NAD+ IV drips sell at $400-800 a session. NMN bottles have become the supplement aisle's hottest trend. Meanwhile, the labs with the strongest longevity evidence - ApoB, HbA1c, fasting insulin - are the ones most "biohackers" never check. Here's the honest read on NAD, and the five labs that actually move the longevity math.
What NAD+ is, and why it's not magic
Nicotinamide adenine dinucleotide (NAD+) is a coenzyme in mitochondrial energy production, PARP-driven DNA repair, and sirtuin signaling. Whole-body NAD+ drops roughly 50% between age 30 and 70, which is where the anti-aging pitch comes from.
Oral NAD+ itself is almost useless - it degrades in the gut. Supplementation works through precursors: nicotinamide riboside (NR) or nicotinamide mononucleotide (NMN), or subcutaneous NAD+ injections that skip first-pass metabolism.
Human outcome data - lifespan, disease prevention, objective biological age - remains thin. We don't sell NAD as "anti-aging." We position it as one layer on top of a metabolic baseline.
What the research actually shows
Oral NR has 6+ randomized trials showing 2-3x increases in NAD+ metabolites (NAAD, MeNAM) at 300-900 mg/day. Dose response plateaus around 900 mg. NMN data is trending the same way, with smaller sample sizes.
Injectable NAD+ raises whole-blood NAD+ within hours and lasts days per dose. Human clinical outcome trials remain small - think case series and member-reported outcomes, not Phase 3 endpoints.
IV NAD+ at infusion clinics costs $300-800 per session and adds no evidence advantage over subQ. We skip IV NAD+ for that reason. See the comparison of formats.
The five labs that move longevity more than NAD
ApoB under 80 mg/dL is the single highest-leverage cardiovascular target - MESA and UK Biobank data tie every 20 mg/dL drop to roughly 30% lower event risk. Lp(a) over 50 mg/dL layers additional risk and needs a dedicated plan.
HbA1c under 5.5% and fasting insulin under 8 uIU/mL track metabolic trajectory better than weight or waist alone. hs-CRP under 1.0 mg/L signals low systemic inflammation - above 3.0 is a red flag regardless of LDL.
Retesting every 3-6 months beats annual snapshots. Trends catch the shift; single draws miss it. Run the Advanced panel to get all five in one draw.
What to do now
Run the Advanced lab panel before spending on any NAD protocol. Fix ApoB and HbA1c first; those are the levers with durable human outcome data.
If the baseline is already clean and recovery or cognitive signal is the goal, start with oral NR at 300-600 mg/day for 12 weeks, retest, and decide whether to escalate to injectable NAD+ under provider review.