NAD+: The anti-aging drip that might not work

People are paying thousands for IV infusions of a molecule central to cellular energy that promise to slow aging and reverse disease. Celeste McGovern examines the science, the hype and what really boosts NAD⁺

In the quest to stay forever young, Hollywood and the biohacking set have found their latest fix, and it doesn’t come in a cream or a capsule. It comes in a drip.

Wellness and functional medicine clinics from London to Los Angeles market it as a “cellular reset.” At longevity retreats, luxury five-star spas and member clubs, celebrities (and many of their followers) are reclining in leather chairs for hours at a time, hooked up to intravenous lines delivering a light golden liquid straight into their bloodstreams that costs between $900 and $1,300 a dose.

Jennifer Aniston told the Wall Street Journal that she gets NAD⁺ weekly by IV, a treatment she thinks is “the future.”

“I’m going to NAD for the rest of my life, and I’m never going to age,” model Hailey Bieber quipped to Kendall Jenner on an episode of Keeping Up with the Kardashians as they lounged on a sectional attached to IV lines pumping NAD⁺ into their veins. “It’s what we consider a really fun day,” Jenner explained.

In only their late 20s, Jenner and Bieber are among the younger generation embracing treatments that promise to ward off aging before it shows. Optimization before decline is the idea.

And NAD⁺ has become the molecule that is front and center in that arena. Wellness brand Goop recently hailed it “the new status supplement.” It’s seen a meteoric rise in popularity and is now available in subcutaneous shots as well as IV, transdermal patches, nasal spray, skin creams and a mind-boggling array of oral supplements.

Crucial molecule

Billed as a kind of biological cheat code—a way to boost energy, sharpen the brain, repair the body, and turn back time at the cellular level—it sounds almost too good to be true.

Except NAD⁺ science, which was never really about preventing wrinkles, is real, and NAD⁺ is undeniably important to cell function. But whether these infusions deliver it into cells or simply into the bloodstream is still debated. Can it really be “boosted,” and with what effects?

NAD⁺, short for nicotinamide adenine dinucleotide, is a vital coenzyme that keeps every cell in the body running. From your brain to your skin to your heart, it’s necessary for the production of energy.

Inside the mitochondria, the microscopic power plants of the cell, NAD⁺ shuttles electrons between molecules along the respiratory chain, allowing the chemical reactions that turn food into ATP, the body’s usable energy currency. If NAD⁺ is low, energy is low.

Beyond that, NAD⁺ is also critically involved in repairing DNA damage—the kind that accrues gradually through stress, toxins, UV exposure and simply breathing. It helps regulate your internal body clock and influences how the immune system responds to threats.

Not only do high levels promote health but low levels lead to cell death and inflammation.¹

“Systemic health depends on organ health; organ health depends on tissue health; tissue health depends on cellular health,” says microbiologist Jin-Xiong She, a genomics researcher and former director of a biotechnology and genomic medicine center at Augusta University. “When it comes to helping our cells function optimally, no other molecule comes close to NAD⁺.”

It’s not glamorous, but it is crucial.

NAD⁺ was discovered more than a century ago, in 1906. Long before it became a buzzword in longevity clinics, researchers figured out that it’s critical to life and that deficiency can kill people.

In the 1930s, they discovered that the devastating disease pellagra (identified by its Four D’s: dermatitis, diarrhea, dementia and death) became epidemic after a new processing method removed the vitamin B3–rich germ from corn. The epidemic was at its root an NAD⁺ deficiency disease, and it was halted when vitamin B3 (niacin), a regulating factor in NAD⁺ production, was added to refined grains.

It wasn’t until the turn of the century that NAD⁺ emerged again. Shin-ichiro Imai and Leonard Guarente, researchers at the Massachusetts Institute of Technology, published a landmark paper showing a possible link between longevity of yeast cells and the protein Sir2, which depends directly on NAD⁺ to function. It appeared to link cellular energy to aging for the first time.²

Since then, a stream of animal and cellular studies has shown that NAD⁺ declines with age and posited that “supplementation may be an effective anti-aging intervention.”³

More recently, it’s been confirmed that NAD⁺ levels decline with age in humans, too. They drop as much as 10–50 percent in key tissues, according to a widely cited 2020 review in Experimental Gerontology.⁴

If NAD ⁺ drops, mitochondrial machinery doesn’t function as well, leading to impaired energy production and an increase in oxidative stress, which shows up as cellular aging.

