Two of the Biggest Names in Anti-Aging, Head to Head
NAD+ and peptides are arguably the two hottest categories in the longevity and optimization space right now. Both promise to slow aging, improve recovery, and boost cellular function. Both have enthusiastic proponents and vocal skeptics. And both come with significant price tags that make choosing between them a real financial decision for most people.
Dr. Ashley Froese has clinical experience with both, and in this video she does something refreshingly useful: she compares them directly. Not in the vague both are great way that most wellness content defaults to, but with specific analysis of mechanisms, evidence strength, clinical outcomes, and practical considerations. With 234K views, it clearly resonated with people trying to figure out where to put their money and their trust.
NAD+ Basics: What You Need to Know
NAD+ (nicotinamide adenine dinucleotide) is a coenzyme found in every cell in your body. It is essential for energy production, DNA repair, and the activity of sirtuins, a family of proteins that regulate cellular aging and stress responses. Without adequate NAD+, your mitochondria cannot efficiently convert food into energy, your DNA repair mechanisms slow down, and your cells become more vulnerable to the accumulated damage that drives aging.
The problem is that NAD+ levels decline with age. By age 50, most people have roughly 50% of the NAD+ levels they had at 20. By age 80, the decline can reach 80% or more. This decline correlates with many of the hallmarks of aging: reduced energy, slower recovery, cognitive decline, increased inflammation, and impaired immune function.
The NAD+ restoration approach takes several forms. IV NAD+ infusions deliver the molecule directly into the bloodstream, bypassing the digestive system entirely. This is the most direct and expensive option, typically $250-$1,000 per session, with protocols ranging from weekly to monthly. Oral precursors like NMN (nicotinamide mononucleotide) and NR (nicotinamide riboside) are converted to NAD+ in the body. These are cheaper and more convenient but have lower bioavailability. Subcutaneous NAD+ injections sit between IV and oral in terms of cost and convenience.
The evidence for NAD+ restoration is compelling at the mechanistic level. In animal studies, boosting NAD+ levels reverses age-related mitochondrial dysfunction, improves muscle function, enhances DNA repair, and extends lifespan in certain model organisms. The human data is more limited but growing. A 2022 study in Nature Aging found that NMN supplementation improved muscle insulin sensitivity and metabolic function in prediabetic women. Several ongoing trials are testing NAD+ interventions for cognitive function, cardiovascular health, and exercise performance.
Where NAD+ Falls Short
Dr. Froese identifies several limitations of NAD+ therapy that its proponents often gloss over. First, the relationship between blood NAD+ levels and intracellular NAD+ levels is not straightforward. An IV infusion will dramatically raise your blood NAD+ levels, but whether that translates to meaningful increases inside your cells (where NAD+ actually does its work) is less clear. The molecule is large and does not freely cross cell membranes.
Second, the subjective effects of NAD+ therapy are highly variable. Some patients report dramatic improvements in energy, mental clarity, and recovery. Others notice little to nothing. Dr. Froese suggests this variability may be related to baseline NAD+ status: people who are significantly depleted (heavy drinkers, poor sleepers, metabolically unhealthy individuals) tend to notice the biggest effects, while already-healthy people may be above the threshold where additional NAD+ makes a perceptible difference.
Third, the cost of sustained NAD+ therapy is substantial. IV infusions at $500+ per session on a weekly or biweekly schedule add up to $12,000-$26,000 per year. Oral NMN at effective doses runs $50-$150 per month, which is more manageable but still significant for an intervention with limited long-term human outcome data.
How Peptides Compare
Peptides operate through fundamentally different mechanisms than NAD+. Where NAD+ works at the metabolic and energetic level (fueling cellular machinery and activating longevity pathways), peptides work as signaling molecules that direct specific biological processes. A healing peptide like BPC-157 tells your body to accelerate tissue repair. A growth hormone secretagogue like CJC-1295 tells your pituitary to release more growth hormone. An anti-inflammatory peptide like KPV tells your immune system to reduce inflammation.
This difference in mechanism creates a difference in clinical application. NAD+ is broad-spectrum. It supports general cellular function across all tissue types. It does not target a specific problem. It raises the baseline performance of your entire cellular infrastructure. Peptides are targeted. They address specific biological goals with specific compounds. If you have a torn tendon, NAD+ will not speed healing the way BPC-157 can. If you want to build muscle, NAD+ alone is not going to stimulate growth hormone the way CJC-1295/Ipamorelin will.
