By Dr. Charles Kamen, MD — Board-Certified Neurologist, LiveWell21, Las Vegas, NV
Albert Einstein College of Medicine (MD, 2011) | Yale-New Haven Hospital Internship (2011–2012) | Loma Linda University Neurology Residency (2015–2018) | ABPN Board Certified
Las Vegas has quietly become one of the most serious sports cities in America. Between the Raiders, the Golden Knights, the Aces, UFC's permanent home at the Apex, and a thriving community of endurance athletes training in the Red Rock and Lake Mead corridors, this city's athletic population is larger and more demanding than most people realize. I see a meaningful number of competitive and recreational athletes at LiveWell21 — from professional fighters to marathon runners to CrossFit competitors — and NAD+ therapy has become one of the most requested protocols in this population.
The interest is driven by a straightforward biological reality: athletic performance and recovery are fundamentally mitochondrial problems, and NAD+ is the molecule that makes mitochondria work. This is not a stretch or a marketing reframe. The connection between NAD+, cellular energy production, and recovery capacity is established biochemistry. What I want to do in this post is walk through the specific mechanisms, the research that supports them, and how I think about NAD+ therapy for athletes at my practice.
Every muscle contraction, every sprint interval, every set of heavy deadlifts — it all requires ATP. And the vast majority of ATP during sustained exercise is produced through oxidative phosphorylation in the mitochondria. NAD+ is not a peripheral player in this process; it is a central cofactor. In its reduced form (NADH), it donates electrons to Complex I of the electron transport chain, initiating the cascade that ultimately produces ATP.1
When you train hard, your mitochondria are working at maximum capacity. The demand for NAD+ increases accordingly. And here is where the problem emerges: intense exercise itself consumes NAD+. The enzyme CD38, which degrades NAD+, is upregulated by the inflammatory response that accompanies hard training. PARP enzymes, which repair exercise-induced DNA damage in muscle cells, also consume substantial amounts of NAD+. The harder you train, the more NAD+ you use — and the more you need.2
For younger athletes with robust NAD+ synthesis, this is manageable. The body replenishes what it uses. But for athletes over 30 — and certainly over 40 — the natural decline in NAD+ production means that the gap between demand and supply widens. Recovery takes longer. Training capacity plateaus or declines. The subjective experience is familiar to any aging athlete: you can still do the work, but you pay for it more than you used to.
The evidence connecting NAD+ to exercise physiology is substantial, and it has accelerated meaningfully in recent years.
Mitochondrial biogenesis: NAD+ activates SIRT1, which in turn activates PGC-1alpha — the master regulator of mitochondrial biogenesis. In plain terms: adequate NAD+ levels tell your cells to build more mitochondria. A 2016 study in Cell Metabolism by Mills et al. demonstrated that long-term NMN (an NAD+ precursor) administration in mice improved mitochondrial function, increased endurance capacity, and reversed age-associated physiological decline — including exercise tolerance.3
Human performance data: A randomized, double-blind, placebo-controlled trial published in the Journal of the International Society of Sports Nutrition in 2022 examined NMN supplementation (600 mg/day and 1200 mg/day) in amateur runners over six weeks. The higher-dose group showed significant improvements in oxygen utilization during exercise (ventilatory threshold) compared to placebo. The researchers attributed this to enhanced mitochondrial respiration capacity.4
Muscle recovery and inflammation: Exercise-induced inflammation is a normal and necessary part of the training adaptation process. But excessive or prolonged inflammation impairs recovery. NAD+-dependent sirtuins — particularly SIRT1 and SIRT3 — regulate inflammatory pathways including NF-kappaB. Research published in Nature Medicine has demonstrated that sirtuin activation reduces excessive inflammatory signaling while preserving the adaptive inflammatory response that drives training gains.5
Neuroprotection in contact sports: This is where my neurology background becomes particularly relevant. Athletes in contact sports — boxing, MMA, football — face cumulative neurological stress from repeated subconcussive impacts. NAD+ supports neuronal DNA repair through PARP activation and protects against excitotoxicity through SIRT1-mediated pathways. While I want to be clear that NAD+ therapy is not a treatment for traumatic brain injury, the neuroprotective mechanisms are relevant to athletes who want to support brain resilience alongside physical recovery.
