Are NAD (Nicotinamide adenine dinucleotide) injections a recommended treatment for any medical condition?

NAD Injections: Not Recommended for Any Medical Condition

NAD (Nicotinamide adenine dinucleotide) injections are not recommended for any medical condition due to lack of clinical evidence supporting their use and absence of established guidelines recommending them for any specific medical condition. 1

Understanding NAD and Its Role

• NAD+ is an essential coenzyme involved in over 400 enzymatic reactions in the body, including energy metabolism, DNA repair, and antioxidant effects 1
• NAD+ levels naturally decline with age and in certain disease states, which has prompted interest in supplementation strategies 2
• While NAD+ is crucial for cellular function, the specific delivery method of injectable NAD has not been validated in clinical guidelines 1

Current Evidence and Guidelines

• No established clinical guidelines from major medical organizations recommend NAD injections for any medical condition 1
• The American Academy of Physical Medicine and Rehabilitation does not endorse NAD injections due to insufficient clinical evidence 1
• Recent systematic reviews have found limited high-quality clinical trials evaluating injectable NAD for specific conditions 3
• Most research has focused on oral NAD precursors rather than direct injections 4, 2

Safety Concerns with NAD Injections

• Injectable forms of NAD bypass normal digestive processes and may lead to unpredictable blood levels 5
• High-dose nicotinamide (a form of vitamin B3 related to NAD) can cause adverse effects including:
  • Flushing, nausea, vomiting, and liver toxicity 1
  • Potential inhibition of poly(ADP-ribose) polymerases (PARPs), which protect genome integrity 5
  • Alterations in cellular methyl metabolism affecting DNA and protein methylation 5
• Injection-related risks including infection, pain, and inflammation at injection sites 1

Appropriate Niacin Supplementation

• For individuals requiring niacin supplementation, established guidelines recommend:
  • Enteral nutrition: 18-40 mg per day of niacin in 1500 kcal 6
  • Parenteral nutrition: at least 40 mg of niacin per day 6
• Dietary sources of niacin (meat, poultry, fish, nuts, legumes) are the preferred method for maintaining adequate NAD+ levels 1
• Upper intake levels have been established at:
  • 10 mg/day for nicotinic acid due to potential flushing effects 1
  • Approximately 900 mg/day for nicotinamide for adults 1

Alternative Approaches Being Studied

• Oral NAD+ precursors (nicotinamide riboside and nicotinamide mononucleotide) have been more extensively studied than injections 4, 2
• Clinical trials of oral NAD precursors have shown:
  • Safety and tolerability in humans 2
  • Ability to increase NAD+ levels in tissues 4
  • However, efficacy for specific health conditions remains less robust than suggested by preclinical studies 4, 2

Clinical Applications Under Investigation

• Limited evidence suggests potential benefits of NAD-boosting compounds (not specifically injections) for:
  • Chronic fatigue syndrome - some improvement in quality of life and fatigue intensity 3
  • Muscle insulin sensitivity in specific populations 3
  • Psoriasis and enhancement of skeletal muscle activity (preliminary findings) 7
• However, these findings remain preliminary and require larger, well-designed clinical trials before clinical recommendations can be made 7