Does NAD+ actually give you more energy?

Cellular energy is not the same as feeling energetic

Inside your mitochondria, NAD+ carries electrons from broken-down nutrients to the machinery that makes ATP, the molecule cells use as fuel. Without enough NAD+, that process stalls. This is solid, textbook biochemistry.

The leap that does not hold up as neatly is from cell chemistry to how you feel at 3 p.m. Feeling energetic depends on sleep, mood, blood counts, thyroid function, fitness, blood sugar, hormones and much more. A healthy person's cells are generally not short of NAD+ in a way that limits daily energy, and if they are, it has not been shown that topping it up changes how tired they feel.

What the human trials measured

The best-studied products are oral precursors, especially nicotinamide riboside (NR) and nicotinamide mononucleotide (NMN). In a 2018 randomized crossover trial of adults aged 55 to 79, NR raised NAD+ in blood cells by about 60%. It did not change resting metabolic rate, physical activity, body composition, glucose measures or exercise capacity.

A 2023 review in The Journals of Gerontology concluded that these compounds are safe and raise NAD+, but that clinical evidence of improved physiological function is unclear. Another 2023 review in Science Advances found few clinically relevant effects of NR in humans, noting no consistent change in muscle function or metabolism. Trials have been small and short, and many did not measure fatigue as a main outcome.

What about injections and IV drips?

Injected or infused NAD+ skips digestion, which sounds like an advantage. But a small 2019 pilot study of a six-hour IV infusion found that NAD+ was cleared from the blood quickly for the first two hours and broken down into related molecules. The study measured chemistry, not energy or wellbeing.

There are no well-designed trials showing that NAD+ injections or infusions improve energy in healthy adults or work better than oral precursors. Reports of feeling sharper or more energetic are real experiences, but without a placebo comparison, it is hard to separate a true effect from expectation, natural fluctuation or other changes made at the same time.

Fatigue usually has a findable cause

Before attributing low energy to NAD+, it is worth checking the explanations that are common, measurable and treatable. MedlinePlus lists several that come up often in midlife.

• Iron deficiency or anemia
• An underactive or overactive thyroid
• Low vitamin B12 or vitamin D
• Poor sleep, insomnia or obstructive sleep apnea
• Depression, anxiety or chronic stress
• Side effects of medicines such as antihistamines, blood pressure drugs or sleep aids
• Perimenopause, menopause or low testosterone
• Prediabetes, diabetes, alcohol use or deconditioning

Why the hype outpaces the evidence

Much of the excitement around NAD+ comes from animal research. In mice and other models, NAD+ falls with age, and restoring it improves some markers of muscle function, metabolism and resilience. Those results are genuinely interesting, but animal findings often fail to carry over to people, and the doses, routes and lifespans involved are very different.

Human studies so far have mostly answered a narrower question: can we raise NAD+ in people, and is it safe in the short term? The answer to both appears to be yes. The bigger question, whether doing so makes people healthier, more energetic or longer-lived, is still open. Larger and longer trials with outcomes people actually care about are needed.

If you want to try NAD+ anyway

That can be a reasonable choice, as long as you treat it as an experiment. Set two or three specific goals before you start, such as fewer afternoon crashes or quicker recovery after workouts. Keep other routines stable so you can judge the effect, and agree on a review point with your clinician.

Injections may cause redness at the site, flushing, nausea or a brief sense of chest tightness, and these usually ease with dose or timing changes. NAD+ is not offered during pregnancy or breastfeeding, and people with active cancer should talk with their oncology team first.

Regulatory status and cost

NAD+ for injection is compounded by licensed pharmacies. It is not FDA-approved, FDA has not reviewed it for safety, effectiveness or quality, and it is not equivalent to any branded product. NR and NMN are sold as dietary supplements, which do not require FDA approval before sale.

HealifyMD's compounded NAD+ Injection starts at $199/month with no membership fee. If you need baseline labs, the Comprehensive Lab Panel is $199 (one-time). Your price is confirmed at the eligibility review.