The flip side is that peptides require more knowledge to use well. You need to know which peptide matches your goal, what dose to use, how long to use it, and what monitoring is appropriate. NAD+ protocols are simpler. Boost the levels, monitor the response, adjust as needed.
Dr. Froese's Clinical Observations
This section is the most valuable part of the video because it draws on actual clinical outcomes rather than theoretical mechanisms. Dr. Froese has prescribed both NAD+ and various peptides to hundreds of patients, and her observations are nuanced.
For energy and general vitality, she finds NAD+ more consistently effective. Patients who report fatigue, brain fog, and slow recovery from exercise tend to respond well to NAD+ restoration, especially if their baseline metabolic health is poor. The effect is not dramatic in most cases, more of a 15-25% improvement in subjective energy levels, but it is consistent and broad-based.
For specific therapeutic goals, peptides outperform NAD+ consistently. A patient with a chronic rotator cuff injury will get more benefit from a BPC-157/TB-500 protocol than from NAD+ infusions. A patient wanting to improve body composition will respond better to growth hormone peptides than to NAD+ alone. A patient with gut inflammation will benefit more from BPC-157 or KPV than from NMN supplementation.
For longevity and aging optimization in otherwise healthy patients, she sees the best results from combining both. NAD+ restoration establishes a higher baseline of cellular function. Peptides address specific areas where age-related decline is most noticeable for that individual. The combination is synergistic in her clinical experience, with patients reporting outcomes better than either approach alone.
The Cost-Benefit Breakdown
For someone on a budget who has to choose one, Dr. Froese suggests starting with the approach that matches your most pressing need. If you have a specific injury, a specific hormonal concern, or a specific inflammatory condition, peptides targeted at that issue will give you the most noticeable return on investment. If your main complaint is generalized fatigue, slow recovery, and a sense of declining vitality without a specific target, NAD+ may be the better starting point.
Oral NMN at 500-1,000mg per day represents the most accessible entry point for NAD+ restoration. The cost is $50-$100 per month, the evidence is growing, and the safety profile is clean. For peptides, starting with a single compound targeted at your primary concern, working with a physician who can monitor your response, and evaluating after 8-12 weeks is the rational approach.
If budget allows both, the combination makes biological sense. NAD+ ensures your cells have the fuel they need to respond optimally, and peptides provide the specific signals that direct that response toward your goals. Think of NAD+ as upgrading your engine and peptides as telling the car where to go.
Practical Steps to Take Today
Get baseline testing. For NAD+ assessment, ask for an intracellular NAD+ test (some specialty labs offer this) or use proxy markers like inflammatory markers, fasting insulin, and mitochondrial function indicators. For peptide therapy, baseline labs should include a comprehensive metabolic panel, CBC, hormone panel, and IGF-1 if considering growth hormone peptides.
Start with one intervention. Adding NAD+ and three peptides simultaneously makes it impossible to know what is helping. Pick the one that best matches your primary goal and evaluate it systematically.
Track meaningful outcomes. Subjective energy ratings, recovery time from exercise, sleep quality scores, and body composition measurements are more useful than blood levels alone. The question is not whether your NAD+ levels went up. The question is whether you feel and function better.
Reassess at 90 days. If you are seeing meaningful improvements, continue and consider adding the second intervention. If not, either adjust the protocol or redirect your investment to a different approach. The worst outcome is spending money on something for years without ever knowing whether it is actually helping.
Dr. Froese makes one final observation that ties the comparison together nicely. The longevity field as a whole is moving toward combination approaches where multiple interventions address different aspects of aging simultaneously. NAD+ and peptides fit this model naturally because they target complementary biological layers. NAD+ addresses the cellular energy and DNA repair infrastructure. Peptides address specific tissue and organ-level functions. Neither approach is sufficient on its own for the full scope of age-related decline, and neither is a substitute for the foundational lifestyle factors, sleep, exercise, nutrition, and stress management, that remain the highest-leverage interventions for most people. The question is not NAD+ or peptides. It is whether either one makes sense for your specific situation, and if so, in what order and at what dose.