Chasing Energy
Hi, I'm Daniel Lucas and I share tools, tips and insights to fuel a life worth living.
My mission in life is to 'Make Healthy Living More Accessible'.
I'm a former endurance athlete as well as the inventor and founder of the Sprout Spout. I host of the Chasing Energy podcast to give you insights that fuel a life worth living. I'm not just a health entrepreneur; I'm a lifelong learner passionate about unlocking human potential through nutrition, fitness, and mindset.
On Chasing Energy, I delve into the science behind peak performance, exploring topics like nutrition, exercise, sleep, stress management, and cognitive enhancement. I interview leading experts and share practical strategies for optimizing your health and well-being. My goal is to empower you with the knowledge and tools you need to live a vibrant, energized life.
I'm excited to share my story, insights, and experiences with you. Whether you're a health enthusiast, athlete, parent, or simply someone looking to feel your best, I believe we can all benefit from a deeper understanding of how our bodies and minds work.
Chasing Energy
Dr. Fabio Almeida on NAD Therapy, Longevity, and Health Optimization
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Join Dr. Fabio Almeida and host Daniel for a focused discussion on NAD therapy, longevity, and health optimization. Learn how NAD supports energy, brain health, and recovery for cancer survivors, athletes, and anyone over 35. Discover practical advice on dosing, subcutaneous injections, and combining NAD with other longevity strategies. Key topics include health span vs. lifespan, managing side effects, and the science behind anti-aging interventions. For more, visit drfabio.com and nadezpen.com.
Timestamps:
00:00 – Introduction & Dr. Fabio’s background
03:00 – What is NAD and why does it matter?
07:00 – NAD for cancer recovery & brain health
12:00 – Subcutaneous NAD injections & dosing
18:00 – NAD for athletes and energy
22:00 – Health span vs. lifespan
27:00 – Combining NAD with other longevity strategies
32:00 – Managing side effects & practical tips
36:00 – How to get started with NAD therapy
Dr. Fabio Almeida on NAD Therapy, Longevity, and Health Optimization
[00:00:00]
Introduction to Dr. Fabio Almeida
daniel_20_09-18-2025_133335: Dr. Fabio from Arizona. Thanks for being on chasing energy today.
My pleasure. Thank you for having me.
Yeah, we got a lot to cover. We're gonna talk about, uh, NAD and a lot of what makes it such an interesting thing at this place in time in our lives, and that's, that's kind of how we got connected. So tell us a little bit about what drew you, first of all, um, into your profession.
Like where, what drew you, makes you passionate about what you do daily for people and tell people about that.
Dr. Fabio's Background in Nuclear Medicine and Oncology
fabio-almeida_1_09-18-2025_103333: Sure. So, um, I'm a bit of an odd duck, uh, from the in, in medicine. Um, so, uh, kind of a varied background. Um, I'm board certified in multiple different specialties, but, uh, primarily I started off as a molecular imaging, uh, nuclear medicine molecular imaging specialist. So I have a background in nuclear physics and um, predominantly in imaging.
Using radionuclides, um, for, uh, functional imaging, physiologic imaging, uh, and is something that's the mainstay
daniel_20_09-18-2025_133335: stand,
fabio-almeida_1_09-18-2025_103333: care. Um, and I spent a fair amount of my career doing that in the academic world with research and in, uh, with multiple imaging clinics.
daniel_20_09-18-2025_133335: Uh,
fabio-almeida_1_09-18-2025_103333: and, um, in particular, uh, it was just [00:01:00] kind of a, I'm gonna give you a little background that transitions into, you know, why we are passionate about NAD uh, in the oncology world.
We, I did a lot of work in, uh, early imaging, uh, with PET imaging and prostate cancer with, uh, specific type of imaging called PSMA imaging. And, um, that's a, was a focus of my research for a couple of decades. Um, and, uh, when I was at the University of Arizona, um, we kind of transitioned that. A research protocol into somewhat of a concierge oncology practice.
And, uh, so we were taking care of a lot of cancer patients, um, across the board, um, that we were discovering things on these imaging studies that basically standard of care didn't know how to handle. So we kind of became their primary care, uh, folks for people. Um, so, uh, as part of my, you know, continuing educational background, um, I did a fellowship in integrative medicine, uh, which was also at the University of Arizona.
I'm also trained as a bariatric obesity medicine physician. Uh, I have a background in, um, uh, basically, uh, uh, [00:02:00] culinary nutrition. So, uh, you know,
daniel_20_09-18-2025_133335: being
fabio-almeida_1_09-18-2025_103333: being able to, uh, really understand how nutrition affects, um, things and all of, all of this has really been, uh, initially was focused to really helping our cancer patients, uh, thrive.
Transition to Integrative Medicine and Longevity
daniel_20_09-18-2025_133335: Okay.
fabio-almeida_1_09-18-2025_103333: Okay. So, um, for the last decade or so, we really became, uh, a, a adult medicine primary care, uh, integrative medicine, longevity medicine type of clinic. We still manage a lot of cancer patients. We, I see new cancer patients all the time,
daniel_20_09-18-2025_133335: all the
fabio-almeida_1_09-18-2025_103333: um, to really help manage their care. But
daniel_20_09-18-2025_133335: But
fabio-almeida_1_09-18-2025_103333: primary focus is, has, has really been on all the things that standard of care is not able to provide.
So we, we guide people through standard of care, but we know that there's some limitations on, um, you know, what that has to offer either in being able to, to deal with the issues, but particularly with side effects, um, uh, quality of life, um, and longevity. And, uh, so we've really kind of fill in the gaps, uh, for a lot of folks in the cancer world.
On, on, on that.
daniel_20_09-18-2025_133335: that.
Cancer Medications and Longevity Medicine
fabio-almeida_1_09-18-2025_103333: And, and of course, uh, uh, not of course, but uh, uh, as part of it too, then I see people who are just interested in longevity. Uh, with no cancer, so adult [00:03:00] medicine. Um, so what we bring to the table is a lot of tools that are,
daniel_20_09-18-2025_133335: Are
fabio-almeida_1_09-18-2025_103333: again, standard of care, but all the other things that are in, um, the complementary and kind of on alternative world, you know, whether it's supplements or off label medications, those kind of things.
What is interesting in the longevity, um, kind of world right now when we look at the different medications or supplements and things that are kind of keen interest that are being studied right now, uh, with keen interest, a lot of these came from the cancer, uh, or oncology world.
daniel_20_09-18-2025_133335: Yeah. Um,
fabio-almeida_1_09-18-2025_103333: so things like low-dose naltrexone and rapamycin, metformin, um, which is actually a diabetes drug,
daniel_20_09-18-2025_133335: drug.
fabio-almeida_1_09-18-2025_103333: our experience in understanding, um, of them
daniel_20_09-18-2025_133335: understandingthem them
really rooted in what,
fabio-almeida_1_09-18-2025_103333: You know, how they work for cancer and, uh, and the transitioning to kind of longevity or anti-aging.
Um. Because probably the underlying mechanisms for which they might help for cancer are gonna make us do better, all overall. But, uh, so it was, it's uh, an area where we bring a lot, uh, kind of a deep area of expertise into it.
Introduction to NAD and Its Benefits
daniel_20_09-18-2025_133335: it,
fabio-almeida_1_09-18-2025_103333: Um, and a lot of comfort in dealing [00:04:00] with these medications. 'cause we've, we've, you know, worked with them, uh, for a long period of time.
So, um, so that's a little bit ofhistory of kind of how we, uh, arrive where we are, but in particular with, uh, a molecule like NAD. And we can talk at, at some point a little bit about the specifics of
daniel_20_09-18-2025_133335: of
fabio-almeida_1_09-18-2025_103333: mechanism and, and, and things like that for the NAD of how and why it's important. But, um, NAD is a, um, a, a co-enzyme that we, uh, we found basically to be extremely useful in our cancer patients who were having issues with cognitive dysfunction, brain fog, fatigue, um, after
NAD for Chemotherapy Side Effects
fabio-almeida_1_09-18-2025_103333: chemotherapy.
daniel_20_09-18-2025_133335: effects of the treatments for the cancer or the cancer itself?
fabio-almeida_1_09-18-2025_103333: Uh, from the treatment, uh, predominantly, well, some cancers will cause them, but a lot of therapies that we use for, for cancer, um, actually cause oxidative stress. They cause, uh, you know, a certain amount of cellular damage. Um, and we're,
daniel_20_09-18-2025_133335: we're,
fabio-almeida_1_09-18-2025_103333: we're purposely doing that to the cancer cells. But unfortunately there's, there's, uh, um, you know, uh, it affects all the cells in the body, right?
We see collateral damage.
daniel_20_09-18-2025_133335: That's
fabio-almeida_1_09-18-2025_103333: Um, and, um, and cognitive function. Brain brain fog is a, [00:05:00] a real classic, um, side effect that happens across the board in a lot of, of.
daniel_20_09-18-2025_133335: of
fabio-almeida_1_09-18-2025_103333: Therapies that are, that are significant, you know, so chemotherapy and, and, and, uh, for example, in women with breast cancer with, uh, hormone deprivation, you know, we take the estrogens away, we use certain medications for that, or men with prostate cancer where we use, uh, androgen deprivation therapy, reducing testosterone, maybe some different mechanisms on them we don't fully understand, but,
daniel_20_09-18-2025_133335: but,
fabio-almeida_1_09-18-2025_103333: but people basically, uh, don't feel well with them.
