Updated: Jan 3
What is NAD?
Nicotinamide adenine dinucleotide (NAD) is a coenzyme that is naturally present in all of the body’s cells and is essential for multiple vital cellular processes, such as DNA repair. Mitochondria use it to produce Adenosine triphosphate (ATP), the source of energy for use and storage at the cellular level. As we age, NAD is gradually depleted, and by age 50, NAD levels are at about half of what they are in neonates (Billington et al.). This depletion can lead to DNA damage and mitochondrial malfunction. Therefore, infusion of NAD can be beneficial in counteracting cellular degenerative processes and protecting against further damage. Arthur Harden and William John Young discovered NAD in 1906, but researchers have more recently studied its health benefits, and its full potential is now more known to us (Katsyuba, 2017).
1. NAD Offers Many Health Benefits to Your Patients
NAD offers many benefits to your patients. Research shows that NAD regulates the activity of Sirtuins. There are seven Sirtuins, and they all work to repair DNA, control the cell cycle, and aid in Mitochondrial function and metabolism. Sirtuins need NAD to function properly (Mehmel, 2020).
By activating SIRT1—a protein that responds to inflammation, metabolic and oxidative stressors—NAD may help protect against age-related diseases, such as Diabetes, by enhancing hepatic insulin sensitivity and supporting glucose metabolism and insulin production. In addition, NAD can lead to improved vascular function and protect the liver from steatosis (Johnson et al.). One study showed that NAD has the potential to protect against cardiac hypertrophy, metabolic dysregulation, and cardiac inflammation through SIRT1 activation (Mehmel, 2020). NAD may lead to a decrease in depression and anxiety by balancing Serotonin and Dopamine levels.
NAD depletion is a significant risk factor for neurodegenerative diseases, such as Alzheimer’s Disease (Mehmel, 2020). Furthermore, it may help neurodegenerative diseases by controlling the circadian rhythm and reducing inflammation (Levine et al.). NAD also improves cognitive function by helping to activate the brain’s neuron function, thus assisting the cells in regenerating. This activation can help increase cognition, mental clarity, and memory function (Mehmel, 2020).
One study looked at how NAD plays a role in Sars-CoV-2. The extensive cell damage and the inflammatory response caused by Covid-19 showed disturbed NAD metabolism. New research demonstrates that NAD is released during the early stages of inflammation and has an immunoregulatory role. Restored levels of NAD could restore energy levels and impaired Sirtuin function and rebalance immune response to Covid-19. This study supports the possible usage of NAD as an early treatment-supporting agent against Covid-19 to reduce inflammation and regenerate damaged lung tissue (Mehmel, 2020).
NAD is beneficial for healthy people as well! Do you have patients who want to improve their athletic performance or increase their recovery after workouts? NAD will aid in recovery after intense training or after an injury.
2. NAD is Well-Tolerated
One study administered 750mg in normal saline over six hours, showing that NAD is primarily well-tolerated. At eight hours after the start of the NAD infusion, the research team noted that there were significant declines in the liver function enzymes gamma-glutamyl transferase, lactate dehydrogenase, and aspartate aminotransferase and a significant increase in plasma bilirubin. However, they did not regard this observation as clinically crucial due to the limited sample size of the control group (Ross Grant, 2019).
NAD is generally well-tolerated, but side effects may include headaches, shortness of breath, constipation, increased plasma bilirubin, and decreased levels of the gamma-glutamyl transferase, lactate dehydrogenase, and aspartate aminotransferase (Empower).
While there are no reported contraindications/precautions for NAD infusions, it has not been evaluated in pregnant or breastfeeding people and should be avoided (Empower).
3. NAD Provides Added Revenue to Your Practice
Currently, IV infusion is the safest and most efficient way of absorbing NAD. NAD infusion costs range from $400 to $1000 per infusion based on the dose (250mg to 1000mg). Most patients will need loading doses of NAD when they start infusion and then can go to maintenance infusions. They will likely feel the benefits of NAD after just a few infusions, if not right away. These amazing benefits will keep your patients coming back regularly for more infusions!
Add-ons for NAD infusions can include but are not limited to B-Complex, B12, Vitamin C, Magnesium, and Glutathione push with an additional add-on cost of $40 to $100 per infusion.Things to ConsiderIt is important to note that NAD does require a prescription to administer. Depending on the dose, infusions range from two to six hours and are typically infused at 250mg over two hours. NAD is stored at 68°F to 77°F (20°C to 25°C) and away from heat, moisture, and light.
NAD will be a great addition to your infusion practice by offering your patients many health benefits. NAD infusions are a holistic, all-natural way to help your patients feel healthier and increase their overall wellness!
Billington RA, Travelli C, Ercolano E, et al. Characterization of NAD uptake in mammalian cells. J Biol Chem. 2008;283(10):6367-6374. doi:10.1074/jbc.M706204200
Empower. 2022. Overview of Nicotinamide Adenine Dinucleotide (NAD+). Accessed September 5, 2022. https://www.empowerpharmacy.com/drugs/nad-injection
Johnson S, Imai SI. NAD + biosynthesis, aging, and disease. F1000Res. 2018 Feb 1;7:132. doi: 10.12688/f1000research.12120.1. PMID: 29744033; PMCID: PMC5795269. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5795269/
Katsyuba E, Auwerx J. Modulating NAD+ metabolism, from bench to bedside. EMBO J. 2017 Sep 15;36(18):2670-2683. doi: 10.15252/embj.201797135. Epub 2017 Aug 7. PMID: 28784597; PMCID: PMC5599801.
Levine DC, Hong H, Weidemann BJ, Ramsey KM, Affinati AH, Schmidt MS, Cedernaes J, Omura C, Braun R, Lee C, Brenner C, Peek CB, Bass J. NAD+ Controls Circadian Reprogramming through PER2 Nuclear Translocation to Counter Aging. Mol Cell. 2020 Jun 4;78(5):835-849.e7. doi: 10.1016/j.molcel.2020.04.010. Epub 2020 May 4. PMID: 32369735; PMCID: PMC7275919.https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7275919/pdf/nihms-1586021.pdf
Massudi H, Grant R, Braidy N, Guest J, Farnsworth B, Guillemin GJ. Age-associated changes in oxidative stress and NAD+ metabolism in human tissue. PLoS One. 2012;7(7):e42357. doi: 10.1371/journal.pone.0042357. Epub 2012 Jul 27. PMID: 22848760; PMCID: PMC3407129.https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3407129/
Mehmel M, Jovanović N, Spitz U. Nicotinamide Riboside-The Current State of Research and Therapeutic Uses. Nutrients. 2020 May 31;12(6):1616. doi: 10.3390/nu12061616. PMID: 32486488; PMCID: PMC7352172.https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7352172/
Ross Grant, J. B. (2019, September). A Pilot Study Investigating Changes in the Human Plasma and Urine NAD+ Metabolome During a 6 Hour Intravenous Infusion of NAD+. Frontiers in Aging Neuroscience. Retrieved from Frontiers.org: https://www.frontiersin.org/articles/10.3389/fnagi.2019.00257/full