you know big enzymes there andthey're basically involved in
DNA repair.
So that can then help to boost,like egg and sperm as well,
integrity.
So we're really wanting toboost that sirtuin pathway
without getting too technical,because I'm actually not a super
technical kind of person, butyou know there's also in the
cells.
We've got this thing calledanother enzyme called CD38.
(08:04):
Now this enzyme basically isthe primary NAD plus consuming
enzyme in the ovaries.
So it gets higher, it expressesmore activity with age which
contributes to these decliningNAD levels, follicle depletion,
reduced fertility.
So the NR supplementation can'tstop this CD38 from, you know,
(08:26):
increasing with age.
That just happens.
Maybe there's something else Idon't know about that does that.
But it basically can elevatethese ovarian NAD plus levels
which then helps to kind ofmitigate the kind of
consequences, I guess, of thissort of CD38 driven depletion.
So it really is kind of gettinga little bit technical there,
(08:47):
but it's actually kind ofhelping to reduce something or
it's helping to balancesomething that is causing egg
and ovarian ageing.
Speaker 1 (08:57):
Can I ask about dose?
So do you find that as we age,for instance, that the dose of
NR has to be escalated?
Do you find, maybe, certainconditions, certain types?
Of aberrations with oocytes.
That NR is that you usedifferent doses for.
Speaker 2 (09:17):
I certainly do use a higher dose in sort of, I guess,
what they would call poorresponders, so basically people
who either don't respond well toIVF cycles, and that's where we
can sort of really see eggquality is really in that
assisted reproductive setting.
Do you know what I mean Like?
I mean, as women get older whenthey're trying, naturally we
(09:38):
definitely assume that there'san egg quality component there
once people start to get over 38, 40, 42.
You know Lots of my patientsare over 41, 42, 43, 44.
So we know that egg qualityprobably isn't going to be
amazing then.
So I will often use the higherdoses at that point If they've
(09:58):
been doing IVF and we can seethe specialist or the
embryologist kind of givingfeedback about egg quality or
the eggs aren't.
You know that sort offertilization to day three
embryo is very egg qualitydriven.
So if we're not seeing kind ofmuch movement in that embryo
progression from day one tothree, I will often kind of
(10:19):
increase the dose as well.
So, you know, depending onwhere they are and how old they
are and things like that, Ithink, because we can't measure
egg quality, we kind ofessentially we start off with a
bit of a stab in the dark, basedon their history and their age,
and then, if they are movinginto the assisted reproductive
sort of IVF world, we get a lotmore information um on that.
(10:43):
So yeah, I definitely will umuse higher doses in people with
sort of seemingly poorer eggquality right god.
Speaker 1 (10:53):
And and what about its use?
Um, as well, a metabolicbalancer and and as an
anti-inflammatory, like I'veheard of its use in polycystic
ovarian syndrome.
Speaker 2 (11:05):
The other thing too, just with the egg quality,
because I think that's somethingthat people are like super
interested in.
It also can also, researchersshowed, increase and stimulate
ovarian follicle growth.
So really important.
There are some animal studiesthat I love as well that shows
that the NR increases theproportion of embryos reaching
(11:26):
those advanced developmentalstages, so day five and beyond.
So, giving you know, I guess,better IVF outcomes and also, in
mice, increased life birth rate.
So you know, it really doesseem to kind of really give a
lot of health to that egg.
You know, I guess getting thatreproductive potential sort of
protected but like and all theway through Anyway, I just
thought of, you know, I guess,getting that reproductive
potential sort of protected andall the way through Anyway, I
(11:47):
just sort of, you know, thoughtI'd throw that in there With
PCOS.
I've sort of started using it alittle bit for PCOS, look,
mostly in the setting offertility and PCOS, but I can
see where it is starting to kindof show some promise in sort of
managing PCOS.
You know, even people whoaren't necessarily trying to
(12:09):
conceive.
It does work as ananti-inflammatory.