And, uh, uh, cognitive dysfunction, brain fog, as most people describe it,
daniel_20_09-18-2025_133335: it,
fabio-almeida_1_09-18-2025_103333: is something that is, is really common. And we evenhave a, uh, terminology for 'em, chemotherapy induced, uh, cognitive dysfunction. Uh, so it's a known entity. So, um, we began using, uh, NAD IV therapy as part of our regimen to combat that actually many years ago.
Um, based on, you know, our understanding of how NAD works and, and translating it from, um, use in things like, uh, post Lyme's disease, uh, chronic fatigue syndrome. And, uh, we had a lot of success with it. Uh, so it is something where became part of our regimen to [00:06:00] use, uh, uh, high dose NAD IV
Challenges with NAD IV Therapy
daniel_20_09-18-2025_133335: IV
fabio-almeida_1_09-18-2025_103333: in those circumstances.
And, um, so a lot of experience with it
daniel_20_09-18-2025_133335: with it
fabio-almeida_1_09-18-2025_103333: and, um, and, and very useful. So, um, you know, and it's probably going back a decade for us, the challenge I think on, on NAD at least the way, um, it's currently available. You know, there's, uh, I'm sure your listeners, listeners who are familiar with I, uh, NAD have have heard about NAD iv.
daniel_20_09-18-2025_133335: ib.
fabio-almeida_1_09-18-2025_103333: I think, uh, there's a lot of different clinics who are,
daniel_20_09-18-2025_133335: are,
fabio-almeida_1_09-18-2025_103333: who are providing N-A-D-I-V right now. Um, and I think the challenge with it is, is done correctly. There's, there's a, a fair amount of obstacles or challenges with it. It's, uh, when you deliver a a bolus or high dose of IV
daniel_20_09-18-2025_133335: of
fabio-almeida_1_09-18-2025_103333: NAD, um, if you give it too quickly, we can get a lot of side effects.
Uh, and, uh, and it can be very uncomfortable for people. So, uh, to do it correctly, it's given over time.
daniel_20_09-18-2025_133335: I hear, uh, or read about is that, you know, it's very time intensive, right? 'cause it's like three hours. Um, it's also ex fiscally, uh, it's a very
fabio-almeida_1_09-18-2025_103333: Expensive,
daniel_20_09-18-2025_133335: Yeah.
fabio-almeida_1_09-18-2025_103333: Yeah. And
daniel_20_09-18-2025_133335: said, too much, too quick can have some side effects,
fabio-almeida_1_09-18-2025_103333: right.
daniel_20_09-18-2025_133335: right?
fabio-almeida_1_09-18-2025_103333: So, um, our protocol for our cancer patients is, you know, [00:07:00] four to five days, sequentially of 250 to 500 milligrams. You know, we try to achieve three grams in a week, and it's, it's challenging. Yeah. It's, uh, three hours to four hours in, uh, in the IV chair. Now we have a very comfortable situation here.
We make it nice, but
daniel_20_09-18-2025_133335: But
fabio-almeida_1_09-18-2025_103333: it's, yeah, it's a long commitment. Uh, it's an IV every day. Um, and because of, uh, resources and the expense of it, yeah, uh, it's, it can be expensive and, you know, typically out there, I see, you know, IV clinics charging 500 to a thousand dollars. Per iv.
daniel_20_09-18-2025_133335: iv.
fabio-almeida_1_09-18-2025_103333: So, yeah. So it's not really,
daniel_20_09-18-2025_133335: thousands pretty common from
fabio-almeida_1_09-18-2025_103333: yeah.
daniel_20_09-18-2025_133335: Yeah.
fabio-almeida_1_09-18-2025_103333: Yeah. So, so in the situation where I'm dealing with someone who has a profound fatigue, brain fog, whatnot, that we know is, you know, part of the clinically what's
NAD for Wellness and Longevity
fabio-almeida_1_09-18-2025_103333: going on from, you know, a treatment, doing something like that makes sense. 'cause we, we move the needle very quickly on it. But translating that into kind of the wellness or longevity world where, well, I'm not dealing with that kind of level of brain fog, but I want to improve my level of cognitive thinking.
I wanna improve my, uh, energy, I wanna improve sports [00:08:00] performance, make my DNA basically, uh, repair mechanisms better. That is not a sustainable process. Um, as far as basically going in and getting an IV.
daniel_20_09-18-2025_133335: an IV
fabio-almeida_1_09-18-2025_103333: You know, once a month or once a quarter. And that is one of the things that we know with that is it's not a one and done kind of thing.
Uh, you know, NAD naturally declines in our bodies, and if we're replacing it,
daniel_20_09-18-2025_133335: it,
fabio-almeida_1_09-18-2025_103333: we will use it up. Uh, it is a co-enzyme that's used in probably 50% of our, uh, enzymatic processes that the cellular level gets. You know, it's, it powers our mitochondria for a TP production. It's, it's part of the machinery, uh, the molecular machinery of how we function.
And, uh, you don't just raise it back up and it stays there. It unfortunately goes, uh, as we get older that our ability to, to make our own NAD for that process goes down. So, so you need a mechanism by which you have a plan of like, well, if I'm going to start NADI need to be able to continue NAD.
daniel_20_09-18-2025_133335: Right?
fabio-almeida_1_09-18-2025_103333: Um, and, uh, particularly for those who, who really get a lot of, uh, palpable benefits from it, that yeah, they're, then they're looking for how do we do this?
Um. So, so that's was really early on a challenge for us. Um, and as particularly as we were looking at [00:09:00] providing NAD for other clients who, um, they, I knew, we knew they would benefit from it from a longevity perspective, from the cognitive perspective, how do we do this without basically going the route of, uh, monthly or quarterly iv uh, IV therapy?
Um, and this is where we moved into going into subcutaneous, uh, administration. And so, um, so, and that's something that really only has been around for the last, uh, few years, uh, about probably about four where we, we, uh, were able to have formulations that could be done subcutaneously.
Development of Subcutaneous NAD Injections
daniel_20_09-18-2025_133335: Yeah.
fabio-almeida_1_09-18-2025_103333: Um, and that, um, uh, is something we started doing for our clientele almost right away.
And, um, and it evolved into something where, um. You know, initially we're drawing a lot of syringes, you know, uh, preparing the needles. Uh, things we're a concierge practice, so we try to do as much for our clients to make it easy as possible. And, um, we realized that, uh, even with going to subcutaneous, uh, injections where people could do them more frequently, we could teach 'em how to do it at home.
Still some challenges on, um, you know, dealing with needles, dealing with syringes, dealing with vials, proper dosing, um, all of those components on it. Um, and so, uh, we transitioned into, or [00:10:00] we created a system by where we incorporated all of this into a, a pen injection, um, to make it really easy. And, uh, and that's been very successful for our clienteles.
The idea, uh, has been to, to minimize the must and fuss with it. And, um, I have clients age, you know, 45 to, I think my oldest patient's, 89.
daniel_20_09-18-2025_133335: Wow.
fabio-almeida_1_09-18-2025_103333: Who, who, who basically is able to self-administer their NAD. Um, and that, I think that's part of this, this process is anything we want to do
daniel_20_09-18-2025_133335: Yeah. So
fabio-almeida_1_09-18-2025_103333: it, it needs to be sustainable.
Mm-hmm.
daniel_20_09-18-2025_133335: a background in, in cancer, uh, prevention or treatment. Um, you sort of migrated into this as a byproduct of helping people recover from the collateral damage of the cancer treatments. And now you're finding that it has a lot of use and I, I tend the term longevity. I'm not anti longevity, but what, when, what, in a lot of cases, we're not talking about longevity, we're talking about optimal life, which is,
fabio-almeida_1_09-18-2025_103333: Mm-hmm.
Health Span vs. Longevity
daniel_20_09-18-2025_133335: consider to be different from living as long as you possibly can.
Um, a lot of
fabio-almeida_1_09-18-2025_103333: Yeah.
daniel_20_09-18-2025_133335: about is enjoying or being more, enjoying your, your days more. I guess you could,
fabio-almeida_1_09-18-2025_103333: Yeah.[00:11:00]
daniel_20_09-18-2025_133335: Yeah.
fabio-almeida_1_09-18-2025_103333: I think we're, we're, we're trying to use the word health span. I think now is the, is the word that might be trying to describe that. We wanna be.
daniel_20_09-18-2025_133335: I have heard that term.
fabio-almeida_1_09-18-2025_103333: Healthy for as long as possible.
daniel_20_09-18-2025_133335: as
fabio-almeida_1_09-18-2025_103333: Absolutely.
daniel_20_09-18-2025_133335: Ab absolutely. Um,
What to Expect from NAD Injections
daniel_20_09-18-2025_133335: so. What I'd like to do is sort of quiz you a little bit about, um, when, when someone, let's say that they are looking into N AV injections. Tell us what type of experience and, uh, you know, we're talking about, you were talking about the IVs aren't the most sustainable thing in terms of either cost or time or convenience. Tell us what, what someone should expect to, I mean, I'm 48, so give me an idea of what someone like me would expect if we're pretty athletic and we want to investigate NAD injections, what would they feel? What would they, what, what roughly would it cost for say, a, uh, to, to try out the treatment for a month or
fabio-almeida_1_09-18-2025_103333: Mm-hmm. Yeah.
daniel_20_09-18-2025_133335: Yeah,
fabio-almeida_1_09-18-2025_103333: So, so the idea for us was to, to, um, be able to provide sufficient NAD that, uh, for the vast majority of people that are actually going to have a palpable sensation that yes, [00:12:00] things are.
daniel_20_09-18-2025_133335: are,
fabio-almeida_1_09-18-2025_103333: You know, they can tell that they're on the NAAD. Okay. Um, which is one of the things just as oppo, uh, as that differentiates it, I think from a lot of other longevity things that we talk about out there where we don't have measurable or, or, uh, objective evidence that they're doing anything we maybe at the cellular level.
