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Step 5: Surgery Surgery is considered a last resort and is only used when all other treatment options have failed and quality of life is significantly impaired

Alz Res Therapy 17 , 43 (2025)

Rather than directly supplying NAD+ precursors (like NMN or NR), it works by blocking an enzyme that consumes nicotinamide, theoretically preserving the substrate pool for endogenous NAD+ production

The reason supervised therapy exists is that signaling molecules belong in a clinical workflow, with a licensed prescriber, a regulated pharmacy, a documented evaluation, and a follow up plan

Annals of Palliative Medicine

There's a couple states that are cracking down on people and people know to avoid those states