NAD+

The single most common mistake I see with NAD+ elsewhere is running it too fast. Infused quickly, it causes chest tightness, flushing, and nausea, and patients understandably never come back. I run roughly 250–500 mL over two to four hours, starting at the low end for first-timers, and I stay involved in the titration. For patients who cannot give up an afternoon, I use subcutaneous injections — a 30-gauge half-inch needle, about 10–12 mm into the abdominal fat pad — usually twice weekly between infusions.

I recommend NAD+ most often to patients preparing for or recovering from surgery, patients whose jobs live on airplanes, and patients focused seriously on longevity and metabolic health. A loading series of four to six weekly infusions, then monthly maintenance, is where I see real change; a single infusion is a nice afternoon, not a result. I review every medication and supplement first — blood pressure and psychiatric medications matter here — and I will tell you plainly if I do not think you need it.