Um, so, so for us, the goal was to be able to provide, um, convenient access to, uh, at least a thousand milligrams per month.
daniel_20_09-18-2025_133335: Mm-hmm.
fabio-almeida_1_09-18-2025_103333: Um, and, um, and some people react to, uh, less than that, but that's what we found has been, um, kind of the dosing that across the board people respond to the most. And, um, the idea with that then is to be able to split that into, um, uh, multiple injections through the month, usually two times, uh, per week.
Um, not sequential days. Um, and um, but you know, that's kind of where we start.
daniel_20_09-18-2025_133335: is, this is a podcast host, not a doctor. I, me. I mean, um, uh, what we're doing when we take the NAD is we're actually increasing the, our NAD levels, right? And the benefit of the IV is it increases those levels dramatically very quickly, then it drops off.
How NAD Levels Work in the Body
daniel_20_09-18-2025_133335: And so what we're doing by having those injections two times a [00:13:00] week, say, um, we're basically keeping those levels at a, NAB levels at a moderate amount, depending on how much we inject. Of course
fabio-almeida_1_09-18-2025_103333: That is correct. Yeah. So anytime we do a bolus or a large injection,
daniel_20_09-18-2025_133335: mm-hmm.
fabio-almeida_1_09-18-2025_103333: we're gonna have like a peak amount of it. And yeah, the idea is to replace that NAD, um, and, uh, kind of the NAD pool and NAD basically gets metabolized up. It gets into the cells, it, it gets into the mitochondria, the powerhouses of the cells, and it's used for a TP production, the basically the energy systems of our cells
daniel_20_09-18-2025_133335: So my
fabio-almeida_1_09-18-2025_103333: Now.
daniel_20_09-18-2025_133335: if someone is, uh, in a very, very, uh. Physical and they're training, say an hour and a half a day.
An hour a day. Do they use those stores up quickly, more quickly than someone who's say just a, a brisk walker?
NAD for Athletes and Exercise
fabio-almeida_1_09-18-2025_103333: So, so it's, it's interesting that it kind of goes both ways. So exercise in and of itself, it, um, increases our NAD production. So our, our, um, our own NAD mechanisms will, will ramp up with that, but strenuous activity or, you know, um, basically significant resistance training or endurance training. We will deplete that NAD, um, uh, at a faster level.
So we will see, when we do measurements of, um, particularly athletes, we can see basically where the NAD levels are, and we'll see particularly post competition, [00:14:00] real, um, significant and uh, uh, effort. Um, provided that there's a, there's a significant dip in the NAD. The thing is athletes do tend to, because they generate more of it from the concept of doing exercise, they will have a, a recovery of that to a certain extent.
Um, so there's an advantage to that, which is always why, you know, natural ways of getting your NADF are great, but what we find is then being able to replace that, uh, more consistently. Um, we see, uh, recovery times, uh, after exercise basically reduced. We see basically higher energy levels in the, in that, uh, exercise.
We see higher performance. Um, it's, and so that we're helping your body not. End up in that depleted, uh, situation. Um, so, and this is where, again, being able to do it with more frequent, smaller doses of, uh, the NAD, um, self injection at home,
daniel_20_09-18-2025_133335: It
fabio-almeida_1_09-18-2025_103333: it it, that's really where I think people find that that's, uh, it's, uh, has the most utility and is the most convenient way to do it.
Um, part of it too is that, you know, from a timing perspective, you, if you're gonna go for an iv,
daniel_20_09-18-2025_133335: iv,
fabio-almeida_1_09-18-2025_103333: is it, is it going to be in, uh, in sequence with, well, when I [00:15:00] just did my exercise? Or can you time that properly
daniel_20_09-18-2025_133335: Yeah.
fabio-almeida_1_09-18-2025_103333: home? I, you know, with this, you basically, well, I've finished my exercise, you, you, uh, rest a little bit and you, uh, can give yourself, uh, a boost of it.
Um, so, so the ability to really, um, keep the,
daniel_20_09-18-2025_133335: the N
fabio-almeida_1_09-18-2025_103333: or get the
daniel_20_09-18-2025_133335: the
fabio-almeida_1_09-18-2025_103333: NAS up to a higher level and maintain them, they really need to have something. Uh, uh, like the system, um, now the, you know, NAD basically there's,
daniel_20_09-18-2025_133335: there's
fabio-almeida_1_09-18-2025_103333: there's multiple different formats for which it comes in, or at least administration. Um, IV is really where it all started.
IV vs. Subcutaneous NAD Administration
daniel_20_09-18-2025_133335: Mm-hmm.
fabio-almeida_1_09-18-2025_103333: it's where we have the most clinical experience. There's a lot of literature on utility of it.
daniel_20_09-18-2025_133335: it.
fabio-almeida_1_09-18-2025_103333: Um, we know that it basically, um, from a clinical perspective, we have measurable effects from it, cognitive function, performance of functions, those kinds of things. And so, so NAD into, basically, into the system directly.
Um, either IV or subcutaneous is the most, is the most effective and bioavailable form of NAD. Now, there are oral forms, uh, there's, uh, oral forms of,
daniel_20_09-18-2025_133335: I have for you because
fabio-almeida_1_09-18-2025_103333: mm-hmm.
daniel_20_09-18-2025_133335: the oral forms, what I've read is that only like 15 to 20% actually makes it in, [00:16:00] in past the digestive process. And so what a, I have seen recommended was doing this sublingual, is a little bit better absorbed, which, what's your experience with that?
Oral NAD Precursors and Bioavailability
fabio-almeida_1_09-18-2025_103333: Yeah, so, so the, the, the challenges of oral administration, well, first off, uh, uh, the oral versions are not NAD, they're what are called NAD precursors. They're NMR, uh, and NMN. And so, um, so they're one-off from the NAD,
daniel_20_09-18-2025_133335: Yeah.
fabio-almeida_1_09-18-2025_103333: because if you just take NAD straight, uh, it doesn't, it doesn't get absorbed in the intestinal lining, so you don't get any of it.
So it has to be done differently. Um, and there's issues with bioavailability though. So as you said, uh, 15%, 20% at most, uh, is actually able to make it through the digestion into your system, and then it still has to be converted over and, and utilized. And, um, we've had limited success with it. I think we've tried both NMN and MNR and a lot of our clients, um, and we just did, we're not achieving the same results with it.
The other is that you have to take a lot of pills to achieve that. Now your question about sublingual, um. Th [00:17:00] that's always a, you know, sublingual administration bypasses the gut to a certain extent. Um, and so, uh, because of the, the vascularity under our tongue, uh, so we can get it into the bloodstream. So that's potentially a, uh, a good way of doing it.
I think the dosing on it a little bit, we're rarely not sure, um, you know, how much works on it. And, um, it usually has to be in a lipophilic, a fat kind of containing formulation. Um, I've also seen nasal spray, uh, version of it for the same idea on it.
Sublingual and Nasal NAD Options
daniel_20_09-18-2025_133335: Do you know if the
fabio-almeida_1_09-18-2025_103333: and so,
daniel_20_09-18-2025_133335: uh, is considered to be any more effective in terms of being absorbed by the body?
fabio-almeida_1_09-18-2025_103333: um, you know, I think that, uh, um, again, because we have the vessels, the blood vessel exposure to it, um, it's reasonable.
daniel_20_09-18-2025_133335: I'm
fabio-almeida_1_09-18-2025_103333: I'm just not a huge fan of, uh, and that's something that you pretty much have to do every day. So the dosing on these, whether it's sublingual. Oral or nasal, it's a daily per thing you have to do.
I'm just not a big fan on, on, uh, nasal sprays in general, unless you have to really do it
daniel_20_09-18-2025_133335: it.
fabio-almeida_1_09-18-2025_103333: because we see long-term issues with the mucosa. It changes [00:18:00] basically how that works. And, um, it's, it's something that I find that, again, long term people don't stick to it,
daniel_20_09-18-2025_133335: Yeah.
fabio-almeida_1_09-18-2025_103333: um, because of the inconvenience of it. But, um, so there are alternatives.
But in our experience, these, the subcutaneous injections, uh, once or twice a week have really been the most effective. Um,
daniel_20_09-18-2025_133335: particularly
fabio-almeida_1_09-18-2025_103333: with the ability to kind of titrate the dose as to find what dose really is optimal or maximum for people and, um, uh, and get consistent results with it.
