NAD+ Therapy Explained: Do Injections and Supplements ...

The first time I ever heard about NAD+ injections was in 2023, when a mom friend I’d met up with after school drop-off leaned toward me and started whispering, like we were two schoolgirls at the back of class. She was getting NAD+ injections through a concierge doctor, someone who required a referral, charged a steep annual fee, and promised white-glove care along with access to peptides like GLP-1s, vitamin injections, and NAD+.

She leaned in closer so the other Brentwood moms sitting nearby, similarly uniformed in beige Jenni Kayne sweaters and Alo leggings, couldn’t hear us. We were sipping matcha lattes, and her excitement was electric. “I’m doing NAD+ injections for hair growth,” she said, beaming. “Is it working?” I asked.

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“I’m not sure yet,” she shrugged. “But my friend says her hair got super thick after a few months. And she’s fitter than ever. I’m so excited!” She passed me the contact for her source. And just like that, I felt it happen... curiosity quietly spreading.

(Amy Chang)

This is the fever that carries wellness trends through Los Angeles, saturating the culture as quickly as a paper napkin dropped into a glass of water. Anecdotes, gossip, and whispers of who’s doing what and getting it from where pepper nearly every interaction. You hear about an “NAD infusion” at a friend’s 40th birthday dinner. You open TikTok and an MD influencer explains “mitochondrial boosting” in under 30 seconds. A mom at drop-off credits her new “peptide stack” for bouncing back after her third baby. You see Hailey Bieber and Kendall Jenner hooked up to NAD IVs on Hulu’s The Kardashians, and suddenly it all feels inevitable, like the science is settled, the efficacy proven when in reality it’s still nascent and, to some degree, uncertain.

What Is NAD?

Nicotinamide adenine dinucleotide (NAD for short) is one of the most important molecules in the body, according to Dr. Chris Rinsch, a longtime mitochondrial researcher and co-founder and president of Swiss biotech company Amazentis.

“Every time you eat, NAD helps turn nutrients into ATP; the energy that powers everything from your muscles to your brain,” he explained to me. NAD also helps regulate key pathways that maintain mitochondrial health. Without sufficient NAD, cells can’t function optimally. Research shows that NAD levels decline with age, dropping significantly by midlife, especially in women, whose hormonal fluctuations throughout perimenopause and menopause may accelerate that decline.

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In a culture obsessed with staying young, energized, and at the top of its game, many hoping to add centenarian to their list of accomplishments, it’s easy to see why the wellness industry has latched onto this powerhouse coenzyme, weaving it eagerly into daily routines.

But with anything new, the first question should always be: Is it safe?

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NAD Is Still So New

Relative to other well-established health discoveries like vitamin C, whose scurvy-preventing power was demonstrated in the 18th century, according to research published in The Royal Society, or creatine, first described in the 19th century, nicotinamide adenine dinucleotide is comparatively recent. NAD was discovered in the early 20th century by Arthur Harden and William John Young while studying alcoholic fermentation. The pair identified it as a heat-stable “coferment” required for yeast to convert sugar into alcohol.

Published studies highlight that over the course of the 20th century, scientists gradually expanded their understanding of NAD from identifying its vitamin precursors in 1938 to mapping key enzymes involved in NAD biosynthesis over the following decades.

But, it wasn’t until much later, in 2000, Shin-ichiro Imai, a professor of developmental biology at Washington University School of Medicine in St. Louis and a leading figure in NAD biology, and Leonard Guarente, Ph.D., an American biologist and Novartis Professor of Biology at MIT, published a landmark finding showing that the longevity-related protein Sir2 functions as an NAD-dependent enzyme, linking cellular energy metabolism to gene regulation pathways involved in aging.

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Building on that insight, in 2009 Shin-ichiro Imai proposed a model suggesting that NAD production, regulated by proteins such as sirtuins and NAMPT, may act as a coordinating system that influences aging and longevity across the body.

What’s the Best Way to Supplement NAD?

At first glance, the solution seems simple: NAD declines with age, so we should supplement it. Done. But it’s not that simple.

(Amy Chang)

NAD is a large molecule and doesn’t easily enter cells. Because of that, researchers have focused on NAD precursors, the building blocks the body uses to make more NAD, such as niacin, nicotinamide mononucleotide (NMN), and nicotinamide riboside (NR).

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But the complexity doesn’t end there. None of these are FDA-approved therapies for longevity and under the Dietary Supplement Heath and Education Act of 1994, supplements do not need FDA approval for safety or effectiveness before they hit the market. Safety is largely the manufacturer’s responsibility, meaning the FDA can intervene only after a product is shown to be misleading or unsafe. In plain English, supplements are regulated after the fact, not before.

