Long Covid, NAD+

Jun 8

NAD+ Therapy, Long COVID, and the Energy I Thought I Lost Forever

I want to talk about something I have been doing quietly, consistently, and very intentionally for the last five-plus weeks.

NAD+ infusions.

Twice a week.

And if you have seen me in clinic recently with an IV running while I am still talking through labs, treatment plans, mold, Lyme, hormones, peptides, and everything else under the sun…

Now you know why.

I am experimenting on myself again.

Because that is what I do.

Not recklessly. Not randomly. But with curiosity, caution, and the same question I ask for every patient who walks through my door:

What is the body missing that would allow it to heal?

And for me, after COVID and the forced vaccinations that followed, one of the things my body has clearly been missing is cellular energy.

Not caffeine energy.

Not adrenaline energy.

Not “push through and pretend you are fine” energy.

Real energy.

The kind I have not felt since before COVID changed everything.

The Fatigue That Changed My Life

Before COVID, I was not perfect.

None of us are.

But I had a level of stamina that I could count on.

Afterward, something shifted.

The best way I can describe it is this:

It felt like my body had a hidden energy leak.

No matter what I did, I could not fully refill the tank.

Sleep did not restore me.

Supplements helped, but only so much.

Mitochondrial support helped, but not enough.

I could function, because I am stubborn.

I could work, because my warriors need me.

But inside, I knew the difference.

I knew what my body used to feel like.

And I knew I was not there yet.

Before NAD+, I Had to Stop the Leak

This is the part people miss.

You cannot pour energy into a system that is actively leaking.

Before I started NAD+ infusions, I spent two weeks preparing my body.

I used two foundational supplements specifically to help stop the “energy leak” before trying to push the mitochondria harder.

And I still take them daily.

Why?

Because NAD+ is not magic.

It is not a fairy dust IV.

It is a tool.

A powerful one, yes.

But if the body is inflamed, toxic, depleted, infected, or running on pure stress chemistry, you may not tolerate it well or get the full benefit.

So before we “turn on” energy production, we have to ask:

Is the wiring safe?

Is the engine damaged?

Is the system ready?

That is the difference between functional medicine and throwing trendy treatments at a tired body.

What Is NAD+?

NAD+ stands for nicotinamide adenine dinucleotide.

It is a coenzyme found in every cell of the body.

That sounds boring until you understand what it does.

NAD+ is central to:

Mitochondrial energy production
DNA repair
Cellular resilience
Redox balance
Healthy aging pathways
Sirtuin activation
Brain and nervous system function

In plain English:

NAD+ helps your cells make energy, repair damage, and respond to stress.

And in long COVID, post-viral illness, chronic fatigue, mold illness, Lyme disease, and chronic inflammatory states, those systems often get hammered.

Why NAD+ Makes Sense for Long COVID

Long COVID is not one thing.

That is why it has been so difficult to study and treat.

For some people, it is primarily neurological.

For others, it is vascular.

For others, immune.

For others, mitochondrial.

For many, it is all of the above.

But one of the recurring themes in the literature is mitochondrial dysfunction, oxidative stress, inflammation, immune dysregulation, endothelial dysfunction, and impaired energy metabolism. Reviews of long COVID have increasingly highlighted mitochondrial dysfunction as a possible driver of fatigue, brain fog, exercise intolerance, and multisystem symptoms. Research also suggests SARS-CoV-2 can disrupt mitochondrial function directly and indirectly through the inflammatory immune response.

That matters because mitochondria are your energy factories.

If they are inflamed, damaged, or inefficient, the whole body feels it.

Muscles feel weak.

The brain feels foggy.

Sleep stops being restorative.

Exercise becomes punishment.

The nervous system stays reactive.

And you start living life like your battery never charges past 37 percent.

NAD+ is one of the key molecules mitochondria need to function.

So the logic is simple:

If long COVID creates a mitochondrial energy problem, then supporting NAD+ biology may be one way to help restore cellular energy.

Now, let me be very clear.

We do not have massive, definitive, perfect clinical trials proving IV NAD+ is the answer for long COVID.

We barely have enough good studies for long COVID treatments in general.

What we do have is emerging research showing mitochondrial dysfunction is important in long COVID, and early clinical interest in NAD+ precursors like nicotinamide riboside, also known as Niagen, for long COVID symptoms such as fatigue, cognition, and sleep. A registered clinical trial has studied Niagen in people with persistent post-COVID brain fog and physical symptoms, and Niagen Bioscience has reported results from a randomized controlled trial evaluating NAD+ elevation with nicotinamide riboside in long COVID.

Is that the same as IV NAD+?

No.

Is it proof that all NAD+ therapies are equally effective?