Combining NAD with Other Supplements
daniel_20_09-18-2025_133335: Do you think
fabio-almeida_1_09-18-2025_103333: Um.
daniel_20_09-18-2025_133335: any benefit to, maybe doing sublingual between injections?
fabio-almeida_1_09-18-2025_103333: You know, so what we know from our studies of uh, looking at NAD levels in people is we can detect when they're low. I think what we don't know is what's the optimal high level
daniel_20_09-18-2025_133335: Yeah. And,
fabio-almeida_1_09-18-2025_103333: and, and ultimately it would be, well, could,
daniel_20_09-18-2025_133335: that, is that a relative number? Is it gonna be Like, is high the same for one person as it is the other?
Or are they generally pretty close?
fabio-almeida_1_09-18-2025_103333: it's a good question. I don't think we really know. When we do a comparison of what we think is low, we're usually, we're comparing it to a cohort of, of teens, early [00:19:00] twenties people. So,
daniel_20_09-18-2025_133335: of
fabio-almeida_1_09-18-2025_103333: you know, we comparing almost kinda like how we do with, with DEXA scans and comparing, you know, bone mineral density to a population, we find a young cohort where we think, well, that's probably where it's optimal.
And then we compare everybody else to that. Um, and, uh, so young normals. Um, and so we know where that, where your natural NAD is at your potentially your optimal time in, in life, uh, from a, um, a metabolic kind of an aging perspective. Um, but we don't know is more, more better if you raise it past a certain level or does it just, uh, you know, not get utilized by your metabolism.
daniel_20_09-18-2025_133335: with within ad? Is there, is there a consequence to when you stop? Do you just go back to your baseline of energy or is there actually gonna be a, a basically a rebuilding period where your body has to get used to, to things again? Yeah,
fabio-almeida_1_09-18-2025_103333: yeah, I, you know, we don't see like a rebound kind of thing where, where people have like a crash or anything after it, but I, I, I find that those who have a, uh, a positive benefit from it have been on it for a bit of time, um, uh, over weeks to months of not being on it.
Stopping NAD: Effects and Considerations
daniel_20_09-18-2025_133335: it. They,
fabio-almeida_1_09-18-2025_103333: They, they notice the difference.
daniel_20_09-18-2025_133335: Oh, [00:20:00] I, I
fabio-almeida_1_09-18-2025_103333: you know?
daniel_20_09-18-2025_133335: notice a difference pretty quickly. I was just, um, wondering,
fabio-almeida_1_09-18-2025_103333: Yeah.
daniel_20_09-18-2025_133335: basically go back to baseline after, or does is there, is
fabio-almeida_1_09-18-2025_103333: So, so,
daniel_20_09-18-2025_133335: so for example, When I hear people talk about TRT. Right. And, uh, one of my concerns when, when, especially when younger people are talking to me about TRTI go,
fabio-almeida_1_09-18-2025_103333: Hmm.
daniel_20_09-18-2025_133335: you pretty much, unless I'm mistaken, you have to stay on it the rest of your life. Once you get on that injection cycle
fabio-almeida_1_09-18-2025_103333: Yeah.
daniel_20_09-18-2025_133335: you can see what I'm trying to say here,
fabio-almeida_1_09-18-2025_103333: Mm-hmm.
daniel_20_09-18-2025_133335: with, uh, NAD, is it less consequential to have the injections and then you say, I can't, I can't stay on the injections this at this point in my
fabio-almeida_1_09-18-2025_103333: Yeah. Yeah. So, so what you're describing is, is kind of the feedback mechanism, right? So with, with TRT, um, adding, adding testosterone and adding, um, basically endogenous. Uh, uh, exogenous out outside testosterone shuts down any
daniel_20_09-18-2025_133335: Yeah.
fabio-almeida_1_09-18-2025_103333: process of your own to create your own. So, and this is the same thing kind of with thyroid hormones.
So once we start replacing hormones,
daniel_20_09-18-2025_133335: Yep.
fabio-almeida_1_09-18-2025_103333: our bodies have a feedback mechanism that they understand well, that level is. And so the mechanisms that would generally force us to create our own, which are, you know, hormones that come from pituitary gland, this is, uh, uh, hormone releasing, uh, peptides that come from our brain.
They basically start to shut down. So you, you then, [00:21:00] if you stop these medications, yeah, you're now gonna go to a lower level than, than where you were before you started. Um, there can be recovery from that, but it can actually take a long time. So you are shutting down your natural processes. NAD is is different.
And NAD you kind of have to think more of is like food. Um, and that this is, you know, NAD is, is part of our, uh, citric acid cycle from the perspective of that we break down fats, carbohydrates, proteins, go through a whole cellular process to make it into a TP. And the NAD basically allows you to utilize those, those core macronutrients down at the cellular level.
And it makes it efficient, but it doesn't, it doesn't shut down your, as far as we know, it does not shut down your normal or natural ability to make it.
NAD vs. TRT: Dependency Concerns
daniel_20_09-18-2025_133335: it.
fabio-almeida_1_09-18-2025_103333: So you would pretty much go back to the baselines of where your production level were. And that's, that's been our experience with it. We don't see people have a, have a reversal or a deepening of, of their, you know, fatigue or, or, or issues, um, uh, be that, you know, without the NAD.
daniel_20_09-18-2025_133335: When I, I've, when you see NAD um, talked about online, one of the things that people, and, uh, I don't know [00:22:00] that there's any studies or science behind this, but they cl there's, there are people that claim it.
It gives you much more youthful appearance and, and things like that. Have you, has that been your experience an anecdotally,
NAD and Youthful Appearance
fabio-almeida_1_09-18-2025_103333: Yeah, so, you know, anecdotally
daniel_20_09-18-2025_133335: a data? Do you have any anecdote on that
fabio-almeida_1_09-18-2025_103333: a data. So, um, uh, full disclosure, you know, like you, I do the NAD myself and part of it for a lot of the things in, in the clinic here is, um, yeah, I'm, I'm, I'm gonna be a Guinea pig on all longevity and, uh, you know, all these things. Part of it too is I want, you know, I wanna understand how they work and, and if I'm gonna advocate for them, I wanna understand if there's side effects or there's any downside to it, uh, what the process is.
So, uh, even a lot of the development of, of the injection pen, it was, it was for me, you know, I wanted to be able to do this much more conveniently and travel with it and do all these things. Now, that being said is, um, uh, I, I would say that we have seen, um, uh, skin changes, uh, people basically, you know, having a more youthful, uh, look.
Um, and, uh, you know, a lot more energy, a lot kind of, people have people coming in saying they, you know, they feel like they're glowing, you know? So we do see that. Now those are, those are
daniel_20_09-18-2025_133335: are
fabio-almeida_1_09-18-2025_103333: pretty subjective and they're hard to, you know, quantify on it. So, um, one of the things is, you know, the, the potential benefits of NAD.
The list of benefits is really long. It seems like it's, you know, it's a miracle drug, right? And I'm a little always [00:23:00] cautious when I see these kind of things that it's like, it's great for just about everything. Um, and, uh, so, you know, over the years we've like looked into specifically these, you know, different areas and, um, and a lot of things have been corroborated, you know, from, from studies or when we look at the mechanisms.
Um, and so there's a fair amount of validation for it being, uh, you know, anti-inflammatory and that it
NAD Benefits: Anti-Aging and DNA Repair
fabio-almeida_1_09-18-2025_103333: works as you knower
daniel_20_09-18-2025_133335: know, uh,
fabio-almeida_1_09-18-2025_103333: er winds and, Uh, working at the DNA level to increase DNA repair, um, and being looked at for, uh, early dementia, Alzheimer's, Parkinson's for, for various reasons. Um, so we do see that. Um, and, um, uh, and we get reports back from our clients of just a lot of positive effects on them.
Uh, and one of them that's just, this is,
daniel_20_09-18-2025_133335: is, uh,
fabio-almeida_1_09-18-2025_103333: uh, from a personal perspective, one of the things that I notice when I do my
Personal Experience: Visual Acuity Improvements
fabio-almeida_1_09-18-2025_103333: NAD injections. Is I get, uh, a visual acuity that I don't have normally. Um, and so, uh, you know, the retina is a highly metabolic area, uses a lot of mitochondrial energy as the brain does.
And for whatever reason, mine basically, uh, really likes the NAD. So I guess on a daily basis or when I'm doing these things, uh, um, there's not an en enough NAD there, uh, on, on every other day that I don't do it. But, um, my visual acuity goes way up. And I've had [00:24:00] other clients who have just independently reported that to me without me prompting them, that
daniel_20_09-18-2025_133335: yeah,
fabio-almeida_1_09-18-2025_103333: the same kind of thing where now they can see and read signs when they're driving that they normally couldn't.
Um, you know, I don't, I don't
daniel_20_09-18-2025_133335: I
fabio-almeida_1_09-18-2025_103333: entirely understand the full mechanisms of that, uh, because, you know, uh, but it's something that is consistent. Um, and at least for myself it's consistent and, um, and a lot of other, um, just energy level. Uh, reporting basically of, uh, stamina and fatigue and or just, you know, how your workday goes.
Um, I have a lot of professionals. I have actually a lot of physicians who are in my practice who are not in my specialty. They're not different specialties. Um, so, uh, they come to me for their, their longevity or, uh, kind of practice and their overall, I'm their primary care doc. And I hear this across the board from the docs who were, we tend to be a little bit more critical and they were always wondering, is this a placebo effect?
Is it, is something, are we just basically having a very powerful placebo effect?
daniel_20_09-18-2025_133335: specific result if you didn't prompt them.
