Athletes constantly push their limits. Most days, they spend countless hours training in the gym or on the field, doing whatever it takes to prepare for the demanding competition days that follow. As a result, their bodies burn through enormous amounts of energy. This energy doesn’t come from nowhere; it is generated at a cellular level through processes that require substantial support.
While it is essential for athletes to eat well and get ample sleep, this is only part of the equation. To optimize the energy systems that fuel their performance, the body depends significantly on an important molecule called NAD+ (nicotinamide adenine dinucleotide).
NAD+ acts as a coenzyme (a helper molecule) and is involved in hundreds of cellular functions, particularly those that convert food into energy and facilitate cellular repair. Without adequate NAD+ levels, energy production slows and recovery becomes sluggish.
Beyond that, NAD+ is also crucial for cellular repair, DNA maintenance, and inflammation control, which are all things that can impact an athlete’s resilience. Supporting NAD+ levels may help optimize cellular energy production and recovery processes, allowing athletes to train harder, recover faster, and dominate their sport.
In this article, we’ll provide all the information you need to understand NAD+. We’ll explore its function, effects on athletic performance and recovery, and why athletes are more prone to NAD+ depletion. We’ll also share some science-backed natural methods to boost NAD+ levels and discuss how they may interact with other supplements commonly found in an athlete’s supplement stack.
NAD+ for Athletes: What is NAD+, What are the Energy Systems That Depend on It, and Why It Matters for Athletes
NAD+ is a coenzyme found in every living cell that is essential for your body to carry out biological processes that directly affect how the body functions, including energy production, cellular repair, brain function, and metabolic health.
NAD+ is a foundational molecule for everyone, but for athletes, having optimal NAD+ levels is even more crucial. Why? Let’s start with energy production.
At the core of athletic performance is energy, and NAD+ is essential for the systems that produce it. This all happens through three major systems in your body:
- Phosphagen System (ATP-PC or Immediate System): Provides immediate power for explosive movements lasting up to 10 seconds. NAD+ isn’t directly involved here, but this system integrates with NAD+-dependent pathways.
- Glycolytic System (Anaerobic Glycolysis): This system generates energy for moderate to high intensity bursts that last from about 30 seconds to 2 minutes. It relies heavily on NAD+ to break down glucose, whether oxygen is readily available or limited.
- Oxidative System (Aerobic System): This system takes over for longer-duration activities. NAD+ plays a central role here by helping convert nutrients into ATP via mitochondrial respiration.
Each of these systems is critical, and your body constantly shifts between them depending on the demands of your training. While they don’t all rely on NAD+ in the same way, the molecule plays a key role in regulating and sustaining energy balance at the cellular level.
But that’s only the beginning. NAD+ also plays a central role in mitochondrial health (which determines how efficiently your cells create energy), muscle repair, inflammation, and metabolism; all of which impact how an athlete feels, recovers, and performs.
NAD+ Supports Mitochondrial Function
We’re sure you’ve heard it a million times: to optimize performance and support recovery, you need to fuel your body with the right nutrients. What you may not know is that for those nutrients to enter the cell where they can be used to produce energy, your body has to first convert them into a form that your cells can utilize.
That happens inside your mitochondria (a.k.a. the powerhouse of the cell) through a process called cellular respiration, where nutrients are broken down and converted into ATP (the main energy currency of the cell).
They can’t do this without the help of NAD+. Without enough NAD+, the mitochondria get confused and mitochondrial electron transport becomes less efficient. As a result, nutrient conversion slows down, and so does your energy output.
The impact that NAD+ has on mitochondrial function directly affects endurance, strength, and recovery. Every muscle contraction, movement, and recovery process in your body relies on this process to sustain energy at every level of performance. This function alone can have a significant impact on your training and performance, and it can’t happen if your body is low on NAD+.
NAD+ Enhances Energy Production
Athletes don’t just need energy; they need fast, efficient, and sustained energy across every stage of training and recovery. Whether or not you have that kind of energy depends on how well your body produces ATP (adenosine triphosphate), your primary source of cellular fuel.