The protocol I design for athletes differs from what I prescribe for a patient primarily concerned with cognitive aging or addiction recovery. Athletic use of NAD+ is about optimizing a system that is already functioning — pushing recovery capacity, maintaining mitochondrial density, and extending the window of peak performance.
Pre-competition loading: Some athletes schedule NAD+ IV infusions in the two to three weeks before a major event — a fight, a race, a competition season. The goal is to ensure that cellular energy machinery is operating at peak capacity when it matters most. This is not a last-minute intervention; it is a strategic preparation built into the training calendar.
Recovery acceleration: Post-competition or after an unusually intense training block, NAD+ IV therapy can shorten the recovery window. The mechanism is straightforward: you are restoring the cofactor that mitochondria need to repair cellular damage, clear metabolic waste, and rebuild muscle tissue. Athletes who incorporate post-event NAD+ infusions consistently report returning to full training faster than they did before adopting this protocol.
Maintenance during heavy training: For athletes in sustained high-volume training phases — marathon training blocks, fight camps, competitive CrossFit seasons — monthly NAD+ infusions combined with daily oral NMN supplementation help maintain NAD+ levels that would otherwise be chronically depleted by training load.
The over-40 athlete protocol: This is where I see the most dramatic results. Athletes over 40 who are experiencing the gradual decline in recovery capacity, training tolerance, and performance output often respond remarkably well to NAD+ repletion. In many cases, the decline they have attributed to "getting older" is significantly related to declining NAD+ levels — and it is at least partially reversible.
I want to be transparent: NAD+ therapy alone is not going to make you a better athlete. It is one component of a comprehensive performance and recovery strategy. At LiveWell21, the athletes I work with typically combine NAD+ with:
This integrated approach is what distinguishes clinical sports medicine from picking individual therapies off a menu. NAD+ fits into a system — it does not replace one.
I owe you the honest version. NAD+ therapy will not:
I include these caveats because honesty about limitations is what separates evidence-based medicine from marketing.
NAD+ is not currently on the World Anti-Doping Agency (WADA) prohibited list. It is an endogenous molecule — your body produces it naturally. Replenishing NAD+ levels through IV therapy is comparable to IV hydration or vitamin infusion, which are also not prohibited. That said, competitive athletes should always verify the current WADA prohibited list and check with their sport's governing body before any intervention. Rules change, and I advise my patients to stay current.
Training in the Las Vegas metro presents specific demands that are worth acknowledging. Desert heat increases metabolic demand and fluid loss. Many athletes in Henderson, Summerlin, and the surrounding areas train outdoors for significant portions of the year in conditions that accelerate NAD+ consumption through heat stress and elevated metabolic rates. UV exposure — abundant in southern Nevada — also contributes to DNA damage that activates NAD+-consuming PARP enzymes.
These environmental factors mean that Las Vegas athletes may experience NAD+ depletion more rapidly than athletes training in temperate climates. It is one of several reasons I see strong interest in NAD+ therapy from the local athletic community.
If you are an athlete in the Las Vegas area interested in NAD+ therapy, the process starts with a consultation. I evaluate your training load, recovery patterns, current supplementation, and metabolic health before designing a protocol. This is not a one-size-fits-all infusion — the dose, frequency, and complementary therapies depend on your specific physiology and goals.
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This content is for educational purposes and does not constitute medical advice. Consult a qualified physician before beginning any IV therapy or supplementation program. NAD+ therapy is not intended to diagnose, treat, cure, or prevent any disease. Athletes should verify current anti-doping regulations with their sport's governing body before any intervention.