NAD+ / NMN / NR
B+ 7.1/10
aka Nicotinamide mononucleotide, Nicotinamide riboside, Niagen
- Evidence
- Moderate (raises NAD+ reliably); Weak (functional/outcome endpoints) (6/10)
- Benefit
- Varies (5/10)
- Risk
- Low (9/10 safety)
- Legality
- OTC
- Dose / route context
- 250-1000 mg/day NMN or NR (sublingual or oral); IV NAD+ infusions also used
- Class
- Supplement
- Last reviewed
- Aug 18, 2026
Read Off Label grades NAD+ / NMN / NR as B+ (7.1/10) based on moderate evidence, variable benefit magnitude, and a low-risk safety profile.
Yoshino 2021: NMN 250 mg/day improved muscle insulin sensitivity 25% in prediabetic women.
Studied, labeled, or reported-use context: 250-1000 mg/day NMN or NR (sublingual or oral); IV NAD+ infusions also used — OTC; not individualized guidance.
What it is
Yoshino 2021: NMN 250 mg/day improved muscle insulin sensitivity 25% in prediabetic women. Multiple RCTs show elevated NAD+ but inconsistent functional outcomes (strength, cognition, CV markers). Boosting NAD+ is easy; demonstrating clinical benefit is not. Phase II randomised placebo-controlled pilot in amnestic mild cognitive impairment (Alzheimer's & Dementia, Jul 2026; n=42 completers, 12 weeks): nicotinamide riboside doubled blood NAD with no serious adverse effects, but produced no improvement in cognitive function (primary outcome), total cerebral blood flow, or blood pressure. Exploratory analysis suggested possible regional cerebral-blood-flow increases in the hippocampus. A direct illustration of the row's existing split: raising NAD+ is reliable, translating that into a functional outcome is not. A 2026 randomized, double-blind, placebo-controlled trial of **NMNH-Ca** — a *reduced* form of NMN, chemically distinct from the NMN and NR sold today — dosed 80 healthy adults aged 40-65 at 125, 250 or 500 mg/day for 90 days. Whole-blood NAD+ rose dose-dependently (+8.2, +15.9 and +39.9 micromolar at day 90 versus +2.3 on placebo), with no serious adverse events and no treatment-related discontinuations. Exploratory endpoints — blood-derived phenotypic age, six-minute walk distance and quality-of-life scores — moved favourably at 500 mg. **This is a preprint and has not been peer-reviewed**, and the functional endpoints were exploratory rather than powered, so it does not move this row's rating. It is included because it is one of the few NAD-precursor trials run for 90 days in healthy middle-aged people rather than patients, and because it is the same pattern this entry has always described: raising NAD+ is easy and reliable, converting that into something a person would notice is not yet established.
Mechanism
Precursors to NAD+ — essential cofactor for sirtuins (SIRT1-7), PARPs, CD38; ETC; cellular NAD+ declines with age