It reduces that oxidativestress, so that's kind of, you
know, reducing inflammationthere, increasing again the
mitochondrial health I talkedabout before, increasing again
the mitochondrial health Italked about before and it also
does a few things you know.
(12:30):
Basically, you know helpingwith the cellular metabolism,
you know increasing ATP function.
So a polycystic ovary isgenerally a pretty inflamed
ovary.
So you know there's lots goingon there and there's generally a
level of inflammation.
So really, you know, reducingthose ROS, or reactive oxygen
species, can really help toreduce any cellular damage
that's been caused byinflammation.
It also, too, helps to reduceovarian fibrosis or these
(12:55):
fibrosis associated genes, andthat's going back to that sort
of activation of that CERT1,cert3 kind of pathway.
So really, enhancing ovulationand reducing fibrosis, reducing
inflammation, you know really isworking on a part of PCOS.
Speaker 1 (13:13):
Yeah, sure, and obviously alongside other
therapies like myo-inositol,exercise, weight loss, blah,
blah, blah yeah.
Speaker 2 (13:20):
Yeah depending on what's going on testosterone
inflammation, you know insulinresistance.
So as a part of a treatment, Ican absolutely see where that's
going to play a role.
Speaker 1 (13:33):
Yeah, sure, and what about?
You were mentioning the IVFsort of process previously.
If we think about temporaldosing like when can you?
And are there any times whereyou shouldn't use NR?
With regards to the IVF cycleor the IVF process, yeah, when
(13:58):
do you use it?
When do you hold back?
Speaker 2 (14:00):
I use it all the way up until an egg collection.
So it's not something that isgoing to be contraindicated with
IVF medications, which isfantastic.
It doesn't, you know, increaseestrogen, like sometimes
ubiquinol at very high doses,cancer.
Sometimes we drop back, youknow, ubiquinol dose sort of in
that sort of IVF cycle.
So you know I'm using NR likeall the way up until, kind of
(14:21):
egg collection.
Now you know they sort of sayyou know what gets you pregnant,
keeps you pregnant.
So you know I'll often drop thedose back and actually use it
for a little bit longer afterthat in certain women, depending
on, you know, sort of oxidativestress, inflammation.
But yeah, so it's not.
You know it's not shown toaffect implantation, which is
(14:43):
obviously a good thing, so youcan be using it kind of all the
way through.
But that real, I guess yeah, youdon't have to be sort of
stopping it before they starttheir IVF stimulation medication
, which is great.
Speaker 1 (14:56):
Gotcha.
Speaker 2 (14:57):
I'm just going to segue.
Speaker 1 (14:58):
Yeah, in that enhanced study.
Speaker 2 (15:02):
they're actually using it.
It's only six weeks, you know,I think it probably does need to
be longer, but hopefully that'sthe beginning of many studies.
But they use that all the wayup until egg retrieval or their
trigger injection.
So yeah, that sort of gives youa lot of confidence too that
you know IVF doctors are runninga trial and actually kind of
(15:22):
using it up until egg retrieval.
Speaker 1 (15:26):
Gotcha, tell us a little bit more about this
ENHANCE study.
Speaker 2 (15:32):
Yeah, so it's a study that they're doing.
I think they're doing frommemory.
I think it's like 250milligrams, which is a low dose,
and 1,000 milligrams daily andit's six weeks up until egg
retrieval.
So I guess that's kind of fourweeks before they start their
stimulation and then they saysort of two weeks during
(15:55):
stimulation, which some of themwon't get to two weeks.
So you know, I mean, look, youknow, yay for any studies you
know like, because it's so hardto get research, particularly in
these patient groups, right.
I mean I'm not part of it atall.
But I'm guessing if you say tosomebody, would you like to be
part of the study, you mighthave this.
You know this nutrient that hasbeen shown to well that we
(16:17):
think might help egg quality, oryou could have the placebo.
I'm going to guess a certainbig chunk of them jump out of
the study and go and take itanyway.
But I mean, I don't know.
So I'm guessing it's probablyhard to get kind of big studies.
I would like love there to be astudy that was taking it for at
least three months.
