HBOT with NAD+ IV and Peptides: A Longevity Protocol Explained

Longevity medicine is increasingly defined by multi-modal approaches, combining therapies that target different but complementary biological mechanisms to achieve outcomes that no single intervention can deliver alone. One of the most compelling multi-modal protocols in contemporary practice combines hyperbaric oxygen therapy (HBOT), intravenous NAD+ infusions, and targeted peptide therapy. This article explains the scientific rationale for each component, how they interact synergistically, and what a combined treatment course looks like in clinical practice.

Mitochondrial Synergy: HBOT and NAD+

The foundation of this protocol rests on mitochondrial health. Mitochondria, the organelles responsible for producing the vast majority of cellular energy, require two key substrates to function optimally: oxygen and NAD+.

Oxygen as Mitochondrial Fuel

The mitochondrial electron transport chain (ETC) uses oxygen as the final electron acceptor in the process of oxidative phosphorylation, the primary mechanism by which cells produce adenosine triphosphate (ATP). When oxygen availability is limited, mitochondrial efficiency declines, ATP production falls, and cells shift towards less efficient metabolic pathways.

HBOT at 2 ATA dramatically increases the amount of dissolved oxygen in the blood plasma, delivering supraphysiological oxygen levels to tissues throughout the body. This enhanced oxygen availability provides mitochondria with an abundance of their primary substrate, supporting more efficient energy production.

Research published in the journal Aging has demonstrated that repeated HBOT sessions can improve mitochondrial function in human subjects, as measured by changes in mitochondrial membrane potential and ATP production capacity. These improvements are not limited to the duration of the HBOT session; repeated exposure appears to induce lasting adaptive changes in mitochondrial biology.

NAD+ as Mitochondrial Cofactor

NAD+ (nicotinamide adenine dinucleotide) is equally essential for mitochondrial function. It serves as a critical cofactor in the ETC, shuttling electrons between enzyme complexes as it cycles between its oxidised (NAD+) and reduced (NADH) forms. Without adequate NAD+, the ETC cannot operate efficiently regardless of how much oxygen is available.

NAD+ levels decline significantly with age, falling by as much as 50% between young adulthood and older age. This decline impairs mitochondrial function and is now recognised as one of the hallmarks of biological ageing.

Intravenous NAD+ infusion directly restores circulating NAD+ levels, bypassing the slower and less efficient oral supplementation route. IV administration achieves rapid elevation of NAD+ in the bloodstream, making it available to tissues and organs that need it most.

The Combined Effect

When HBOT and NAD+ IV therapy are combined, the synergistic logic becomes clear. HBOT provides the oxygen substrate, and NAD+ provides the cofactor, together addressing both sides of the mitochondrial energy equation simultaneously. This dual approach may produce improvements in cellular energy production that exceed what either therapy could achieve independently.

Clinical observations at Longevity Thailand suggest that patients receiving both therapies report greater improvements in energy levels, cognitive clarity, and recovery capacity compared to those receiving either therapy alone. Whilst these observations are encouraging, controlled comparative studies are needed to quantify the magnitude of the synergistic effect.

NAD+ IV Timing with HBOT Sessions

The scheduling of NAD+ infusions relative to HBOT sessions is a clinical consideration that can influence therapeutic outcomes.

Optimal Sequencing

At Longevity Thailand, the standard approach is to administer NAD+ IV infusion in the morning, followed by an HBOT session later in the day or the following morning. This sequencing allows NAD+ levels in the bloodstream to rise before the enhanced oxygen delivery of HBOT maximises mitochondrial activity.

The rationale is straightforward: if NAD+ levels are replenished before the flood of oxygen arrives, mitochondria have both substrates available simultaneously, creating optimal conditions for energy production.

Practical Considerations

NAD+ IV infusions typically take two to four hours, depending on the dose and infusion rate. Patients are advised to maintain good hydration before and during the infusion, as dehydration can exacerbate the mild side effects sometimes experienced during NAD+ administration (flushing, nausea, or chest tightness).

