She Said "I'm Already Doing All of That." I Had Nothing Left to Tell Her.

The patient who sent me back to the literature, the number that changed how I read a label, and the trial that took away what I wanted most.

He was 68 and fine on paper. Blood pressure, A1c, lipids, all fine.

He had come in because he could not get off my exam table without pushing up on her arms.

So I ran the checklist. Activity? Walking four times a week. Protein? Tracking it. Resistance training? Twice a week since his sister broke a hip.

"I'm already doing all of that," he said.

I sat with my hand on the keyboard and had nothing to add.

So I typed the word we type. Deconditioning. A soft word for a hard process: the reserve is gone, and whatever comes next, she will not bounce. I have put it in four hundred charts and never had anything to prescribe for it.

Pushed off the arms.

Not because I needed to. That is how I stand up now, and I never noticed until I spent a morning noticing it in someone else.

Here is what is different for us. Patients get to be surprised. We do not. I know which 70-year-olds walk into my office and which arrive in a chair, and that was not decided at 70. It accumulated across the decade I am standing in now.

That evening I did what I had avoided for years.

I read the NAD+ literature properly, not the abstract a patient forwards me. My answer had always been no, and I had reason. One analysis of fifteen NMN products found content from none detectable to slightly over label claim, three with none at all. When a patient hands me a bottle, the base rate says the label is wrong.

I was right about those bottles. Every time.

But somewhere in the reading it landed on me. Dismissing the industry and dismissing the molecule are two different acts, and I had been doing the second while believing I did the first.

One trial separates them, and I had never read it.

Conze randomized 140 healthy adults aged 40 to 60 to a NAD+ precursor at 100, 300 or 1,000 mg daily for eight weeks. Whole-blood NAD+ rose 22, 51 and 142 percent (Sci Rep 2019;9:9772).

Look at the bottom arm. 100 mg daily was statistically indistinguishable from placebo at every timepoint. Not a smaller effect. None.

Nearly every bottle I waved off held 100 to 250 mg. For twenty-two years I had been running a study with no treatment arm and concluding the treatment did not work.

A 125 mg label is not a gentler version of the studied product. It is the placebo arm, sold at retail.

Which is where I made the mistake of getting hopeful.

Cognition. My working life runs on it: eighteen minutes a visit, a full in-basket by noon, decisions all day on partial information. If I could have bought one thing off this shelf it would have been that.

Martens gave a NAD+ precursor to older adults with mild cognitive impairment for twelve weeks. Blood NAD+ roughly doubled. Cognitive function, the primary outcome, did not improve (Alzheimers Dement 2026;22:e71605). Underpowered at 42 completers. But the trial that went looking found nothing.

So I do not get that, and nor does any brand implying otherwise. Zhang's meta-analysis of 12 trials put it plainly: "an exaggeration of the benefits of NMN supplementation may exist in the field" (Crit Rev Food Sci Nutr 2025;65:4382–400).

Reserve. The capacity to absorb a hard day and still be usable the next.

Morifuji ran 60 people on 250 mg for twelve weeks and missed the primary endpoint. What improved were secondary findings, walking time and sleep-related daytime dysfunction (GeroScience 2024;46:4671–88). Secondary means hypothesis, not conclusion.

But walking speed and daytime function are the measurable shadows of the process I keep typing that word for, and they moved at an adequate dose in people her age. A modest claim, and the only one here I can make without embarrassing myself.

One question left. Did the bottle hold the dose those trials used.

Most fail immediately. Under 300 mg, or buried in a blend, which is the same as not telling me. If I cannot see milligrams I cannot reason about a dose.

The one I settled on prints every amount. 500 mg NMN, 500 mg trans-resveratrol, 5 mg piperine. Purity published as a number, over 99 percent, not the phrase "high purity." Assayed twice per batch, raw material and finished capsule, for identity, potency, heavy metals and microbial contamination. GMP, FDA-registered, domestic.

The resveratrol is there on mechanism, not outcomes; the best human trial found nothing (Diabetes 2013;62:1186–95). And you cannot enter a lot number to pull that batch's certificate. Retrieval by lot is the standard I want and it is not there.

He came back six weeks later.

The evidence for feeling sharper is not there, and nobody can sell it to him honestly.

The evidence for recovery and walking speed is early and secondary, but it exists at a real dose. More than most of what gets forwarded to him.

And we would go through his medication list first, because resveratrol has antiplatelet activity.

Then he asked if I took it.

I do. 500 mg daily since spring. My impression is that the Monday after a weekend on call is easier than it was.

I am one unblinded person who wanted it to work. Worst study design there is, and I would refuse it from a colleague.

So the aggregate matters more than I do. Across the reviews: 549 mention energy, 141 clearer thinking, 91 deeper sleep.

Onset runs four weeks to three months against a thirty-day refund window. Mark day 25 and decide then. It refunds on an opened bottle, which is the only thing that makes thirty days usable.

Every trial above is in PubMed, and two argue against the product. Read Martens and Zhang first.

Then buy one bottle and give yourself what you would give any patient. A real dose, an honest timeline, and permission to conclude it did nothing.

I still type that word most weeks. I would like to keep typing it about other people.