This finding has prompted a new line of research: Can restoring NAD⁺ or increasing it with supplements and infusions counter the slower, more diffuse decline associated with aging?

It’s a question that has become one of the most active areas of research in biomedicine. Since NAD⁺ is at the basis of cellular energy production, augmenting its actions could affect everything from brain function, cardiovascular health and metabolism to the way our skin and eyes age.

Brain health

The brain is the most energy-demanding of organs, and if NAD⁺ is the bottleneck in energy supply, the brain is one of the first places to feel the strain.

Neurons are long-lived cells that are rarely replaced and metabolically ravenous, requiring a constant stream of energy to function and to repair themselves. NAD⁺ is critical in that system, supporting mitochondrial activity, regulating oxidative stress and enabling the DNA repair processes that keep these cells alive over decades.

“We know that NAD⁺ is essential to almost every cellular process in the human body, and what cellular processes are more urgent than those that happen within our cranium?” asks Dr She, author of The Tao of NAD (GWN Publishing, 2025). Bottom of Form“Could underperformance, sluggishness, injury, illness and impairment be alleviated with NAD⁺?” he asks.

Longevity researcher Eric Verdin has described NAD⁺ as a “central regulator” linking metabolism to neurodegeneration, noting that replenishing NAD⁺ levels could represent a “therapeutic opportunity” for age-related diseases, particularly those affecting the brain.⁵

That idea has gathered momentum. A growing body of research now shows that NAD⁺ depletion is a consistent feature of major neurodegenerative diseases, including Alzheimer’s and Parkinson’s. When levels fall, several things begin to go wrong at once: Mitochondrial function slows, oxidative stress rises and the brain’s ability to repair DNA damage falters.

In laboratory studies, raising NAD⁺ using compounds such as nicotinamide riboside (NR), an NAD⁺ precursor, has been shown to improve memory, reduce inflammation and even slow features of neurodegeneration in animal models. In some cases, researchers observed reduced buildup of amyloid proteins and improved neuronal survival.

A recent review of 20 peer-reviewed, published preclinical studies evaluating NR concluded that it’s a demonstrably safe compound and found that oral supplementation increased NAD+ levels, improved brain function, lowered inflammation and slowed degeneration in mice. There is “ample evidence to support clinical evaluation of NR as a support for brain health,” its authors wrote.⁶

These are laboratory and animal findings, however. Human results have been mixed. In a small pilot trial involving people over age 50 with mild cognitive impairment (usually considered a precursor to Alzheimer’s disease), NR supplementation of 1,500 mg twice daily was safe, and some biomarkers changed favorably but did not lead to clear improvements in cognitive performance, although those receiving NAD⁺ declined at a slower rate than those receiving placebo.⁷

One of the most promising human studies came from patients with Parkinson’s disease in 2022. In a small, randomized trial, 30 people recently diagnosed with the disease and untreated with drugs were given 1,000 mg of NR or placebo for 30 days.

The supplement was shown to be safe and to increase NAD⁺ levels in the brain in about three-quarters of those who received NR. This increase came with measurable changes in brain metabolism and “mild” improvements in clinical symptoms. Longer trials with higher doses are underway.⁸

Anecdotal evidence suggests some people with Parkinson’s have experienced greater benefits with infusions of NAD⁺. Addison Thompson, a retired New Orleans police officer, was diagnosed with Parkinson’s disease more than a decade ago and found the drugs he was given had “little to no effect.”

“I had tremors constantly, I tripped, I was very unsteady on my feet. I had to eat with a spoon. I couldn’t sleep. I just about gave up,” he says in a testimonial video for Springfield Wellness Center, the first NAD⁺ clinic in America.

A friend took him to the clinic, where he was infused with 1,000 mg of NAD⁺. “Within an hour,” he says, “my tremors stopped. I quit stumbling. I quit drooling at night. My peripheral vision was perfect. I saw no more images. It just makes you feel wonderful. You feel younger.”

It’s compelling, but the placebo effect is powerful too. Many researchers say IV administration is useless because the molecules being delivered are too large to enter cells (see The trouble with IV infusion, below). And whether NAD+ supplementation actually affects neurodegeneration is unclear.

“Unfortunately, researchers have not conducted enough clinical trials to test NAD’s effects on neurodegenerative diseases for anyone to make empirical claims in favor of NAD,” says Dr She. “But we are excited for what future studies might show.”

