It’s not often that you hear Harvard-trained doctors, wellness girlies, elite athletes, Joe Rogan, and Hailey Bieber all agree on something. But right now, the word on everyone’s lips is NAD+. Nicotinamide adenine dinucleotide, aka NAD+, seems to be everywhere you look — you’ll find it in doctor’s offices, health food stores, and the beauty aisle as it’s incorporated into a wealth of treatments that claim to do everything from help you sleep better, give you more energy, make your skin glow, and even make your body act younger. From IVs and injections to intranasal sprays and even eye creams, NAD+ and its precursors NR (nicotinamide riboside) and NMN (nicotinamide mononucleotide) are, if you believe the hype, the closest thing one might have to a fountain of youth. Move over anti-aging, longevity is the new name of the game.
“NAD+ is a coenzyme that is found in every living cell,” explains Mona Rosene, MS, RD, global director of scientific affairs at Tru Niagen & Niagen Plus, which produces NAD+ supplements and IVs. It’s found in every cell, from your brain to your muscles to your skin, explains Rosene, acting as the engine oil that fuels the cells. “The two primary functions of NAD+ are to create ATP, which is energy,” says Rosene. “It’s the energy the cells use for everything from digesting food to movement to all the voluntary, involuntary activities that our body does. The other function of NAD+ is cellular defense and repair.” She uses the skin as an example, noting that when we are exposed to metabolic stressors, such as when we get a sunburn and trigger an inflammatory reaction, NAD+ repairs that damaged tissue. “As NAD+ is being consumed by proteins called sirtuins, then the pool of NAD+ drops,” says Rosene. “And if it drops a significant amount, then it has suboptimal function for creating ATP and also for cellular defense repair. That’s why you always need to have an input of NAD+ as well as an output, because it’s a continuum — it’s always being consumed and produced.”
As Leonard Guarente, PhD, Novartis Professor of Biology at MIT and cofounder of Elysium Health, explains, those sirtuin proteins are crucial to helping the body slow down the aging process and NAD+ is the fuel they need to continue to function at optimal levels — however those NAD+ levels will naturally decrease as we age. “As you get older, NAD+ levels start to fall. And so you’ll not only be compromised with respect to producing energy in cells, but you’ll also lose the benefits of these sirtuin proteins to restrain the aging process,” he says. Studies have shown that NAD+ levels decline by up to 50% between ages 40 and 60, leading many scientists to focus on how to replenish those NAD+ levels so that the cells continue to have that fuel to create energy and provide the necessary cellular defense. “If you can replenish that lost NAD+, then you will reverse those effects and restore the ability to produce energy and restore the ability to restrain aging via these sirtuins,” says Guarente. Cue the soft, sweet music of a thousand wellness clinics suddenly getting their NAD+ wings.
Different Types Of NAD+, Defined
From IV clinics to doctor’s offices, NAD+ is on the menu everywhere you turn. But, not everyone agrees on the best method of delivery or even on what should be in the treatments. For some, the preferred option is NAD+ itself. “IV wise, it’s best using the active form of NAD+,” says Jason Phan, MD, founder of LIVV Natural Health, a naturopathic med clinic and holistic wellness center in San Diego. “For absorption, the NAD+ IV is vastly better than most of the precursors. If you’re using precursors, it’s got to get into the stomach and then assimilate into the blood. So you lose a lot of absorption there. With precursors you also need coenzymes and vitamins to make sure that they can turn into NAD+ — zinc, selenium, vitamin E. There’s different vitamins that will help NAD+ actually be produced.” Phan starts most patients off with a 50 milligram drip, eventually moving them up to 100 milligrams, however there are some that can go as high as 200 milligrams and even 400 milligrams. However, side effects for those IVs can be intense due to the bacteria used in the IVs to keep the NAD+ stable. Rosene notes that some have reported side effects including nausea, vomiting, diarrhea, stomach cramping, skin flushing, and headache.
