NMN and NR ("NAD boosters")
Sold as anti-ageing. They raise a molecule in the blood reliably, but no trial has shown they make people healthier, stronger or longer-lived, and in Parkinson disease one made symptoms worse.
At a glance
| Our verdict | Raise NAD+ in the blood but improved no clinical outcome. Never in Parkinson disease. |
| Sold for | Ageing and energy (claimed) |
| How sure the evidence is | Very low for any health benefit |
| Cost a month | NMN about $40 to $80; NR about $68 |
Written for adults in Canada. It explains the evidence; it is not advice for you personally. Last reviewed 20 October 2026.
Supplement Check
Is it right for you?
Already taking NMN or NR? Your check tells you whether to stop, and what does more for the reasons you started. Our Supplement Check looks at:
- Parkinson disease
- Cancer, current or under treatment (theoretical, no data)
- Pregnancy and breastfeeding (no data)
- Kidney or liver disease (no data)
- Whether you hope it will build muscle or strength
- Every medicine you take
Coming soon. The Supplement Check and the Online Health Assessment open once our safety testing is complete.
$59 when it opens, paid once. Adults 18 and over, anywhere in Canada. While the service is new, Dr. French reads every report himself, and your report arrives within 3 working days. More about the Supplement Check
What it is
NMN (nicotinamide mononucleotide) and NR (nicotinamide riboside) are forms of vitamin B3 that the body turns into NAD+ (nicotinamide adenine dinucleotide), a molecule cells use to make energy. NR is sold under a few brand names. NMN is sold by many makers; a pharmaceutical form (MIB-626) has been developed as a drug. [1]
Both are licensed natural health products in Canada. A licence confirms the ingredient is permitted; it does not test what is in the bottle. [2]
How it acts
They feed the pathway the body uses to recycle NAD+. NAD+ falls with age and with inactivity in muscle; fit older adults have muscle NAD+ close to young adults, and levels track daily steps. [3] The idea is that topping up NAD+ slows ageing. That is a mechanism, not proof: raising NAD+ in the blood has not been shown to improve health. Excess is cleared as nicotinamide and then broken down to end-products called 2PY and 4PY.
What it is used for, and what the evidence says
A 2026 review of 33 human studies found that NAD+ rises consistently, but body, metabolic and blood-vessel results are mixed and often null. [4] Almost all trials had 12 to 90 people and lasted 2 to 24 weeks. None measured heart attacks, disability or death. No NMN trial has lasted more than 24 weeks. [5]
| Use | What the trials found | How sure we are |
|---|---|---|
| NAD+ in the blood | Raised reliably. NR 100, 300 and 1,000 mg raised whole-blood NAD+ by 22%, 51% and 142% within 2 weeks. [6] NMN raised blood NAD+, levelling off at 600 mg. [7] A pooled review of 12 trials (513 people) agrees. [8] This shows the product is absorbed. It is not a health outcome. | High |
| Blood sugar, HbA1c, cholesterol, weight | No effect in pooled trials of NMN on fasting blood sugar, average blood sugar (HbA1c), cholesterol, weight or body mass index. Most trials were at high risk of bias or had some concerns, and the authors suspect “an exaggeration of the benefits”. [8, 5] | Low |
| Insulin sensitivity | NMN 250 mg improved muscle insulin sensitivity in 25 women with prediabetes over 10 weeks (one small trial). [9] NR 2,000 mg did nothing in 40 obese men over 12 weeks. [10] | Low |
| Muscle and strength, age 60 and over | No effect on muscle mass, grip, walking speed, chair stands or knee strength. In people with mild cognitive impairment, NR made physical-performance and chair-stand scores worse. [11] | Low |
| Blood pressure | Pooled NMN trials (10 trials, 349 people): diastolic (lower number) 2.15 mmHg lower; systolic not significantly changed overall. [12] | Low |
| Walking in narrowed leg arteries (peripheral artery disease) | NR 1,000 mg for 6 months in 90 people: 6-minute walk 17.6 m further than placebo; 31 m in those who took it reliably. [13] | Low |
| Parkinson disease | The largest and longest trial of any NAD+ booster: 410 people with early Parkinson disease, NR 500 mg twice a day for a year. Symptoms were worse than with placebo: 2.72 points on the Parkinson disease rating scale, and non-movement symptoms 4.22 points worse. [14] | Moderate (harm) |
How sure we are: High means further research is very unlikely to change the answer; Moderate, it might; Low, it may well change; Very low, we are very unsure. These follow the GRADE method that guideline panels use.
