NAD+ (Nicotinamide riboside)
NAD+ (nicotinamide adenine dinucleotide) is a coenzyme involved in cellular energy production and metabolic processes. It plays a key role in mitochondrial function, DNA repair, and cellular signaling. NAD+ levels naturally decline with age, which has led to interest in supplements designed to support its production.
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This page summarizes anecdotal reports and community observations, not medical evidence. Reports may be incomplete, biased or inaccurate and are not medical advice or recommendations. “Risk” here refers to how frequently severe or prolonged symptom worsening is reported, not to proven causation or population-wide probability. Individual responses vary widely, and absence of issues in some users does not rule out significant reactions in others.
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Within PFS/PSSD/PAS communities, NAD+ boosters are discussed in relation to their potential interactions with mitochondrial energy metabolism, DNA repair, and epigenetic regulation pathways. NAD+ is a core "helper molecule" found in every cell and is central to energy metabolism (mitochondrial function) and cellular maintenance. NAD+ comes up because it sits upstream of several big systems people suspect are unstable in these syndromes: mitochondrial energy, DNA repair, and cell-signaling/epigenetic regulation through NAD+-dependent enzymes (notably sirtuins and PARPs) and NAD+ consumers like CD38. That's a plausible overlap on paper, but it does not mean NAD+ reliably improves PFS/PSSD/PAS symptoms in practice. These mechanisms may interact with pathways involving mitochondrial function, DNA repair, epigenetic regulation, or cellular energy metabolism that are often discussed in relation to PFS / PSSD / PAS.
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Community Reports: Mixed Outcomes & Variable Risk Signal
Across PFS/PSSD communities, NAD+ boosters (especially NMN/NR) are most often described as “doesn’t move the needle much”—some report mild energy/mood changes, many report no meaningful change, and a subset describe feeling noticeably worse (a “crash” or flare). There are scattered reports of strong negative reactions after NAD+ precursors (including NMN) in the PSSD community, which is why many people treat NAD+ experiments as variable-response rather than “safe by default.”
Evidence basis: general NAD+ biology and safety literature; anecdotal reports (online forums/self-reports). No controlled studies establishing benefit for PFS/PSSD/PAS-specific outcomes.
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Public comments reflect individual experiences and opinions. They are not medical advice and may not be accurate or representative.