Uh,
fabio-almeida_1_09-18-2025_103333: Yeah. And, and I find that amazing, you know, and, uh, um, and so, um, and, and we've seen various other things, but along the lines of things where, uh, the vast majority of people report it.
Age Considerations for NAD Therapy
daniel_20_09-18-2025_133335: be limited. [00:25:00] To your older patients, just because, and I, and I say that 'cause generally people under 40 don't have site issues. So I, I'm generalizing, but,
fabio-almeida_1_09-18-2025_103333: Yeah.
daniel_20_09-18-2025_133335: did that, that begs the question like, what do, what do say the people who had perfect eyesight to start with, what kind of experiences did they have with it
fabio-almeida_1_09-18-2025_103333: Okay. Well, so that, uh, you, you kind of really hit on it, um, um, in that I have this discussion with younger people who come to our clinic or who are approaching us about the NAD as to, you know, how much benefit they're gonna get. So it's, I think, one of these things where if you,
daniel_20_09-18-2025_133335: you're
fabio-almeida_1_09-18-2025_103333: stores or NAD levels are pretty optimum already adding more NAD you may not notice, right?
So, so, um, as we get older and we start filling these things, then uh, then yeah, that differential starts to become much more noticeable. Um, energy levels, stamina. Just, you know, uh, cognitive, uh, and concentrating, uh, abilities. Um, so it is one where I do, you know, I,
daniel_20_09-18-2025_133335: I,
fabio-almeida_1_09-18-2025_103333: I was actually speaking to someone, uh, [00:26:00] in their twenties recently and, you know, uh, weightlifter, uh, bodybuilder and interested in NAD and I was like, well, I'm not sure you're gonna get anything out of it.
'cause I would hope your NAD levels are pretty optimal already. Um, so, uh, now that being said.
daniel_20_09-18-2025_133335: it's, you could use that same logic across the board for a lot of things. For example, um, someone in their mid twenties saying, should I, should I be low carb? Right? And they're already running, you know, five miles a day. I go, it's probably at your age and your lifestyle is probably not gonna make that big a difference if you're 45.
Diet makes a much bigger difference in terms of macros and micros and all those things.
fabio-almeida_1_09-18-2025_103333: yeah, that
daniel_20_09-18-2025_133335: to kind of paraphrase, NAD there is to say. you're, if you're younger and in your prime, there's these things are tiny tweaks to, to play around with. They're not big needle changers.
fabio-almeida_1_09-18-2025_103333: right. And I agree. And, and, and that's for the vast majority, I think, when, when people encounter, uh, illnesses or, um, you know, viral, you know, we see this with post COVID, with Lyme disease, other things. And when they're younger, that's a different story. So we know that stress, um, due to illness or otherwise will deplete your NAD.
And so there, [00:27:00] there's a role for it from a clinical perspective and when you're younger, but if you're otherwise healthy, um, just use, looking at trying to maximize or optimize performance. Yeah, I, I, I think there's less rolemy rule of thumb, my kind of guideline on it is, you know, 35 and older, um, start thinking about it and, uh, maybe staying ahead of it.
Um, certainly, um, I think the, the, the human body has an amazing resilience, uh, to repair up to a certain age. And once we hit that, you know, 35, 45, we, we start on the other end where we, we have to pay attention to these things. Um, and, um, and we can reverse a lot of, a lot of negative processes that, uh, we may have encountered in our youth.
But, uh,
daniel_20_09-18-2025_133335: uh, um,
fabio-almeida_1_09-18-2025_103333: um, yeah, I agree with you on that.
NAD for Addiction Recovery
daniel_20_09-18-2025_133335: so, um, I actually came to start, uh, really researching NAD about, uh, eight or nine months ago. Uh, Dr. Craig Conniver, uh, did a podcast with Ho Andrew Hoberman, and it was on peptides, which is
fabio-almeida_1_09-18-2025_103333: Mm-hmm.
daniel_20_09-18-2025_133335: is, you wouldn't think that's what turned me on to NAD. But at the end of the podcast, Andrew Huberman asked him, you find [00:28:00] to be the most beneficial, uh, intervention period? He said, oh, peptides are good, but nothing comes close to injecting NAD.
He said, nothing like he said, I've seen so many, uh, this was one of the things that I found. what was pretty consistent was apparently it's used a lot for addiction like alcoholics, people who are addicted to drugs. Apparently it's one of those things that really helps people break the cycle. Have you had that experience as well?
fabio-almeida_1_09-18-2025_103333: Yeah, that's, um, that's not the type of, of medicine I practice, but that's also where. You know, our earlier experience with, uh, N-A-D-I-V, that's, you know, that's what basically we're leaning on is basically addiction medicine, really had a lot of, of, um, experience with it and literature on it, safety, what the protocols were.
So our initial protocols actually emulated a lot what we were doing for addiction. And, um, and it's been something that's still quite, quite used, um, for it. So I, I would absolutely agree with that. The, the mechanisms by which, um, it works. I don't know that we fully understand, um, from, you know, uh, a lot of other mechanisms we do, but, uh, yeah, we've, we've seen very good results with that.
Ideal Candidates for NAD Therapy
daniel_20_09-18-2025_133335: So let's, let's pretend you're, you're talking to, uh, the [00:29:00] audience here. Who would you say would be a good candidate to researching this and, and maybe contacting your clinic?
fabio-almeida_1_09-18-2025_103333: Um, so, um, so certainly anybody who has encountered any kind of chronic illnessand has been left with any residual fatigue issues orchronic fatigue or brain fog, whatnot. That's, they're, they're right off the bat, a very good candidate. I think otherwise, um, like I said, kind of age afterbeyond 35, 45 when you're looking at, uh, kinda optimizing what you're doing, um, optimizing your, your exercise routine and, uh, kind of protecting your DNA, uh, from aging, I think that's a, a good place to start.
Um, my clientele, everyone over 55, almost everyone's on.
daniel_20_09-18-2025_133335: it. Mm-hmm.
fabio-almeida_1_09-18-2025_103333: Uh, so we find thatit's kind of rare, um, that, uh, it wouldn't be something where people are interested in. Um, and, uh, and that there's not a rationale for it. Um, so, um, and, and
daniel_20_09-18-2025_133335: and
fabio-almeida_1_09-18-2025_103333: you know, like you had mentioned, basically I think entity is Right, is pretty much the top of the line as far as a optimizing your metabolism and as a, a, you know, health span or longevity, uh, type of, uh, molecule.
daniel_20_09-18-2025_133335: All right.
Introduction to the NAD Easy Pen
fabio-almeida_1_09-18-2025_103333: So, um, we talked a little bit about the injection pen, um, and you had some other questions on that. So basically I know [00:30:00] for the audiences that, uh, who hasn't seen this, basically, you know, this is what it looks like. Uh,
daniel_20_09-18-2025_133335: Uh,
fabio-almeida_1_09-18-2025_103333: essentially, uh, a dose vial
daniel_20_09-18-2025_133335: mm-hmm.
fabio-almeida_1_09-18-2025_103333: that goes into a pen that, uh, this has multiple doses in it.
daniel_20_09-18-2025_133335: Mm-hmm.
fabio-almeida_1_09-18-2025_103333: We attach a sterile needle that is a one time use needle. Uh, this is a 30,
How the NAD Pen Works
daniel_20_09-18-2025_133335: 31
fabio-almeida_1_09-18-2025_103333: needle. Very, very tiny. And,
daniel_20_09-18-2025_133335: uh,
fabio-almeida_1_09-18-2025_103333: uh, the, you're able to dial in the dose.
daniel_20_09-18-2025_133335: for the audience that needle is, needle is about, um, synonymous with a mosquito at this point. It's
fabio-almeida_1_09-18-2025_103333: Yeah, it's, yeah. And so part of the, the idea on this was for us to develop a system that, one, easy to use, easy for us to instruct people on how to do it, uh, remotely, um, sterile, which is very important so that, you know, anytime you're doing an injection, if there's any, not a sterile technique being done, you know, you risk getting a little skin infection, which, which can get outta hand.
So we always wanna be careful with that. Um, uh, easy to do. We can dial in the dose also, that if I have a client who says, Hey, I've been doing a hundred milligrams, which we, you know, tell 'em how much to, to dial up on here and they're feeling like it's too [00:31:00] much, well, we can reduce that dose. Um, and we, so it's just a simple conversation.
We have to re send a new prescription or any of those kind of things then.
daniel_20_09-18-2025_133335: do the numbers on the back relate to the amount of NAD they're getting?
fabio-almeida_1_09-18-2025_103333: Yeah, so, so basically a unit, uh, a number on here is essentially, um,
daniel_20_09-18-2025_133335: a
fabio-almeida_1_09-18-2025_103333: a one milligram, or I should say it's, it's one unit is, uh, two milligrams. Um, our concentration of what we're able to provide on here is 200 milligrams per, uh, per milliliter. Okay. So that was the other component on here is, is that when you're doing these injections, we wanna keep the amount of material that you're injecting, particularly since it's just, just going under the skin, it's subcutaneous to a reasonable amount.
So it's small and we're not injecting like two mls or something, you know, a large like that. And a lot of the, the, the, uh, providers of NAD that are out there, that's what you have to do. You know, you have to put. Uh, one M1 cc, or one ml or two mls in to get those kind of doses. So in order to get these doses, you gotta do a lot more injections.
