According to a scoping review for the Nordic Nutrition Recommendations 2023, niacin (vitamin B3) is the precursor of NAD, and the amino acid tryptophan is the substrate for the body’s own NAD synthesis. The WHO describes pellagra as the disease caused by a lack of niacin and/or tryptophan. A review in Folia Medica Cracoviensia (2021) describes skin inflammation with pronounced sensitivity to sunlight, gastrointestinal symptoms and neuropsychiatric complaints. A case report in General Hospital Psychiatry (2008) describes the psychiatric signs as non-specific and easily overlooked, for example irritability, poor concentration, anxiety, fatigue, restlessness, apathy and depression.
As causes of pellagra, reviews name, for example, chronic alcohol misuse, certain medicines (immunosuppressants and tuberculosis drugs such as isoniazid) and disorders of the digestive tract. In carcinoid syndrome, niacin deficiency has also been known for decades. According to the review in Folia Medica Cracoviensia (2021), the diagnosis rests mainly on the clinical picture, with auxiliary tests playing a secondary role. Niacin status is assessed primarily by urinary excretion of nicotinamide metabolites, according to the scoping review for the Nordic Nutrition Recommendations 2023. In carcinoid syndrome, definitions and markers vary between studies (Nutrition, 2026).
For NAD+ infusions themselves, a systematic review in Ageing Research Reviews (2026) found no eligible outcome trials of intravenous or intramuscular NAD+ for anti-aging or wellness indications. A review in Frontiers in Aging (2026) considers the evidence for intravenous NAD+ preliminary and insufficient for routine clinical or wellness use and names nausea, cramping, flushing and chest discomfort as reported side effects.
This question belongs to the topic Conditions alongside burnout. It lists further questions.
What can be raised at a medical check-up about NAD+ infusions and niacin deficiency, meaning a lack of niacin, a precursor of NAD?
- alcohol consumption, honestly and in amounts
- all medicines, for example isoniazid or immunosuppressants
- diarrhoea or other digestive problems
- skin changes in areas exposed to the sun
- diet and weight loss
Exhaustion can have many causes, including illnesses that need treatment. For this reason a medical assessment comes before coaching, usually starting at the GP practice.
When can exhaustion become an emergency? · Why see a doctor before coaching for burnout?
Which prompt can be given to an AI assistant about NAD+ infusions and niacin deficiency, meaning a lack of niacin, a precursor of NAD?
At the start of your answer, point out that this topic needs medical review and that your information may contain errors. First ask me which city I am searching in. List doctors in my city who assess a niacin deficiency (vitamin B3), for example with alcohol use, medicines or digestive problems. Give the source for every piece of information and mark what is uncertain. Do not make a diagnosis and do not recommend any treatment. Separately, tell me which details I should check directly with the practice.
With some services, the prompt needs to be pasted after signing in. The AI services belong to third parties. Depending on the service and the extent of use, signing in and costs may apply. AI answers can contain errors.
Which sources support the answer on NAD+ infusions and niacin deficiency, meaning a lack of niacin, a precursor of NAD?
- World Health Organization (2000): Pellagra and its prevention and control in major emergencies
- Freese R, Lysne V (2023): Niacin – a scoping review for Nordic Nutrition Recommendations 2023. Food & Nutrition Research 67, 10299
- Hołubiec P et al. (2021): Pathophysiology and clinical management of pellagra – a review. Folia Medica Cracoviensia 61(3), 125–137
- Prabhu D, Dawe RS, Mponda K (2021): Pellagra a review exploring causes and mechanisms, including isoniazid-induced pellagra. Photodermatology, Photoimmunology & Photomedicine 37(2), 99–104
- Badawy AA (2014): Pellagra and alcoholism: a biochemical perspective. Alcohol and Alcoholism 49(3), 238–250
- Prakash R et al. (2008): Rapid resolution of delusional parasitosis in pellagra with niacin augmentation therapy. General Hospital Psychiatry 30(6), 581–584
- Baldini L et al. (2026): Niacin deficiency in carcinoid syndrome: definitions, biomarkers, and a pragmatic framework for clinical assessment. Nutrition 153, 113379
- Gallagher C, Emmanuel OO (2026): NAD⁺ supplementation for anti-aging and wellness: a PRISMA-guided systematic review of preclinical and clinical evidence. Ageing Research Reviews 116, 103057
- Alangari A et al. (2026): Narrative review of intravenous NAD(+) and NAD(+) precursors in wellness and translational medicine. Frontiers in Aging 7, 1887175