Our world today is not what it was yesterday. The coronavirus disease has made a huge number of changes in our daily life. This affected all segments of the population, but especially the elderly and people with chronic diseases, since they are more susceptible to infection and difficult to tolerate Covid-19. 

The pathogenesis of SARS-CoV-2 infection in humans remains unclear, but it is known that the areas of primary damage in Covid-19 are the immune system and cell DNA. As a result, an inadequate hyper reaction of the immune system (cytokine storm) (1), inflammatory processes in various organs (2), multiple organ failure, massive destruction of cells, oxygen and energy deficiency at the body and cellular levels occur (3). Such disturbance in the immune system and increase of the proinflammatory cytokines (TNF‐α and IL‐6) are age-associated and makes elderly people defenseless to airway inflammation, with a following uncontrolled systemic inflammatory response (4).

It was proven that Covid‐19 disease is associated with the energy budget disbalance in the body. As the energy budget worsens, our organism tries to balance the budget by scavenging building blocks and energy from the healthy tissues. When the budget becomes unmanageable the patient dies (3). The disease may be more fatal for the elder patients, both because they may have additional health problems or also because they may have a slower energy metabolism, or their metabolism may produce at a slower rate (3). Also, increased catabolism of NAD(H) during protein ribosylation in the DNA damage repair process may explain the greater susceptibility of the elderly population to the acute respiratory symptoms of COVID-19 (5).

As the virus is studied, the protocols for treating the disease change and recommendations for prevention appear. At the same time, recommendations are often directed only to symptomatic rather than pathogenetic treatment. 

Since the energy metabolism is disrupted during coronavirus and there are manifestations of a lack of energy (3), it would be logical to add NADH supplement to the protocol treatment and as a preventive measure to replenish the energy balance. Moreover, it is known that NADH supplement helps not only to fill the energy deficit but also is effective in DNA repair, genomic stability, and programmed cell death and metabolism, cell response to a variety of stresses, including oxidative stress. 

NADH effect on the energy metabolism of the cell can be mediated through the regulation of proteins of the sirtuin family, which can modulate glycolysis, glycogen synthesis, and the activity of acetyl-CoA-synthetase (6; 7). Also NAD+/NADH has a crucial role in the regulation of mitochondrial functioning not only at the level of the tricarboxylic acid cycle and electron transport chain, but also at the level of regulation of mitochondrial membrane permeability, which determines the viability and functionality of the entire organelle as a whole (8). 

Today there is increasing evidence that NADH/NAD+ plays a critical role not only in energy metabolism, but also in cell death and various cellular functions including regulation of calcium homeostasis and gene expression. It has also been indicated that NAD+ and NADH are mediators of multiple major biological processes including redox reactions and aging. NAD+/NADH produce the biological effects (DNA repair, genomic stability, and programmed cell death and metabolism, cell response to a variety of stresses) by regulating numerous NAD+/NADH-dependent enzymes and metabolic pathways, including: poly(ADP-ribose) polymerase (PARP) (9), sirtuins (10) and NAD glycohydrolase (CD38 and CD157).

Some data suggest that boosting cytoplasmic NAD may restore antiviral PARP functions to support innate immunity to Covid-19 and other viruses susceptible to PARP-mediated antiviral activity (11). This way, NAD is involved in regulating DNA repair, cell death (12) and oxidative stress response through these enzymes. 

Thus, the administration of anti-aging immunomodulation factors like NADH supplements can prevent pro-inflammatory cytokines over-activation, helps to regulate the inflammatory process and to maintain and restore the antioxidative defenses of the body and its energy balance, disrupted by the Covid-19 virus. Increasing the NAD level will also result in stabilizing telomeres and this has a positive impact on immune cells function (13).

In 80% of people, the disease proceeds in a rather mild form and until recently it was believed that such patients are completely healthy, but today we have evidence of the existence of the so-called Long Covid – symptoms of chronic fatigue that persist for up to a year, exacerbation of various chronic diseases, the appearance of cardiovascular and respiratory failure, diabetes, neurological disorders. Scientists believe that one of the possible causes of such consequences is impaired energy production in mitochondria, oxidative stress and chronic inflammation (14). Accordingly, it is advisable for such patients to take NADH supplements after recovery from coronavirus disease to reduce the possible manifestations of Long Covid-19.

In a series of clinical works, investigated the ability of NADH to provide a therapeutic effect in different syndromes and diseases, that the same time occurs during Covid-19 and Long Covid. Different clinical studies suggest NADH may help to:

Thus, the use of the NADH supplement (for example Original NADH Instant Power®) for prevention, during Covid-19 and for reducing the negative consequences of this disease is effective and safe, has a high level of evidence and can be used in all population groups, especially the elderly and patients with chronic diseases.

Dr. Oksana Klymenko M.D., PhD, 
SNHS Dip. (Holistic Nutrition), Medical Doctor, Researcher in the fields 
of molecular physiology and pathophysiology, 
molecular biology, genetics, cell biology


  1. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China
  2. Pathological findings of COVID-19 associated with acute respiratory distress syndrome
  3. COVID‐19 disease causes an energy supply deficit in a patient
  4. Proinflammatory cytokines, aging, and age-related diseases
  5. In Silico Insights into the SARS CoV-2 Main Protease Suggest NADH Endogenous Defences in the Control of the Pandemic Coronavirus Infection
  6. Nutrient control of glucose homeostasis through a complex of PGC-1alpha and SIRT1
  7. Sirtuins deacetylate and activate mammalian acetyl-CoA synthetases
  8. The dynamic regulation of NAD metabolism in mitochondria
  9. Oxidative stress and PARP activation mediate the NADH-induced decrease in glioma cell survival
  10. Metabolic control by sirtuins and other enzymes that sense NAD+, NADH, or their ratio
  11. Coronavirus Infection and PARP Expression Dysregulate the NAD Metabolome: A Potentially Actionable Component of Innate Immunity.
  12. NAD+ depletion is necessary and sufficient for poly(ADP-ribose) polymerase-1-mediated neuronal death
  13. Influence of NAD+ as an ageing-related immunomodulator on COVID 19 infection: A hypothesis
  14. Long covid could be four different syndromes, review suggests
  15. Therapeutic effects of oral NADH on the symptoms of patients with chronic fatigue syndrome
  16. Adipose tissue NAD+ biosynthesis is required for regulating adaptive thermogenesis and whole-body energy homeostasis in mice
  17. In Silico Insights into the SARS CoV-2 Main Protease Suggest NADH Endogenous Defences in the Control of the Pandemic Coronavirus Infection
  18. NAD metabolism: Implications in aging and longevity
  19. Metabolic Responses to Reductive Stress
  20. Interview: Dr. George Birkmayer on NADH for Energy, Healthy Immune Function and More
  21. Implications of NAD metabolism in pathophysiology and therapeutics for neurodegenerative diseases
  22. Mechanisms of Dopamine Oxidation and Parkinson’s Disease
  23. Antidepressant-like effect of nicotinamide adenine dinucleotide in the forced swim test in rats

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