So that was where, uh, we worked really hard to, uh, to have that concentration. So [00:32:00] 50, uh, units on here is essentially 100 milligrams. Um, and that's where, that's the what we recommend for most people, um, to do that twice a week, 50 twice a week. Um, and there's enough, you know, we provide a thousand milligrams so there's enough there actually to do, you know, for a little bit longer or to do additional.
Um, and that's, that's not, that's, um, not the upper limits, uh, of it. Um, so occasionally I will have someone who wants to do an, uh, an IV version. They want a high, they need a high dose of it, but they're not, either their veins are not very good or they just really don't wanna do an iv.
daniel_20_09-18-2025_133335: iv.
fabio-almeida_1_09-18-2025_103333: And we'll do a, we'll do a, what we call a short course of high dose or high intensity on, on the pen
daniel_20_09-18-2025_133335: Yeah.
fabio-almeida_1_09-18-2025_103333: have people do it every day.
Um, and even go up to 150 milligrams per injection.
NAD Dosing for Athletic Events
daniel_20_09-18-2025_133335: So if I'm training for a marathon. Okay, so when you're training for a marathon, you'll have a couple of say 20 mile runs, and then you have the race. What if I were, if you were looking at my training schedule, when would you tell someone like that, Hey, you need the ideal time for you to do a higher dose?
Is this versus this,
fabio-almeida_1_09-18-2025_103333: Yeah. So
daniel_20_09-18-2025_133335: pre big run, post big run?
fabio-almeida_1_09-18-2025_103333: both. So usually we will, um, for a, uh, a, basically a competitive event. Um, and, uh, I, this is also the sameadvice I give to my pre-surgical patients before they're [00:33:00] going in for surgery orfor chemotherapy. Uh, we intensify the dosing to, um, to boost up 500 milligrams the week before.
So five.
daniel_20_09-18-2025_133335: five,
fabio-almeida_1_09-18-2025_103333: Basically five days. And then, um, uh, then, uh, also then
afterwardsto
daniel_20_09-18-2025_133335: the,
fabio-almeida_1_09-18-2025_103333: the, the, the, um, you know, not immediately after you need a little bit of restbut a few hours after completing the,
daniel_20_09-18-2025_133335: uh,
fabio-almeida_1_09-18-2025_103333: um, whatever that challenge istoadminister the NAD usually a hundred milligrams. And depending on basically how fatigued you are from that, potentially continueanother500 milligrams afterwards.
So, so it's five to four, five after is kind of an ultimatepre and postNAD boosting protocol.
Pre and Post-Event NAD Protocol
daniel_20_09-18-2025_133335: I apologize. I don't know the name of that pen. I call it, I, I would call it something like, um, uh, dial a, dial a
fabio-almeida_1_09-18-2025_103333: Easy pen. We call it Easy pen. I mean, for, yeah,
daniel_20_09-18-2025_133335: pen slash uh, dial a dose, what would that, what would that number be?
For, for, for people?
fabio-almeida_1_09-18-2025_103333: so it would be doing 50 50 units,
daniel_20_09-18-2025_133335: would they? But they
fabio-almeida_1_09-18-2025_103333: on, on it.
daniel_20_09-18-2025_133335: for that or 50.
fabio-almeida_1_09-18-2025_103333: No, so, so the, so the, they still set it to 50,
daniel_20_09-18-2025_133335: uhhuh
fabio-almeida_1_09-18-2025_103333: and so you're doing a hundred milligrams. Remember it's two milligrams per unit. So there, so it's a hundred milligrams or 50 units. Um, and they would do five separate injections, one, one a day for five days. Okay.
daniel_20_09-18-2025_133335: it.
fabio-almeida_1_09-18-2025_103333: Um, now, uh, you could go higher, but the, the issues with when we, for the same issues we have with iv, you start getting really high doses.
So you do [00:34:00] multiple injections of the NAD in a really short period of time, like on Right. You know, back to back. Um, you're gonna have side effects from the NAD and they're short term. Um, and you get over them. They're not harmful, but they're cons, they're annoying. Um, you can get some, uh, kind of a, uh, flushing that same kind of thing that happens with niacin.
Um, there can be some gastrointestinal issues. People can feel nauseated and get a headache. Um, uh, a very high dose, very quick of NAD people will get a feeling of chest pressure. Um, and it's not actually cardiovascular, it's not pulmonary. It's a vagus nerve response to that. So, uh, or Persantine response.
Um, it's all, they're all okay, but they're annoying.
daniel_20_09-18-2025_133335: point of return there where you go, you need, you're gonna need to weigh this out to, to your particular need past a certain point. I mean, I, as someone who's been an athlete for a while, you think about having a cup of coffee before a race is a very good idea.
Having two cups of coffee, you're starting to get into, like, you might get into GI distress, you might
fabio-almeida_1_09-18-2025_103333: Mm-hmm.
daniel_20_09-18-2025_133335: a little early, might have a crash mid-race. So just knowing that effective dose to give you sort of like the optimal performance and recovery,
fabio-almeida_1_09-18-2025_103333: Yeah. Um, absolutely the [00:35:00] dose
daniel_20_09-18-2025_133335: dose
fabio-almeida_1_09-18-2025_103333: important and it's, you know, and, and, and the guidelines I just gave you, that's, that's worked for a lot of people, but it's, you know, you have to titrate it. Um, so I have other folks who are very, very sensitive to this, um, and that we, we reduce their dose. Um, so, um, and that's, that's I think part of with what we do that differentiates
daniel_20_09-18-2025_133335: us
fabio-almeida_1_09-18-2025_103333: as well as, you know, we're a full on clinic.
We deal with our clients every day and, and we're very passionate about these things and we support everybody on the other end of this. So there's a clinical team behind it. So when questions like this come up, um, as they do, uh, you know, I'm about to do this, or I'm, uh, I'm gonna have this surgery, or I'm gonna do this event, uh, guidelines or advice on, you know, how do we, how do we, um, increase, decrease, optimize NAD and, and for us, that's part of what we do as part of our support program with NAT.
NAD with GLP-1 Medications
daniel_20_09-18-2025_133335: what interventions and or supplements have you found to be complimentary towards taking NAD?
fabio-almeida_1_09-18-2025_103333: Well, interestingly, um, we do a lot of work with GLP one medications as well. I mean, I'm, as I mentioned before, I'm also, uh, board certified in bariatrics in, uh, in obesity medicine. And, um, and that's a peptide that we've used for a long time, [00:36:00] NAD pairs extremely well with the GLP one medications. Um,
daniel_20_09-18-2025_133335: there's fatigue
fabio-almeida_1_09-18-2025_103333: and, uh, particularly when people are getting a little bit more calorie deficit,
daniel_20_09-18-2025_133335: mm-hmm.
fabio-almeida_1_09-18-2025_103333: um, going on, which is what we're going for, uh, in a lot of those people.
Um, adding NAD has been extremely helpful. Um, and it's made all the difference for, for certain people. So, so that one is, which is quite popular, so we're doing a lot of GLP plus NAD, um, you know, otherwise I think, um, you know, we look at, you know, from our clientele, we look at overall their whole health system and, uh, as far as what other nutrients are important for them.
daniel_20_09-18-2025_133335: And,
fabio-almeida_1_09-18-2025_103333: and it's an, it is an individualized kind of assessment on it. Um, so it's, otherwise I, you know, um, you know, there's, uh, no real contraindications that we have. We have never really run into any kind of herb or drug, uh, interactions with it.
daniel_20_09-18-2025_133335: Um, but,
fabio-almeida_1_09-18-2025_103333: um, I would, uh, say I'm, I'm a little bit more cautious of people who are on a lot of antihypertensives who might be, um, um, occasionally running low in blood pressure, um, with NAD, um, just because we do sometimes get, uh, a blood pressure effect, a little bit of lowering blood pressure, which is good for most people.
Um, but, um, yeah.
daniel_20_09-18-2025_133335: Okay. All right. So any, any other, uh, I we're kind of wrapping up on NED and I, I know we're, we're, we're getting near the end here, but I did want to ask, are there
Other Longevity Interventions: Rapamycin and Metformin
daniel_20_09-18-2025_133335: any other interventions, whether it's supplements or otherwise that you've been [00:37:00] kind of bullish on lately that like the science and research has been, I'm not asking you to, uh, commit
fabio-almeida_1_09-18-2025_103333: tocommit Sure.
daniel_20_09-18-2025_133335: Is a fix, but I'm, I'm curious as to what's intrigued you lately.
fabio-almeida_1_09-18-2025_103333: Yeah. Sothe GLP whole area beyond weight loss there, it's also very intriguing. There's lots of other mechanisms that we're seeing for anti-cancer, anti-inflammation, thatit's rising up to the top of the shelf, uh, from a longevity perspective. So where it's appropriate, it's something that I thinkhas been interestingto watch that.
Nowwe Do a lot of work also with rapamycin, with low-dose naltrexone, with metformin, and we havea good history with those. Um, and those I think are things that, um, you know, before we really started using NADI think we useda lot more of them. Uh, from anAging and longevity perspective, but, uh, they, they require a much more individualized approach because,
daniel_20_09-18-2025_133335: Yeah.
