Question explored with the scientific record
Conversation so far
- 1 Nattokinase for IPF
- 2 Taking Zinc (30mg) with NR for IPF
- 3 Zinc with Nicotinamide riboside
Answered on this page ↓
Zinc with Nicotinamide riboside
The short version: the evidence for zinc plus nicotinamide riboside in IPF is indirect and thin, with no human trial testing the combination in this disease.
None of the retrieved records test zinc plus nicotinamide riboside in IPF patients. The closest is a 2025 mouse study of heart failure where a supplement combining nicotinamide riboside with folate and B12 improved survival and exercise capacity, with sex-specific differences [1]. That is a different organ, a different disease, and a different combination. A 2024 human trial of nicotinamide riboside alone in peripheral artery disease found a modest improvement in 6-minute walk distance at 3 months (22.4 meters, p=0.029) that faded by 6 months (17.6 meters, p=0.08) [2]. The same trial reported diarrhea in 39% of the NR group and nausea in 14% [2]. Neither study involved zinc or IPF.
Zinc at 30 mg daily is within the tolerable upper intake level for adults (40 mg/day), but chronic use can cause copper deficiency. In IPF, where fibrosis is driven by TGF-β, zinc's role is ambiguous: it is an essential cofactor for antioxidant enzymes, but excess zinc can also activate profibrotic pathways. No study here tests that balance in IPF.
The mechanistic evidence for nicotinamide riboside is limited to cell studies. A 2026 paper found that NR suppresses inflammatory cytokine production in skin cells by blocking the p38 MAPK pathway [3]. That is a plausible anti-inflammatory mechanism, but it was demonstrated in keratinocytes, not lung fibroblasts, and at concentrations that may not be reached in human lung tissue after oral dosing.
| Outcome | NR alone (PAD trial) | Placebo | Difference |
|---|---|---|---|
| 6-min walk change at 3 months | +22.4 m | baseline | +22.4 m (p=0.029) |
| 6-min walk change at 6 months | +17.6 m | baseline | +17.6 m (p=0.08) |
| Diarrhea | 39.3% | 27.6% | +11.7% |
| Nausea/vomiting | 14.3% | 24.1% | -9.8% |
The evidence does not support the combination. The known risks are gastrointestinal side effects from NR and potential copper depletion from chronic zinc. The potential benefit is speculative, based on a mouse heart failure model and a cell study of skin inflammation.
My call: the combination is untested in IPF, the mechanistic rationale is weak, and the human data for NR alone shows a modest, possibly transient benefit in a different disease. Confidence: low.
Sources used 3
-
Sex-specific benefits of a combined supplementation of B vitamins, nicotinamide riboside, folate and cobalamin, in a murine model of heart failure
In a murine model of established heart failure induced by transverse aortic constriction, a diet supplement combining nicotinamide riboside (NR), folate and B12 (3VitB) improved survival and exercise capacity, preserved cardiac energy metabolism and mitochondrial function with s…
DOI: 10.1186/s13293-025-00764-x -
Nicotinamide riboside for peripheral artery disease: the NICE randomized clinical trial
Nicotinamide riboside (NR) improved 6-minute walk distance in peripheral artery disease after 6 months, NR alone showed a clinically meaningful benefit while NR with resveratrol did not add further improvement, warranting confirmation in a larger trial.
DOI: 10.1038/s41467-024-49092-5 -
Nicotinamide mononucleotide and nicotinamide riboside attenuate cytokine production in human keratinocytes via suppression of p38 Pathway
NMN and NR suppress TNF-α/IFN-γ-induced inflammatory cytokine and chemokine expression in HaCaT keratinocytes and inhibit p38 MAPK phosphorylation without altering AKT, ERK, JNK, or NF-κB signaling, suggesting potential for atopic dermatitis treatment.
DOI: 10.1007/s11033-026-11615-2