But you know, the start ofanything is amazing and often
(16:38):
then, obviously, if there's somepromise shown there, like there
are in the you know mice andanimal trials they've been doing
for a long time.
Speaker 1 (16:46):
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 itbe great if this did.
But I have heard of trials thatwere stopped early because the
results were so dramatic, soblindingly dramatic for people,
that it was unethical tocontinue taking the placebo it
(17:08):
would be amazing.
Wouldn't it be great if thatwas the case.
That would be awesome.
It's amazing.
Speaker 2 (17:12):
And it is so hard, I guess with naturopathy, isn't it
?
Because it's often likesometimes we get these single
nutrients or these single, youknow coenzymes that are just
amazing and show improvement andthings like that, but there's
always so many other things kindof going on that you're like,
you know, we know that proteinis so important for kind of egg
quality.
You know, we know that, youknow like.
(17:34):
So I guess, like diet andlifestyle and everything, even
if it's not with othersupplements, you know, I mean it
would be amazing to kind of beable to sort of capture all that
together.
But yeah, you're right, I meanmean, gosh, if you could go.
Yeah, a thousand milligrams forsix weeks before showed any
improvement, and then you wenton to a bigger study that did it
for longer or added insomething I think you know.
(17:55):
I can't imagine that youwouldn't see it, because I see
it in clinic all the time yeah,yeah, I.
Speaker 1 (18:01):
I guess the danger is wanting a nutrient to be a drug
, you know, because drugs arevery powerful agents which block
or upregulate thingsdramatically, often with
attendant side effects.
Nutrients are things that we'veevolved to handle, so it's a
little bit of a differentballgame, it's hard to ask
someone over a short period oftime yeah, I don't know if it
(18:24):
shows the group, but you know,like I mean how you choose that.
Speaker 2 (18:27):
Like, are there other issues?
Is it just anyone doing it?
You know, was it?
People had sperm issues as well, but like they may as well take
this to improving.
I mean I actually don't knowthose details, so maybe maybe
that's all you know umfine-tuned out in the study, but
um yeah so?
Speaker 1 (18:44):
so we've mainly spoken about egg for egg quality
so far.
What about sperm quality?
What about males?
Speaker 2 (18:52):
yeah, so it is.
It is good.
I mean, in that same sort ofway, it is good for sperm
quality as well.
So a lot of the um, a lot ofthe research that we use for egg
quality and also kind of spermquality is based on anti-aging
research, right.
You know the amount of mypatients who you know on
ubiquinol and they're onresveratrol or they're on
(19:13):
nicotinamide, riboside and allthese kind of you know beautiful
antioxidants that we've got,and then, once they're pregnant,
they're kind of like oh yeahlike my husband wants to kind of
buy those now is it, is it okayfor him to, for him to take
them, like all the guys in thegym or he's listened to some
cubanman podcast or you know.
So it's like it's really.
It makes you realize, like youknow, they're like what he's got
(19:35):
, you've got nr.
Like my husband's asking me whyI've got this type of thing,
because it really is so much thebulk in that anti-aging, you
know, kind of research.
So men and women like you knowa lot of our, a lot of the
issues is this sort of, you know, dna damage.
You know poor mitochondrialkind of health, inflammation,
aging eggs, aging sperm, so youknow anything that does kind of,
(19:57):
you know, boost the sort ofhealth of the egg and help with
DNA repair, which is such athing as we kind of age.
Um, it definitely does play arole there.
So I don't know that there's asmuch research on it as yet, but
I think it's yet the next, thenext ubiquinol, if it's not
already right.
Speaker 1 (20:18):
isn't it funny that it took going to the gym to to
start men to uh to realize thatthere was a function for these
anti-ageing nutrients.
I think that's funny.
Yeah, yeah, yeah.
And you also mentionedubiquinol.
So we may as well cover off onthat because, like I can
remember, ruth Trickey was likethe first, let's say, fertility
(20:39):
specialist who really graspedthe use of this, and I remember
her saying, on the basis of onesmall trial, she started to use
it and then it just becamemandatory, it became just
general approach.