This is one of many reasons that some believe that NAD+ precursors — that is, one of the five dietary molecules that the body uses to synthesize NAD+, like NR and NMN — are both better tolerated and more effective ways to get your NAD+ treatments. “Simple logic would say NAD+ is going to be better than the precursors, because it is the real deal,” says Guarente. “And the precursors have to be made into NAD+ inside ourselves. But the problem is that NAD+ does not get into cells for two reasons: One is that it’s too big [of a molecule] and two is that it’s charged and there’s no transporter for getting NAD+ into cells.” Rosene is also on team precursor, noting that an NR IV like the patented version that Niagen Plus offers has much less intense side effects and are generally better tolerated by patients. “The side effects on Niagen Plus NR IV were very minimal — some tingling in the jaw,” notes Rosene. “We have noticed some women, right around their cycle, had more pain and we don’t know why. Hopefully we can get some more data on that.” In a recent randomized, placebo-controlled study funded by the brand, the NR IV was found to have a 75% shorter infusion time than an NAD+ IV, as well as better tolerability and increased peak NAD+ levels by 20.7% after three hours — outperforming both an NAD+ IV and NR supplements. Rosene does note that there is very limited data on NAD+ IVs but that anecdotally, “People love it if they can get through the side effects.” That’s not to say NAD+ IV’s are completely dubious — as she points out, NAD+ IVs have been used since the ‘60s in patients battling alcohol and drug addiction, although again, clinical studies are limited and more research is needed to truly know the difference in benefits of NAD+ versus precursors like NR and NMN.
The Most Effective NAD+ Treatments
It’s not just the type of NAD+ that doctors disagree on — with so many applications available, there’s also not a true consensus on the best way to get your NAD+ fix. While IVs might be the hot topic with celebrities, they aren’t the only option. You can’t throw a rock without hitting a patch, subcutaneous injection, intranasal spray, supplement, or topical cream boasting NAD+, NR, and NMN as its star ingredient. “I always say, if you have accessibility to the IVs, get the IVs first and then subcutaneous injections next, then it’s going to be the patches, then it’s going to be the oral supplements,” says Phan. For the average person, an NAD+ IV would be in the 100 to 400 milligram range once a month. Depending on the dosage, they can take anywhere from two hours to four hours and the price can range from $500 to $2,000 per treatment. According to Jamie Gabel, PA-C, MS, director for Advitam at the Shafer Clinic in New York City, if someone attempts to do too high of a dosage too fast, they can experience some unpleasant side effects like a racing heart, simply because they are feeding the body pure cellular fuel. “You are essentially feeding every cell in your body energy, or what it needs to ramp up energy. So sometimes people can feel a little pressure in the chest, and nobody ever wants to feel that. It’s scary,” he says.
Phan notes that injections can range from $100 a shot to $500 to $1,000 for buying the vial and can be administered in a clinical setting or by the patient at home. Intranasal sprays, patches, and ingestibles range in prices, but offer patients a cheaper and more convenient way to supplement NAD+ at home, although all but Guarente believe that IVs are the most efficacious delivery method for NAD+ and its precursors. For Guarente and Elysium Health, the focus is on NR and NMN supplements via the brand’s Basis and Signal products. “I favor oral administration over IV because there have been more studies on oral administration,” he says. “You want to place your bet on where you know the data points, and oral administration works. So, why put yourself through the torture of regular IV infusions? You don’t need to and it may well turn out to be worse in terms of efficacy.”
One thing all of TZR’s sources did agree on was that they were extremely skeptical of the influx of topical beauty products boasting NAD+ and NAD+ precursors. While a handful of brands have jumped on the trend and begun to market products featuring NMN, NR, and even, allegedly NAD+, the consensus is these products are highly unlikely to be able to boost NAD+ levels through a topical application for a variety of reasons. “If it doesn’t get into cells, all you’re doing with topicals is you’re giving [NAD+] yet another barrier,” says Guarente. “So now it has to get through the skin and then get into cells to work.” There’s also concern that the ingredients used, from water to the preservatives to keep a product shelf stable, can degrade the efficacy of the NAD+ and its precursors, making it even less likely to penetrate the skin barrier and get to living cells that will benefit from the energy that they provide.
