Nicotinamide Adenine Dinucleotide (NAD+) is a vital coenzyme molecule found in every cell in your body, and without it you would not exist. Your body makes its own NAD+ from dietary nutrients, but levels in humans peak between the ages of 20-30 and then gradually decline. NAD+ deficiency has been identified as a key driver of aging, and low levels can manifest in multiple ways.
Both NAD+ and NADH are forms of Nicotinamide Adenine Dinucleotide. The “plus” in NAD+ indicates that the molecule is oxidized, while NADH is the reduced form, with the “H” representing a neutrally charged hydrogen atom. Learn more about what distinguishes the two, and how they work in your body to produce energy, sustain life, and protect health.
The Critical Role of NAD+ and NADH in Energy Production
NAD+ and NADH are two forms of the same molecule, but one carries electrons and the other does not. NAD+ is an electron carrier that provides a stable shuttle for moving electrons across a cell’s internal environment. NAD+ transports the electrons of a hydride – a hydrogen atom with an extra electron – from one region of a cell to another. A hydride is represented by the “H” in NADH.
Both NAD+ and NADH are oxidation-reduction (redox) molecules. Oxidation and reduction occur when molecules gain or lose electrons. Reduction occurs when a molecule gains electrons, such as when NAD+ gains electrons from a hydride to become NADH – in other words, NAD+ is reduced to NADH. Oxidation occurs when a molecule loses electrons, as when NADH loses its hydride to become NAD+. Put simply, NADH is oxidized to NAD+. This process is ongoing, meaning that NAD+ can continuously gain and lose electrons.
Energy is produced in the cells’ mitochondria when food molecules are broken down via a series of chemical reactions to manufacture ATP, the energy molecule. The ability of NAD+ to convert to NADH and vice versa is what makes energy metabolism possible.
It works something like this:
- NAD+ picks up high-energy electrons and a proton from food molecules, turning it into NADH. It’s like charging a battery.
- Once energized, NADH delivers those electrons to the electron transport chain in the mitochondria and hands them off, creating ATP. In the process, NADH converts back to NAD+.
- NAD+ is now ready to pick up more electrons, continuing the cycle of powering the cell to turn food into usable energy in the form of ATP.
This cycle continues throughout your lifespan, picking up steam when demand is high – e.g. during exercise – and slowing down when you’re at rest. Factors that affect the efficiency of energy production include type and quality of food molecules available, number and size of cellular mitochondria, and efficiency of your oxygen delivery system. In general, a very fit person with a nutrient-dense diet will produce more energy, more efficiently than an out-of-shape person with a nutrient-deficient diet.
Causes and Symptoms of NAD+ Deficiency
Your body makes NAD+ from key precursors in the foods you eat. NAD+ precursors are essentially forms of vitamin B3 and related compounds.
NAD+ precursors include:
- Niacin (nicotinic acid), a form of B3 found in meat, fish, poultry and nuts.
- Nicotinamide (NAM), also a form of vitamin B3 found in eggs, milk, and fish.
- Nicotinamide Riboside (NR), a form of B3 found in yeast and dairy products.
- Nicotinamide Mononucleotide (NMN), a direct NAD+ precursor found in cruciferous vegetables like broccoli and cabbage, and in avocados.
- Tryptophan, an essential amino acid found in turkey, chicken, eggs, cheese, and seeds.
NAD+ precursors include:
A nutrient-dense diet of high-quality foods may provide enough NAD+ precursors to meet your needs, but the older you get, the more precursors you need to keep up with age-related depletion of NAD+ levels.
Causes of NAD+ Depletion include:
- Aging, where NAD+ depletion contributes to age-related symptoms.
- Insufficient dietary intake of NAD+ precursors.
- Chronic stress and systemic inflammation, causing overuse of NAD+ for DNA repair.
- Excess alcohol consumption that depletes NAD+ in the liver.
- Metabolic disorders like diabetes, obesity, and neurodegenerative diseases.
When NAD+ depletion reaches critical levels, you may begin to notice symptoms, but they will likely have a gradual onset, and people often shrug them off as a natural consequence of getting older. But improving your diet and supplementing with precursors can help to slow the rate of NAD+ depletion and even reverse its symptoms.
Common symptoms of NAD+ depletion include:
- Chronic Fatigue and Low Energy – NAD+ is responsible for ATP production in cellular mitochondria via the electron transport chain. ATP is the energy molecule released from fat and carbohydrate metabolism that drives muscle contraction and other critical cellular functions.
- Cognitive Impairment – Brain fog, poor concentration and memory lapses can indicate low NAD+, which supports neuronal function and repair in the brain and Central Nervous System.
- Muscle Weakness or Reduced Endurance – Low NAD+ can reduce muscle energy production, leading to weakness, reduced exercise capacity, and muscle fatigue.