Benefits
- NAD+ in the blood: Raised; High
- Blood sugar, HbA1c, cholesterol, weight: No effect; Low
- Muscle and strength, age 60+: No effect; Low
- Diastolic blood pressure: About −2 mmHg; Low
- Walking, peripheral artery disease: +17.6 m (one trial); Low
- Parkinson disease: Worse; Moderate
- Heart attack, disability, death: Never studied; No evidence
Risks and side effects
- Short term, well tolerated. Up to 24 weeks and up to 2,000 mg a day, pooled NMN trials found no rise in side effects, serious side effects or liver tests; [5] NR 2,000 mg for 12 weeks without serious events; [10] NR up to 1,000 mg without flushing or a rise in LDL cholesterol. [6] Long-term safety is unknown (very low certainty).
- Parkinson disease: worse movement and non-movement scores with NR over a year. [14]
- Vitamin B3 end-products. 2PY and 4PY, where excess B3 ends up, were linked to heart attacks and strokes in two cohorts (4PY: about 1.9 to 2 times the risk) and caused blood-vessel inflammation in mice. [15] Whether these supplements raise heart risk this way is untested (very low certainty), but it is a plausible route.
- Cancer: NAD+ supports tumour cell energy in laboratory models; no human data.
- Unreliable products. Independent testing found NMN content from 28.6% above the label to none at all. [16]
Interactions with medicines
No interactions with medicines have been established in people, and no effect on the liver enzymes that clear medicines has been reported. The concerns are adding up vitamin B3 and cancer treatment.
| Medicine | What can happen | What to do |
|---|---|---|
| Niacin or nicotinamide products, B-complex | Vitamin B3 adds up | Do not take together |
| PARP-inhibitor cancer medicines | Possible opposing effect (theoretical) | Do not take during cancer treatment |
Who should not take it
- Parkinson disease: never. If you take it, stop and tell your neurologist.
- Cancer, current or under treatment (theoretical, no data).
- Pregnancy and breastfeeding (no data).
- Kidney or liver disease (no data).
- Older adults hoping for more muscle or strength: no benefit shown.
- Under 18 (no data).
Dose and timing
We do not recommend a dose. For reference, trials used NMN 250 to 900 mg a day (some up to 2,000 mg) and NR 300 to 2,000 mg a day. [7, 5, 6, 10, 13, 14]
If you take it now: blood NAD+ tests are not clinically validated and do not predict any outcome. There is nothing to measure that matters.
What we know about Canadians
On 20 October 2026, Health Canada's licence database listed 581 active product licences naming NMN and 55 naming nicotinamide riboside. A licence confirms the ingredient is permitted; it does not test content. [2] We found no Canadian data on how many people take them. Nearly half of Canadians (45.6%) took at least one supplement in 2015. [17]
How sure are we: not graded. No Canadian data on NMN or NR use; the text is from the Health Canada licence database and national supplement-use data.
An honest comparison: muscle, blood sugar and blood pressure
The outcomes NAD boosters are sold for, set against exercise and the leading medicines, with the cost a month in Canadian dollars.
| Option | Effect | How sure we are | Cost a month (CAD) |
|---|---|---|---|
| NMN or NR | No effect on muscle, blood sugar or weight; [11, 8] diastolic −2.15 mmHg; [12] walk +17.6 m (one trial) [13] | Low | $40 to $80 |
| Resistance training, older adults | Lean mass +1.1 kg (49 studies); [18] training also raises the key NAD+-making enzyme in muscle [19] | Moderate | $0 (walking) to $50 (gym) |
| 7% weight loss and 150 minutes of activity a week | 58% fewer new cases of diabetes in prediabetes [20] | High | Free |
| Endurance exercise | Blood pressure −3.5/−2.5 mmHg overall; −8.3/−5.2 in high blood pressure [21] | Moderate | $0 to $50 |
| Home walking programme, peripheral artery disease | 6-minute walk +50.7 m [22] | Moderate | Free |
| Metformin (prediabetes) | 31% fewer new cases of diabetes [20] | High | $5 to $10 |
| One standard-dose blood-pressure medicine | About −9/−5 mmHg [23] | Moderate | $5 to $15 |
Read honestly: exercise does more than NMN or NR for every outcome measured, raises NAD+ production where it matters (in muscle), and costs less. The walking gain from a home walking programme is about three times the NR result.