Whether you’re sprinting, lifting, or grinding through intervals, your muscles rely on rapid ATP production. NAD+ is essential for the metabolic pathways that generate it. When NAD+ levels drop, those pathways slow down, energy output decreases, and so does your ability to perform.
NAD+ Supports DNA and Muscle Repair
DNA is essentially your body’s instruction manual for all cellular activities, telling your cells what to do, when to repair, and how to function, and it’s constantly exposed to factors that can alter its structure and cause damage. Normal metabolic processes, exposure to environmental toxins, and even errors during DNA replication can all result in DNA damage.
And while exercise can boost DNA repair mechanisms and offer a protective effect (some studies even indicate that individuals with a higher aerobic fitness level may have lower levels of baseline DNA damage and show faster DNA repair), in some cases, it can also have the opposite effect.
Studies also show that overtraining or intense exercise, like the type of training many athletes engage in, may temporarily increase markers of DNA damage, particularly in overtrained athletes or those new to high-intensity exercise.
If your body can’t keep up with repair, it affects how well your cells function, recover, and adapt to training. For athletes who push their bodies hard, this can create specific issues related to DNA damage that can impact athletic performance, including:
- Muscle Damage: Intense exercise can cause microscopic tears in muscle fibers, a natural part of the muscle-building process, and some DNA damage can occur as a result.
- Oxidative Stress: Intense exercise can produce a lot of “bad” molecules called Reactive Oxygen and Nitrogen Species (RONS), which can damage the DNA in cells.
With proper recovery protocols, this damage is usually temporary. However, if an athlete is overtrained and under-recovered, and the DNA damage accumulates over time without being repaired, it could potentially lead to slower recovery, reduced performance gains, and a higher risk of injury and illness over time.
This is where having sufficient NAD+ levels becomes crucial. NAD+ supports the DNA repair process by activating enzymes like PARPs (Poly ADP-ribose polymerases), which detect and signal DNA damage for repair. It also fuels the activity of sirtuins, particularly SIRT1, which plays a role in DNA repair and reducing oxidative stress.
NAD+ Helps Control Training-Induced Inflammation
Intense training triggers microtrauma and systemic stress that causes inflammation. While some inflammation caused by this stress is a necessary and beneficial part of the healing and adaptation process, excessive or prolonged inflammation can backfire, resulting in stalled recovery and contributing to the risk of overtraining-related setbacks.
Chronic inflammation can also lead to a vicious cycle involving NAD+. Research shows that chronic inflammation can lead to the degradation of NAD+, and conversely, low NAD+ levels can exacerbate inflammation. This creates a negative feedback loop where chronic inflammation and NAD+ decline reinforce each other. Inflammation drives NAD+ depletion, which in turn can exacerbate inflammation.
The goal isn’t to eliminate inflammation from training; instead, it’s to manage and optimize the inflammatory response, and that’s exactly what NAD+ can do.
NAD+ is involved in regulating inflammation in a few unique ways:
- Sirtuin Activation: NAD+ fuels enzymes called sirtuins that help regulate inflammation. One of them, SIRT1, can reduce pro-inflammatory signals by interfering with key pathways involved in the inflammatory response.
- Boosts Antioxidant Defenses: NAD+ helps your body make NADPH, which is used to recharge antioxidants like glutathione. These antioxidants clean up harmful molecules (free radicals) that cause inflammation and cell damage during tough training.
- Mitochondria Protection: As mentioned earlier, mitochondria are involved in energy production, but they also play a crucial role in regulating inflammation. Damaged mitochondria can trigger inflammatory responses. NAD+ helps keep mitochondria functioning properly, which supports both energy production and inflammation control.
Optimal NAD+ levels help your body stay in balance, making chronic inflammation less likely. For an athlete, controlled inflammation means protection of muscle integrity, faster recovery, reduced soreness, and the ability to maintain training output (all things that are crucial for peak performance).
NAD+ Fuels a Healthy Metabolism
Metabolic health is often overlooked unless an athlete is struggling with maintaining a healthy weight. However, your metabolism isn’t just responsible for your weight; it’s the foundation of peak athletic performance.
