NAD+: what is it, how is it taken, and what the research says...

What NAD+ is

Nicotinamide adenine dinucleotide, usually written NAD+, is a coenzyme present in every living cell. It shuttles electrons through the reactions that turn food into a usable form for cellular processes, and it is consumed by several families of enzymes, including the sirtuins and the PARPs, that are involved in DNA repair, cell signalling and the regulation of the body clock. NAD+ exists in two forms, NAD+ and NADH, which cycle between each other as metabolism runs. The body makes NAD+ from precursors in the diet, including niacin and tryptophan, and recycles it continuously.

Why levels change

Studies in animals and in human tissue samples have reported that NAD+ levels fall with age, and that they are lower in people under sustained metabolic stress. The proposed reasons include increased consumption by repair enzymes, reduced synthesis, and inflammation. It is this observation that drives the interest in raising NAD+ levels, and it is important to be clear about the limit of what is known: a lower level has been measured, and raising it is being studied, but the clinical consequences of doing so in healthy adults are not yet established.

What the research has examined

Energy metabolism

NAD+ is central to mitochondrial function, and animal studies have examined whether raising NAD+ changes mitochondrial output. Human trials to date are small and mostly use oral precursors rather than NAD+ itself.

DNA repair

The PARP enzymes that repair DNA consume NAD+. Research has examined whether NAD+ availability limits repair capacity, particularly in older tissue.

Ageing biology

The sirtuins, which require NAD+ to function, are studied in longevity research. This is the most discussed and the least settled area; findings in model organisms have not been reproduced as clinical outcomes in people.

Circadian rhythm and sleep

NAD+ levels oscillate with the body clock, and the relationship between NAD+ and sleep regulation has been examined in laboratory studies.

Neurology

NAD+ has been studied in the context of brain ageing and in some neurological conditions. This is research-stage work and is not a basis for treatment claims.

In every one of these areas the honest summary is the same: there is a plausible mechanism, there is laboratory evidence, and there is limited human outcome data. A good physician will say so.

The three routes

Intravenous

NAD+ given by infusion at a licensed clinic. It delivers the largest dose in one session and is administered by clinical staff. Sessions take time, commonly one to several hours depending on dose and rate, because faster infusion is associated with nausea and flushing. In the UAE an IV requires a documented medical indication from the physician.

Subcutaneous injection

A compounded NAD+ solution in a vial or pen, self-administered at home after training. The physician determines the amount and frequency for each person. This is a compounded prescription product.

Intranasal spray

A compounded NAD+ spray used according to the prescription. Physicians may describe it as a maintenance route or an adjunct, and absorption by this route is less studied than by injection.

How physicians structure a protocol

Protocols may be described in two phases. An initial phase, sometimes called a loading phase, is followed by a maintenance phase and may move from IV to injection or spray. The right structure depends on the person, the reason for the protocol, their blood work and how they respond. We do not publish doses or schedules because they are the physician's decision; what the physician prescribes will be specific to you and will carry a review date.

What the physician looks at first

A health history, current medications and any supplements, and in many cases a baseline blood panel. NAD+ is not appropriate for everyone, and a physician will decline to prescribe it where it is not indicated.

Side effects and practicalities

Reported effects include nausea, flushing, dizziness and chest tightness during faster IV infusions, and irritation at the injection site. Compounded NAD+ is kept refrigerated and has a limited shelf life. The licensed compounding pharmacy provides storage and expiry instructions with each ready-to-use order, and delivery is cold-chain.

If you want to understand whether any of this is relevant to you, an independent DHA-licensed physician can review your case. Take the two-minute quiz at /find-my-stack or book a physician consultation at /book (AED 300 deposit, credited to your first order).