NAD+ Protocol: The Sequence the Research Followed
One of the three fixes its parts before anything begins. The other two are written after the fact, and only one of them is honest about it.
Someone searching for an NAD+ protocol usually wants a sheet of paper with quantities and days on it. Three such sheets exist, they come from completely different places, and only one of them was written before anyone knew how things would turn out. Working out which document you are holding is the whole exercise, and it takes about five minutes once you know what to look for.
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Three documents answer to the name NAD+ protocol
The first is a clinic's infusion procedure, an internal operating sheet describing how staff run an appointment. The second is a registered trial protocol, a formal document lodged before enrolment that specifies what will be done and how it will be judged. The third is a vendor or forum schedule, a list of amounts and intervals assembled from other lists.
They share a word and nothing else. The clinic sheet describes a service. The trial protocol describes an experiment. The vendor schedule describes a purchase. Confusing the first for the second is the mistake that makes an infusion look evidence based, and confusing the third for either is the mistake that gets someone hurt.
The clinic sheet, in the order the appointment actually runs
An infusion appointment is a genuinely ordered process, and describing that order is not the same as endorsing it.
It begins with an intake form, usually covering medical history, current medication and pregnancy, and a consent document that in most jurisdictions is doing legal work rather than clinical work. A bag is prepared, either at a standard quantity for everyone or scaled loosely by body weight. A cannula goes into a vein in the arm or hand.
The drip then starts slowly, and this is the part that defines the appointment. Staff watch for flushing, chest tightness, nausea and cramping, and they adjust the rate downward when those appear. The session runs for hours because of that adjustment. When the bag is empty the cannula comes out, there is a short observation period, and the client leaves. Frequently the last step is a conversation about buying several more sessions at a package price.
Now list what that sequence does not contain. No baseline measurement of anything. No outcome defined in advance. No follow up appointment at which a defined result is read. No comparison group. No mechanism by which the service could be found not to have worked. It is a well ordered procedure for delivering a bag of fluid, and it is not a protocol in the sense that word carries in research.
The registered trial protocol, and the order its parts are locked
A research protocol is defined by when its parts are fixed rather than by what they contain, and the order is not negotiable.
The question comes first, stated narrowly enough to be answerable. Then the population, written as eligibility and exclusion criteria that decide who may take part and who is kept out for safety. Then the intervention and whatever it will be compared against, because a result with nothing to compare it to is an anecdote with a larger sample. Then the outcome, named specifically, with the day it will be read written down. Then the safety monitoring, including who has the authority to stop the study. Then the analysis plan, fixed in advance so that the numbers cannot be sifted afterwards for whatever looks best.
Only when all of that is locked does the first participant receive anything.
Everything about that ordering exists to make the study capable of producing an unwelcome answer. Amounts and intervals are in the document too, but they are near the end of the list of things that make it a protocol, and they are the only part that ever gets copied.
What those protocols were protocols for
Here is the point at which the borrowed authority collapses.
The registered trials in this field, the ones with proper protocols, overwhelmingly studied precursors given by mouth: nicotinamide riboside and nicotinamide mononucleotide. Their protocols specify an oral capsule, a daily quantity, a defined period of weeks or months, and typically a blood measurement as the primary outcome.
None of that describes an intravenous infusion of the assembled coenzyme. Different molecule, different route, different quantity, different pattern of delivery. A clinic citing the strength of the research behind this molecule is citing documents that were written about a different intervention, and the citation is accurate right up to the point where it is applied.
The vendor schedule, which fixes nothing at all
The third document is the weakest and the most widely circulated.
Trace a specific schedule back through the pages repeating it and the trail runs from an article to a second article to a forum post to a product listing, and then it stops. There is no layer beneath the product listing where someone measured something. Where the numbers connect to anything physical, they tend to connect to how much is in a container and how many sessions fit in a package.
A schedule assembled that way cannot be wrong, which sounds like a strength and is the defect. It has no predicted outcome to miss, no date on which anything is checked, and no criterion under which the person following it would conclude it had failed. It can only be continued or abandoned on a feeling.
| Component | Registered precursor trial | Clinic infusion sheet | Vendor schedule |
|---|---|---|---|
| Question fixed before starting | Yes | No | No |
| Who is excluded, and why | Yes, on safety grounds | Partly, via an intake form | No |
| Comparison group | Yes | No | No |
| Outcome named, with a reading date | Yes | No | No |
| Product of verified identity | Yes | Depends on the supplier | No |
| Authority to stop the whole thing | Yes | Not applicable | Nobody |
| Published whichever way it came out | Expected | Not applicable | Never |
What none of the three gives you: a way of being wrong
Strip the vocabulary away and one difference separates the trial protocol from the other two documents. The trial can fail. It was built so that it could.
Neither the clinic sheet nor the vendor schedule contains anything capable of returning a negative result. A person completes a course of infusions, feels roughly as they did before, and the framework offers no way to register that as a finding. It becomes a reason to try more sessions, or a reason to conclude the product was underdosed, and either way the schedule survives.
That is why the word protocol matters here rather than being a quibble about terminology. A protocol is a commitment made in advance about how you will judge yourself. Two of these three documents make no such commitment, and the one that does was written about capsules.
Reading a schedule someone sends you
Four questions sort any document in under a minute, and they work regardless of how professional the formatting is.
Ask when it was written relative to the outcome it describes. Ask what it says will happen and on which day, because a document with no predicted result is not making a claim. Ask what it says about who should not do this, since a sheet with no exclusion criteria has not thought about harm. Ask who published it and what they sell.
A registered trial protocol answers all four without difficulty. A clinic sheet answers the last one honestly and the first three not at all. A forum schedule answers none, and usually cannot say where its own numbers came from.