Your metabolic health determines how your body converts nutrients into fuel, builds and maintains muscle mass, and keeps energy output consistent across demanding training blocks, and NAD+ is required for nearly every step in this process.
When NAD+ is low, so is your metabolic efficiency. This can make it harder to build muscle, regulate body composition, or hit your performance goals, even if your diet, training, and other aspects of recovery are all dialed in. If you want a healthy metabolism and all the benefits that come with it, you need to keep your NAD+ levels optimized.
What Happens When an Athlete’s NAD+ Levels Drop Too Low?
As you can see, in some way or another, either directly or indirectly, NAD+ influences almost every part of performance and recovery. When levels drop, those systems can’t keep up, and you’ll feel the energy drain from head to toe.
Your brain becomes foggy and unfocused, you don’t have much energy, your muscles fatigue more quickly, and your recovery slows. If levels stay low long enough, you could begin to notice deeper signs of cellular dysfunction, such as visible aging, a slower metabolism, and early cognitive decline.
While NAD+ is essential for everyone, maintaining optimal levels is especially important for athletes who push their bodies to the limit and rely on constant energy turnover, rapid cellular repair, and efficient recovery between training sessions.
The problem is that NAD+ production slows with age. It can also become depleted due to some of the very things that athletes must do to stay at the top of their game.
Why Athletes Are at Higher Risk for NAD+ Depletion
Your body naturally produces NAD+, and for the first few decades of life, it typically makes enough. But once you hit your late 30s or 40s, levels can decline by up to 50%.
However, if you aren’t approaching middle age, that doesn’t automatically mean your NAD+ levels are optimal. Age isn’t the only reason NAD+ levels can drop. Chronic stress, poor sleep, illness, and environmental toxins can all interfere with your body’s ability to produce or recycle NAD+.
So can high physical output. While exercise is one of the best things you can do for long-term health, and can even enhance NAD+ production under the right conditions, extreme or prolonged physical stress can do the opposite. This means athletes are at an even higher risk of burning through NAD+ faster than their bodies can replenish it.
Even small drops in NAD+ can lead to noticeable dips in physical and mental performance. If your goal is more consistent energy, better recovery, and longer-lasting stamina, optimizing your NAD+ levels can make a noticeable difference. Which is exactly why NAD+ therapy is gaining popularity among athletes seeking optimal performance and recovery.
The Science Behind NAD+ and Athletic Performance: Benefits of NAD+ for Athletes
Optimizing NAD+ levels ensures efficient cellular energy production for the most basic functions that anyone, regardless of their activity level, can benefit from. However, NAD+ can give athletes a distinct edge in several ways.
NAD+ Enhances Endurance and Physical Stamina
NAD+ is essential for cellular energy function. It allows your cells to efficiently convert nutrients into ATP, the energy currency that fuels everything from sprints to long competition days.
Without enough NAD+, ATP production can potentially stall, and your endurance and stamina could suffer. However, when energy production is efficient, you can maintain performance for longer, delay fatigue, and push through plateaus with greater consistency.
Whether you’re training for a marathon or grinding through high-volume weight sessions, maintaining optimal NAD+ levels may help sustain stamina and physical output.
While clinical evidence for direct endurance improvements in healthy athletes remains limited, many athletes who come to our centers report more consistent energy levels when supporting NAD+ function with NAD+ therapy.
NAD+ Supports Faster Muscle Recovery and Repair
As athletes know, recovery is non-negotiable if you want to consistently train hard, prevent plateaus, and perform your best. Recovery is where progress happens, and NAD+ plays a key role in how quickly and effectively your body bounces back.
NAD+ supports multiple cellular repair processes, including DNA repair and muscle tissue regeneration, which are critical after training stress, especially in high-intensity or high-volume training programs.
With enough NAD+, your body has the support it needs to better clear out damaged cells, reduce the inflammatory load, and begin repair more efficiently. This translates to less downtime and a faster return to training.
