NAD, Peptides, and the Truth About Wellness Trends with Ashley Madsen

I've been a fangirl of Ashley Madsen's work for a while, so getting her on the show was a real treat. Ashley is a double board-certified physician associate, international speaker, and educator in functional medicine, longevity science, and performance optimization.

We start with NAD, which is everywhere online right now, and Ashley explains why the real story is far more nuanced than "we lose it with age, so replace it." She also explains the role of methylation support, and why building a foundation matters before layering on the fancy stuff.

From there we talk about peptides. Ashley breaks down how it works, who it may help, and why the human safety data behind it stands out. We even play a rapid-fire round on peptides.

We close on where personalized medicine is going, why "knowledge replaces fear," and Ashley's lovely idea of the lily pad effect, how every pivot and even every failure prepares you for what comes next.

A note: this is one of our more clinical conversations, and everything discussed is educational, not medical advice. Any therapy mentioned should be considered only with a qualified clinician.

FAQs

Do NAD levels really just drop as we age?

Not in the simple way it is often described. Production does change, but a major factor is how quickly the body breaks NAD down, which can accelerate with conditions like insulin resistance, chronic infections, and other physiological stress. So rather than only replacing NAD, it often makes more sense to ask why it is being depleted in the first place and to address that underlying cause.

What's the difference between IV NAD and NAD precursors like NR?

NAD itself has to be broken down before cells can use it, is difficult to deliver where it is needed, and is hard to test accurately. Precursors like NR (nicotinamide riboside) are building blocks the body converts into its own NAD, and they tend to be easier to use and better tolerated. IV NAD infusions can cause side effects like palpitations, nausea, or flushing and often must be given slowly over hours, whereas precursors are generally gentler. Both have their place, but they are not interchangeable.

Should everyone be getting NAD drips?

No, and this is a point worth emphasizing. NAD levels do not meaningfully decline in the teens and twenties, so routine drips for otherwise healthy young people are not well supported. There is also a mechanistic concern: over-supplying NAD can activate the very pathway that breaks it down. IV NAD appears most appropriate in specific, clinician-supervised situations rather than as a weekly routine for everyone. Personalized means matched to your actual needs, not to a trend.

Why might someone need methylation support with NAD?

NAD plays a role in methylation, a fundamental cellular process. People who already have methylation challenges, whether from genetic variations or low levels of nutrients like B12, folate, and B6, can sometimes feel worse when NAD or its precursors are added without that support. This is part of why building a nutritional foundation first, under clinical guidance, tends to lead to better outcomes and fewer adverse reactions.

Are peptides like SS-31 right for anyone?

No. Even a promising peptide is highly individualized. SS-31, for example, is generally avoided in pregnancy, breastfeeding, and active cancer because the safety data in those settings is insufficient. Whether any peptide is appropriate depends on a person's health history, current treatments, and goals, and is a decision to make with a qualified clinician who can ensure appropriate use and monitoring. Anything discussed here is educational, not a recommendation.

Why isn't a trending wellness treatment automatically right for me?

Because effective care depends on your individual biology, history, and goals, not on a treatment's popularity. A therapy that helps one person significantly may do little for another whose body has different needs and a different starting point. The better question is always whether something fits your situation, not whether it is widely used.

Why do foundations matter before advanced treatments?

Advanced therapies generally work well only when the basics are already in place. If your body is missing key nutrients or carrying an underlying imbalance, adding a sophisticated intervention on top often produces disappointing or even uncomfortable results. Nutrition, sleep, stress, and correcting deficiencies create the conditions that let anything else work.

Is more of a good treatment always better?

No. The body runs on balance, and over-supplying a single input can sometimes activate the very processes you were trying to support, or simply do nothing useful. Thoughtful, individualized amounts tend to matter more than maximum intervention.

What does "personalized medicine" actually mean?

It means tailoring care to your specific biology, labs, history, and goals rather than applying the same protocol to everyone. Increasingly, this includes looking at individual data to guide decisions, so that what you receive reflects your needs rather than a general trend.

How can I make health decisions without fear?

Understanding tends to dissolve fear. When you know what something is, how it works, and whether it suits your situation, you can make a clear-eyed decision. Asking questions is not being difficult; it is exactly what good decision-making requires.

What should I do if I don't feel heard by my provider?

Take it as a signal to keep looking rather than as a dead end. No single clinician has every answer, and everyone sees through the lens of their own experience. Seeking another perspective is a legitimate form of self-advocacy, and finding the right partner in your care is worth the effort.

Get the Handout

Full Transcript

Instagram

TikTok

Youtube

Become a Patient

Medical Providers Join my Clinician Education Platform

Subscribe to our Newsletter

Learn at Pinnacle to earn FREE CE/CME credit for listening to this episode

Ashley Madsen

Instagram

Website