By Natasha Thomas, MD
Content revised: 01/27/2024

Posted on: September 3, 2021

NAD+ therapy has emerged as a promising solution for individuals facing chronic fatigue and many of the undiagnosed symptoms commonly written off as symptoms of aging. By replenishing cellular energy and combating oxidative stress, NAD+ therapy has helped patients like Grace, who struggled with persistent and debilitating fatigue despite healthy habits, to reclaim their vitality and get their lives back. 

When someone’s “energy tank” is running on empty, they can usually figure out why. 

“I should eat better,” they’ll say. Or, “I know I should get more sleep, exercise…fill-in-the-blank.” 

But one patient was quite different. 

Grace1 tried hard to support her health in all the right ways. But she still had no energy. 

A 55-year-young grandmother, Grace arrived for her appointment looking like a woman in good health. She was in good shape physically, not overweight. But appearances can be deceiving.

“Dr. Thomas, I do everything right. I take supplements; I eat all organic; I don’t smoke, drink, or eat sugar; I exercise; I get enough sleep…I do all the right things, but I’m dragging. My energy is low all the time. I tire out so easily. I have no endurance when I exercise; my muscles even seem like they have no energy. Forget about having enough energy to go out and have fun with friends. I feel way older than I am. I don’t know what else to do! What’s wrong with me?”

Chronic fatigue. It doesn’t sound all that serious, but when fatigue consumes your life, you have no energy, and no amount of sleep helps, it can make a person feel desperate.

nad+ therapy, image of a person who appears to be in their 40s sitting down with their head resting on their crossed arms with a tired expression on their face, representing fatigue and the potential need for NAD+ therapy.

I could see she was very worried. Her weariness made her look older. She had no sparkle. It was as if she had no energy to feel happiness, let alone joy.  

“I’ll run some tests to make sure there aren’t any hidden causes behind your chronic fatigue, and we’ll see what we find,” I reassured her. “Almost always there are hidden causes.” 

I investigated all the possible culprits: 

Nothing significant turned up. Grace had a fairly clean slate in all those areas. No typical suspect seemed to be causing her chronic fatigue. 

However, I knew of something that might help. 

I told her about an intravenous treatment that was causing a lot of excitement in the functional medicine world, especially among anti-aging specialists. It’s called NAD+ therapy.

What Is NAD?

NAD is an essential coenzyme (a helper molecule), whose abbreviation stands for nicotinamide adenine dinucleotide. “Essential” means we can’t live without it—that’s how important it is. 

For example, one function of NAD is to convert the food we consume into cellular energy, which is why it seemed a possible candidate in Grace’s situation. Her body seemed to have a disconnect between all the healthy things she did and her energy level. I thought maybe NAD+ could provide the missing link. NAD is involved in multiple processes in every cell in the body—in one form or the other.


Depending on which function it’s performing, NAD takes one of two forms—NAD+ or NADH. Put simply, NAD helps move the hydrogen molecule around for cellular reactions. When it’s ready to carry the hydrogen electron, it’s NAD+, and when it’s actively carrying hydrogen, it’s NADH.

Why Is Hydrogen So Important? 

Hydrogen is the most abundant periodic table element in the universe. Water makes up about 60 percent of the human body. The brain and heart are 73 percent water, and the lungs, amazingly, are 83 percent water. Since two-thirds of water is hydrogen (H2O), we realize how essential hydrogen is. 

Hydrogen is not only a key part of our DNA, it also plays a vital role in digestion. When it binds with chlorine, it forms hydrochloric acid, which breaks down protein, necessary for cellular building and repair. These facts clue us in to the importance of the NAD connection.

Mitochondria are miniscule energy factories within our cells, which can only produce more energy when they have everything they need, and one thing they need is hydrogen to create adenosine triphosphate (ATP). NAD transports hydrogen to keep the mitochondria happy. And when our mitochondria are happy, we have energy!

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Does NAD+ Help with Energy?

Not only does NAD help our energy by feeding hydrogen to the mitochondria, but NAD+ protects our energy against its greatest enemy—oxidative stress. By reducing oxidative stress, NAD+ not only preserves our energy but prevents the myriad symptoms which oxidative stress can cause.

What Happens When NAD+ Is Low?

As we age, oxidative stress goes up, and unfortunately, NAD+ levels go down. This translates into lack of energy, skin wrinkling, brain fog, cardiovascular disease, and most of the other “symptoms” we associate with aging. You’ll notice how the symptoms of low NAD+ match symptoms we call aging. Some of the most common symptoms of low NAD+ include:

So naturally, researchers wondered, would raising NAD+ levels slow aging? Would it improve brain function and energy? Would people feel and look younger? 

The results of numerous studies seemed to answer: yes, yes, and yes.

As I explained all of this to Grace, she regained hope. “How can my NAD+ levels be raised?” she asked.

The precursors to NAD can be found in meat, milk, and vegetables. But Grace’s diet was already impeccable. So, I told her about NAD+ therapy.

How Can NAD+ Be Restored?