Athletes often report reduced soreness, quicker muscle recovery, and more consistent performance when NAD+ levels are supported. However, controlled studies specifically measuring recovery metrics in athletic populations are limited.
Optimal NAD+ Levels Reduce Cumulative Training Stress and Injury Risk
Athletic training is physically demanding, and if you push yourself too hard, it can lead to the production of unstable molecules known as reactive oxygen species (ROS). When ROS overwhelm your body’s natural defenses, they can disrupt the balance between free radicals and antioxidants, resulting in a condition called oxidative stress.
If oxidative stress is not properly managed, it can accelerate cellular breakdown, delay recovery, and increase the risk of injury over time. NAD+ plays a crucial role in helping your body manage this stress. It activates enzymes such as sirtuins and PARPs, which support antioxidant defenses, control inflammation, and promote cellular repair.
When NAD+ levels are optimal, your body is better equipped to handle the demands of training, recover more quickly, and avoid the long-term wear and tear that can hinder your progress.
NAD+ Gives Athletes a Cognitive Edge
Athletic performance isn’t just physical. Mental focus, reaction time, and decision-making under pressure can significantly impact a training session or competition outcome.
NAD+ plays a critical role in brain health and cognitive function. It supports mitochondrial efficiency in brain cells, which directly affects how well your brain processes information, stays sharp, and bounces back from stress.
When NAD+ levels are healthy, athletes have the mental edge (focus, clarity, quick thinking, mood stability, mental stamina, etc.) required to train hard, adapt under pressure, and stay locked in.
However, when NAD+ levels drop, those same areas begin to decline. Brain fog, slower reaction time, irritability, and mental fatigue become more common, especially during heavy training blocks or high-stress environments.
How Can Athletes Naturally Support NAD+ Levels?
Athletes put more stress on their bodies than the average person, which means they also burn through NAD+ faster. Add any other risk factors that contribute to NAD+ decline and levels can become too low to support basic functions, let alone the cellular energy that athletes require.
The good news is that, with the right support and raw materials, your body can hold on to it a little tighter and even produce more.
Here are a few proven ways to help replenish and maintain healthy NAD+ levels:
Eat a Diet Rich in NAD+ Precursors
Certain foods contain precursors your body can use to produce more NAD+. These include foods high in tryptophan, niacin (vitamin B3), and nicotinamide riboside (NR). Good sources include wild-caught fish, pasture-raised poultry, mushrooms, whole grains, leafy greens, and dairy.
While diet modifications alone are unlikely to significantly raise NAD+ levels in individuals with substantial depletion, they can provide a foundation for your body to build upon.
Exercise Balance
Research shows that regular aerobic exercise can stimulate NAD+ production. However, too much exercise without proper recovery can deplete NAD+ faster than the body can replenish it.
Getting in enough physical activity to support NAD+ production isn’t the issue for most athletes. The bigger challenge is balance. Athletes require strategic programming with built-in deloads, rest days, proper nutrition, and high-quality sleep to help their bodies recover enough to maintain optimal NAD+ levels.
Protect NAD+ With Smart Lifestyle Habits
Diet and exercise are only two lifestyle habits that can impact NAD+ levels. Stress, sleep deprivation, excessive alcohol, environmental toxins, and certain medications can all interfere with your body’s ability to produce NAD+.
Supporting your body’s natural ability to maintain NAD+ means prioritizing:
- 7–9 hours of consistent quality sleep
- Stress management
- Avoiding smoking and limiting alcohol
- Managing psychological stress and inflammation
- Incorporating daily recovery practices (breathwork, stretching, myofascial release, cold/heat therapy, adequate protein intake, etc.)
- Using more advanced recovery strategies as needed (chiropractic/body work, massage, Ozone Therapy, IV vitamin infusions for athletes, stem cell therapy, etc.)
NAD+ Precursor Supplements
NAD+ precursor supplements, such as nicotinamide riboside (NR) or nicotinamide mononucleotide (NMN), do not contain NAD+ itself. Instead, they are believed to support the building blocks your body uses to produce and recycle NAD+.
