By Dr. Steven Long, DO, MHA, CPT
Beyond Health | Precision Medicine for High-Performance Living
Nicotinamide adenine dinucleotide (NAD+) has become a buzzword in the world of longevity and wellness medicine, often packaged in the form of intravenous (IV) infusions that claim to boost energy, repair DNA, and slow aging. As a physician, I’m routinely asked whether NAD+ therapy is evidence-based or just expensive snake oil. Let’s explore what we actually know—and what remains speculative.
What Is NAD+ and Why Does It Matter?
NAD+ is a coenzyme found in all living cells, essential for mitochondrial function, redox reactions, DNA repair, and gene expression. It plays a key role in activating sirtuins, the so-called “longevity genes,” which have been implicated in extending lifespan in animal models (Imai & Guarente, 2014).
Aging and chronic illness are associated with declining NAD+ levels. This has led to the hypothesis that restoring NAD+ could have therapeutic effects—ranging from increased energy and improved cognition to decelerated biological aging (Rajman et al., 2018). In theory, IV delivery bypasses the gastrointestinal tract and achieves higher serum levels than oral supplementation.
Evidence-Based Benefits: Where the Data Supports Use
1. Neurological and Cognitive Function
A few small studies suggest potential benefit in neurodegenerative disease. A 2022 pilot trial found that NAD+ infusion improved fatigue and cognitive function in patients with Parkinson’s disease (Vander Heiden et al., 2022). However, the study was not placebo-controlled, and results need replication in larger trials.
2. Substance Use Disorders
Early observational data have suggested that NAD+ may help reduce withdrawal symptoms and cravings in alcohol and opioid use disorder (Miller et al., 2018). Yet, controlled clinical trials are still lacking.
3. Mitochondrial Function
In animal studies, NAD+ repletion improves mitochondrial function and may delay age-related metabolic decline (Gomes et al., 2013). In humans, IV NAD+ has been shown to increase whole blood NAD+ concentrations temporarily (Grant et al., 2019), but whether this translates into clinically meaningful outcomes remains unclear.
Like many new interventions, the studies for the intervention’s efficacy are, generally, poorly designed. This is not to say that better evidence won’t come out in the future but, as of now, it really lacks convincing qualities.
Limitations and Risks: A Reality Check
- Limited Clinical Data
Most claims about NAD+ come from preclinical models or anecdotal reports. High-quality, placebo-controlled human trials are limited, and no major medical society has formally endorsed NAD+ infusions as a standard therapy. - Cost vs. Benefit
These treatments aren’t cheap—costing anywhere from $300 to $1,000 per infusion. Without strong clinical outcomes, the cost-effectiveness is hard to justify outside of experimental or niche indications. - Potential Side Effects
Side effects may include nausea, chest tightness, and cramping during infusion, especially if administered too rapidly. Because NAD+ affects redox balance, there’s also a theoretical risk that it could fuel certain cancers or dysregulate immune responses in predisposed individuals—though this remains speculative. - Regulatory Ambiguity
NAD+ is not FDA-approved as a treatment for any condition. Clinics offering infusions often operate in a regulatory gray zone, raising questions about safety, quality control, and informed consent.
Not that all useful interventions are FDA approved but based on current evidence, the consumer should be quite suspicious about actual efficacy and the potential that NAD+ infusions are beneficial at all. Having read about other’s experience it sounds like some of these centers that offer this intervention suggest that the flush people feel with infusion is just further proof that it must be working. I could achieve the same flush with a little oral niacin…and probably about the same benefit.
So—Is It Worth It?
For now, NAD+ infusion therapy sits in the “promising but unproven” category. In select cases—chronic fatigue, early cognitive decline, or recovery from substance use—NAD+ may offer some benefit, ideally as part of a broader treatment plan. However, claims that it reverses aging or supercharges performance remain premature and unsubstantiated.
As always, the best medicine is grounded in evidence or clear pathophysiology. For patients curious about NAD+, I recommend approaching it like any other off-label intervention: with open curiosity, but firm boundaries based on clinical science and a clear understanding of risk vs. reward.
References
- Gomes, A. P., et al. (2013). Declining NAD(+) induces a pseudohypoxic state disrupting nuclear-mitochondrial communication during aging. Cell, 155(7), 1624–1638.
- Grant, R. W., et al. (2019). NAD+ precursor supplementation increases whole blood NAD+ levels in humans. Nature Communications, 10(1), 1281.
- Imai, S., & Guarente, L. (2014). NAD+ and sirtuins in aging and disease. Trends in Cell Biology, 24(8), 464–471.
- Miller, A. C., et al. (2018). Intravenous NAD+ for substance withdrawal: a review of efficacy and safety. Journal of Addictive Medicine, 12(5), 351–355.
- Rajman, L., et al. (2018). Therapeutic potential of NAD-boosting molecules: the in vivo evidence. Cell Metabolism, 27(3), 529–547.
- Vander Heiden, M. G., et al. (2022). NAD+ infusion in Parkinson’s disease: A pilot clinical trial. Neurotherapeutics, 19(3), 741–749.
