NAD+ Therapy: Quick Facts
What This Guide Covers
NAD+ (nicotinamide adenine dinucleotide) is a molecule that exists in every cell of your body and plays a crucial role in energy production and cellular repair. As we age, NAD+ levels decline—and an entire industry has emerged around boosting them. But does it actually work?
What Is NAD+ and Why Does It Matter?
NAD+ is a coenzyme found in all living cells. It's essential for:
- Energy metabolism: Helps convert nutrients into cellular energy (ATP)
- DNA repair: Activates enzymes (sirtuins, PARPs) that repair damaged DNA
- Cellular signaling: Regulates circadian rhythm and stress responses
- Mitochondrial function: Maintains the "powerhouses" of your cells
The Decline with Age
Here's what got longevity researchers excited: NAD+ levels appear to decline by approximately 50% between ages 40 and 60 in some tissues. This decline correlates with many age-related conditions—leading to the hypothesis that restoring NAD+ might slow aspects of aging.
Important distinction: Correlation is not causation. NAD+ declining with age doesn't prove that boosting it will reverse aging effects. That's the hypothesis being tested, not a proven fact.
The Science: What We Know (and Don't)
Strong Evidence (Animal Studies)
In mice and other animal models, boosting NAD+ has shown impressive results:
- Improved mitochondrial function
- Enhanced muscle endurance and strength
- Better insulin sensitivity
- Extended lifespan in some models
- Improved cognitive function in older mice
These results drove much of the excitement around NAD+ therapy. However...
Weaker Evidence (Human Studies)
Human trials have been more modest:
- NR supplementation: Safely increases blood NAD+ levels (proven)
- NMN supplementation: Also raises NAD+ levels (proven)
- Functional benefits: Mixed results, mostly small or no effects
- Lifespan extension: No human data (would take decades)
Key Human Studies to Know
- NR in overweight adults (2018): 1,000mg/day for 6 weeks raised NAD+ by 60%, but no measurable effect on metabolism, body composition, or blood pressure.
- NMN in older adults (2022): 250mg/day for 12 weeks showed modest improvement in walking speed in some participants.
- IV NAD+: Very limited published data. Most "evidence" is anecdotal or from uncontrolled clinic observations.
The Honest Summary
NAD+ precursor supplements (NR, NMN) can effectively raise NAD+ levels in humans. What's unclear is whether higher NAD+ levels translate to meaningful health benefits. The impressive mouse results haven't consistently replicated in humans—at least not yet.
IV vs Oral: Delivery Methods Compared
IV NAD+ Infusions
IV infusions deliver NAD+ directly into your bloodstream:
- Duration: 2-4 hours per session (sometimes longer)
- Dose: Typically 250-1,000mg per infusion
- Frequency: Often 2-4 sessions initially, then monthly maintenance
- Side effects: Nausea, flushing, chest tightness during infusion (common)
Controversial point: Some researchers argue that IV NAD+ is rapidly metabolized and may not actually reach cells more effectively than oral precursors. The premium price may not reflect superior bioavailability.
Oral Supplements (NR & NMN)
Rather than taking NAD+ directly (which is poorly absorbed), oral supplements use precursors:
| Precursor | Full Name | Notes |
|---|---|---|
| NR | Nicotinamide Riboside | Most studied, FDA GRAS status, Tru Niagen brand |
| NMN | Nicotinamide Mononucleotide | Popular in longevity community, more variable quality |
| Niacin | Vitamin B3 | Cheapest option, but causes flushing and may have limits |
Which Is Better?
There's no clear evidence that IV NAD+ produces better outcomes than oral precursors. The research on oral NR/NMN is actually more robust than IV NAD+ research. The main argument for IV is faster acute effects (you may feel something immediately)—but lasting benefits are unproven either way.
