A goal of the treatment is to increase activity of the citric acid cycle. Pyruvate dehydrogenase and the 2-oxoglutarate dehydrogenase are rate limiting enzymes in the citric acid cycle. NADH inhibits pyruvate dehydrogenase and 2-oxoglutarate dehydrogenase. Increasing levels of NAD+ via supplemental nicotinamide mononucleotide, which is marketed as an anti-aging and longevity supplement, would increase levels of NADH which would inhibit pyruvate dehydrogenase and 2-oxoglutarate dehydrogenase which would decrease activity of the citric acid cycle which is disastrous. Activities of the E3 subunits of the pyruvate dehydrogenase complex and 2-oxoglutarate dehydrogenase complex, which have NAD+ as substrates, left unstimulated by supplements are completely acceptable.
A key goal is to increase activity of the citric acid cycle. Supplemental pantothenic acid and sulbutiamine, which is a fat-soluble form of thiamine, can be of assistance in increasing activity of the citric acid cycle. Supplemental niacin, niacin derivatives, riboflavin and lipoic acid must be religiously avoided in increasing activity of the citric acid cycle. Unfortunately, nicotinamide mononucleotide is worse than useless as a supplement.
Decreased activity of enzymes in the citric acid cycle is present in Alzheimer’s disease. Supplemental nicotinamide mononucleotide could increase incidences of Alzheimer’s disease which is most definitely not the way to add healthy years to lifespans.