Intravenous (IV) NAD+ therapy is offered widely at addiction clinics and IV “drip” bars and wellness centers. We examined the research and asked an NAD+ expert to see if there’s evidence to support the claims.When comedian and podcaster Joe Rogan contracted COVID-19, he threw “the kitchen sink” at it, including, among other things, IV NAD+ infusions. He shared about it on his show, the Joe Rogan Experience, reaching more than 10 million people. Rogan touts IV NAD+ therapy as a sort of overall health booster, and he’s not the first to endorse it. IV NAD+ is now widely available at IV “drip” bars alongside other popular treatments, and many addiction treatment facilities market IV NAD+ therapy for detox and recovery.
With all of the hype around IV NAD+ benefits, we decided to take a look at the scientific research behind it to see if any of the claims are supported by evidence. Here’s what we found.
What is NAD+ and why are people taking it intravenously?NAD+, or nicotinamide adenine dinucleotide, is a critical coenzyme found in every cell in your body, and it’s involved in hundreds of metabolic processes. NAD+ and its reduced form, NADH, play a central role in creating energy (ATP) in the metabolic reactions that make up cellular respiration. Mitochondrial function, maintenance of healthy DNA, sirtuin function—all of these need NAD+, too. And by middle age, our NAD+ levels decline by roughly half of youthful levels, so it makes sense that people are interested in strategies for increasing NAD+ levels and supporting the chemistry that keeps us up and running.
Research on NAD+ dates back to 1906, but scientific interest really picked up in the 1990s when renowned researcher, professor, and Elysium co-founder Leonard Guarente, Ph.D., discovered the connection between NAD+ and sirtuins (the so-called “guardians of the genome”). This research includes decades of lab studies showing the potential health benefits of increasing NAD+ levels, as well as recent human clinical trials—the first, conducted by Dr. Guarente and the Elysium team—showing that a precursor to NAD+ called nicotinamide riboside can raise NAD+ levels in blood safely and sustainably.
IV NAD+ therapy has a different history. It emerged in the 1960s, not in the research laboratory, but as a treatment protocol for addiction to drugs, according to the case reports of a doctor at a treatment facility near Seattle. Today, many addiction clinics offer a course of treatment with IV NAD+ and make claims that it can relieve withdrawal symptoms and help “detox” as an alternative to narcotics like Suboxone. More recently, as part of the growing wellness industry, IV drip bars offer a variety of intravenous vitamin cocktails as well as IV NAD+, with accompanying claims to reverse cell damage, aid mental clarity, and help with athletic performance and recovery.
Here’s the issue: None of the claims about IV NAD+ benefits are supported by scientific evidence in humans. In fact, the FTC began taking action against clinics making claims about the benefits of IV therapies in 2018, and as recently as 2020 issued a warning against a clinic offering IV NAD+ (among other therapies) for treatment of COVID-19.
Okay, so what do we know about IV NAD+ benefits?Overzealous claims don’t necessarily invalidate IV NAD+ therapy. Instead, we can look to clinical research for information about the potential benefits. A pilot study was published in Frontiers in Aging Neuroscience in 2019. In it, researchers documented changes in plasma and urine levels of NAD+ and its metabolites during and after a six-hour, 750-milligram NAD+ intravenous infusion in 11 healthy men ages 30 to 55. After two hours, there were no changes in NAD+ or its metabolites; at six hours, NAD+ levels reached 398 percent above baseline in plasma and the rate of NAD+ excretion in urine increased 538 percent.
Those sound like large increases, but what does the study actually tell us? “The conclusion they’re making is that the NAD+ was rapidly degraded,” Guarente says. “What they’re saying is that the profile is consistent with NAD+ glycohydrolase and NAD+ pyrophosphatase activity, which is degradation, and urinary excretion of the products.” What about the increase in plasma NAD+? Well, the NAD+ was injected into plasma (blood = plasma + cells), so you would expect it to increase in the plasma.
The important question is whether it gets into the cells, and according to Guarente NAD+ itself doesn’t get into most cells. That’s why Basis and Signal provide nicotinamide riboside (NR) and nicotinamide mononucleotide (NMN), respectively, precursors that get inside the cells and are efficiently transformed into NAD+.
It remains a mystery what’s happening during the first two hours of the study, Guarente says, during which time there were no changes to plasma NAD+ levels. Future studies would be required to understand this better.
Are there proven ways to increase NAD+?While IV NAD+ has been used in addiction clinics and is a popular wellness treatment, it’s important to consider it like any other intervention—according to the best available scientific evidence. For now, we only know that NAD+ is degraded and excreted when administered intravenously. We don’t know if any of the NAD+ makes it into cells, and even if it does, whether there is a sustained effect of IV NAD+ treatment. Furthermore, there are known risks associated with IV infusion including: infection at the injection site, phlebitis or inflammation of your veins, air embolism where air bubbles enter your vein and block your blood flow–potentially causing heart attack or stroke, blood clots such as deep vein thrombosis, and of course, pain. A 2020 study examining complications related to IV infusion in 450 patients, in a hospital setting, reported at least one complication in 39.11 percent of the patients. Another research review from 2019 reported that 31 percent of patients suffered from IV-administration induced phlebitis.
In contrast, there are other scientifically proven methods for increasing NAD+ levels that have been proven to be safe, well-tolerated, convenient, and effective. In 2017, Guarente and other members of our team conducted a clinical trial, studying 120 healthy adults over the course of eight weeks. The results showed that Elysium’s NAD+ supplement, Basis, which includes the NAD+ precursor nicotinamide riboside, safely and sustainably increases NAD+ levels in whole blood, including the cells, by 40 percent from baseline.
“We know that oral supplementation with NAD+ precursors is a sustainable and effective way to raise NAD+ to healthy, youthful levels,” Guarente says. “And that’s the end goal here, right?”
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