Now, if that doesn’t deter you, then the next question becomes how to administer NAD or its precursors: oral supplements, subcutaneous injections, or IV infusions? On that, medical experts strongly disagree.

Experts Can’t Agree

When I asked Leonard Guarente about NAD injections and IVs, his response was straightforward: he’s not a fan of either. “You want to replenish what’s lost with aging,” he said. “You don’t want artificially high levels when you don’t understand the consequences.” That’s why Guarente, along with his co-founder and CEO, Eric Marcotulli, of the NAD supplement brand Elysium, believes oral supplementation makes the most sense.

“NAD belongs in cells, not in the bloodstream,” Guarente explained. “And NAD itself doesn’t efficiently enter cells. That’s why we focus on precursors like NR and NMN. Cells can convert those into NAD.”

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The goal, he emphasized, isn’t excess but restoration. “Flooding the bloodstream can trigger immune reactions. Burning sensations. People have unpleasant experiences, and there’s no evidence of sustained intracellular benefit.” Their advocacy centers on modest increases supported by thoughtful human clinical trials, not dramatic delivery methods.

In real-world clinical settings, however, some physicians see things differently, though not uncritically.

Dr. Cameron Chesnut, MD, FAAD, FACMS, a board-certified dermatologic and facial plastic surgeon and founder of Clinic 5C, a multidisciplinary practice that integrates facial plastic surgery, dermatology, wound care, and regenerative medicine, uses NAD in his practice and acknowledges the limitations of the data but remains open to its utility. “There’s strong mechanistic plausibility,” he said. “We know what happens when NAD is absent. We know it plays a central role in high-energy tissues like the brain and skin. The human data just hasn’t caught up yet.”

In his practice, NAD is used primarily around surgery and periods of high metabolic stress. He advises patients to take oral NAD precursors several weeks before surgery, followed by five NAD+ IV sessions during the immediate post-operative period. Anecdotally, he reports improved recovery times, though he’s candid about the trade-offs.

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“It’s expensive. It’s time-consuming. And the side effects are real,” he said. “Nausea, chest tightness, that’s an autonomic response. You’re stimulating the vagus nerve. It’s manageable, but it’s real.” Even so, he’s clear that NAD is not a magic bullet. “You’re not going to NAD your way out of poor sleep or a bad diet,” he said. For him, NAD is always secondary to foundational health.

Others opt out entirely. Dr. Avinish Reddy, a physician at Elevated Medical, doesn’t use NAD with his patients. “It’s an intracellular compound,” he told me. “Whether it even goes intracellular in a meaningful way is controversial. I don’t think there are studies showing clear long-term benefits yet.” Instead, Reddy points to far less glamorous interventions: sleep, exercise, and eating healthy.
“If you sleep more and reduce chronic sleep deprivation, you reduce oxidative stress,” he said. “Exercise improves mitochondrial pathways. These things naturally increase NAD.”

When it comes to supplements, Reddy’s list is short and conservative: vitamin D when deficient, omega-3s, methylated B vitamins if labs indicate a need and creatine, one of the few supplements that has largely delivered on its promises in studies.

WHY Is It so Hard to Know What to Believe?

Historically, discoveries like NAD and its link to aging would take decades to move through rigorous, double-blind, placebo-controlled human trials before entering the mainstream consciousness. That slow march defined medical innovation for more than a century. Today, wellness trends often outpace the research. In the age of longevity bros, wellness influencers, and MD content creators, early-stage science is tested publicly, shared anecdotally, and amplified online at wildfire speed, often faster than medical professionals can contextualize or caution against it.

My Experience With NAD

And yes, I’m guilty of contributing to the NAD fever. After that first conversation at drop-off, I started looking into NAD+. Like any rabbit hole, once you begin digging, you quickly find yourself immersed. I asked friends. Talked about it on Instagram.

My online community, many of whom move in elite circles, started responding. One told me her billionaire boss had been injecting NAD at home for years. A Brazilian supermodel DM’d me that she’s a longtime fan. An Indian mega-influencer said he gets NR IVs between Milan and Paris fashion weeks. Once I started asking, the stories poured in.

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As a self-proclaimed try-tarian, someone willing to try almost anything once in the name of beauty and wellness, including stem cell IVs in Seoul and placenta injections in Tokyo, I decided to explore NAD for myself.