So take us through ubiquinolwhile we're there.
What dose do you use?
When do you use it?
Are there times when you don't?
(21:00):
You mentioned some times youmight pull back, and both males
and females for two.
Yeah, yeah.
Speaker 2 (21:07):
So I do tend to use ubiquinol, um the more active
version of kind of coq10 um.
You do tend to kind of get whatyou pay for, in that sense.
And again, going back to ourconversation about um, you know
like how people can kind ofbreak it down and convert it um,
is it not?
Everybody converts protein intoubiquinol actually quite a
small proportion, um.
(21:27):
So I do tend to kind of goupstream and and go with
ubiquinol.
So, again, depending on theirage and history and and ivf
history and what have you, butlike the dose that sort of sits
well in most of the research isabout 600 milligrams a day,
which is a pretty decent dose interms of cost, right, like I
(21:50):
mean ubiquinol, I mean the samewith nr.
They're beautiful in the sensethat they fit into a nice little
teeny tiny capsule and they'reswallowed easily and digestion
feels great.
And you know they're not sortof your b vitamins and they're
not your.
You know taking four or sixfish oil a day, so like they're,
but they're, they're not sortof your B vitamins and they're
not your.
You know taking four or sixfish oil a day.
So like they're, but they'reexpensive, right.
So it's like a little.
It's like gold in a little.
(22:10):
It's like gold in a littlecapsule.
So sometimes you know you aretrying to kind of choose and
sometimes you know you reallywant to, I guess, use better
doses of less things rather thansort of spreading yourself too
thin.
The amount of people that come,having read whatever sort of
certain books that are great forgetting people started on their
egg health journey, that aretaking, you know, ubiquinol and
(22:34):
have been taking it for a longtime off the internet or
whatever, just kind ofself-prescribed, it's quite
amazing, without knowing whatthe issue is.
And is it the dose?
Is it the amount?
Is it whatever's in there?
Is it how?
It's quite amazing, withoutknowing what the issue is, and
is it the dose?
Is it the amount?
Is it whatever's in there?
Is it how it's processed?
But they'll be like.
You know, I've been doingubiquinol for kind of ages and
you're like, can you just giveme a few months on a different
(22:55):
type and or dose?
You know, um, and they do getbetter results, as we mentioned
before.
They're obviously doing lots ofother things as well, um, but
but it is important.
So if that was sort of younger,as in like maybe under 38,
maybe I'd just do 300 milligramsof ubiquinol right, you know
particularly if they'll just trynaturally.
(23:15):
But if anybody's going into theibf setting, I'm like, even if
it's their first attempt andthey're, you know, 37, even if
there's not a known reason andit's a suspected egg quality, ie
doesn't look like implantationfailures, sperm looks fine.
We don't kind of know.
I will use that 600, if we canfinancially for three or four
(23:38):
months beforehand and it's areally big consideration because
you want to work with yourpatients and I would rather I
was.
Sometimes I write one to two,because the ones that I use are
300s, and they say what do youmean one to two?
And I'm like if you're feelingrich today, you could have two,
but if you're just like feelingnormal, go with the one.
So even though I like them andyou know their weight is higher,
(23:58):
their BMI is higher, if they'reover sort of 90 kilos, I mean
you know the research is sayinggive them 900.
I rarely use that.
Again, I'd want to see realbang for my buck.
You know like I'd be extradisappointed if the quality
wasn't as good.
So there definitely will besome people that are open to
(24:20):
that.
But I think these are allthings that you've got to assess
your patient as a human, as anindividual, and really prescribe
personalized medicine.
Speaker 1 (24:30):
Yeah, I love what you're saying there, belinda,
about.
You know, if you've got ahigher BMI you're going to have
to use higher doses of things.
You've then got to choose yourbest bang for buck.
But the issue is the BMI and Iget the fight, you know, I get
the struggle, I understand it,but without addressing that BMI,
without addressing lean musclemass versus fat mass, then you
(24:56):
just you're always hooked intohigher dosage of nutrients
because of the inflammatorynature of adipose tissue.