Heart health

The same NAD⁺ pathways that support energy in the brain appear to be critical in maintaining heart function.

For decades, public health told people that cardiovascular disease was a plumbing problem: too much cholesterol clogging the pipes. Their answer, as usual, was a pharmaceutical drug. Cholesterol-lowering statins became the most-prescribed drug on the planet, notwithstanding the long list of side effects, particularly in the most cholesterol-dependent organ in the body: the brain.

Starting in the 1990s, however, another picture of heart disease pathology began to emerge. It showed inflammation irritating and damaging arteries under oxidative stress. The failing heart, required to beat about 100,000 times per day, is not simply “weak” in this picture. It is metabolically exhausted. Which is where NAD⁺ enters the story.

Reviews in Circulation and other journals now describe NAD⁺ metabolism as central to cardiac health, aging and disease. Experimental NAD⁺ boosting shows benefits in animal and laboratory models of atherosclerosis, ischemic injury, diabetic cardiomyopathy, arrhythmias and heart failure.⁹

Niacin’s role

Long before NAD⁺ became a wellness trend, niacin, or vitamin B3, was already used as a heart drug. Nicotinic acid, another form of the vitamin, was used in high doses to lower “bad” triglycerides while raising “good” HDL cholesterol.

Older trials and studies suggested niacin could slow or even partially reverse atherosclerosis in some settings. The American College of Cardiology noted that niacin also dampens vascular inflammation.¹⁰

Trials from the statin era added high-dose niacin to statins, and most concluded that adding niacin didn’t prevent more heart attacks,¹¹ though some found it did.¹² Plus, the researchers pointed to niacin’s side effects, including flushing and raised blood sugar at high doses.¹³ However, other versions of niacin, such as niacinamide, don’t cause flushing.

Vitamin B3 biology did not vanish, however. It reemerged under a new name: NAD⁺ metabolism. New research on NAD⁺ and heart failure is bearing out the role of its precursor niacin.

One 2025 randomized trial looked at 180 patients with heart failure caused by ischemic cardiomyopathy (i.e., damage after heart attacks). Patients given intravenous NAD⁺ for seven days saw their heart function improve, measured by the amount of blood pumped with each beat, compared to those on placebo. They also had fewer hospitalizations and adverse events. Giving NAD⁺ appeared to help a damaged heart pump better, at least in the short term.¹⁴

The NAD⁺ research suggests that rather than cholesterol clogging the heart pipes, mitochondrial exhaustion may play a role in heart failure. When NAD⁺ is depleted through aging, metabolic stress, chronic inflammation or oxidative damage, the heart may lose some of its ability to repair, adapt and generate energy to keep beating. Restoring NAD⁺ may be one way to restore that energy.

Metabolic health

If NAD⁺ is central to the body’s energy production, then metabolic disease is where its effects should be easiest to see. Conditions like insulin resistance and prediabetes are, at root, problems of fuel handling: Glucose builds up in the blood, fat metabolism goes off track and cells struggle to use energy properly.

When you try to boost NAD⁺ in these situations, the response is not always predictable, however.

One recent study looked at 25 postmenopausal women with prediabetes who were overweight or obese. They were given either the direct NAD⁺ precursor nicotinamide mononucleotide (NMN) or a placebo, and researchers measured insulin sensitivity using the most precise method available.

The result was that muscle cells became more responsive to insulin. But, unexpectedly, nothing else changed significantly. The women had no parallel drop in blood sugar levels or body weight, and no improvement in overall metabolic health.¹⁵ So, one part of the system improved, but the bigger picture stayed the same.

When Chinese researchers pooled results from dozens of trials (more than 14,000 people), they found something similar. Using NAD⁺ boosters such as NR and NMN consistently improved lipid markers—lowering triglycerides, total cholesterol and LDL while raising HDL. But there was a trade-off: Average blood glucose levels increased, too.

So fat metabolism improved, but blood sugar worsened. Not exactly a great “metabolic reset.” What’s more, the researchers concluded that “the supplement of NAD⁺ precursors seems to have little effect on healthy people, but it has a significant beneficial effect on patients with cardiovascular disease and dyslipidemia.”¹⁶

So, from available research, we’ve learned that NAD⁺ helps regulate how the body handles both fats and sugars, helps muscles respond better to insulin, improves lipid (cholesterol) profiles and supports cellular energy pathways. For healthy individuals, boosting NAD⁺ may not be helpful, but it may be for those with cardiovascular disease and metabolic disorders.