I first tried injectable NAD sent by mail after consulting a medical professional. I was instructed to inject myself five days a week using fine insulin needles, reconstituting powdered NAD+ with bacteriostatic water. I researched the compounding pharmacy, a 503B outsourcing facility registered with the FDA and subject to inspection (though compounded products themselves aren’t FDA-approved the way pharmaceutical drugs are), with third-party batch testing for purity which gave me some comfort that what I was home injecting myself was of quality.

But still, something didn’t sit right. I questioned if I was doing the injections correctly. At the same time, the daily injections became increasingly irritating. I stopped though not before noticing a marked increase in my energy levels and hair thickness.

I then explored NAD IVs, opting for the precursor NR. I tried several sessions, spaced months apart, at a location. Each time, I left with mixed feelings. A single session costs upwards of $1,500. I felt energized, and my skin even seemed to glow weeks later, but the time, cost, and uncertainty made it hard to justify.

Where I’ve landed: injections and IVs are out for me. Oral supplements are in.

Which NAD Oral Supplements Are the Best?

The challenge with NAD supplements is that they sit at the intersection of exploding consumer interest and bare minimum regulation. The supplement industry remains largely unregulated by the FDA, allowing brands to make sweeping, often unverified claims and in some cases misrepresent what their products actually contain and do. As the NAD wellness trend accelerates, fueled by social media, celebrity adoption, and longevity hype, it has become ever more difficult for consumers to suss out what’s meaningful science from glossy marketing.

Recently, laboratory testing has raised uncomfortable questions about the broader NAD supplement boom. In one widely cited market-surveillance analysis, ChromaDex, the makers of Tru Niagen, a patented form of nicotinamide riboside used in multiple peer-reviewed human clinical trials, tested 39 commercially available nicotinamide riboside (NR) supplements. Only about 13 percent met or exceeded the NR amounts listed on their labels. Several contained little to no NR at all. These findings highlight a massive problem in the supplement space: a widening gap between what brands promise and what’s actually inside the bottle.

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Despite skepticism from physicians like Dr. Reddy, who remains wary of brands rushing to gain market share, consumer demand shows no signs of slowing down. According to the Global Wellness Institute’s Global Wellness Economy Monitor 2025, the global wellness market has reached $6.8 trillion. Searches for NAD+ on Vitamin Shoppe surged nearly 500 percent in 2025. In the first quarter alone, the retailer reported that its cellular health and healthy aging category nearly doubled in Q1, with NAD products driving roughly 90 percent of that growth. Google search data mirrors this surge, with searches for “What is an NAD supplement?” increasing more than 786 percent over the past year.

In a category buzzing with hype, a small number of brands do stand out. Among those on the market, Elysium and Tru Niagen distinguish themselves by publishing rigorous clinical studies, a level of scientific rigor that’s increasingly rare in the supplement world.

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Elysium’s NAD precursor supplements are designed to increase NAD⁺ levels in the body. While Timeline, founded by Swiss biotech company Amazentis, takes a different but synergistic approach. Its co-founders, Patrick Aebischer and Chris Rinsch, have studied mitochondrial biology for more than two decades at EPFL, often referred to as “Switzerland’s MIT.” In 2025, I traveled to Switzerland in partnership with Timeline to visit their lab firsthand...and seeing the science up close only deepened my confidence in the rigor behind their work. And their main compound, urolithin A, a fermented postbiotic that activates mitophagy, helps the cell clear out damaged mitochondria, improving mitochondrial efficiency.

In other words, explains Rinsch, while NAD precursors aim to increase the amount of fuel available, Urolithin A improves the health and performance of the machinery using that fuel. I prefer taking the two together because they address mitochondrial health from complementary angles. Together, they address mitochondrial health through both quantity and quality, a distinction that matters in a supplement landscape where nuance is often lost.

What’s Next for NAD?

And while the category continues to expand rapidly, meaningful research is underway with ongoing human clinical trials on NAD precursors in populations with conditions including ALS, osteoporosis, menopause, neurological disorders, Parkinson’s disease, and aging more broadly. The science is compelling and genuinely exciting, but still early. Many of these studies won’t be completed until 2027 or later.

For now, I’ll be sticking with oral NAD precursor supplements and urolithin A, while keeping a healthy distance from injections and IVs. In an era where wellness trends routinely outrun the research accelerated by algorithms, anecdotes, and aspiration.... restraint may be the most evidence-based choice we have. My advice, proceed with curiosity, not urgency, my friends. Spend wisely. And remember: sometimes the most powerful move in wellness isn’t chasing the next best thing, it’s waiting until the science catches up.

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