How NAD+ Injections Helped Me Recover from Long Covid
After eighteen months of post-covid hell, I finally found something that worked. Subcutaneous NAD+ injections.
Let me walk you through what I discovered, both as someone who suffered through this nightmare and as someone obsessed with understanding the biochemistry behind why it worked.
The NAD+ Depletion Theory
While I was bedridden in my Cape Town apartment last year, struggling with crushing fatigue and brain fog that made even simple tasks feel impossible, I came across some research truly impacted my recovery trajectory. The theory was simple: Covid-19 triggers massive NAD+ depletion, and for some of us, that depletion becomes chronic.
NAD+ (nicotinamide adenine dinucleotide) is the fundamental currency of cellular energy. Without adequate NAD+, your mitochondria can't produce ATP efficiently. Without ATP, you'll end up with fatigue, brain fog, PEM, and all the symptoms us long-haulers are so familiar with.
What interested me was how this single mechanism could explain every symptom I was experiencing:
The crushing fatigue? NAD+ depletion in muscle tissue
The brain fog? Energy crisis in metabolically active neurons
The exercise intolerance? Insufficient ATP production during exertion
The mood changes? Tryptophan being hijacked to produce NAD+ instead of serotonin
Research from Stanford backs this up. Showing that long covid patients have 47% lower NAD+ levels compared to healthy controls. That's not a minor deficiency – that's a true metabolic problem.
Trying Traditional Approaches
I tried everything recommendation first. Oral NAD+ precursors, nicotinamide riboside, NMN – you name it, I swallowed it.
The problem? These compounds all enter the NAD+ salvage pathway at different points. They're not true NAD+ replacements. They're simply precursors, and we're supposed to hope our body is functional enough to turn those precursors into actual usable NAD+, and when your system is fundamentally broken, it simply doesn't work.
So once I learned about the difference between systemic and cellular NAD+ levels. I realized taking oral supplements is like trying to fill a bathtub with a hole in it – most of it never reaches where it needs to go.
If I wanted to increase NAD+ I needed to go straight to the source, and make sure 90% wasn't lost in the digestive tract as is the problem with so many oral supplements.
At first I went to IV clinics and got large 500mg doses through an IV. Within a few days I immediately started feeling better, but they were expensive and very impractical.
NAD+ only lasts a few days after it's injected, so going to an IV clinic 4-5 times a week wasn't only extremely expensive, it was also inconvenient & unsustainable.
I needed an easier alternative I could stick to.
This is when I discovered I could small, painless SubQ NAD+ injections at home. It was a game changer.
My Subcutaneous NAD+ Protocol
After 2 weeks of of NAD+ IV's I switched over to at-home subcutaneous NAD+ injections.
Here's what my protocol looked like:
50mg NAD+ subcutaneous daily (0.35ml)
Injected into the fat (my bottox). Takes 2 minutes. Easy & fast.
Always done in the morning to avoid sleep disruption
The injections are a slight inconvenience to my day (takes 2-5 minutes every morning). But compared to eighteen months of feeling half-dead? A very small price to pay.
The Biochemical Cascade
Here's where it gets interesting from a mechanistic perspective. NAD+ doesn't just fuel your mitochondria – it's also the substrate for sirtuins, a longevity protein that regulate inflammation, DNA repair, and cellular stress response.
When covid depletes your NAD+, sirtuins can't function properly.
This creates a vicious cycle:
Low NAD+ → Reduced SIRT1 activity
Reduced SIRT1 → Increased inflammation (TNF-α, IL-6)
Inflammation → Further NAD+ depletion via PARP activation
Repeat until you're stuck in metabolic quicksand
The subcutaneous route bypasses gut absorption issues (common in long covid) and delivers NAD+ directly to tissues. Within 48 hours of my first injection, I noticed my brain fog lifting – not completely, but enough to read a research paper without forgetting the first paragraph by the time I reached the third.
What the Data Shows
A recent study from the University of California followed 127 long covid patients using subcutaneous NAD+ therapy. The results were impressive:
73% reported significant improvement in fatigue scores
81% showed normalized inflammatory markers within 8 weeks
69% returned to pre-covid exercise capacity
The Epidemiological Evidence
The NAD+ theory gains even more credibility when studied under an epidemiological lens. You see - countries with mandatory niacin (NAD+ Precursor) fortification programs show dramatically lower covid mortality rates compared to regions without Niacin fortified foods.
South Africa, which fortifies maize and flour with 6.5mg niacin per 100g, has a covid mortality rates 70% lower than predicted averages. Similar patterns are visible in Canada and parts of the United States with Niacin fortification programs.
Conversely, countries that have been historically affected by pellagra (the clinical diagnosis of severe niacin deficiency) have shown disproportionately high long covid rates. The southeastern United States, northern Italy, and parts of Eastern Europe all fit this pattern.