Speaker 2 (25:04):
Yeah, and it's a really tough one.
You know all my patients areracing against the clock, you
know, I mean I don't have theluxury really of seeing the 32
year old who wants to conceivenext year although.
I did have one this week and Iwas like oh, your preconception
bless.
I'm so happy.
You know I generally have.
You know, we've done fivecycles.
I'm about to turn 41.
(25:25):
You know, this is my weight,this is my life, and so we are
you know kind of trying to fasttrack things a lot.
Speaker 1 (25:34):
Yeah, Can I just sort of delve on one of those
impeders Is that a word?
One of those blocks, thoseroadblocks, yeah, the roadblocks
to success.
And you know you're mentioningpeople who've gone through five
cycles.
You know that emotional agony,the incredible stress that and I
(25:57):
will say this mainly women, butnot only women, couples
certainly put themselves throughor are put through uh, stress.
So, if, if, can we just talk alittle bit about what else you
use with regards to using nr forfor fertility management with
(26:18):
egg and or sperm quality?
Perhaps ubiquinol?
Um, if it's relevant, what elsedo you use and when?
Speaker 2 (26:27):
um, yeah, great question, yeah, so I'd like to
think that it's an impossibleanswer.
I'm going to answer, don'tworry.
I'd like to think it's animpossible answer because I'm
you know, I'm tailoring it.
You know it is sort ofindividualized kind of medicine
and we need to fix up.
You know, nutrient deficiencies, things like vitamin D my gosh,
the amount of people that areon high doses of vitamin D
(26:49):
because it's just so relatedinto egg quality, implantation,
immune, everything.
So you know that's definitelykind of looked at.
Fish oils and good qualityessential fatty acids are really
important.
When we're looking atantioxidants, it's so hard
because how long is a piece ofstring?
and people come saying oh thisand this and this and this and
this and this and this and thisand whatever and sort of you
(27:11):
know maybe brands that aren'tnecessarily amazing, who knows
or doses and we have to rein itall in.
But you know, definitely, look,ubiquinol, nac and NR would be
in my stable of.
You know, older women, ivfsupport, egg quality, you know,
(27:31):
anti-inflammatory, mitochondrialhealth they would be probably
in my top three if I had tochoose.
And the IVF doctors who referto me and or suggest things to
patients a lot of them, that'sin the top three also.
I mean, obviously we're lookingat folate and methylation, you
know, do they need differenttypes of folate?
B12, super important Sometimes.
(27:53):
Riboflavin is your littlemissing link.
B2, you know, particularly inolder women.
Lipoic acid in older women ohmy gosh, the list goes on,
doesn't it?
So inositol sometimes, you know,we do have insulin resistance a
lot.
And you know, particularly, ifyou expand your definition of
(28:15):
insulin resistance to be aboveeight instead of above 10 or 20
um, you're suddenly using it awhole lot more um.
So it's, you know, and that'swhat I mean by being very
individualized.
You do need to look at apatient's kind of whole health
and and whole health picture andthen not forget our beautiful
(28:36):
basis of, of diet and lifestyle.
But but diet, you know, um,it's, it's, it's so important
and the difference that I see.
And if my patients, if I wasjust had my science hat on and
my patients weren't thesebeautiful humans who just
deserve, deserve to have thissuccess, I would go hey, can we
(29:00):
just get you protein adequatefor three months and do a cycle
and see what happens?
You know, but of course I'mpopping in all the antioxidants
and nutrients and and thingslike that at the same time,
because I just want them to havethe absolute kind of best
chance of things working.
But I would say I would sayfour months of protein rich diet
(29:23):
, you're going to get a hugeincrease in success in certain
populations.
Speaker 1 (29:29):
I love what you said then and forgive me, this is my
brain going back tomitochondrial health but I loved
what you said.
I just picked up that you'dspoke about riboflavin b2.
So if we think about nr beingthe b3 and riboflavin being the
b2, they're the two main feedersnot the only, but the two main
feeders to the electron transferchain fad nad, nadh+.
