health & science

‘Anti-ageing’ pill’s breast milk benefit

Breastfeeding women are being warned to wait for clinical trials of a touted anti-ageing supplement before trying it to boost their milk supply, despite a promising study in rats. But Twitter is awash with claims it boosts energy and more, reports Eloise Gibson.

A vitamin supplement being promoted as an anti-ageing wonder pill has been found to have another potential benefit - helping breastfeeding mums make more milk.

But while the finding is being hailed by some as an exciting potential boost for new mothers, the only breastfeeding mums who have tried it are lactating rats and mice.

As for breastfeeding women, they’ve have been warned not to take nicotinamide riboside, or NR, until it’s been proven safe for them and their babies. The supplement’s owner, Chromadex, can’t say exactly when clinical trials on lactating humans will start, only that it will be “as soon as possible”. Its website advises breastfeeding women to "consult a physician".

For a study just published in the journal Cell Report, the University of Iowa’s Charles Brenner – who is also the chief scientist at ChromaDex – and a team of researchers carried out a battery of tests on rat and mice mums and their offspring.

While the benefits to the rodent mums were promising – more milk and seemingly more robust pups – they did not necessarily make the rodent children obedient, at least not when it came to listening to the scientists. Notes on the study's methods record that: “Our rats were largely immobile in open-field testing and declined to perform a beam walk.”

New products frequently work well in early rodent trials but flop when they’re later tested on humans.

Until more studies in people are done, two New Zealand researchers say people should be wary about any claims of benefits from taking NR, a form of vitamin B3 that’s naturally found at low doses in milk. More than a dozen studies are recruiting participants or are underway to test whether NR helps with heart health and other various health goals – but none of them are testing it on pregnant or breastfeeding women. Studies in other adults show NR seems to be safe to take, but published trials haven’t yet delivered any clear evidence of benefits in people.

New York obstetrician and gynaecologist Alyssa Dweck is an associate clinical professor at the Mount Sinai School of Medicine and a paid spokesperson for ChromaDex. She sometimes recommends NR to menopausal women at her clinic if they don’t want to take hormones for fatigue (although Dweck is paid for her time speaking publicly about NR she doesn't get paid kickbacks for recommending people use it). But she says she wouldn’t recommend the supplement to the lactating mums she sees at her clinic yet, until human trials prove it is safe for them.

Still, Dweck is excited about the rodent study. She says: “We tend to be very cautious about obstetrics. I’m not going to recommend it (to breastfeeding mums) because that is not the standard of care, but we hope it’s just a matter of time.”

“Obviously, this is an early study and not in humans, however the possible translation to humans is very exciting, because in my world (of obstetrics) women are concerned about their milk production after delivery, or lack thereof, so the fact that there is information suggesting a supplement might improve milk production is very exciting, because we don’t have anything else to offer women,” says Dweck. There are few reliable medicines that promote milk production (called galactagogues) and the old remedies, like beer, are no longer considered healthy, she says. 

ChromaDex is funding a raft of studies in a bid to get better evidence and has given the product to many researchers. The supplement industry globally is a multi-billion dollar business, despite a dearth of evidence that vitamin supplements benefit people with reasonably good diets.

“To the average person, it looks compelling but it’s nonsense. Who knows, in the future they may do a study and find out it works for something. But based on what’s known now I wouldn’t recommend that anyone take this."

- Pharmaceutical and natural product researcher Shaun Holt 

ChromaDex has been battling a competitor, Elysium Health, over claims of theft and employee poaching, all while funding studies aimed at showing NR is that rare thing - a supplement with proven, measurable benefits. ChromaDex has an exclusive licence to produce NR as a vitamin supplement, and, until the companies fell out, it used to sell its raw product to Elysium for inclusion in Elysium’s own-branded products.

The four published studies in people so far show that taking NR supplements seems to be safe in non-breastfeeding adults who aren’t pregnant. But evidence of benefits has been mixed, or too preliminary to rely on. One trial – prompted by promising results in obese rodents - found that NR supplementation in doses of 2000mg a day appeared safe “but didn’t improve insulin sensitivity in 40 obese men”.