- Metabolic Dysfunction – Low NAD+ can lead to weight gain, insulin resistance, and high blood sugar due to NAD’s role in cellular glucose metabolism.
- Accelerated Aging – Symptoms like reduced skin elasticity, wrinkles, and stiff joints and connective tissues can indicate NAD+ deficiency, becauseNAD+ activates sirtuins – a family of enzymes involved critical biological processes like DNA repair, energy optimization, and stress responses.
- Increased Oxidative Stress – NAD+ supports antioxidant defenses against cellular damage, inflammation, and chronic metabolic diseases.
- Poor Immune Function – Low NAD+ can increase the risk of infections and slow your rate of recovery due to poor immune cell function.
- Sleep Disturbances – NAD+ regulates your circadian rhythms via sirtuins that govern sleep and wake cycles.
- Cardiovascular Issues – NAD+ supports endothelial function, helping to regulate blood pressure and maintain cardiovascular health.
- Neurological Symptoms – NAD+ depletion can affect neurotransmitters and brain function, causing symptoms like mood swings, anxiety and depression.
- Digestive Issues – NAD+ supports cellular health in the gastrointestinal tract, and deficiency can lead to gut dysfunction and poor nutrient absorption.
Common symptoms of NAD+ depletion include:
One CoEnzyme, Dual Roles
To sum up the differences between NAD+ and NADH:
- NADH is bound to a hydride and is actively carrying electrons
- NADH is the reduced form of NAD+
- NAD+ is the oxidized form of NADH
- Both NAD+ and NADH continually convert from one form to the other
Below is a table comparing NAD+ (Nicotinamide Adenine Dinucleotide – oxidized form) to NADH (Nicotinamide Adenine Dinucleotide – reduced form):
| Feature |
NAD+ |
NADH |
| Full Name |
Nicotinamide Adenine Dinucleotide (oxidized) |
Nicotinamide Adenine Dinucleotide (reduced) |
| Oxidation State |
Oxidized form |
Reduced form |
| Chemical Structure |
Contains a positively charged nicotinamide ring |
Contains a neutral nicotinamide ring with an added hydride ion (H⁻) |
| Role in Metabolism |
Acts as an electron acceptor in redox reactions |
Acts as an electron donor in redox reactions |
| Function |
Accepts electrons and protons during catabolic reactions (e.g., glycolysis, Krebs cycle) |
Donates electrons to the electron transport chain for ATP production |
| Energy State |
Low-energy state (accepts electrons to become NADH) |
High-energy state (carries electrons for energy production) |
| Electron Carriage |
Does not carry high-energy electrons |
Carries two high-energy electrons and one proton |
| Biological Processes |
Involved in oxidation reactions (e.g., converting substrates to products) |
Involved in reduction reactions (e.g., ATP synthesis in mitochondria) |
| Conversion |
Converted to NADH by gaining electrons and a proton |
Converted to NAD+ by losing electrons and a proton |
| Location in Cell |
Found in cytoplasm, mitochondria, and nucleus |
Primarily found in cytoplasm and mitochondria |
| Absorption Wavelength |
Absorbs UV light at ~260 nm |
Absorbs UV light at ~340 nm (due to reduced nicotinamide ring) |
| Key Example Reaction |
Glyceraldehyde-3-phosphate to 1,3-bisphosphoglycerate (glycolysis) |
Donates electrons in the electron transport chain (oxidative phosphorylation) |
Get the Best NAD+ IV Therapy in NYC
Whether your understanding of NAD+ vs NADH is crystal-clear or clear as mud, you don’t need to understand the chemistry to reap the rewards. Scientific research has accumulated mounds of evidence that NAD+ plays a critical role in human health, and that deficiency leads to reduced physical and mental performance. As you age, even the most nutrient-dense diet may not be enough to make up for natural NAD+ depletion.
At Invita Wellness, we’re here to help boost your NAD+ levels with potent NAD+ IV infusion and NR injection therapies, delivered in the convenience and comfort of our Manhattan clinic in trendy SoHO. Contact us today, and see what a difference NAD+ therapy can make in your health, vitality and quality of life.
*Please note: NAD+ is a nutrient coenzyme, not a medication. It should not be considered an alternative to medical advice or pharmaceutical prescriptions from your health care provider. Consult your doctor if you have concerns about NAD+ therapy.
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Resources
White, Amanda T., and Simon Schenk. “NAD+/NADH and skeletal muscle mitochondrial adaptations to exercise.” American Journal of Physiology-Endocrinology and Metabolism 303.3 (2012): E308-E321.
NAD+/NADH and skeletal muscle mitochondrial adaptations to exercise
Ying, Weihai. “NAD+ and NADH in cellular functions and cell death.” Front Biosci 11.1 (2006): 3129-3148.
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