What Is NAD+? Benefits, Aging & How NAD+ Injections Work

NAD+ shows up on wellness menus, in supplement ads and in anti-aging talk online. So what is NAD+, and can a shot or a drip really help you feel younger? This guide gives you plain, doctor-led answers: what NAD+ does, why it drops with age, what raises it, and what NAD+ injections can and cannot do.

What is NAD+?

NAD+ is a helper molecule found in every cell of your body. The letters stand for nicotinamide adenine dinucleotide. Doctors call it a coenzyme: a small molecule that enzymes need before they can do their work.

Without NAD+, your cells could not turn food into energy. It is not a vitamin, a hormone or a protein. Your body builds it from forms of vitamin B3 and from tryptophan, an amino acid found in protein foods.

NAD+ and NADH: two forms of the same molecule

NAD+ has two forms that switch back and forth all day. When your cells break down food, NAD+ picks up electrons (tiny charged particles) and becomes NADH. NADH carries those electrons to the mitochondria to help make energy, then turns back into NAD+.

In this energy loop, NAD+ is reused. But other enzymes break it apart as they work, so your body rebuilds most of it from those parts, and food tops up what is lost.

What does NAD+ do in your body?

NAD+ helps your cells make energy and repair themselves. It has four main jobs.

• Making energy. NAD+ helps your mitochondria, the tiny power plants inside each cell, make ATP. ATP is the energy every cell runs on, from your heart to your skin.
• Repairing DNA. Repair enzymes called PARPs use NAD+ as fuel to fix daily DNA damage from sun, smoke and normal life.
• Running maintenance proteins. Sirtuins are a group of seven proteins that help control inflammation, metabolism and how cells cope with stress. They cannot work without NAD+, which is why people call them “longevity proteins”.
• Sending signals. Some enzymes in immune cells use NAD+ to make signals that help cells talk to each other.

When your supply cannot keep up, cells make less energy and repair more slowly. This is the thinking behind NAD+ injections at our Markham clinic: giving your body more NAD+ to work with, after a doctor checks your health.

Why do NAD+ levels drop as you age?

NAD+ levels drop with age because your body uses more of it and recycles less of it. A common estimate is that some tissues hold about half as much NAD+ in middle age as in youth, though this varies a lot from person to person.

These are the main things that push NAD+ down:

• More CD38. CD38 is an enzyme on immune cells that breaks down NAD+. It rises with age and with long-term, low-level inflammation.
• More DNA damage. Sun, smoking and pollution damage DNA, and every repair uses up NAD+.
• Slower recycling. The main enzyme that rebuilds NAD+ tends to slow down as you get older.
• Alcohol and high blood sugar. Breaking down alcohol and extra sugar turns NAD+ into NADH, which tips the balance the wrong way.
• Poor sleep and sitting a lot. Both can lower the NAD+ your body makes.

NAD+ and aging: what to expect

Raising NAD+ may support the energy and repair systems that slow down as you age. But NAD+ does not reverse aging, and it is a newer wellness treatment, so we set honest expectations from the start.

Think of NAD+ as one piece of a healthy-aging plan that also includes sleep, exercise, food and skin care. Results vary from person to person.

What are the signs of low NAD+?

There is no single clear sign of low NAD+, and routine blood tests do not measure it. Instead, people often notice a mix of slow, general changes:

• Tiredness that does not go away with rest
• Brain fog or trouble focusing
• Slower recovery after exercise
• Lighter or broken sleep
• Feeling less able to cope with stress
• Skin that looks dull or tired

Many other things can cause these signs. Low iron, thyroid problems, low vitamin B12 or D, sleep apnea, low mood and blood sugar problems can all feel the same. Because Dr. Xu is a medical doctor, your consultation also looks at these other causes before NAD+ is suggested.

Special tests that measure NAD+ exist, but they are rarely used and have no agreed “normal” level. So your plan is based on your symptoms, health history and goals.

What are the benefits of NAD+?