Some research shows that supplementing with NR or NMN may help the body rebuild NAD+ levels more efficiently, particularly in individuals with severely depleted levels due to aging, intense training, or high physical activity.
However, it’s important to note that research on the effectiveness of precursors like NR and NMN is mixed and still emerging, and there are limitations in how effectively oral NAD+ precursors are absorbed and utilized due to digestive breakdown.
If you want to try taking an NAD+ precursor supplement, they are widely available and generally well-tolerated. That said, don’t forget that quality and dosing matter. Look for clinically studied forms from a reputable brand and consult a qualified provider for personalized guidance.
Clinical NAD+ Therapy for Direct Replenishment
NAD+ therapy isn’t the same as NAD+ precursor supplements or even oral NAD+ products that contain the molecule itself, but also face limitations in digestion and absorption. Like precursors, oral NAD+ supplements rely on your body’s ability to convert or utilize the compound once ingested.
Clinical NAD+ therapy is much more advanced and allows for direct delivery to the bloodstream via injection or IV, potentially achieving higher bioavailability than oral supplements, though comparative studies in athletic populations are limited.
For athletes needing a more rapid or targeted intervention, NAD+ Therapy can possibly offer faster and more effective results. Even if levels aren’t severely depleted, athletes may benefit from this more advanced method of NAD+ support, especially during periods of intense training, travel, or high recovery demands.
Many athletes report subjective improvements in energy and recovery following clinical NAD+ therapy. However, placebo-controlled studies specifically in athletic populations are needed to confirm these benefits.
Peptide Add-On to Boost the Effects of NAD+ Therapy
There is a synthetic peptide called 5-Amino-1MQ, which is really popular for metabolic health and longevity, that experts have discovered pairs well with NAD+ therapy to enhance and even prolong treatment benefits.
This promising compound works synergistically with NAD+ by helping reduce the activity of NNMT, an enzyme that depletes NAD+ levels. By limiting this drain, 5-Amino-1MQ may help preserve and elevate NAD+ levels in the body, particularly in athletes and individuals over 40, whose natural stores are more challenging to maintain.
Your body can’t make 5‑Amino‑1MQ. To reap its benefits, you must introduce it to the body through peptide therapy, which is only available via prescription at qualified functional medicine centers that specialize in peptide therapy.
To learn more about combining NAD+ and 5-Amino-1MQ, read “NAD+ and 5-Amino-1MQ Synergy in Therapy.”
Is NAD+ Therapy Safe and Legal for Athletes to Use?
While NAD+ therapy has been researched and considered safe for healthy adults, there are still individual factors to consider. You should always consult with your doctor or a qualified healthcare provider to assess whether NAD+ support is suitable for your specific goals, health status, and training demands.
Additionally, while NAD+ is a natural coenzyme found in every cell of the body and by no means a performance-enhancing drug, if you are an athlete subject to drug testing, it’s important to understand regulations. At the time this article was published, NAD+ therapy is not listed on the World Anti-Doping Agency (WADA) Prohibited List. However, these lists often change. You should always verify with your governing body to ensure full compliance with anti-doping rules.
It’s also worth noting that NAD+ supplements and therapy are not a replacement for proper training, nutrition, or recovery. They should be viewed as an advanced strategy to support cellular function and optimize energy production, which is especially important for athletes who deplete NAD+ at a faster rate and require higher levels for peak performance and recovery.
Additionally, while many longevity experts and researchers have reason to believe NAD+ therapy can support cellular health and aging-related decline, there are other studies that suggest NAD+ therapeutics do not significantly alter skeletal muscle metabolism or improve athletic performance in healthy humans.
There is no question that NAD+ is essential for cellular function. However, athletes should have realistic expectations about performance benefits and prioritize proven recovery methods alongside any NAD+ support.
NAD+ Interactions with Popular Supplements for Athletes
Several supplements commonly used by athletes may indirectly support NAD+ pathways and pair well with NAD+ therapy. While most haven’t been studied specifically for direct synergy, here’s what we know about their potential interaction:
Creatine
Creatine plays a central role in ATP regeneration, especially during high-intensity exercise. While it operates through a different energy system than NAD+, maintaining a balance of both ATP and NAD+ is key for sustained physical output and recovery.
