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For instance, when intra-portal insulin levels are increased [e.g., obesity, Cushings syndrome or due to treatment with glucocorticoids and glucagon-like peptide-1 receptor agonists (GLP-1RA)] or decreased (e.g., anorexia nervosa and T1D) in disease states, these secondary changes (secondary association) alters hepatic GH sensitivity resulting in discordant GH and IGF-I levels (high GH/low IGF-I levels and low GH/high IGF-I levels, respectively)
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Importantly, supplementation can **increase** measurable NAD+ metabolism: in a 2018 randomized, placebo-controlled crossover trial published in Nature Communications by Martens and colleagues at the University of Colorado Boulder (24 healthy middle-aged and older adults), 1,000 mg/day of the NAD+ precursor nicotinamide riboside (500 mg, twice daily) elevated NAD+ in blood cells by roughly 60% versus placebo over 6 weeks, with no serious adverse events reported
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