In the past few years, I have noticed more and more patients asking about NAD+. Sometimes it comes up because a friend had an infusion and felt great afterward. Other times it is from a podcast or a book about longevity. The question usually lands the same way. “Is this something I should be doing right now?”
I like when people ask this question. It tells me they are curious, paying attention, and wanting to understand the science rather than just following a trend. NAD+ itself is not new. We have known about it for decades. What is new is that patients are beginning to connect it to the everyday things they notice in their own bodies such as fatigue, focus, recovery, and the way aging feels from the inside.
What is NAD+ and Why Does it Matter for Energy
Every cell relies on NAD+. Without it, energy production slows down. Patients often describe this as dragging in the afternoon, having a harder time concentrating, or needing more recovery time after a long week.
At a cellular level, the mitochondria are part of that story. They are the tiny engines inside cells that make energy from the food we eat. NAD+ is one of the molecules they depend on. When it is low, those engines cannot keep up and the slowdown shows up as fatigue or fog.
NAD+ is also connected to repair. It helps protect DNA, supports enzymes that calm inflammation, and even influences the natural rhythm of sleep and wake. These are not things you can sense in the moment, but you notice when they are off.
Levels of NAD+ drop with age. By the time we reach midlife, they are much lower than they were in our twenties. That quiet decline often shows up in ways patients describe every day such as less energy, slower repair, and a general sense of resilience that is not what it used to be.
How NAD+ Came Back Into the Conversation
For decades NAD+ stayed mostly in the world of research. It was a molecule biochemists talked about, not something patients asked about. That shifted around 2018.
A new wave of interest in longevity science reached the public. Researchers including Dr. David Sinclair at Harvard published work showing how NAD+ is tied to sirtuins, enzymes that influence aging, repair, and stress response. Books, interviews, and podcasts began to highlight it. Suddenly NAD+ was not just a lab term. It was part of conversations about healthspan, energy, and living well longer.
From there, it spread quickly. IV clinics started advertising NAD+ drips. Supplement companies began offering NAD+ precursors. And patients began walking into practices like mine wondering if this was something that might help them feel better.
The Top 5 NAD+ Delivery Methods
There is not one single way to raise NAD+ levels. Some approaches provide precursors, which is raw material the body can use to make NAD+. Others deliver NAD+ more directly. Each method has strengths and drawbacks.
1. Oral Precursors
Two of the most common are NMN, which is nicotinamide mononucleotide, and NR, which is nicotinamide riboside. These give your body the building blocks it needs to make NAD+.
They are convenient and well studied. The effects tend to be gradual rather than immediate, which makes sense given how the body uses them. Quality matters, so I always remind patients to choose carefully and look for third-party tested, regulated products.
2. Subcutaneous Injection
This is a small injection just under the skin given daily or a few times per week.
It provides more immediate support than oral options and avoids the digestive tract. It does require medical oversight and comfort with injections so it is not for everyone.
3. Nasal Spray
NAD+ can also be absorbed through the mucous membranes in the nose.
This is easy, fast acting, and something patients sometimes use when they need extra focus. Research is still limited, so sourcing and safety are especially important here.
4. Skin Patch
A patch applied to the skin releases NAD+ slowly over several hours.
It can help maintain steady levels through the day. The drawback is needing to wear the patch which not everyone finds practical.
5. IV Infusion
An infusion delivers NAD+ into the bloodstream over the course of a few hours.
It bypasses digestion and allows higher amounts but it must be given slowly. That makes it time consuming and sometimes uncomfortable. Much of what is infused is cleared quickly by the body. It is also one of the more expensive options, which is why I use it sparingly in practice.
NAD+ Benefits Patients Often Notice
NAD+ is not a stimulant. It does not work like caffeine or sugar. But when it is supported in the right way, patients often describe some common shifts.
- More consistent energy throughout the day
- Less of a mid-afternoon slump
- Clearer mental focus
- A sense of greater resilience
For some it is subtle. For others it feels like the piece they were missing.
The Cancer Question
Because NAD+ supports cell growth and repair, patients sometimes ask if that could also mean it supports cancer cells. It is a fair question.
Both healthy and unhealthy cells rely on NAD+. But what drives cancer more strongly are things like DNA damage and chronic inflammation. NAD+ actually helps protect against both.
The research we have now suggests that restoring NAD+ to normal levels is supportive, not harmful. Still, if someone is in active cancer treatment, I recommend talking with their oncology team before starting NAD+ in any form.
How I Approach NAD+ in Practice
In my practice, I see NAD+ as one option, not the first step. We always begin with the basics such as sleep, food, movement, and stress. Those protect NAD+ naturally. Without them, no supplement or infusion will make much difference.
Once those foundations are in place, NAD+ can be worth considering. Some patients do well with oral precursors. Others respond better to nasal spray or small injections. I recommend IV infusions for very specific cases.
No matter the method, safety matters. The supplement market is crowded and not always well regulated. Guidance from a clinician helps ensure the product is safe and appropriate.
Is NAD+ Right for You?
NAD+ has been part of human biology all along. What has changed is our awareness of it. Patients now ask about it because they want steadier energy, sharper focus, and a better path to aging well.
I do not see NAD+ as a trend. I see it as a molecule that helps explain why energy and repair feel different over time and as a tool we can use thoughtfully to support those processes. For some patients, it makes a noticeable difference. For others, it is one piece of a larger plan.
The key is context. When the basics are steady, NAD+ can add a quiet layer of support in the background of daily life. Sometimes that extra support is what helps patients feel more like themselves again.