The main possible benefits of NAD+ are more energy, clearer focus, healthier metabolism and support for healthy aging, including your skin. Results vary from person to person, so we set honest expectations before you start.

The table shows each common benefit, how NAD+ may help, and what you may notice.

Some people notice very little. NAD+ is not a cure for any disease, and Dr. Xu reviews how you respond before planning more sessions.

Can NAD+ help aging skin?

NAD+ may help aging skin from the inside, because skin cells need energy to make collagen and repair sun damage. But NAD+ works on overall skin health, not on one line or spot. We see NAD+ as support for your skin plan, not a replacement for targeted skin treatments.

Skin cells lose NAD+ with age, and sun exposure speeds this up, because repairing UV damage uses NAD+. Sirtuins need NAD+ to help keep collagen in good shape. Low NAD+ is also linked to worn-out skin cells that stop dividing and send out inflammation signals.

At home, a niacinamide (vitamin B3) serum or cream is a simple, gentle skincare step. Used daily, it can help with uneven tone, redness, fine lines and a weak skin barrier.

Asian skin and NAD+

In Asian skin (Fitzpatrick III–V), aging often shows first as dark spots, uneven tone and loss of firmness, more than deep lines. NAD+ does not fade pigment or lift sagging skin. For those changes, Dr. Xu plans targeted treatments for aging skin, chosen for your skin type, and NAD+ can sit alongside them as general support.

How can you raise NAD+ naturally?

You can support your NAD+ levels naturally with protein and vitamin B3 foods, regular exercise, good sleep and less alcohol. These habits will not double your NAD+ overnight, but they help your body build and recycle it every day.

Foods that support NAD+

Food does not give you much ready-made NAD+, because your gut breaks it down. Instead, food gives you the building blocks, mainly vitamin B3 and tryptophan. Good sources include:

• Fish such as tuna, salmon and sardines
• Chicken, turkey and lean meat
• Eggs, milk and yogurt
• Peanuts, beans and lentils
• Mushrooms, green peas and whole grains

Daily habits that support NAD+

• Move most days. Both cardio and strength training help your muscles make and recycle more NAD+.
• Protect your sleep. NAD+ follows your body clock, so regular sleep and wake times help.
• Drink less alcohol. Your liver uses NAD+ to break alcohol down.
• Use sunscreen and do not smoke. Both cut the DNA damage that uses up NAD+.
• Avoid overeating. Some people also use time-restricted eating, which means eating only within a set window each day.

NAD+ supplements vs injections vs IV: what is the difference?

NAD+ supplements are pills that give your body building blocks to make NAD+, while injections and IV drips give NAD+ itself and skip the gut. The right choice depends on your goals, your health and how fast you want NAD+ to rise.

What are NMN and NR?

NMN (nicotinamide mononucleotide) and NR (nicotinamide riboside) are the two most popular NAD+ supplements. They are precursors, which means your body turns them into NAD+ in one or two steps. NR is also sold under the brand name Niagen.

Oral NR and NMN are easy to take every day, but they work slowly and quality varies by brand. Niacin, another form of B3, also raises NAD+, but large doses often cause flushing and can strain the liver. NAD+ nasal sprays and patches are sold too, but they are less established.

The table compares the four main ways to raise NAD+.

What to look for in a NAD+ supplement

Choose a product that lists the exact dose, is third-party tested and has no “proprietary blend” that hides amounts. Be careful with big promises such as “reverses aging”, and tell Dr. Xu about every supplement you take.

How do NAD+ injections work?

A NAD+ injection uses a small needle to place NAD+ under your skin or into a muscle, so it skips your gut. NAD+ given this way goes into your bloodstream, and your body’s cells use it. NAD+ injections are also called NAD shots or NAD+ shots. How much you notice depends on your starting health, your dose and your daily habits.

NAD+ injection or NAD+ IV therapy?