Why we don't recommend it
We do not sell NMN or NR and our check never recommends them. They raise NAD+ in the blood, but in trials they have not improved blood sugar, cholesterol, weight, muscle or strength, and no trial has measured anything that matters most, such as heart attacks, disability or survival.
Already taking it? If you have Parkinson disease, stop it and tell your neurologist. Otherwise, you can save $40 to $80 a month by stopping, and put the time into regular exercise, which has proven benefits for all of these.
They raise NAD+ in the blood, but in trials they have not improved blood sugar, cholesterol, weight, muscle or strength, [11, 8] and independent tests found many products far off their label. [16] In people with Parkinson disease, a one-year trial of 410 patients found nicotinamide riboside made symptoms slightly worse than placebo, so Dr. French's ruling is never in Parkinson disease. [14] You would spend $40 to $80 a month; regular exercise raises NAD+ production in muscle and has proven benefits for all of these. So we do not sell them.
Supplement Check
Before you buy it, get it checked
Already taking NMN or NR? Your check tells you whether to stop, and what does more for the reasons you started. Our Supplement Check looks at:
- Parkinson disease
- Cancer, current or under treatment (theoretical, no data)
- Pregnancy and breastfeeding (no data)
- Kidney or liver disease (no data)
- Whether you hope it will build muscle or strength
- Every medicine you take
Coming soon. The Supplement Check and the Online Health Assessment open once our safety testing is complete.
$59 when it opens, paid once. Adults 18 and over, anywhere in Canada. While the service is new, Dr. French reads every report himself, and your report arrives within 3 working days. More about the Supplement Check
Disclosure of financial interest
White Pine Medical earns money from products bought through our Fullscript dispensary. Dr. French's Code of Ethics requires him to tell you this. You do not have to buy anything from us: every product is named by its ingredient and dose so you can buy it at any pharmacy, and the advice is the same wherever you buy it, or if you buy nothing.
References
- Pencina KM, Lavu S, Dos Santos M, Beleva YM, Cheng M, Livingston D, et al. MIB-626, an oral formulation of a microcrystalline unique polymorph of β-nicotinamide mononucleotide, increases circulating nicotinamide adenine dinucleotide and its metabolome in middle-aged and older adults. J Gerontol A Biol Sci Med Sci. 2023;78(1):90-6.
- Health Canada. Licensed Natural Health Products Database, programming interface: product licences, medicinal ingredients and doses [Internet]; read 20 Oct 2026. Available from: https://health-products.canada.ca/api/natural-licences/
- Janssens GE, Grevendonk L, Perez RZ, Schomakers BV, de Vogel-van den Bosch J, Geurts JMW, et al. Healthy aging and muscle function are positively associated with NAD+ abundance in humans. Nat Aging. 2022;2(3):254-63.
- Gallagher C, Emmanuel OO. NAD+ supplementation for anti-aging and wellness: a PRISMA-guided systematic review of preclinical and clinical evidence. Ageing Res Rev. 2026;116:103057.
- Yang W, Huang J, Tang Z, Chen C, Sun Y. Safety and metabolism-related outcomes of oral nicotinamide mononucleotide supplementation in adults: a systematic review and meta-analysis. Nutrients. 2026;18(14):2251.
- Conze D, Brenner C, Kruger CL. Safety and metabolism of long-term administration of NIAGEN (nicotinamide riboside chloride) in a randomized, double-blind, placebo-controlled clinical trial of healthy overweight adults. Sci Rep. 2019;9(1):9772.