HBOT sessions last 60 to 90 minutes at 2 ATA. When both treatments are scheduled on the same day, sufficient time is allowed between sessions for the patient to rest, hydrate, and eat if needed.

Frequency and Duration

A typical combined protocol involves NAD+ infusions on three to five days of the treatment week, with HBOT sessions scheduled daily or five times per week. The total course duration depends on the clinical objectives, ranging from 10 days for a focused longevity boost to 21 days for a comprehensive programme.

Peptide Therapy and HBOT: Complementary Mechanisms

The addition of targeted peptide therapy to an HBOT and NAD+ protocol adds a third dimension of therapeutic support. Peptides are short chains of amino acids that can influence specific biological pathways with precision.

BPC-157 for Tissue Repair

BPC-157 (Body Protection Compound-157) is a synthetic peptide derived from a protein found in human gastric juice. Extensive preclinical research has demonstrated its ability to promote angiogenesis, accelerate wound healing, protect against tissue damage, and modulate the nitric oxide system.

When combined with HBOT, BPC-157 may enhance the tissue repair processes that hyperbaric oxygen initiates. HBOT stimulates neovascularisation, and BPC-157 promotes the formation and stabilisation of new blood vessels through complementary molecular pathways. The result is a more robust angiogenic response than either therapy produces alone.

For patients undergoing regenerative medicine programmes that include musculoskeletal repair, gut healing, or post-surgical recovery, the combination of HBOT and BPC-157 addresses tissue repair from multiple angles simultaneously.

Thymosin Alpha-1 for Immune Optimisation

Thymosin Alpha-1 (Ta1) is a naturally occurring peptide that plays a central role in immune system regulation. It enhances the function of dendritic cells, natural killer cells, and T lymphocytes, supporting both innate and adaptive immunity.

In the context of a longevity protocol, immune optimisation is essential. Age-related immune decline (immunosenescence) contributes to increased susceptibility to infections, reduced cancer surveillance, and chronic low-grade inflammation. Thymosin Alpha-1 addresses these changes by restoring immune competence.

HBOT complements immune modulation by enhancing the oxygen-dependent killing mechanisms of immune cells and modulating inflammatory pathways. The combination of HBOT and Thymosin Alpha-1 may support more comprehensive immune system optimisation than either approach alone.

Enhanced Delivery

An additional benefit of combining peptide therapy with HBOT is the potential for enhanced tissue delivery. The improved blood flow and capillary perfusion achieved during and after HBOT sessions may facilitate more effective distribution of peptides to target tissues, particularly in areas with compromised circulation.

Building a Personalised Longevity Protocol

A multi-modal protocol combining HBOT, NAD+ IV, and peptide therapy is not a one-size-fits-all programme. At Longevity Thailand, each protocol is designed individually based on comprehensive clinical assessment.

Initial Assessment

Before treatment begins, patients undergo thorough evaluation including:

Medical history review covering current health status, existing conditions, medications, and previous treatments.

Biomarker testing to establish baseline values for key indicators of biological age, mitochondrial function, inflammation, immune status, and metabolic health.

Functional assessment evaluating physical performance, cognitive function, and quality of life metrics that serve as reference points for measuring treatment outcomes.

Goal setting to align the treatment programme with the patient’s specific health and longevity objectives.

Protocol Design

Based on the assessment results, the medical team designs a treatment programme that specifies the HBOT protocol (number of sessions, pressure, duration), the NAD+ infusion schedule (dose, frequency, duration of course), the peptide selection and dosing (based on clinical indication and patient goals), and the integration and timing of all three modalities.

The protocol may also incorporate additional complementary therapies such as IV antioxidant support, lifestyle counselling, nutritional guidance, and stress management strategies.

What a Combined Treatment Course Looks Like

A typical day during a comprehensive longevity protocol at Longevity Thailand might follow this pattern:

Morning (8:00 to 12:00): NAD+ IV infusion administered over two to four hours in a comfortable clinical setting. During the infusion, patients can read, work, or rest. Vital signs are monitored, and hydration is maintained.

Midday (12:00 to 13:30): Rest period with a nutritious meal. Patients are encouraged to hydrate well and eat balanced meals that support mitochondrial health and NAD+ metabolism.