The main difference is speed and dose. A NAD+ injection is quick, takes about 15 minutes and uses a smaller dose. NAD+ IV therapy is a slow drip into a vein over about 30 to 60 minutes, so a larger dose can go in gently.

NAD+ needs to go in slowly. If a drip runs too fast, some people feel chest tightness, cramps or nausea, and slowing it usually settles these within minutes. Dr. Xu chooses the route and dose that suit your health and goals.

NAD+ is also different from a vitamin drip. A Myers cocktail gives vitamins and minerals, such as B vitamins, vitamin C and magnesium, while NAD+ gives the coenzyme itself. You can compare all our drips on our IV nutrient therapy page.

What happens at a NAD+ visit?

Your first visit starts with a health check, not a needle. Dr. Xu reviews your health history, medicines, supplements and goals, and makes sure NAD+ is safe for you. Then:

1. Dr. Xu sets your dose and chooses an injection or an IV drip.
2. Our team cleans the skin and prepares the treatment.
3. You have the injection or the drip, and you are watched the whole time.
4. You rest for a short while, then go back to your day.

Dr. Dan Xu and our team perform each treatment. Afterward, drink plenty of water and skip hard exercise for 24 hours.

NAD+ side effects: are NAD+ injections safe?

For most healthy adults, NAD+ injections are well tolerated, and side effects are usually mild and short. The most common are a sting or redness where the needle goes in, flushing, mild nausea and headache. Most of these depend on the dose and on how fast NAD+ goes in.

Common side effects

• Stinging, warmth or a small bruise at the injection site
• Redness or mild swelling that fades within a few days
• Flushing or a warm feeling in the face and chest
• Nausea or an upset stomach
• Headache or light-headedness
• Tiredness or muscle cramps on the day

How we keep side effects low

We keep these effects low by starting with a lower dose, running drips slowly and watching you during treatment. If you feel unwell at any time, tell our team and we slow down or pause. Allergic reactions are rare, and because you are monitored, our team can act right away. Clean technique keeps the small risk of infection low.

Who should avoid NAD+ or wait?

NAD+ is not right for everyone. Because Dr. Xu is a medical doctor, your consultation also checks for these reasons to wait or avoid NAD+:

• Pregnancy or breastfeeding, since NAD+ is not recommended during pregnancy or breastfeeding
• A known allergy to NAD+ or any ingredient in the injection
• Severe liver or kidney disease
• Active cancer, cancer treatment or a recent cancer history, since there is a concern that some tumours may use NAD+ to grow
• Unstable heart disease or recent chest pain
• Treatment that weakens the immune system, an active infection or an uncontrolled long-term illness

Please bring a list of all your medicines and supplements. NAD+ is a wellness treatment, so it should never replace care for a medical condition.

How much do NAD+ injections cost in Toronto?

In Toronto, NAD+ injections and NAD+ IV drips cost about CAD $350–800 per session. Prices are for reference only and reflect general Toronto pricing. Please contact us for your exact price.

Your price depends on your dose, whether you have an injection or an IV drip, how many sessions are in your plan and whether you add other treatments. Most people start with a short course, so plan for several sessions, not just one.

Dr. Xu gives you a clear price for your plan at your free consultation.

Do NAD+ injections work, and are they worth it?

NAD+ injections do raise NAD+ in your body, and many people say they feel more energy. Whether that is worth it depends on your goals, your health and your budget. NAD+ is a newer wellness treatment and results vary, so we set honest expectations from the start.

NAD+ injections may suit you if:

• You feel tired or foggy, and other causes have been checked
• You want extra support for healthy aging, alongside good habits
• You are healthy overall and understand that results vary

NAD+ injections are probably not a good fit if you expect them to reverse aging, cause weight loss or replace treatment for a health problem. They also make less sense before sleep, food, exercise and alcohol have been looked at, since these shape your NAD+ every day.

If you decide to try NAD+, Dr. Xu sets a goal with you, such as steadier energy, and checks your progress after the first sessions. If nothing changes, the plan changes or stops.