I,
fabio-almeida_1_09-18-2025_103333: you know, we're
daniel_20_09-18-2025_133335: I've, I've kind of looked into the rapamycin and metformin for a few years, andwhile I've never tried it, my caution with it was, um, and I'm, and I apologize, which, which one it is, but they're often used for diabetes. [00:38:00] Right. So,
fabio-almeida_1_09-18-2025_103333: okay. Or the metformin.
daniel_20_09-18-2025_133335: yeah, Metformin. And so for someone who's super active, uh, in training a lot, it actually works against you in the sense that your blood sugar, it's, it, it lowers your
fabio-almeida_1_09-18-2025_103333: Yeah.
daniel_20_09-18-2025_133335: which caninterfere with your training.
fabio-almeida_1_09-18-2025_103333: Yeah. So, yeah, so that's, that's, uh, a important thing to understand with these is that, well, when you have, uh, you know, if you're pre-diabetic or if you're a little bit insulin in, uh, sensitivity issue, so insulin insensitive, Metformin has a, a, a role improving your glucose metabolism and improving all of that.
But if it is normal. Um, yeah, what are you, are you getting the same benefits from it? Uh, Metformin's an A MPK inhibitor, which is part of why we think it has some longevity, uh, components to it has some anti-cancer activity, uh, to it. Um, and, um, inexpensive, very well tolerated. So it's something that I think is gonna remain on the radar and is being investigated as potentially a jero protective, and we'll continue to watch that.
Um, to a certain extent. I think the GLP one medications are going to replace some of that, [00:39:00] that space of where I think, well, we're gonna get a lot of that. Um, rapamycin, I think, um, is interesting. Uh, from the perspective, is that loads of data on it from a anti-aging or a longevity perspective? Um, I think the, the data that I see on pretty much every organism for which rapamycin has, has been tested on and has demonstrated.
daniel_20_09-18-2025_133335: uh,
fabio-almeida_1_09-18-2025_103333: Uh, a longevity, um, result. Um, except for in people, just because the studies can't be done, we can test on everything else. The challenge I have with, with it is, you know, high doses of rapamycin, what it's, uh, what it is, um, clinically indicated for is, is, uh, an immunosuppressant we use it for, for transplant, uh, um, patients,
daniel_20_09-18-2025_133335: Um. And to,
fabio-almeida_1_09-18-2025_103333: and to dampen the immune system.
Uh, so we're not having, uh, uh, an auto reaction to or a transplant rejection.
daniel_20_09-18-2025_133335: And,
fabio-almeida_1_09-18-2025_103333: And, um, you know, the way we're using it in, um, for optimizing health is in low dose. And I think we're getting better at understanding what that, that regimen should be, what that sequence should be. But until recently, it was kind of all over the map.
daniel_20_09-18-2025_133335: map,
fabio-almeida_1_09-18-2025_103333: Um, and I think we're starting to see people settled into, you know, low dose once a week kinds of regimens. Um, but I have had clients, um, who have been on it, who, um, [00:40:00] developed, uh, lip pmic issues. So their cholesterol, uh, triglycerides started to rise, or their glucose basically started to rise and we started to measure them having essentially pre-diabetes for which then we manage their cholesterol, you know, either naturally or with statins or we manage their, uh, their sugar with metformin.
And when I look at a, uh, if we're trying to use a medication for longevity that then I have to use potentially one or two additional medications to counter the potential side effects, it stops making less sense to me. Um, and uh, so I have a little bit of a challenge with that. And, um, and
daniel_20_09-18-2025_133335: to a credit card and it
fabio-almeida_1_09-18-2025_103333: yeah.
Managing Cholesterol and ApoB
daniel_20_09-18-2025_133335: act there.
Since you brought up
fabio-almeida_1_09-18-2025_103333: Yeah.
daniel_20_09-18-2025_133335: um, I know
fabio-almeida_1_09-18-2025_103333: Mm-hmm.
daniel_20_09-18-2025_133335: we're running short on time here, but I want to, I do wanna sort of ask, 'cause uh, this was one of my favorite takeaways from, uh, Peter Atias book was, you know, he focused on, uh, the A POB. Have you had any insight? The, whenever I ask about A POB, the only thing I ever hear is to take a preventive statin.
Have you had any insights as to things you can do to control A POB?
fabio-almeida_1_09-18-2025_103333: [00:41:00] Yeah. So I mean, I'm not opposed to stats. I think they are, they're, they're okay for the right people. Um, as, and if you're not having side effects. Um, I do like using, uh, natural statins if we can. So get Reggie Rice in combination with things like beta cyto, sterol and, and going that route and see if we can control that.
But it is, it is a challenge when we see, um, uh, that we know that basically diet, exercise and other things don't really have an impact on, uh, apolipoprotein B. Right. And, um, and we know that that's one of the atherosclerotic atherogenic components of cholesterol. Right? So, um, you know, I, I it's one there, there's a, a balance, a balancing act on whether I think, uh, I would prescribe, uh, a statin just to maintain that or manage that in isolation.
daniel_20_09-18-2025_133335: would be the precursor? And, and you say, you were talking about red yeast rice and I didn't get the, the, what the combination would be there. What would be the, the sort of like first line of defense?
fabio-almeida_1_09-18-2025_103333: Well, um, like rege rice and betas sterile basically help control level, uh, cholesterol levels. Rege rice is
daniel_20_09-18-2025_133335: Essentially
fabio-almeida_1_09-18-2025_103333: statin,
daniel_20_09-18-2025_133335: [00:42:00] Yes.
fabio-almeida_1_09-18-2025_103333: so it has some statin activity with it.
daniel_20_09-18-2025_133335: the other one you mentioned. Yeah. Yeah.
fabio-almeida_1_09-18-2025_103333: Yeah. Um, beta cyto sterol acts a little bit more as a cholesterol blocker, uh, for intestinal absorption. Um, and, um, and, uh, uh, pretty good combination I believe.
But, um. So, you know, that's from, from my practice. That's usually where I start. But I think it, it, um, we, you know, I look at the overall cardiovascular risk and profile of someone. So we're gonna see what their cholesterol levels are. We're gonna make sure they've optimized their, their nutrition, that they're exercising.
We'll do, uh, a little bit more intensive study of their cardiovascular system, uh, coronary artery ct,
daniel_20_09-18-2025_133335: ct,
fabio-almeida_1_09-18-2025_103333: uh, stress testing, and just understand where people are and we're gonna maximize lifestyle, uh, interventions first.
daniel_20_09-18-2025_133335: interventions
fabio-almeida_1_09-18-2025_103333: um, and
daniel_20_09-18-2025_133335: and
fabio-almeida_1_09-18-2025_103333: despite that, occasionally we run into someone, they're doing everything right and they've got a, uh, genetic cholesterol profile that is not great.
And, um, and we know that.
daniel_20_09-18-2025_133335: that
fabio-almeida_1_09-18-2025_103333: You know, they, they run the risk basically of developing atherosclerotic disease. Um, which is still our number one, you know, particularly for men, is still our number one way we go out.
daniel_20_09-18-2025_133335: Yeah.
fabio-almeida_1_09-18-2025_103333: And [00:43:00] so, uh, it's, it's worth, uh, addressing, um, from that perspective. So, um, and even from our, our, uh, the way we run is like, well, you know, there's, we have our, our standard of care recommendations for kind of how we titrate or how we tier different cholesterol for different levels.
And for us is to, to
daniel_20_09-18-2025_133335: to
fabio-almeida_1_09-18-2025_103333: as many complimentary, um, methods, lifestyle methods first, so that, uh, we can use low dose, uh, statins. We keep, keep the, the level of medications down to a minimum.
daniel_20_09-18-2025_133335: Yeah. Okay. So the takeaway there is try the, red yeast rice and the was the be beta
fabio-almeida_1_09-18-2025_103333: Beta cyto sterile.
daniel_20_09-18-2025_133335: I, yeah, I can.
fabio-almeida_1_09-18-2025_103333: There's a, there's a couple of different products out there. If you look at, you know, the, the herbal products out there or the, the, the supplement products that you'll see these, you'll see that as a combination. Um, and
daniel_20_09-18-2025_133335: I'm just
fabio-almeida_1_09-18-2025_103333: usually with a few other things on there.
daniel_20_09-18-2025_133335: oil, that's all. And, uh, and then
fabio-almeida_1_09-18-2025_103333: Yeah.
daniel_20_09-18-2025_133335: uh, uh, you're saying dose up the statin only to the point where it's beneficial and No, no more.
fabio-almeida_1_09-18-2025_103333: Yeah. I mean, so, you know, I think that statins kind of get a, a bad rap, or I shouldn't say get a bad rap, you know, we, um, in our standard of care system, in our healthcare system, and we know statins work,
daniel_20_09-18-2025_133335: I,
fabio-almeida_1_09-18-2025_103333: I, I don't, I don't dismiss the evidence that, you know, [00:44:00] we have direct correlation between improving basically cardiovascular uh, outcomes, mor mortality from cardiovascular events and statins.
daniel_20_09-18-2025_133335: statins,
fabio-almeida_1_09-18-2025_103333: You know, there's a pretty good relationship with that. But I think overall in our healthcare system, we don't basically address any of the, any of the other underlying, well, how did you get there? Uh, you know, so, uh, nutritional patterns basically, uh, fitness, um, have a huge aspect to these. And, um, so we're maybe a little too quick to go to a statin without addressing those other issues.
