A Deep Dive on NAD+
NAD+ is getting a lot of attention in the longevity space right now—but most of the conversation skips over the parts that actually matter clinically.
I’m a physician with a wellness/longevity medicine practice and a few things I consistently see being oversimplified (sharing clinical perspective only, not promoting anything):
- NAD+ isn’t just about “energy”—it’s also consumed in DNA repair and inflammation pathways, which is part of why levels decline with age
- Taking NAD+ directly (IV or oral) doesn’t necessarily mean it’s getting into cells in a meaningful way
- Precursors like NMN and NR have a stronger mechanistic rationale—but human outcome data is still early
- There’s no “best protocol”—context (metabolic health, stress load, baseline physiology) matters more than the compound itself
From a clinical standpoint, the bigger issue is that these therapies are often used in isolation, without much attention to:
- insulin sensitivity
- body composition
- sleep / recovery
- overall metabolic baseline
Which is where things tend to break down long-term.
If you want to dig into the dense biochemistry—including the Salvage Pathway bottleneck, the structural differences between NR and NMN, and the exact clinical trials—I published the full, un-paywalled clinical briefing here:
Beyond the Biohack: A Clinical Guide to NAD+ and Cellular Energy
I’ll be monitoring this thread today. Let me know if you have any questions regarding the pharmacokinetics of these compounds or how we approach cellular optimization in clinical practice.