NAD⁺ Injections and NAD Boosters: Evidence Gaps, Safety Concerns, and Public Health Implications

This article examines the growing use of NAD⁺ injections and NAD-boosting supplements, including nicotinamide riboside (NR) and nicotinamide mononucleotide (NMN), from a public health perspective. Although NAD⁺ plays a fundamental role in cellular metabolism, ageing biology, and DNA repair, commercial wellness markets have rapidly promoted NAD interventions as anti-ageing, cognitive-enhancing, and disease-preventive therapies despite limited clinical evidence. The paper provides a narrative public health and regulatory analysis of the evidence base, safety concerns, and governance challenges associated with these interventions. Current human trials demonstrate biochemical activity and measurable adverse effects but provide little evidence of meaningful clinical benefits such as reductions in cardiovascular disease, cancer, neurodegeneration, or mortality. Long-term safety remains uncertain, particularly in the context of chronic use and population-level exposure. In addition, the article examines broader risks associated with the supplement market, including product adulteration, inconsistent quality control, weak post-market surveillance, and misinformation-driven consumer adoption. These factors create potential pathways for both direct and indirect harm, including behavioural displacement from evidence-based prevention and increased downstream health-system burden. The analysis concludes that the rapid diffusion of NAD⁺ infusions and NAD-boosting supplements represents an emerging public health concern characterised by evidence gaps, safety uncertainty, and regulatory challenges. The paper calls for precautionary governance, stronger regulatory oversight, improved pharmacovigilance, and clearer evidence-based communication regarding the risks and limitations of NAD-related interventions.