Speaker 2 (29:54):
So it's really like I love just being we very rarely
All the friends when we go tothe go-to, don't they All the
friends?
All the bees are like this youknow they're all so important B6
, b9, folate, you know B12.
Speaker 1 (30:08):
It's like it's just a bee fest and what's in thets is
usually not enough for thesepeople yeah, but but very rarely
do I hear a practitionermention riboflavin specifically,
so I love how your mindchannels into these certain
nutrients to target them.
Can I ask Belinda about herbs?
(30:30):
Are there any herbs that youfavour?
Perhaps even you knowinter-cycle to maybe help manage
stressful situations, or anyother herbs that you might help
with, even fertility?
Speaker 2 (30:46):
Yep, look, I love my herbs as well.
I think we all do, or anybodywho works with herbs loves herbs
.
So I don't tend to use them inthe IVF cycle.
I'm a big believer in you know.
If you're doing IVF you know.
We just don't know thoseinteractions and of course
there's some that would be fineto use through the cycle.
(31:08):
I tend to just make everybodyhappy.
All the doctors that I workwith know that I'm not going to
use herbs in a cycle.
So they'll always just say whenmy 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.
I don't care if they do, butthey often don't know the brand
names and what have you.
So we've got a trust thinggoing that I'm not going to use
(31:28):
herbs in a cycle if they're incharge they're in charge you
know, um pre-cycle, though itdepends on what we're working on
.
So patients who we know aregoing into the IVF setting I
don't care if their cycle'sperfect.
To be honest, beforehand, youknow, sometimes I say like you
know, it's like you know, if thewalls of the house that you're
moving into aren't amazing butyou're going to paint anyway,
(31:50):
let's not worry about notgetting the house because the
walls aren't great.
So those people might be peoplewho are going to IVF because of
um, that the partner might havehad a vasectomy or there's um,
they're using donor sperm orthere's a reason that they're
not going to conceive naturally.
So it's not like we're kind oftrying to get natural conception
going by getting the cycleperfect for those people.
(32:11):
Sure, we're often working onthe luteal phase.
You know Vitex kind of, you know, probably has to be, I think, a
favourite of everybody's.
I'm loving saffron for kind ofpremenstrual mood stuff.
I mean, not so much sort ofcycle regulation, you know, in
terms of stress, like withaniaashwagandha oh you know who
(32:32):
doesn't love a bit of that, I do.
Look, stress impacts everything, right, I'm a very big believer
in helping my patients not tobe stressed about being stressed
.
So I'm pretty big on.
I don't want you to be stressed, because nobody wants to be
stressed and that it feelshorrible to feel stressed, but
(32:54):
please don't worry about itaffecting your cycle.
From my sort of understanding,unless it's like severe, acute
stress, then it's likely thethought would affect your
hormones, shut down ovulation,make you disappear, kind of
stress which some people look.
Definitely that can happen, butit's not most of the stress
that our patients are under.
(33:14):
I mean, I always say to themlike you're special, but you're
not that special like you.
You know like it's like if, ifthis level of stress not that
I'm rating it was you know itwas related to infertility,
nobody would have a baby.
You know it's all for I thinkpeople fall pregnant in war zone
, in prison, horrifically, inassault situations, you know.
So that whole like you need tobe positive and you need to be
(33:36):
relaxed and things.
It definitely helps 100%, rightfor sure it helps.
You know Everything's betterwhen we're less stressed.
But adding that onto theirplate, you know, if you're
stressed and someone says don'tbe stressed, when did that ever
work?
Speaker 1 (33:54):
yeah, yeah.
But I love that practical pointthere about don't get stressed,
about being stressed, becauseeverybody has stress, um, and
women want to hold women want to.
Speaker 2 (34:06):
What women want to have done something wrong.
Let's call it so that they canfix it next time, you know.
So, that way.
Then you know, was it becausethey exercised too hard?
They got hot at the beach, they?
I mean, the questions are youknow, I'm like it's not what
you're doing.