- Yi L, Maier AB, Tao R, Lin Z, Vaidya A, Pendse S, et al. The efficacy and safety of β-nicotinamide mononucleotide (NMN) supplementation in healthy middle-aged adults: a randomized, multicenter, double-blind, placebo-controlled, parallel-group, dose-dependent clinical trial. Geroscience. 2023;45(1):29-43.
- Zhang J, Poon ET, Wong SH. Efficacy of oral nicotinamide mononucleotide supplementation on glucose and lipid metabolism for adults: a systematic review with meta-analysis on randomized controlled trials. Crit Rev Food Sci Nutr. 2025;65(22):4382-400.
- Yoshino M, Yoshino J, Kayser BD, Patti GJ, Franczyk MP, Mills KF, et al. Nicotinamide mononucleotide increases muscle insulin sensitivity in prediabetic women. Science. 2021;372(6547):1224-9.
- Dollerup OL, Christensen B, Svart M, Schmidt MS, Sulek K, Ringgaard S, et al. A randomized placebo-controlled clinical trial of nicotinamide riboside in obese men: safety, insulin-sensitivity, and lipid-mobilizing effects. Am J Clin Nutr. 2018;108(2):343-53.
- Prokopidis K, Moriarty F, Bahat G, McLean J, Church DD, Patel HP. The effect of nicotinamide mononucleotide and riboside on skeletal muscle mass and function: a systematic review and meta-analysis. J Cachexia Sarcopenia Muscle. 2025;16(3):e13799.
- Zhang M, Chen Y, Jiang N, Zeng J, Zhang J, Wu C, et al. Effects of nicotinamide mononucleotide supplementation on blood pressure: a systematic review and meta-analysis of randomized controlled trials. Nutrients. 2026;18(6):890.
- McDermott MM, Martens CR, Domanchuk KJ, Zhang D, Peek CB, Criqui MH, et al. Nicotinamide riboside for peripheral artery disease: the NICE randomized clinical trial. Nat Commun. 2024;15(1):5046.
- Brakedal B, Skeie GO, Derad C, Alstadhaug KB, Anundskås I, Berven H, et al. Nicotinamide riboside for patients with early-stage Parkinson disease: the NOPARK randomized clinical trial. JAMA. 2026 Oct 8:e2618828.
- Ferrell M, Wang Z, Anderson JT, Li XS, Witkowski M, DiDonato JA, et al. A terminal metabolite of niacin promotes vascular inflammation and contributes to cardiovascular disease risk. Nat Med. 2024;30(2):424-34.
- Sandalova E, Li H, Guan L, Raj SD, Lim TG, Tian E, et al. Testing the amount of nicotinamide mononucleotide and urolithin A as compared to the label claim. Geroscience. 2024;46(5):5075-83.
- Statistics Canada. Use of nutritional supplements, 2015. Health Fact Sheets 82-625-X. 20 Jun 2017.
- Peterson MD, Sen A, Gordon PM. Influence of resistance exercise on lean body mass in aging adults: a meta-analysis. Med Sci Sports Exerc. 2011;43(2):249-58.
- Sun X, Su L, Bu T, Zhang Y. Exercise training upregulates intracellular nicotinamide phosphoribosyltransferase expression in humans: a systematic review with meta-analysis. Front Public Health. 2023;11:1287421.
- Knowler WC, Barrett-Connor E, Fowler SE, Hamman RF, Lachin JM, Walker EA, et al. Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin. N Engl J Med. 2002;346(6):393-403.
- Cornelissen VA, Smart NA. Exercise training for blood pressure: a systematic review and meta-analysis. J Am Heart Assoc. 2013;2(1):e004473.
- Thangada ND, et al. Home-based walking exercise and supervised treadmill exercise in patients with peripheral artery disease: an individual participant data meta-analysis. JAMA Netw Open. 2023;6(9):e2334590.
- Law MR, Morris JK, Wald NJ. Use of blood pressure lowering drugs in the prevention of cardiovascular disease: meta-analysis of 147 randomised trials. BMJ. 2009;338:b1665.
Costs marked as estimates are typical Canadian retail or pharmacy prices, before any drug plan. Certainty grades are ours unless the review gave its own.