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NADH (reduced nicotinamide adenine dinucleotide)

Direct mitochondrial-electron-transport substrate with preliminary RCTs in chronic fatigue syndrome, distinct from NAD+ precursor approaches.

Why

Oral NADH (the reduced form of NAD+) is a direct substrate for mitochondrial electron transport. Small RCTs by Forsyth 1999 and Castro-Marrero 2015 in chronic fatigue syndrome report modest improvements in fatigue severity scores at 5–20 mg/day. Bioavailability of oral NADH is poor, sublingual and enteric-coated forms are intended to improve absorption. Distinct conceptually from NR (precursor) approaches.

How it works

Direct electron donor at complex I of the mitochondrial electron transport chain. Cofactor for hundreds of dehydrogenases. Modulates ATP availability in cells with mitochondrial dysfunction.

Expected onset · Fatigue effects over 4–12 weeks

How to take

Dosage

5–20 mg/day in stabilised sublingual or enteric-coated form, taken in the morning on empty stomach.

Timing

Morning, on empty stomach

On the label

Stabilised NADH in enteric-coated or sublingual form. Avoid unstabilised raw NADH (degrades rapidly).

Ideal for

Adults with chronic fatigue syndrome / myalgic encephalomyelitis exploring mitochondrial approaches.

Safety

Generally well tolerated. Mild nervousness or anxiety at higher doses. Hypotension and headache reported. Bioavailability is the practical limitation, many oral NADH products deliver minimal active material. Pregnancy and breastfeeding data limited.

Evidence

At a glance

Castro-Marrero 2015 RCT (n=80 CFS): CoQ10 + NADH combination reduced fatigue (FIS-40) and improved heart-rate response vs placebo at 8 weeks. Forsyth 1999 pilot (n=26 CFS) reported 31% on NADH improved by 8 weeks vs 8% on placebo. Preliminary evidence, no Cochrane review, EMA HMPC monograph or EFSA-authorised health claim covers this indication; cited RCTs are small or in non-tier-1 journals. Useful as honest reference rather than evidence-grade recommendation.

Limitations

Preliminary evidence, no Cochrane review, EMA HMPC monograph or EFSA-authorised health claim covers this indication; cited RCTs are small or in non-tier-1 journals. Useful as honest reference rather than evidence-grade recommendation.

Where to get it

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