We're trying to kind of improvecertain parameters.
I mean, you know, I always saylike I'm gaslighting my own
(34:28):
profession, right?
you know, it's not what you'redoing, but everything you should
do, all these things you know.
So we're definitely wanting toimprove the bits that we can
improve on and the way that Ikind of look at stress like, yes
, I do use herbs in betweencycles for stress.
For sure is, let's try tobalance the effect of stress on
your body by.
Would you like exercise?
(34:49):
Do you like time in nature?
Can you go for a walk withoutyour phone?
Could you have a cup of teaoutside in the morning before
you start the day?
You know, we find some pocketsof moments in time that they can
slide into their day, that theyfeel.
Do you know what?
Yeah, I could sit outside andhave a cup of herbal tea without
my phone for five minutes.
Great.
Speaker 1 (35:10):
Do that.
Speaker 2 (35:11):
So we balance the effect of stress on the body by
creating some joy and downtime.
Yeah, that's my philosophyanyway.
It doesn't matter, I love it.
Speaker 1 (35:22):
I love it Creating joy and downtime.
You mentioned diets before.
Let's dive into that a littlebit.
And are there any dietaryinterventions, even dietary
choices, sort of approaches,which will increase NADH plus
levels?
Speaker 2 (35:42):
Yeah, so, yes, so not easily, right, you know it's
not like, oh, you don't need todo the supplement anymore
because you ate an avocado or abit of fish or whatever it is.
You know to do the supplementanymore because you ate an
avocado or a bit of fish orwhatever it is.
You know so.
But we certainly want to, Iguess, like fluff out what we're
doing by having that dietarybase there.
And you know people really liketo know what to eat.
(36:03):
You know, just healthy wholefoods just doesn't make them
happy.
You know they need to hearindividual foods, but anyway, so
things that are vitamin B richfoods, so things like avocado
and fish, peanuts, leafy greens,eggs, mushrooms, I think, are
kind of in that list as well.
So those are good.
(36:23):
The body can also convert sometryptophan, which is an amino
acid from protein, into NAD.
So I guess tryptophan could bealso considered a bit of a
dietary source of NAD.
So, again, you know cheese andchicken and turkey and egg
whites and pumpkin seeds, andthis is great because, as I said
, protein, we know is one of themajor macron nutrients needed
(36:44):
for egg quality.
So we're getting double whammyhere on a few things, which is
great here on a few things.
Which is great, our fermentedfoods.
They can also contain smallamounts of NAD.
It'll also improve, I guess,your healthy microbiome in the
gut which helps to absorbnutrients.
So I think they say like yogurtand kefir have some amounts of
(37:05):
NAD, but things like sauerkrautand kimchi rank much higher.
But again, you know, it's likeeating some lentils for iron,
like you know.
I mean it's not going to getyou to high doses diet alone,
but it can boost what's there.
Speaker 1 (37:23):
I think, personally, I must have a histamine
deficiency because I love likeI'll just eat sauerkraut and
kimchi.
I just love them If anythinghappens.
Speaker 2 (37:33):
I mean, touch every piece of wood to my.
You know I don't like toprescribe the histamine diet,
but unfortunately it does haveto happen.
Sometimes I'm like if it'syummy, it's high in histamine,
like it's everything I want toeat.
Speaker 1 (37:46):
Yep, yep, I will sit down.
You know how they give you atiny bowl of kimchi, normally
with a Korean meal.
Speaker 2 (37:51):
Oh, yeah, yeah, yeah, and I'm like no, no, no.
Speaker 1 (37:53):
Big bowl, big bowl yeah yeah.
I've got my gut health.
Yeah, my wife looks at me withdisgust, but anyway, can I ask
about red flags?
Oh, sorry, you go.
Speaker 2 (38:07):
The other thing I wanted to mention is sun
exposure.
So, from a recovering sunaddict no, I'm just a sun addict
that knows that maybe that'sgood in some ways and not good
in other ways.
So limiting sun exposure canalso help to preserve some of
your NAD levels.