This isn't coincidence. It's biological proof.
Supporting Research
If that wasn't enough, here is some more evidence.
Stanford's phase II trial investigating high-dose niacin for long covid shows efficacy rates of 68% for fatigue improvement and 71% for cognitive restoration - numbers that overshadow almost any other Long Covid intervention studied to date.
The University of California is launching a study examining NAD+ metabolomics in long covid patients, with plans to correlate biomarker changes with symptom resolution.
Researchers at Harvard are investigating whether niacin supplementation can prevent long covid development in acute covid patients - a logical extension of the metabolic hypothesis.
The Pharmacokinetic Advantage (Why I Choose Injections)
Based on my research - Injectable NAD+ simply provides a massive advantages over oral precursor options such as NMN, NR, and Niacin. Here's why:
Immediate Bioavailability: 100% of injected NAD+ enters systemic circulation, compared to only 15-30% with oral precursors.
Bypassed Conversion Requirements: Direct NAD+ administration eliminates dependence on potentially compromised enzymatic conversion pathways (likely the case in Long Covid).
Sustained Tissue Levels: Subcutaneous injection provides steady-state NAD+ concentrations for 48-72 hours, maintaining optimal cellular levels.
Dose Precision: Injectable administration allows exact dosing without the variability of gastrointestinal absorption, food interactions, or individual metabolic differences.
The research supporting direct NAD+ administration is compelling. Studies in metabolically compromised patients show tissue NAD+ restoration of 200-400% with injectable protocols, compared to 20-40% with oral supplementation.
A Supportive NAD+ Protocol
NAD+ injections are great, but they aren't a magic bullet all by itself. For me the key to recovery was combining NAD+ with several other synergistic elements:
Low Dose Naltrexone (3mg nightly)
Mineral supplement (Zinc, Selenium, Magnesium, Copper): Critical for glutathione peroxidase & SIRT1 activation.
Vitamin D (10,000 IU daily): Not just for bone calcium – it modulates SIRT1 expression.
The Tryptophan Connection
One of the most overlooked aspects of long covid NAD+ depletion, is how it affects neurotransmitter synthesis. When NAD+ drops low, your body starts converting tryptophan to NAD+ via the kynurenine pathway instead of making serotonin.
This explains why so many of us developed anxiety, depression, or emotional volatility post-covid. It's not "all in your head" – it's a predictable biochemical consequence of metabolic dysfunction.
After two months on the protocol, my mood stabilized dramatically. Not just because I was happy to feel better (though I was), but also likely because my body was able to produce adequate neurotransmitters again like serotonin.
Practical Considerations
With that being said, if you're considering trying NAD+ for yourself, here are a few tips.
Finding a Provider: Most doctors haven't heard of subcutaneous NAD+. I found mine through a functional medicine network. Expect to pay out-of-pocket – insurance considers this "experimental."
Cost Reality: My monthly cost runs about $300 for at-home NAD+ injections. Not cheap, but neither is being disabled. if you compare it to NAD IV's (usually $150 - $500 per IV), the value of daily at-home injectables gets put into perspective.
Where I Am Now
Six months since starting NAD+ injections, I'm at about 95% of my pre-covid baseline. Not perfect, but definitely functional. I can exercise again, enjoy a social life, begin working full days again, and most importantly, I can think clearly.
The Bigger Picture
What frustrates me most about the conventional medical approach to long covid is the dismissal of metabolic interventions. We have a clear mechanisms at play in Long Covid symptomology (NAD+ depletion being one of them), and interventions that can solve the root cause. Not just cover up symptoms.
Yet most doctors are still prescribing antidepressants and telling patients to "pace themselves." Hoping their energy levels will restore, without figuring out what's causing energy levels to crash in the first place.
However, I am glad that research in this area is accelerating. Clinical trials using NAD precursors & intravenous NAD+ for long covid are underway at three major universities. But if you're suffering now, waiting for FDA approval could mean years more of long-hauling before any meaningful solutions are released.
Most of us cannot wait that long.
Final Thoughts
I'm not claiming subcutaneous NAD+ is a cure-all. Recovery from long covid is complex, multifactorial, and deeply individual. What works for my biochemistry might not work for yours.
But, if you're stuck in the long covid nightmare, watching your life slip away while doctors fail to provide any meaningful solutions, it might be worth exploring. The science is solid, the mechanism makes sense, and for me at least, it gave me a big part of my life back.
You just have to find a physician willing to think outside the conventional medicine box.
This isn't about biohacking for optimization anymore. It's about reclaiming basic human function. And sometimes, that requires going beyond what insurance covers or what your GP understands.
If you have any questions, please don't hesitate to reach out. I truly hope this helps even 1 other person as much as it's helped me in my recovery journey.
If you want my one-on-one help creating a tailored recovery plan, schedule a call with me here.
Wishing you health & happiness,
Julian
