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Long-COVID Therapies:
NAD+ IV Therapy

By Tabitha Block, Jonathann Kuo MD

What is NAD+?

NAD is the abbreviation for a compound called nicotinamide adenine dinucleotide, which is well-known for its critical role in energy production. NAD is also involved in the smooth execution of signaling pathways that govern proper functioning of the immune system and cell survival. NAD+, a form of NAD, is responsible for many of these biological functions. As we age, DNA damage from toxin accumulation, ultraviolet light exposure and other stressors cause levels of NAD+ in the body to decline. In addition to the natural decline of NAD+ levels that occurs with aging, many disease states associated with increased oxidative stress cause a reduction of NAD+ levels (28). Under normal conditions, reactive oxygen species (ROS) are produced by many cellular processes, such as oxygen metabolism and antimicrobial activities. These compounds are typically cleared or counteracted by enzymes, but ROS can accumulate if these antioxidant mechanisms are impaired, causing DNA damage and a subsequent reduction of NAD+ levels (29, 30). 

Reduced levels of NAD+ have been shown to cause altered metabolic states and increased disease susceptibility. The consequences of insufficient levels of NAD+ have been widely studied in the context of age-related disorders and neurodegenerative diseases (30-31). More recently, however, research suggests these consequences may contribute to the extensive biological abnormalities seen across the SARS-CoV-2 disease spectrum (32). Early data indicate that NAD+ repletion therapy may reduce symptoms of long COVID (33).

How does NAD+ IV Therapy help reduce long COVID Symptoms?

Enzymes are a type of protein that help speed up chemical reactions in the body. Normally, enzyme production is under tight control to ensure that products are not wasted through excessive synthesization and substrates are not used up too quickly. Many enzymes and proteins depend on NAD+ to carry out their respective functions. For example, some NAD+-dependent enzymes are required for the antiviral activity of the interferon system, an immune response to viral infection (34). Enzymes involved in the interferon system rely on a supply of NAD+ to carry out antiviral responses (34-35). During many viral infections, the NAD+ supply required by the interferon system is undisrupted and the immune system can adequately respond (34). When a person’s cells become infected with SARS-CoV-2, the virus that causes COVID and long COVID, the composition of enzymes produced by the cell’s protein synthesizing machinery drastically changes. Recent research has shown that the SARS-CoV-2 virus stimulates the infected cells to increase the synthesis of NAD+-consuming enzymes which preferentially provide NAD+ to viral activities (35-37). The NAD+-consuming enzymes which become upregulated in SARS-CoV-2 infection cause a severe depletion of available NAD+ (36-37). Without an adequate supply of NAD+, the NAD+-dependent enzymes of the interferon system cannot properly function, leading to impaired antiviral activity (34-37). Further, dysregulation of NAD+ metabolism has been shown to have a wide range of health implications from compromised cardiac function to hyperinflammation and DNA damage due to increased oxidative stress (38).

Although the consequences of SARS-CoV-2-mediated NAD+ depletion are not yet fully understood, preclinical and clinical data has suggested NAD+ supplementation may accelerate recovery from long COVID (39-40). NAD+ supplementation has been shown to increase the body’s resilience to many different diseases. Physician-guided intravenous administration of NAD+ may safely provide direct and effective symptom relief of long COVID symptoms involving NAD+-depletion.

Please see this linked article that we are publishing that summarizes our current understanding of this process. 

What happens during NAD+ IV Therapy?

NAD+ can be administered orally or intravenously, but intravenous administration results in higher concentrations of NAD+ in the bloodstream (21). Prior to your infusion, you will have a consultation with your physician, who will carefully consider your medical history and present symptoms to determine if you are a candidate for NAD+ IV Infusion Therapy. If you are an appropriate candidate, our staff will help you get comfortably set up in one of our infusion rooms. During a NAD+ IV Infusion treatment, one of our highly experienced staff members will place an IV in your arm or hand, which will remain throughout the duration of the therapy. Over the course of 45 minutes to 1 hour, NAD+ will be administered through an IV drip with normal saline.

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