So basically, like when youspend time in the sun, that
direct sunlight on your skinhence why I'm taking NRA every
(38:31):
day forces your body basicallyto use more nad plus to repair
that cell damage from the uvrays.
So you know that doesn't meandon't go in the sun.
Please don't anybody get thatmessage, because I actually
would rather give you nad andvitamin d than I mean than
vitamin d.
You know, um and or both.
But on the other side of that,heated things that aren't the
(38:52):
sun like.
So your infrared saunas or, um,you know, hot tubs and things
like that that raise your corebody temperature, that can also
increase nad production.
So you know, get some heat andand and I guess I don't know
what I'm gonna say wear somesunscreen.
I don't know, look, I love.
Say worse than sunscreen, Idon't know.
Look, I love the sun.
Speaker 1 (39:12):
So you know but like, yeah, yeah, well, I mean
Michael Hollick always says itsensible sun exposure.
It's not about burning yourskin, it's about getting the
appropriate amount of sun foryour skin type to make adequate
vitamin D.
And then stop it and then coverup, and then, if you wanted to
put some sunscreen on orwhatever, but don't go out,
(39:34):
don't put the sunscreen onbefore you go outside, because
you're not going to be makingvitamin d yeah, yeah.
Speaker 2 (39:39):
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 saidit's your skin type and things
like that as well so you know,you've got all those things
being sun exposure.
I mean we see it on skin, right.
Speaker 1 (39:52):
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'sreally an interesting yeah, it's
a really interesting point,though, about using NAD or NR to
help to prevent the damage thatmight be caused by the excess
(40:15):
sun exposure.
Obviously, the point is stopthis excess sun exposure.
There's so much more that wecould go into Belinda.
I just wish we had more time.
But look, I thank you so muchfor taking us through just some
of the points of NR today.
We're always going to say itnicotinamide ribose.
That's it.
(40:37):
So I thank you so much fortaking us through some of the
most important points that weneed to remember with regards to
fertility today.
Obviously, people can learn alot more from you.
I do have one more question,forgive me, I was going to ask
this earlier Red flags.
So, with regards tonicotinamide, we were talking
about tryptophan.
Um, I know this is going to berare, but but those people who
(40:58):
may suffer gout, for instance,do you have any other red flags
or hesitations to nr yeah, um, Ihaven't come across any um and
that's a little bit of the army.
Speaker 2 (41:13):
So please don't um, please don't order
self-prescribed, because belindasaid that there wasn't any
contraindications or red flags,um, but there's nothing that
like comes up in my head that'slike oh yeah, I've got to be
careful of x when like with withnr.
So it seems to be pretty welltolerated.
Um, and there is an impatientsubgroup that I'm not using it
for.
Um, now that you've asked that,I'm obviously going to go and
(41:34):
have to research that and youknow, feel, feel terrible if
there is.
But um, sorry, oops, sorry nowe all learn something every day
.
Speaker 1 (41:43):
Well, I agree with you.
Um like nothing comes to mindexcept for gout.
Speaker 2 (41:48):
Um, yeah, and, and even those is usually high, high
dose yeah, I mean I and I guessyou know my, my patient
subgroup that I'm using it's.
It's not a very goutypopulation, so I haven't
actually had the uh, even eventhe clinical experience to go.
Speaker 1 (42:04):
Oh sorry oh, there you go a few but that that's
confidence moving ahead, um.
But thank you so much.
Thank you so much for taking usthrough some of the more
important points with regards tonr and fertility today.
I know there's a lot more tocover, but you've covered the
most poignant points for peopleand practitioners patients and
(42:26):
practitioners to move ahead withtheir therapy, um, safely and
effectively.
Thank you so much for taking usthrough that today.
Speaker 2 (42:33):
Thank you so much for the conversation and having me.
Speaker 1 (42:35):
And thank you everyone for joining us today.
Obviously, you can find out theshow notes to today's episode
and the other podcasts on theDesigns for Health website.
I'm Andrew Whitfield-Cook.
This is Wellness by Designs.
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