Another study of 30 people, half of whom took 1000mg a day before trading places with the placebo group (meaning they got no dose while the former placebo group took NR), showed it might make people's hearts healthier, but concluded more studies were needed. That study found NR didn’t improve fitness in already-fit middle aged people.

One reason for the excitement from some quarters is that taking NR seems to boost people’s levels of a compound called NAD found in living cells, which declines naturally as we age. NAD might be involved in energy levels and other health-related functions. A University of Colorado Boulder study of 24 middle-aged people found taking 1000mg a day of NR may mimic the effects of caloric restriction, kick-starting the same key chemical pathways responsible for restriction's health benefits.

Scientists think that slashing calories by a third can fend off physiological signs of ageing, but for obvious reasons few people stick to that kind of restrictive diet, and it might even be dangerous for already-slim people. While a supplement achieving a similar thing without the hunger factor for people would be helpful, the authors stressed it was only a pilot study and more work was needed.

The fact that NR research is in its infancy didn’t deter a flurry of excited coverage when ChromaDex launched NR in New Zealand late last year under the brand Tru Niagen. The website claims the supplement “supports healthy ageing” and “fuels the body’s energy engines”. A story at the time in the New Zealand Herald said NR could “keep the effects of ageing at bay” and included a link where readers could purchase the product (although, the Herald also prominently quoted a University of Otago researcher saying more proof was needed).

Newshub featured an interview with ChromaDex chief scientist and NR discoverer Charles Brenner, as did website NowtoLove, which called the supplement “revolutionary” and “the best anti-ageing supplement you've never heard of”.

The supplements cost $164 (on special) for three bottles of 60 pills, or a roughly 90-day supply at the recommended dose of two capsules a day. The pills deliver 250mg, substantially lower than the daily amount tested in some of the published clinical trials.

The health claims being made for NR do not sit well with Shaun Holt, a pharmaceutical and natural product researcher who has his own natural product company, HoneyLab. Because NR is being sold as a nutritional supplement rather than a medicine, the company is allowed to make vague claims that aren’t backed by clinical studies so long as it doesn’t claim specific medical benefits, he says.

Holt says it’s unlikely people are getting anti-ageing or other benefits from NR, labelling some of the hinted-at benefits “garbage”. “It’s a fancy version of vitamin B3 ... and the price is $165 on special! There’s no good evidence that this will help anyone with anything. What happens in rats very rarely happens in people, and this has got all the hallmarks of typical natural product marketing - you’ve got a professor who’s found this out, and all of these vague claims.”

“To the average person, it looks compelling but it’s nonsense. Who knows, in the future they may do a study and find out it works for something. But based on what’s known now I wouldn’t recommend that anyone take this,” says Holt.

Professor Christine Winterbourn, a biochemist and a leading free radical researcher at the University of Otago, Christchurch, is more excited than Holt about the prospects for the supplement. But she also said it was much too soon to say whether it would benefit people.

“There’s an awful lot of supplements out there that, as a scientist, I don’t give the time of day, but with NR the possibilities for health benefits seem to be based on good scientific evidence. Some of the press releases are a bit over the top but I think this product has potential. The animal studies look reasonable, but they are animal studies and the literature is full of studies where people have seen great result in animals and they translate them to humans and they don’t work,” she says.

“Without any human data, I certainly wouldn’t recommend that a [breastfeeding] woman should take it and see what happens," says Winterbourn. "While it may be found in milk, it is found at low levels and you’re taking quite large doses (with a supplement). Also, just because it’s a natural compound it’s not necessarily harmless. NAD is involved in numerous processes including immune function, so it is important to be sure that increasing the level by supplementation does not have other effects that might be harmful."

“The gold standard is a clinical trial showing a positive effect in humans. If this was a drug it would not yet be sold for use in humans but because it’s a nutritional supplement it’s available over the counter and the same rigours are not there,” she says.

Mind you, some people aren't keen on waiting until the clinical trials are in. Customers – including paid promoters – are already posting testimonials on Twitter about how NR helps them recover from workouts, boosts their energy, makes them feel younger, and more.

“Unfortunately one celebrity saying it worked for them is often more powerful than a clinical study in hundreds of people,” says Winterbourn.

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