Real Costs Breakdown
IV NAD+ Infusions
| Dose | Price Range | Duration |
|---|---|---|
| 250mg | $250 - $500 | 1-2 hours |
| 500mg | $500 - $900 | 2-3 hours |
| 1,000mg | $800 - $1,500 | 3-4 hours |
| Luxury/concierge | $1,500 - $2,500+ | Home service premium |
Typical protocol cost: A "loading phase" of 4 infusions ($2,000-6,000) plus monthly maintenance ($500-1,500/month) = $8,000-24,000/year.
Oral Supplements
| Product | Monthly Cost | Daily Dose |
|---|---|---|
| Tru Niagen (NR) | $40-50 | 300mg |
| Generic NMN | $40-80 | 500-1,000mg |
| Premium NMN (liposomal) | $100-150 | 500mg |
Annual oral cost: $480-1,800/year—a fraction of IV therapy.
Common Claims vs Evidence
"NAD+ reverses aging"
Reality: No human evidence for this. Animal studies are promising but don't translate directly.
"NAD+ boosts energy dramatically"
Reality: Many people report feeling more energetic, but placebo-controlled trials haven't shown consistent energy improvements.
"NAD+ helps with addiction/withdrawal"
Reality: Some clinics specialize in this. Evidence is limited to case reports; no randomized trials.
"NAD+ supplements raise NAD+ levels"
Reality: This is actually proven. NR and NMN do increase blood NAD+ levels in humans.
"Higher NAD+ improves health outcomes"
Reality: The key unanswered question. We can raise levels, but benefit evidence is mixed.
Who Uses NAD+ Therapy?
NAD+ therapy has found several distinct user groups:
- Longevity enthusiasts: Willing to try unproven interventions based on biological plausibility
- Biohackers: Experimenting with various interventions, tracking with labs
- Executives/high performers: Seeking any edge, often through concierge medicine
- Addiction recovery: Some use IV NAD+ as part of detox protocols
- Chronic fatigue sufferers: Trying various treatments for persistent fatigue
Our Honest Assessment
The Balanced View
NAD+ is genuinely important for cellular function, and levels do decline with age. The science is real and interesting. However, the marketing has far outpaced the evidence.
If you're considering NAD+ therapy:
- Start with oral supplements (NR or NMN) rather than expensive IV infusions—similar evidence base, fraction of the cost
- Don't expect dramatic results; most human trials show modest or no measurable effects
- Prioritize proven health interventions first: exercise, sleep, nutrition
- If you try it, consider it an experiment, not a proven treatment
When NAD+ Therapy Might Make Sense
- You've already optimized the basics (sleep, exercise, nutrition, stress)
- You understand you're experimenting with uncertain benefits
- You can afford it without financial strain
- You're working with a knowledgeable practitioner who tracks outcomes
When to Skip It
- You're expecting dramatic, proven results
- The cost would cause financial stress
- You haven't addressed basic health factors first
- You're using it instead of seeking care for a real medical condition
Exploring Longevity Options?
Learn about other evidence-based and experimental longevity interventions.
Longevity HubImportant Disclaimer
NAD+ therapy (IV or oral) is not FDA-approved for any medical condition. The anti-aging and longevity claims made by many providers are not supported by rigorous human clinical trials. This information is educational only and should not be considered medical advice.
Consult with a healthcare provider before starting any supplement regimen, especially if you have existing health conditions or take medications.
Sources & References
- • Elhassan et al. (2019). "Nicotinamide Riboside Augments the Aged Human Skeletal Muscle NAD+ Metabolome" - Cell Reports
- • Yoshino et al. (2021). "Nicotinamide mononucleotide increases muscle insulin sensitivity in prediabetic women" - Science
- • Martens et al. (2018). "Chronic nicotinamide riboside supplementation is well-tolerated and elevates NAD+ in healthy middle-aged and older adults" - Nature Communications
- • Covarrubias et al. (2021). "NAD+ metabolism and its roles in cellular processes during ageing" - Nature Reviews Molecular Cell Biology