Scientists have discovered that NAD+ levels can effectively be restored through NAD+ therapy. NAD+ therapy can be achieved in various ways, but it involves the administration of NAD+ or its precursors—like nicotinamide riboside (NR) or nicotinamide mononucleotide (NMN), which the body then converts into NAD+. By restoring NAD+ levels, we can support mitochondrial function, initiate DNA repair mechanisms, and promote overall cellular health.

Does NAD+ Help Chronic Fatigue Syndrome?

Many of the symptoms associated with low NAD+, and commonly tied to aging, are also observed in chronic fatigue syndrome (CFS). These include mental and physical fatigue and metabolic dysfunction, just like Grace was experiencing. By restoring NAD+ levels and enhancing NAD+ metabolism, NAD+ therapy has the potential to correct the low energy production and diminished metabolic health seen in patients with CFS. 

As research continues, scientists are discovering that NAD+ therapy not only holds great promise in managing CFS but offers a number of health benefits in both the short-term and long-term. 

nad+ therapy, image of a person walking along the shoreline looking back at the camera and smiling, representing restored energy and the benefits of NAD+ therapy.

Benefits Of NAD+ Therapy

Using carefully developed protocols for increasing NAD+ levels, scientists have revealed the efficacy of NAD+ therapy in restoring cognitive brain function, facilitating anti-aging, improving neuro-regeneration, and even reducing addictive cravings and behavior. 

Here are some of the many benefits researchers have studied:

  1. Energy production
  2. Anti-aging 
  3. Brain health 
  4. Cardiovascular health 
  5. Nervous system health
  6. Glucose balance
  7. Metabolism

How Does NAD+ Therapy Work?

Research has explored a variety of methods for restoring NAD+ levels and enhancing NAD+ metabolism to address these various health concerns. NAD+ can either be replenished directly or indirectly (through the administration of NAD+ precursors) using the following therapeutic methods:

Oral: Sublingual (under-the-tongue absorption into the bloodstream) is one option. However, this oral NAD+ supplement is less effective than other methods, as the stomach acid destroys much of the NAD+.

Transdermal: Patches to deliver a specific dosage through the skin have been used.  

Injections: With a very tiny needle inserted into the belly fat, NAD+ has been injected subcutaneously. However, because there is less research on this method, and we don’t know how effective it is.

Intravenous: The most studied option with the best and quickest results is the NAD+ IV drip. This is the method I recommended for Grace’s situation. Not only does this method have the most research behind it, but we wanted fast results, and NAD+ IV therapy offers rapid and efficient delivery directly into the bloodstream—bypassing the digestive system and potentially leading to more immediate effects. 

What Are the Risks of NAD+ Therapy?

Naturally, this was an important consideration for Grace. I reassured her that NAD+ therapy is safe and painless. 

When she asked if there were any negative side effects, I reassured her, “Only if the IV drip goes in too fast.” “In that case, the patient might feel a little stomach discomfort or chest pressure. If so, we simply slow down the drip while the body adjusts. That’s the benefit of being here in the office for the treatment.”

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How Long Does NAD+ Therapy Last?

The duration of NAD+ therapy varies depending on the method of administration and the specific protocol used, as well as the individual patient’s health status and treatment goals. When it comes to intravenous NAD+ therapy, a session can range from two to three hours, and the whole treatment process can involve one or multiple sessions over the course of weeks or months. 

For Grace, who was eager to begin her NAD+ IV drip appointments, the first couple of treatments took about 2–3 hours, while the solution slowly infused into her system. She did beautifully. As her system acclimated, her sessions were reduced to 60–90 minutes. 

How Long Does It Take for NAD+ Therapy to Work?

The duration of benefits from NAD+ therapy can vary depending on individual factors such as age, health status, lifestyle, and the specific protocol used for treatment. Some people may experience immediate improvements in energy levels, cognitive function, and overall wellbeing shortly after starting NAD+ therapy, while others may require multiple sessions to notice significant changes.

In general, the effects of NAD+ therapy are thought to be cumulative, with potential long-lasting benefits observed over time.

After five treatments over the course of two weeks, Grace had achieved better skin tone and noticeably greater energy, with increased physical endurance when exercising. Although she wasn’t overweight, her little bit of extra belly fat had also faded within those two weeks.

Grace was thrilled. “I feel so much stronger, like I did when I was younger. I’m easily able to exercise longer without feeling any muscle fatigue. It feels like a heavy burden has been lifted. I have the energy to have fun again!” 

Beyond the physical changes, it was wonderful to see her sparkle return. She was happy again. 

NAD+ Therapy with Natasha Thomas, MD

If you or someone you know is suffering from symptoms of chronic fatigue or “aging,” please seek help. There is always an answer. The body is just urging you (through symptoms) to find it. And I can help you—whether that’s addressing low levels of NAD+ through NAD+ therapy or treating another cause of low energy through treatments like nervous system regulation, hormone balance, or lifestyle medicine. Let’s explore what your answers might be.

Revitalize your life and promote healthy aging through personalized lifestyle medicine with Dr. Natasha Thomas. Schedule a consultation now to take the first step towards a healthier, more vibrant you.

1Not the patient’s actual name.
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