Afternoon (14:00 to 15:30): HBOT session at 2 ATA for 60 to 90 minutes. The session includes gradual pressurisation, the treatment phase breathing pure oxygen, and controlled depressurisation.

Late afternoon: Peptide administration (subcutaneous injection) as prescribed. BPC-157 and Thymosin Alpha-1 injections are typically administered by the clinical team or self-administered after instruction, depending on the protocol.

Evening: Rest and recovery. Patients are encouraged to prioritise sleep, as restorative sleep is essential for maximising the benefits of the day’s treatments.

This schedule is adjusted based on the individual protocol. Some patients may receive NAD+ infusions every other day rather than daily. HBOT sessions may be scheduled five days per week with rest days. Peptide protocols follow their own timing based on the specific peptides used.

Biomarkers and Measuring Progress

One of the distinguishing features of a well-designed longevity protocol is the systematic measurement of outcomes through biomarker testing.

Pre-Treatment and Post-Treatment Testing

Patients undergo comprehensive biomarker panels before and after the treatment course. Key markers include:

NAD+ metabolites: Direct measurement of NAD+ and related metabolites in blood to confirm that infusions are effectively raising systemic NAD+ levels.

Inflammatory markers: C-reactive protein (CRP), interleukin-6 (IL-6), and other inflammatory indicators to assess the anti-inflammatory effects of the combined protocol.

Oxidative stress markers: Measurements of oxidative damage (such as 8-OHdG) and antioxidant capacity to evaluate the balance between oxidative stress and protective mechanisms.

Telomere length: Assessment of telomere length as a biomarker of biological age. Published research has shown that HBOT protocols can increase telomere length, and the combined protocol aims to amplify this effect.

Mitochondrial function indicators: Markers of mitochondrial health including lactate-to-pyruvate ratio and coenzyme Q10 levels.

Immune function panels: Assessment of immune cell populations and function, particularly relevant when Thymosin Alpha-1 is included in the protocol.

Functional Outcomes

Beyond laboratory markers, functional assessments provide practical evidence of treatment effects. These may include cognitive performance testing, physical endurance and strength measurements, sleep quality assessment, and patient-reported energy levels and well-being.

Evidence Context

Intellectual honesty about the state of evidence is a core principle at Longevity Thailand. Each component of the multi-modal protocol has its own evidence base, and the strength of evidence varies between therapies and their combinations.

HBOT: Has the most extensive evidence base among the three components. It is an established medical therapy with regulatory approval for specific indications. Its effects on tissue oxygenation, angiogenesis, and anti-inflammatory signalling are well documented. Emerging research on its longevity applications (telomere lengthening, senescent cell reduction) is promising but still developing.

NAD+ IV therapy: The biochemical rationale for NAD+ repletion is grounded in decades of research. Human clinical trials with NAD+ precursors (NR, NMN) have demonstrated safety and efficacy in raising NAD+ levels. IV NAD+ achieves rapid systemic repletion, though comparative data between IV and oral routes is limited.

Peptide therapy: BPC-157 has extensive preclinical evidence but limited formal human clinical trial data. Thymosin Alpha-1, by contrast, is an approved pharmaceutical in several countries with a well-established clinical evidence base for immune modulation.

The combination: The rationale for combining these therapies is grounded in complementary biological mechanisms. Each therapy addresses a distinct aspect of cellular health and ageing. However, large-scale clinical trials evaluating the specific three-therapy combination are not yet available. Our protocols are informed by published evidence for individual therapies, preclinical data on relevant combinations, and accumulated clinical experience.

We believe this transparency is essential. Patients deserve to understand both the promise and the limitations of the approaches we offer, and our medical team discusses the evidence context openly during the consultation process.

At Longevity Thailand, the combination of HBOT, NAD+ IV, and peptide therapy represents our commitment to comprehensive, evidence-informed longevity medicine. By addressing mitochondrial health, tissue repair, and immune function through complementary mechanisms, this multi-modal approach offers a structured pathway for patients seeking to optimise their biological resilience and long-term health.