Fatigue and vigor

If NAD⁺ is at the heart of energy production and plays a role in regulating circadian rhythms, then it makes sense that it would improve sleep and boost overall energy, at least in some people.

A 2022 study of 108 older Japanese people reported that taking 250 mg of NMN every afternoon for 12 weeks improved lower limb function and reduced drowsiness. This finding could benefit their physical and mental health.¹⁷

Professor Jin-Xiong She’s research on NAD⁺ at the biotechnology and genomic medicine center at Augusta University led him into the corporate science world. He founded Jinfiniti Precision Medicine, which develops diagnostic tests for biomarkers including NAD⁺ blood levels as well as supplements to boost the results into an ideal range.

“Time and again, I have seen how optimizing levels of NAD⁺ leads to a decrease in pain, inflammation, fatigue and brain fog, as mental clarity, stamina, energy, muscle recovery and youthful vigor all increase,” he says. “Clients have reported brighter moods, better sleep, higher libido and more satisfying sexual relations after achieving NAD⁺ optimization.”

One of those clients was Dr James Goodwin, director of the London Brain Network and author of Supercharge Your Brain (Transworld Ireland, 2022). In a written testimonial for Jinfiniti, he said he had started experiencing “really debilitating fatigue in the afternoon.

“About six months ago, I did the NAD⁺ test and got shockingly low results, coming in as deficient. I’m perfectly healthy. I don’t have any diagnosed medical conditions. I exercise regularly, I eat well and I’m not overweight. I was so appalled and determined to start taking the supplements regularly.”

“Two weeks into taking the NAD⁺ supplement, the fatigue disappeared. I was absolutely astonished,” Goodwin said, adding that he would not stop the supplements to find out if he would become fatigued again.

Driver or reflection of health?

For all the hype about NAD⁺ as a magic bullet, it may be reflecting people’s underlying health more than driving it. Plummeting NAD⁺ levels may signal aging but also stress, inflammation, metabolic strain, and wear and tear.

Boosting NAD⁺ may help sometimes, but not if the cause of its fall isn’t also addressed. Infusions might not be enough to counter a life of sitting on the couch, but exercise is one way to dramatically boost NAD⁺ from within, for example (see Other ways to boost NAD⁺ levels, below).

What the science is really revealing is not a great wrinkle preventer but the truth that cellular energy is at the heart of health. And NAD⁺ is at the heart of cellular energy.

The future of NAD⁺ may not lie in a lounger with an IV to the arm or in a “status supplement” but in understanding how to conserve energy naturally through a healthy diet, exercise and the unglamorous work of keeping cells functioning well over time.

Testing for NAD⁺

Several companies offer at-home blood and saliva tests to measure NAD⁺ levels. Studies have verified that in dry blood tests, the kind in which you put a tiny drop of blood on a pre-treated card and send it back to the laboratory, the NAD⁺ is stable at room temperature and provides reliable values.¹

These are a few companies offering at-home testing of NAD⁺:

Jinfiniti Precision Medicine
jinfiniti.com

Renue by Science
renuebyscience.com

GetTested
gettested.io

All have Clinical Laboratory Improvement Amendments (CLIA) certification, meaning they comply with US government quality standards for lab testing.

Measurements tend to range from 10 to 100 micromoles (µM), and optimal values are in the 40–100 µM range. Test results may be influenced by factors including time of day, recent dietary intake, supplements and acute illness, so follow the test instructions carefully.

The trouble with IV infusion

Intravenous drips of NAD⁺ like those used by celebrities Hailey Bieber and Kendall Jenner have been around for decades. Usually, each infusion takes a few hours and might be part of a multi-session dosing schedule.

Starting at $900 a session, that quickly racks up. Since it’s so expensive, invasive and time-consuming, people assume IV is the gold standard of NAD⁺ therapies. But researchers say it’s not.

The trouble is that molecules of NAD⁺ are large. Even when delivered directly into the bloodstream, it cannot easily cross into cells where it’s needed. As neurologist Charalampos Tzoulis bluntly put it, IV NAD⁺ is “silly.”

Without effective mainstream treatments for diseases like Parkinson’s and Alzheimer’s, or for addictions, many people try IV NAD⁺ for symptom relief. “Unfortunately, even when the therapy seems to work on these conditions, the benefits are only temporary,” says Dr She.