Some early research also suggests creatine may support mitochondrial function, which could indirectly complement NAD+ activity.
Beta-Alanine
Beta-alanine increases carnosine levels in the muscle, helping to buffer lactic acid during training. It is a common stand-alone supplement or ingredient found in many pre-workout products that athletes use to enhance performance.
Although beta-alanine doesn’t directly influence NAD+, improved performance and reduced fatigue may help reduce the degree of training-related oxidative stress, potentially easing the NAD+ burden.
Coenzyme Q10 (CoQ10)
CoQ10 is a fat-soluble compound that plays a key role in the mitochondrial electron transport chain, working alongside NADH to generate ATP, your body’s main energy source. Athletes often take a CoQ10 supplement to support cardiovascular health and boost endurance.
Because both CoQ10 and NAD+ are essential for mitochondrial function and cellular energy metabolism, supporting them together may enhance energy output and recovery in tissues with high energy demands, like muscle and brain
Alpha-Lipoic Acid (ALA)
ALA is a powerful antioxidant that many athletes supplement with, which helps regenerate other antioxidants, such as vitamin C and glutathione. It also supports mitochondrial enzymes, which may create a more favorable environment for NAD+ function by reducing oxidative stress.
Magnesium
Athletes often supplement with magnesium because intense training can deplete it through sweat, resulting in muscle cramps, fatigue, and impaired recovery.
Magnesium is required for hundreds of enzymatic reactions, including several involved in NAD+ metabolism. Adequate magnesium levels help support muscle contraction, nerve signaling, and energy production, making it a critical cofactor for both performance and recovery.
Omega-3 Fatty Acids
Omega-3s support brain function and help modulate inflammation. Because it can be difficult to get enough omega-3s from food alone (which can create an imbalance of omega-3s and omega-6s), an omega-3 supplement is usually part of a smart athlete’s supplement stack.
While not directly involved in NAD+ metabolism, reducing chronic inflammation and oxidative stress may help preserve NAD+ levels and improve cellular resilience under physical strain.
Potential Adverse Interactions with NAD+
In terms of common supplements athletes take and other potential negative interactions with NAD+, research identifies a few to be aware of:
- Melatonin may increase sedation when combined with NAD+ precursors or supplements. To minimize drowsiness, take NAD+ earlier in the day and melatonin at night.
- High-dose antioxidants (such as resveratrol or quercetin) may act as pro-oxidants in high doses and could interfere with the cellular signaling processes that NAD+ supports.
- Certain medications: Data is limited, but research suggests NAD+ therapy and NAD+ precursors may interact with certain medications, including insulin, blood pressure drugs, anticoagulants, antidepressants, and chemotherapy agents.
Athletes should disclose all medical conditions as well as any supplements or medications they take during their NAD+ consultation and consult a healthcare professional before combining NAD+ with other supplements or medications.
Conclusion
NAD+ plays a crucial role in cellular processes that support performance, recovery, and cognitive function. Given the various factors that can lead to a decline in NAD+ levels, particularly in athletes who undergo intense training, while research specifically supporting the use of NAD+ therapy for athletic performance enhancement is still in development, NAD+ therapy is certainly worth considering.
From NBA star Kevin Love to celebrities like Hailey Bieber and Jennifer Aniston, athletes and high performers are embracing and openly discussing their experiences with NAD+ therapy and its potential effects on the field, at the gym, and in their minds.
If you’re an athlete interested in exploring cellular health optimization, NAD+ support may be worth discussing with a qualified healthcare provider who can assess whether it fits your individual needs and goals
At Relive Health, we offer personalized NAD+ therapy protocols tailored to athletes of all levels, designed to boost performance and enhance recovery at the cellular level. Visit our center locator to find a Relive Health location near you and discover if NAD+ therapy or one of our other functional medicine services is right for you.