That’s not to say NAD+ isn’t helpful for the skin — there’s a reason that one of the most prominent plastic surgeons in NYC added an NAD+ expert to his practice, after all. “I decided to integrate Advitam Health into Shafer Clinic in order to offer a comprehensive approach to patients who are looking to have a one-stop shop for all things beauty, wellness, aesthetic surgery, metabolic optimization, and recovery,” explains David Shafer, MD, FACS. “It’s important for patients to have access to tools for their overall health and well-being, all under one roof. Advitam Health’s individualized programs are a key part of patient recovery and the healing process. NAD+ therapy, as well as our recovery IVs and other metabolic and cellular treatments, can help patients experience faster healing and improved outcomes post-op. It can help repair damaged cells, reduce inflammation and pain that is caused by tissue damage and scarring, improve overall cellular health, and promote muscle strength. These are amazing benefits for those who want to minimize healing time, pain, and scarring.” Not to mention the “NAD+ glow” that patients report after their IV treatments or after regular usage of NAD+ or NR and NMN supplements.
If your first thought is to jump on TikTok and start an NAD+maxxing trend, cool your jets. While it might sound like you want to get as much NAD+ as you can and, as Hailey Bieber excitedly exclaimed on Keeping Up With The Kardashians, “I’m going to do NAD+ for the rest of my life, and I’m never going to age,” you might want to slow your roll before you hook yourself up to an NAD+ IV every week while slapping on an NAD+ patch and choking down a handful of NR pills. “More is definitely not better with NAD+,” cautions Gabel. “If somebody came to me, even a healthy individual, and was like, ‘I want to do an NAD+ IV drip weekly,’ I don’t think we know enough about that study in that capacity to say it’s good, not negative, or even safe.”
Not to mention there is the very real possibility of an NAD+ overload. “NAD+ cycles between the oxidized state, which is NAD+, and this reduced state, which is NADH,” continues Gabel. “It’s basically a transfer of electrons back and forth during something that we call a Krebs cycle, which is to generate energy. If we’re just loading someone up with too much NAD+, it becomes an imbalance in the ratio.” He notes that while the body does a miraculous job of keeping the NAD+ and NADH ratio balanced, if someone has a process that you don’t want to feed cellular energy to, like cancer, supplementing with NAD+ or NAD+ precursors could potentially accelerate those disease processes. “So it’s important that a practitioner understands that,” says Gabel. “In a medicine-based clinic like ours, if somebody is going to walk in for an NAD+ drip, we do a screening with them. We’ll do their vital signs and find out what their reasoning or goals are.” He notes that not all IV clinics are capable of this level of screening.
The Bottom Line
The last few years has seen a flurry of regulatory activity around NAD+ and its precursors. The FDA briefly took NMN off the market in 2022 so it could study it as a potential drug, however a lawsuit filed by the National Products Association (NPA) was granted a stay in November of 2024, allowing NMN to be sold as a supplement again while the FDA reviews the NPA’s citizen’s petition, with a deadline of July 31, 2025. The banning and unbanning by the FDA created confusion for manufacturers and consumers, but for now, NMN is still legal as a supplement in the U.S. The FDA also released a warning this year to compounders of NAD+ IVs reminding them that food-grade NAD+ should not be used to make sterile drugs without appropriate processing. So, if you were under the impression that just because something looked medical automatically meant it was safe and FDA-approved, sorry to burst that misguided bubble.
When it comes to NAD+, our experts caution anyone looking to dive into the craze to first talk to their doctor before starting any sort of treatment. While it might sound like a miracle wellness treatment, not everyone is a good candidate for NAD+ and there is such a thing as too much of a good thing. Do your research on the clinic, practitioner, and brand to ensure no shortcuts are being taken and your health and safety are the number one priority.