No.

But it is enough for me to say:

This pathway matters.

And clinically, I am paying attention.

My Personal NAD+ Experience

I started doing NAD+ infusions twice weekly.

Slowly.

Carefully.

And over the last five-plus weeks, I have noticed something I have not felt in a long time:

My energy is improving.

My fatigue is improving.

Not overnight.

Not dramatically like some miracle testimonial.

But steadily.

Enough that I noticed.

Enough that Gio noticed.

Enough that I am continuing.

Yesterday, I did 800 mg of NAD+.

That is by far the most I have done in one session.

And last night?

I slept through the night for the first time in over six years.

Now, let me be honest.

It was only five hours.

But I woke up feeling more rested than I have felt in a very long time.

For someone who has spent years fighting for sleep, oxygen, energy, and recovery, that is not a small thing.

That is a breadcrumb.

And in chronic illness, we follow breadcrumbs.

The Part Nobody Tells You: NAD+ Feels Horrible

Let’s not romanticize this.

NAD+ therapy is not a spa day.

No one is lying there thinking, “Wow, what a relaxing little infusion.”

NAD+ can feel terrible if it runs too fast.

Some people feel:

Nausea
Chest tightness
Anxiety
Muscle cramping
Pressure
Shortness of breath sensations
That lovely “why did I pay money to feel like I might die?” experience

It can feel like someone is squeezing your heart muscle while your stomach is debating whether it wants to leave your body.

Super fun.

Especially when you just paid actual money for the privilege.

This is why rate matters.

This is why patient tolerance matters.

This is why we do not just crank it open and hope for the best.

The body gives feedback.

We listen.

What About Niagen IV?

There is another option I have been exploring:

Niagen IV.

For many patients, Niagen is much easier to tolerate.

In my experience, it does not create the same “I may throw up and meet Jesus” feeling that traditional NAD+ infusions can create.

The catch?

It tends to hurt the pocketbook more.

Is Niagen superior for long COVID?

I do not know yet.

Is NAD+ superior?

I do not know yet.

Do we have head-to-head clinical trials comparing IV NAD+ versus IV Niagen specifically for long COVID patients?

No.

And anyone pretending we do is over-speaking.

What I can say is that both are aimed at supporting NAD+ biology, and NAD+ biology appears relevant in post-viral fatigue, mitochondrial dysfunction, and cellular repair.

So for now, I am watching outcomes.

Mine.

My patients’.

The research.

And I will keep adjusting as the evidence and real-world experience evolve.

How Long Should Long COVID Patients Do NAD+?

This is the question I am actively trying to answer.

Because NAD+ therapy is:

Time consuming
Expensive
Not always pleasant
Not always logistically easy

Twice weekly infusions take commitment.

So what is the best protocol?

Four weeks?

Six weeks?

Eight weeks?

Twelve?

Do some patients need loading and then maintenance?

Do some need Niagen instead?

Do some need mitochondrial repair first with other therapies before they can tolerate NAD+?

These are the questions I am asking.

For myself, my current plan is simple:

I am going to continue NAD+ infusions until I stop noticing improvement.

That is my marker.

Not forever.

Not blindly.

But intentionally.

If I am still improving, I keep going.

If I plateau, we reassess.

That is how good medicine works.

The Bigger Lesson

Long COVID taught many of us that the old model is not enough.

You cannot tell someone their labs are normal when they cannot climb stairs.

You cannot tell someone they are fine when their brain no longer works.

You cannot tell someone to exercise their way out of mitochondrial dysfunction.

And you cannot shame people into healing.

We need better tools.

We need better thinking.

We need to look at the body as a connected system.

For many long COVID patients, NAD+ therapy may be one tool worth considering as part of a larger plan that also addresses:

Inflammation
Sleep
Mold exposure
Lyme and co-infections
Mast cell activation
Hormones
Nervous system regulation
Mitochondrial repair
Nutrient status
Detoxification capacity

Because NAD+ is not the whole answer.

But for some of us, it may be a very important piece.

My Honest Take

I am not here to sell you magic.

I am here to tell you what I am seeing, what I am feeling, and what I am learning.

After five-plus weeks of twice weekly NAD+ infusions, I have noticed improvements in energy and fatigue that I have not felt since before COVID changed my body.

After my 800 mg infusion, I slept through the night for the first time in over six years.

That has my attention.

So yes, I will keep going.

Yes, I will keep tracking.

Yes, I will keep refining protocols.

And yes, I will keep bringing you the most cutting-edge information I can find, because this is what I do.

I live it.

I study it.

I test it.

I bring it back to you.

I will see you in my office soon.

And if I have an IV running while we are talking…