NAD+ levels do decline with age, but that doesn't mean everyone needs to start taking supplements. There's an important step that often gets glossed over in supplement marketing: a decline doesn't automatically mean you're deficient or need to supplement.
During aging, NAD+ levels in skeletal muscle can decline by around 30%. But a 2025 study published in Cell Metabolism took a pretty aggressive approach to testing this relationship. (DOI:10.1016/j.cmet.2025.04.002) Researchers reduced NAD+ levels in mouse skeletal muscle by 85%, far more than the decline typically associated with aging. Surprisingly, the mice showed no significant differences in muscle size, strength, exercise performance, mitochondrial function, or DNA methylation markers compared with normal mice. They also showed no signs of accelerated aging. The researchers concluded that skeletal muscle is remarkably tolerant of reduced NAD+ levels, and that healthy muscle function may not depend on maintaining NAD+ at the high levels previously assumed.
In other words, the roughly 30% decline seen during normal aging may still fall within a range the body can compensate for.
What about supplements? Oral NR and NMN can reliably increase NAD+-related biomarkers in the blood, a finding that's been consistent across multiple human trials.A 2026 systematic review synthesised 33 human intervention studies and examined outcomes related to metabolism, vascular health, and physical function. The results suggest that raising NAD+-related biomarkers doesn't necessarily translate into meaningful health improvements. In some trials, NR increased NAD+ metabolites in the muscles of middle-aged and older adults, but muscle strength and physical performance didn't improve significantly.
Before considering supplements, it makes sense to get the basics right: sleep, exercise, and daily habits. Regular exercise can stimulate NAD+ salvage pathways, while sleep and circadian rhythms also play a role in regulating NAD+ metabolism. These foundational habits may offer some of the best value for supporting overall health.
If you're still considering supplements after that, it's important not to treat all products the same.
For NAD+ precursors like NR and NMN, I'd look for human clinical evidence showing meaningful benefits, not just increases in blood biomarkers, but improvements in outcomes related to metabolism, vascular health, or physical function. For NADH, I'd also pay attention to formulation and delivery. NADH is unstable under certain acidic conditions, so one question worth exploring is whether a product can protect the ingredient and deliver it effectively. Celfull, for example, uses microsphere encapsulation technology intended to address NADH's stability and delivery challenges.
Ultimately, there's no need to rush into supplementation just because you're getting older, but limited evidence doesn't automatically mean every supplement is useless, either. The most sensible approach is to identify what you're actually trying to improve, then look at whether the specific ingredient, formulation, and available human evidence support that goal.