His lab conducted a small experiment with 10 people receiving NAD⁺ via IV, showing that it didn’t raise intracellular NAD⁺ levels as well as oral supplements and could even trigger inflammatory responses. Little wonder many people report becoming nauseated or dizzy during infusions (usually when too much is given too fast).

Since more affordable, convenient and effective methods of NAD⁺ boosting exist, oral supplements seem to be a safer bet. The trouble is choosing a good one (see NR vs NMN, and NADH, see below).

Niacin cures

Niacin (vitamin B3) remains the oldest and cheapest reliable NAD⁺ precursor. Its potency was first apparent in pellagra (see above).

More recently, a small but striking human study published in the journal Cell Metabolism in 2020 examined patients with mitochondrial myopathy. The condition is marked by impaired cellular energy production causing profound muscle weakness, plus cardiac, neurological and other issues.

The study found these patients had systemic NAD⁺ deficiency. When they were given niacin in gradually increasing doses up to 1,000 mg, their NAD⁺ levels rose as much as eight-fold, muscle function was restored, and liver fat fell as much as 50 percent.¹

Niacin vs niacinamide

Both nicotinic acid and niacinamide are forms of vitamin B3 that can raise NAD⁺ levels, but they behave differently. In human trials, the typical NAD⁺-raising range of niacin is 250 mg/day, gradually increasing to doses up to 1,000 mg per day (used in the mitochondrial myopathy trial).

With nicotinic acid, flushing is common above 50 mg. It has been linked to worsened insulin sensitivity and glucose control, and sustained-release forms carry a recognized risk of liver toxicity.

Niacinamide is gentler but less metabolically active. It’s typically taken in the 250–600 mg/day range, though some trials have gone as high as 1,500 mg.

As with all high-dose B3 compounds, caution is warranted in people with liver disease, insulin resistance or gout. Some people report sleep disturbances at higher doses.

NR vs NMN, and NADH

Two newer NAD⁺ precursors, NR (nicotinamide riboside) and NMN (nicotinamide mononucleotide), have driven much of the NAD⁺ boom. Both can enter cells and raise NAD⁺ levels.²

Most human research is focused on NR. But in one famous 2013 NMN study by researcher David Sinclair, old mice given NMN developed the muscle capacity of young mice within just a week of supplementation.³

NADH, the reduced form of NAD⁺, has been tested in a few human trials, including for chronic fatigue, but with little clinical benefit.⁴

The best dosages for NAD⁺ boosters

Nicotinamide riboside (NR): 300–600 mg daily

Nicotinamide mononucleotide (NMN): 250–500 mg daily; some protocols use up to 1,000 mg daily

NAD + hydrogen (NADH): 10–40 mg daily

Morning dosing is preferred, as both NR and NMN have been described as “stimulating” or “wiring.” Headaches have been reported at higher doses. Some people find NR causes flushing similar to niacin.

Other ways to boost NAD⁺ levels

While most of the current NAD⁺ buzz is focused on supplements, the body already has its own powerful NAD⁺-boosting mechanisms.

Exercise. A recent human study showed that even a single session of physical activity increased NAD⁺ production in immune cells,¹ while another showed that regular training restores age-related declines in NAD⁺ metabolism.²

Fasting. Fasting and calorie restriction seem to activate NAD⁺ pathways.³

Balanced diet. A diet that is either high-fat or high-sugar causes energy overload, which lowers NAD⁺ levels. And getting enough niacin by eating adequate animal protein is key to NAD⁺ production in the body.⁴

Ketogenic diet. The keto diet shifts the body away from burning glucose as fuel toward using fat-derived ketones instead. In this mode, the body uses less NAD⁺ rather than increasing production, freeing up more NAD⁺ for cellular repair and signaling.⁵ This may explain the diet’s reported effects on brain health, inflammation and metabolic function.

Circadian rhythm. The body’s natural attunement to light and eating patterns regulates its production of numerous compounds, including NAD⁺. Sticking to a regular sleep routine, getting sunlight during the day, avoiding blue light after sunset and maintaining consistent mealtimes can help regulate circadian rhythm, and in turn NAD⁺ levels.⁶

Extreme temperatures. Short-term exposure to heat or cold stress, such as in a sauna or cold plunge, triggers an increase in NAD⁺ production.⁴

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