IV & NAD+ Therapy
NAD+ Therapy for Brain Fog and Fatigue: What the Evidence Shows
NAD+ precursors reliably raise NAD+ levels in the blood, but trials have not consistently shown improvements in fatigue or brain fog. Here is what patients should know before considering NAD+ therapy.
Reviewed by the clinical team at Zest Regen Health · November 5, 2026 · 7 min read
Content managed by Phil Kim, Lucky Consulting Group
NAD+ therapy can reliably raise NAD+ levels in the blood, but high-quality trials have not consistently shown that it improves fatigue or brain fog, and IV NAD+ in particular lacks randomized evidence for those outcomes. At Zest Regen Health in Columbia, Maryland, NAD+ therapy is considered as part of a broader medical evaluation, not as a standalone fix for low energy.
What NAD+ is and why it matters
NAD+ (nicotinamide adenine dinucleotide) is a coenzyme found in every cell and is central to energy production and cellular repair. NAD+ levels decline with age, which has made it a popular target for wellness clinics offering IV NAD+ infusions and oral supplements such as nicotinamide riboside (NR) and nicotinamide mononucleotide (NMN).
What the trials actually show
The evidence separates into two questions: does supplementation raise NAD+ levels, and does it improve how people feel? The first answer is yes. Randomized trials consistently show that oral NR and NMN raise blood NAD+ levels. The second answer is mixed. A 2023 review of human NR trials in Science Advances concluded that functional outcomes such as strength, endurance, and metabolism were mostly unchanged, with only small signals in some measures.
The largest recent trial was in long-COVID. Published in eClinicalMedicine in late 2025, it randomized 58 people to 2,000 mg of NR daily or placebo. NR raised NAD+ but showed no significant between-group difference in cognition, although people who stayed on NR for at least 10 weeks reported within-group improvements in fatigue, sleep, and mood. A small 2022 trial in older Japanese adults found that 250 mg of NMN daily for 12 weeks improved lower-limb function and reduced drowsiness compared with placebo. Those results are promising but preliminary, and meta-analyses of NMN have not found robust effects on physical performance or muscle function.
What about IV NAD+?
IV NAD+ has the least evidence. A 2024 systematic review of 10 studies covering 489 participants found no evidence that IV NAD+ outperforms placebo for fatigue or energy. Randomized data on IV NAD+ are mostly small safety pilots, and one 2024 pilot found IV NAD+ produced more infusion-related side effects than IV NR. In short, the more dramatic the claim, the thinner the evidence.
Why fatigue and brain fog deserve a real evaluation
Fatigue and brain fog have many causes, including iron deficiency, thyroid problems, vitamin D deficiency, poor sleep, stress, and hormonal changes, and several of these are treatable. A clinic that checks labs before recommending treatment is looking for reversible causes first. At Zest Regen Health, diagnostic wellness testing is part of that approach: blood work and a medical history come before any treatment recommendation, including NAD+.
Who may consider NAD+ therapy
- People with persistent fatigue or brain fog after a medical evaluation has ruled out or addressed other causes
- Patients interested in NAD+ as one component of a broader wellness plan, with clear expectations about the evidence
- People who understand that results are not guaranteed and that response varies from person to person
NAD+ therapy at Zest Regen Health in Columbia, Maryland
Zest Regen Health is a physician-guided wellness and regenerative medicine clinic at 8860 Columbia 100 Parkway, Suite 216, Columbia, MD 21045, serving Columbia, Howard County, and nearby Maryland communities. NAD+ therapy is offered after evaluation by our clinical team, and it is discussed honestly, including what the evidence does and does not support.
Learn more about NAD+ therapy at Zest Regen Health
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Meet Dr. Francisco Ward, the clinic's physician
Frequently asked questions
| Question | Short answer |
|---|---|
| Does NAD+ therapy cure brain fog? | No, and no trial shows that; it is best evaluated as part of a broader workup. |
| Do NAD+ supplements raise NAD+ levels? | Yes, oral NR and NMN reliably raise blood NAD+ levels in trials. |
| Is there evidence for IV NAD+ for fatigue? | No randomized trial shows IV NAD+ outperforms placebo for fatigue or energy. |
| What should come before NAD+ therapy? | A medical evaluation, including relevant lab testing, to look for treatable causes of fatigue. |
| Does Zest Regen Health offer NAD+ therapy? | Yes, at the Columbia, Maryland clinic, after a medical evaluation. |
The bottom line
NAD+ therapy raises NAD+ levels, but the evidence that it improves fatigue or brain fog is mixed and preliminary, and IV NAD+ has the least support. For anyone dealing with low energy, the most valuable first step is a medical evaluation that looks for treatable causes before adding any therapy.
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Sources & further reading
- Effects of nicotinamide riboside on NAD+ levels, cognition, and symptom recovery in long-COVID: a randomized controlled trial (eClinicalMedicine, 2025)
- What is really known about the effects of nicotinamide riboside supplementation in humans (Science Advances, 2023)
- Effect of 12-Week Intake of Nicotinamide Mononucleotide on Sleep Quality, Fatigue, and Physical Performance in Older Japanese Adults (Nutrients, 2022)
- Evaluation of safety and effectiveness of NAD in different clinical conditions: a systematic review (2024)
- Randomized, placebo-controlled, pilot clinical study evaluating acute Niagen+ IV and NAD+ IV in healthy adults (medRxiv, 2024)
Talk with our care team about this topic
A member of our clinical team can answer your questions at the Columbia, Maryland clinic. If NAD+ Therapy may be appropriate for you, the first step is a consultation.
Care at Zest Regen Health is physician-guided. Meet our physicians, who evaluate patients at the Columbia, Maryland clinic.