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I see adds for a supplement called Elysium all over FB, and they seem to have real science behind their product. If it safe? Should I be taking it? – M.B. Boston, MA

Great question. First, some background. Many people know Elysium as a mediocre (58% audience score on Rotten Tomatoes) Matt Damon movie from 2013. Classics scholars will remember Elysium from Greek mythology as a heaven-like place where righteous people go after they die. It is likely that the supplement company (the product is actually called Basis) and the movie where both named after the Greek myth.

The Elysium Basis supplement contains Nicotinamide riboside, which is a precursor for a common and essential enzyme cofactor called nicotinamide adenine dinucleotide (NAD+), and pterostilbene, which is a chemical similar to resveratrol. You may have heard of resveratrol as the “active” antioxidant molecule in red wine. You can buy resveratrol supplements in any health food store. Elysium (the company, not the Matt Damon vehicle) has indeed been all over Facebook lately, and their website is impressive. They list 7 (!!) Nobel Price winners as members of their advisory board, plus a number of other accomplished scientists. Their website is really nice, and they highlight research and discovery efforts much like a biotech or pharmaceutical company would. They have even run a clinical trial with the Basis supplement! Honestly, they have done a great job of providing the appearance of scientific gravitas to their product. However, it’s important to note that their Basis product is really not unique. Many other companies sell nicotinamide riboside supplements, and resveratrol supplements have been available for years.

Elysium doesn’t specifically say what their supplement will do or what ailments it treats – as a supplement company, they can’t legally make such claims – we’ll get into why this is the case in just a bit. All the same, they are quick to point out that NAD is critical for cellular health (whatever that is), circadian rhythm, and cognitive function. You will hear claims that NAD can slow or reverse the aging process, treat Alzheimers or Parkinsons, or improve memory or energy. NAD levels seem to decline as we age, so the theory is that adding NAD back into the body will help with aging-related diseases.

So let’s start with NAD. We have already mentioned that NAD is a co-enzyme. Co-enzymes are molecules that help enzymes catalyze chemical reactions. NAD acts as an electron accepter, becoming NADH (NAD plus a hydrogen atom and two electrons). NADH, in turn, can act as an electron donor, passing off its hydrogen and electrons, so that it cycles back to NAD. NAD is critical to many metabolic processes, but the one Elysium highlights the most is redox metabolism. The maintenance of the proper redox state is thought to be critical for all cells, and antioxidants work by scavenging reactive oxygen (and other) molecules to maintain a healthy redox balance. NAD really isn’t an antioxidant in a true sense, but it is required for antioxidant enzymes to function. Eylsium is right that NAD is critical – you need NAD in all of your cells, and there is a lot of it in your body doing its job right now.

NAD is so important for normal cell function that there is a salvage pathway in all cells that recycles NAD and can use similar chemicals to make more NAD. This is why NAD itself is not a vitamin: it’s something your body can make on it’s own, either from scratch or by recycling similar chemicals. On a normal diet, you are able to make or recycle all of the NAD your body needs.

NAD itself is really not absorbed intact, and it doesn’t really help to simply take large doses of it as a supplement, so the approach taken by Elysium (and others) is to feed the salvage pathway with an NAD precursor called nicotinamide riboside. Unlike many supplement companies, Elysium has taken the step to test their supplement in a clinical trial. They have shown that their Basis supplement can in fact increase the levels of NAD in the blood.

This all sounds great, but now things get a little fuzzy. It’s not entirely clear that higher levels of NAD in the blood is actually helpful. The vast majority of NAD’s functions, including redox metabolism, are happening within the cell. The levels of NAD inside cells were not measured in Elysium’s clinical study. Little is known about what NAD may or may not do when it is outside of cells or in the blood. Plus, Elysium (and the rest of the field) can’t really say if a decline in NAD is actually a cause of “aging” (or any of the other ailments NAD has been touted to treat) or if adding a whole lot more of a coenzyme that your body can make on it’s own is actually beneficial. Sure, NAD levels go down as we age, but is this actually causing any harm? Will fixing it with Basis make things better? No one knows.

It is here that the business model and operating procedures of a supplement company differ greatly from biotechnology and pharmaceutical companies. In order to market a drug, pharmaceutical companies have to show that their drug works to treat defined diseases and that it is safe – at least relatively so (for instance, we tolerate some toxicity when treating a life-threatening disease like cancer). On the other hand, supplement companies never have to show that their supplements work or provide any benefit at all. They don’t even have to show that they are safe. They are assumed to be safe until data becomes available that suggests they are not. In this way, supplements are regulated like food, not like drugs.

Elysium ran a clinical trial showing increased blood NAD levels in volunteers after taking their supplement, which is great. Some may wonder why, if this works so well, that Elysium does not seek FDA approval for their product. They don’t do this because having low levels of NAD in your blood is not a disease that needs to be treated. Aging and age-related diseases are the diseases in question, and Elysium has not shown any actual benefits on slowing or reversing the aging process. In their defense, this would be very hard (and quite expensive) to do, but this is exactly what a biotechnology or pharmaceutical company would have to do to sell such a product. They would have to show that it modifies the disease enough to make peoples lives better. As a supplement company, Elysium just has to suggest that it may work and watch the money roll in.

This brings us to the last point, and that is the price of this supplement. A month’s supply of Basis will cost you $60. If you sign up for monthly delivery, it’s $40/month, and you can get additional discounts if you commit to a 6-12 month regime. That is a lot of money. Worse still, the ingredients in their product are very similar to other supplements you can get for much less money. Two months supply of resveratrol will cost you about $12. Several other companies sell nicotinamide riboside for a similar price, but the cheapest source of NAD precursors is Vitamin B3, also known as niacin or nicotinic acid. You can get several months supply of this for about $10, and it feeds into the same salvage pathway as the more expensive nicotinamide riboside supplements.

Elysium’s Basis is probably safe. They have a clinical trial to support this, and both nicotinamide riboside and polyphenols like pterostilbene are common supplements sold by many other companies. Whether it works is another question. Personally, I always come back to the old Carl Sagan aphorism “extraordinary claims require extraordinary evidence.” A chemical that can reverse or even slow the process of aging is definitely and extraordinary claim, and there is no extraordinary evidence here. I’m sure that many of the highly qualified scientists associated with Elysium believe in this product, but they haven’t proved anything yet. My bet is that these types of NAD supplements will be consigned to the bargain basement bin of anti-aging dietary supplements that a few people swear by but never panned out scientifically. Things like DHEA, melatonin, CoQ10, green tea extract, and our friend resveratrol fit in this category already. I really hope I’m wrong about this, but slowing the aging process is a tall order.

What Elysium (the company, not the dystopian SciFi flick) has done, which may be unique among supplement companies, is back their product with a slick ad campaign designed to make consumers think that this product is based on cutting edge science. In some ways it is, but they haven’t used their science to prove that their product works. With that said, if you have the money, there is probably no harm in trying Basis. If you don’t have the money and still want to try it, go with generic niacin and resveratol instead – this will be way cheaper and will give the same biological effect, if there is one.