What evidence is there for treatment with nicotinamide adenine dinucleotide (NADH) for chronic fati

Fråga: What evidence is there for treatment with nicotinamide adenine dinucleotide (NADH) for chronic fatigue syndrome?

A woman wants NADH prescribed from her general practioner as she finds that intake of NADH has improved her fatigue.

Sammanfattning: There is no evidence to recommend treatment with NADH for chronic fatigue syndrome.

Svar: NADH is a coenzyme, involved in ATP generation in the electron transport chain (1). NAD and NADP has been measured in blood in a recent study (2). Two studies were found concerning treatment of chronic fatigue syndrome with NADH (3,4). 26 patients with chronic fatigue syndrome were treated with 10 mg NADH per oral (4 weeks) and placebo (4 weeks) in a randomized, double-blind cross-over study (3). Following a 4-week washout period, subjects were crossed to the alternate regimen. A 10 % improvement was seen in an unvalidated symptom score for 31 % of the patients on NADH compared with 8 % on placebo. No changes were seen in a large number of laboratory analyses (e.g. blood count, immunoglobulin concentrations, 20 different serum analyses, urine analyses) nor in physical assessment. No severe adverse effects were observed. In this study, there are several methodological problems including few patients, a non-validated symptom score and a short period of follow-up.

In the other study, 31 patients were initially included and the period of follow-up was 1-2 years (4). The patients were randomized to NADH, initially 5 mg and increased to 10 mg if symptoms did not improve, or nutritional supplements and psychological therapy for 2 years. An improvement on the symptom score was seen for the first three months compared with baseline data for the patients who received NADH. Thereafter, there was no difference in comparison with the control group. No severe adverse effects were reported. The study was small, the symptom score was not validated and loss to follow-up was large (11 patients). Champe PC, Harvey RA. Lippincott´s Illustrated Reviews: biochemistry. JB Lippincott Company, Philadelphia. Fukuwatari T, Shibata K. Consideration of diurnal variations in human blood NAD and NADP concentrations. J Nutr Sci Vitaminol (Tokyo) 2009;55(3):279-281 Forsyth LM, Preuss HG, MacDowell AL, Chiazze L, Jr., Birkmayer GD, Bellanti JA. Therapeutic effects of oral NADH on the symptoms of patients with chronic fatigue syndrome. Ann Allergy Asthma Immunol 1999;82(2):185-191 Santaella ML, Font I, Disdier OM. Comparison of oral nicotinamide adenine dinucleotide (NADH) versus conventional therapy for chronic fatigue syndrome. P R Health Sci J 2004;23(2):89-93