So for us, we reverse that. Statins, my, is my last thing to add on after we've really been a pretty aggressive at, at all those other things. Um, and so when we do that, we find that, yeah, I just generally don't need, uh, to be on, uh, a high dose regimen.
daniel_20_09-18-2025_133335: Got it. Dr. Fabio, you are a wealth of wisdom, and I'm, I'm truly grateful for what, not not coming on the just coming on the podcast, but for what you've been doing for people.
I found, actually, it's funny enough, I found your practice through ai. I was asking AI a lot of questions, and, uh, you came up as one of the recommended people I should, uh, talk to. [00:45:00] So thank you for all you're doing to help people enjoy their lives and live more fulfilling lives. Uh, we grew up, uh, we're probably to the same generation.
I'm 48, but you know, I,
fabio-almeida_1_09-18-2025_103333: I am 60, so, you know, I'm,
daniel_20_09-18-2025_133335: I need to copy your
fabio-almeida_1_09-18-2025_103333: I have a little bit more, more time on that.
Redefining Aging and Health Span
daniel_20_09-18-2025_133335: you'll, I think
fabio-almeida_1_09-18-2025_103333: Yeah.
daniel_20_09-18-2025_133335: with me here. Uh, we grew up with this idea that once you're over 40, you start hanging things up, and then by the time you're 67, you're pretty much relegated to the house. Um, you know, the big travel plans are gone at that point, and I think a lot of us are, are really trying to question that and, and kind of say, you know, that's. have to, I don't have to submit to that. That doesn't have to be the case. So I really appreciate you bringing this type of information and giving people options to say it. It doesn't, you don't have to sunset your life just because a particular
fabio-almeida_1_09-18-2025_103333: Absolutely. I mean, I, the, the, the, the whole concept of what we're doing, I, I absolutely agree with you and I'll be honest with you, geez, I'm just getting started. You know, I've been, I've been, you know, uh, I've done a lot in my career. Um, moved around a little bit within this kind of space, but
daniel_20_09-18-2025_133335: I'm just,
fabio-almeida_1_09-18-2025_103333: I'm, I'm not ready to hang it up even close.
daniel_20_09-18-2025_133335: Oh, you're
fabio-almeida_1_09-18-2025_103333: And, um, and so, uh, then that's part of us, yeah. Looking at [00:46:00] all of the things that you can do that are in your control to, to kind of, uh, improve that health. Now, you know, ev. Tomorrow's promise to no one. And things happen. We, we have issues that, you know, uh, aneurysms, cancer, other things that are, you know, we want to try to avoid, but part of it is, is making sure we take care of those things that we can.
Um, but that we're not, uh, you know, creating a, a, uh, a, an environment in our bodies such that we're promoting aging and we're promoting, uh, uh, chronic disease and those kinds of things. Um, so yeah, for us it's, it's about living a long life, uh, a functional life and, and potentially then you just hit a cliff when it's time,
daniel_20_09-18-2025_133335: and
fabio-almeida_1_09-18-2025_103333: then you're done.
You're not, not lingering 10 or 15 years with debilitating chronic disease. Um, you know that our healthcare system is really good at keeping it going, but not really making your life enjoyable. So, um, that's kind of our, our thought process.
daniel_20_09-18-2025_133335: uh, I don't know if you've seen this data, but, um, the, the, the blue zones and some of these other zones that what, what, what they found was, um, they had had, say a heart attack or single life, their, their lifespan was very similar to, to basically an Amer uh, the standard American person after that event.
But they were just so much better at preventing that event from occurring in the first place. And
fabio-almeida_1_09-18-2025_103333: Absolutely.
daniel_20_09-18-2025_133335: [00:47:00] that, that's part of what this whole, uh, preventive medicine is about is saying give yourself, you know, you got, you, you can bookmark the odds in your favor to put those type of events, uh, you know, push 'em 10 to 15 years out because of lifestyle changes.
Which is
fabio-almeida_1_09-18-2025_103333: Mm-hmm.
Adding Life to Your Years
daniel_20_09-18-2025_133335: can completely prevent them, but you can basically
fabio-almeida_1_09-18-2025_103333: Yeah.
daniel_20_09-18-2025_133335: take, make use of that time. And again, we're, we're not necessarily interested. I, I, I'm trying, I hope I don't butcher the phrase, but, um, uh, the, there was a runner's phrase that I always clinging to when I was a, when I was a competitive athlete, and it was, I'm not running to add more years to my life, but more life to my years. So, uh, I, I think about that when I, when we have these conversations, because what we're trying to do is, is we're not just sitting here saying, well, maybe you'll live five more years. We're trying to say, you can enjoy that time so much more,
fabio-almeida_1_09-18-2025_103333: Yeah.
daniel_20_09-18-2025_133335: have a
fabio-almeida_1_09-18-2025_103333: I think that is, that is a, uh, a, well, first off the phrase you just used, it's, it's, it's actually practically on my business card, you know, adding life to your years rather than years to your life. Now, we optimally do both, right? But, you know, years to your life without life to your years, I don't think is a, is a really good [00:48:00] goal.
It is, it is. What we have discussions with our clients, um, and understanding your, their goals all the time. Um, this comes up with our cancer patients quite a bit because, you know, they, we potentially, um, you know, if they've got, you know, a stage four cancer, it's, we know we're not going to beat it. Um. W well, what's the, you know, and, uh, what's your choice?
Well, we can try to maximize your time, which means we might subject you to some pretty significant, uh, and very morbid procedures, chemotherapy, whatnot. Or we maximize your enjoyment, which means, well, we're gonna, uh, or, you know, your ability to travel, your ability to be with family. And, um, and again, trying to optimize both of those.
But sometimes it's, it's just really an honest conversation of, of, you know, where are we gonna, where are we going to focus? And invariably, um, uh, I find that people are, you know, they want, they basically want to add life to their years not years of extra life. I think, uh, it just makes a lot more sense. Um, so absolutely agree with you and, uh, and we continue to strive and look at, uh, you know, different mechanisms for that.
Now, just as a, an aside, you know, with my background in culinary medicine,
Blue Zones and Mediterranean Diet
fabio-almeida_1_09-18-2025_103333: blue Zones, Mediterranean style, anti-inflammatory eating. We're all over that. That's a [00:49:00] huge area that we spend time teaching our clients. We have a teaching kitchen. We feed, teach people, people to
daniel_20_09-18-2025_133335: to cook,
fabio-almeida_1_09-18-2025_103333: and we talk about this. Um, and, uh, we've been fortunate to have met with Dan, but, uh, ner, who's the, the founder of that, the National Geographic is, you know, just, uh, he's a wealth of information and all these, and, and, um, you know, potentially a topic for discussion, uh, for, you know, if we wanna dive a little bit deeper in that on another, on another talk.
So, um, but it's one where, you know, uh, dietary patterns come up, uh, and, uh, perhaps even a little bit more passion, um, on that as far as, uh, or individual, uh, passions on it where people come into the conversation. 'cause,
daniel_20_09-18-2025_133335: Uh,
fabio-almeida_1_09-18-2025_103333: unlike NAD if you're not familiar with it, you know, we got the science, we, we have some history on it, but you're coming from maybe from, uh, uh, you know, uh, an area of, uh, not knowing a whole lot.
Everybody eats. Everybody eats probably a couple times a day. Everybody's a little bit of an expert. So, uh, so, uh, it's one of those things that could be a little bit more, uh, a little bit more challenging for, for folks to, you know, to, to digest,
daniel_20_09-18-2025_133335: No
fabio-almeida_1_09-18-2025_103333: so to speak. Yes.
daniel_20_09-18-2025_133335: Well, this has been wonderful, Dr. Fabio. Thank you
fabio-almeida_1_09-18-2025_103333: yeah.
daniel_20_09-18-2025_133335: and, uh, to please tell people where they can, uh, find you and, and your practice.
How to Get Started with NAD Therapy
fabio-almeida_1_09-18-2025_103333: Yeah. So, um, you know, for just a, kind of a general understanding of what we do, dr fabio.com, so D-R-F-A-B-I o.com is our main website. Um, and, uh, there's information on there about NAD, but in particular for those who [00:50:00] just wanna really focus on the NAD, we created a separate website. It's called, uh, N-A-D-E-Z Pen, so N-A-D-E-Z-P-E-N.
And, um, and that'll guide people through a little bit of, um, you know, how to get started with it.
daniel_20_09-18-2025_133335: it.
fabio-almeida_1_09-18-2025_103333: Um, for the most part, uh, I like people to do their due diligence, understand a little bit what they're kind of, uh, getting into and what to expect. And, um, it's part of our process. We do a little bit of an intake, so there's, um, on the other end of those websites as a place for people to register and give us a little health history.
We look at that, make sure it's appropriate, um, and if they, if somebody goes through that and submits it, then, then we reach out to them to, um, um, basically provide the NAD. And you did ask about cost. We mentioned what the IVs cost. Um, for our program, essentially it's $235 per month for a thousand milligrams.
Um, uh, we do charge for shipping. Uh, a little addition on that. We're, we're trying to mitigate that a little bit, uh, more for our clients. But, um, that's, uh, uh, you know, we try to make it as reasonable, um, and, um, sustainable for folks, um, from a pricing perspective.
daniel_20_09-18-2025_133335: extremely reasonable. Alright, thank you so much.
fabio-almeida_1_09-18-2025_103333: All right, well, I appreciate you having me on your program and, uh, look forward to speaking to you soon again.
daniel_20_09-18-2025_133335: Thank you, Dr. Bob.