Have you ever noticed that almost everyone wants to live a long time, but nobody wants to get old?

The resulting desire to find a “fountain of youth” has sparked many medical and healthcare innovations throughout history—including, in recent years, the search for effective “anti-aging” supplements. Of course, these supplements don’t stop your aging: that would be lethal. What they attempt to do is stop the degenerative processes we associate with aging.

Supplements like NAD, NR, NMN, DHEA, and resveratrol have generated a lot of “buzz” as the next big thing in anti-aging and overall health. Today, I want to take a deeper look at each of the top anti-aging supplements on the market so you can understand what they do and whether you should you be taking them.

NAD (nicotinamide adenine dinucleotide)

In recent years, three of the most widely touted anti-aging supplements are NAD (nicotinamide adenine dinucleotide) and its precursors, NR (nicotinamide riboside) and NMN (nicotinamide mononucleotide).

NAD is a coenzyme of vitamin B3 (niacin) found in all living cells. It performs many essential roles, including cellular energy production, DNA repair, cell signaling, removing senescent cells, and maintaining proper cellular function.

As we age, however, NAD levels naturally decline, impacting our energy levels and overall vitality—and perhaps even triggering disease through inadequate DNA repair and cell health maintenance. Indeed, of the 12 recognized hallmarks of aging, at least nine are associated with low levels of NAD.

While direct NAD supplementation isn’t common due to its poor absorption by the cell, there is some evidence that extracellular (circulating) NAD may still provide benefits, even though the NAD may not be entering the cells. NAD proponents also advocate injecting NAD directly into muscle, infusing it into the blood stream, or taking it sublingually or via nasal spray. Its importance is reflected in this Time magazine quote by longevity researcher Dr. David Sinclair:

“NAD+ is the closest we’ve gotten to a fountain of youth.”

While increasing NAD levels is the goal, some researchers argue that boosting NAD levels through supplementation with precursors like NR and NMN, which are more readily absorbed by the cell, is more effective.

NR (nicotinamide riboside)

NR is one such precursor to NAD. By helping the body increase NAD levels, NR can help support energy production and mitochondrial health. Some animal studies suggest that NR supplementation may enhance cognitive function, improve muscle health, and even extend lifespan. However, while these findings are promising, more research is needed to confirm the long-term benefits in humans.

NMN (nicotinamide mononucleotide)

Like NR, NMN is another precursor to NAD. It’s involved in the biosynthesis of NAD and has shown potential in improving metabolic health, enhancing physical performance, and delaying the aging process in animal studies. For example, long-term NMN supplementation in mice delayed the onset of frailty in both sexes, improved metabolic health in male mice, and increased median lifespan by 8.5% in female mice. Exploration of the potential mechanisms of this protection showed that NMN treatment prevented age-related gene expression changes in skeletal muscle and led to a large increase in a microbe associated with reduced inflammation in the gut. Early human trials are encouraging, but we still need more data to fully understand its effects and optimal dosage.

Resveratrol

Another anti-aging supplement, made popular following research into the health benefits of red wine, is resveratrol, a polyphenol found in red wine, grapes, and certain berries. Resveratrol is known for its antioxidant properties, which may protect against inflammation, cardiovascular diseases, and potentially extend lifespan. As with most anti-aging supplements, most of the evidence is based on animal studies, with little large-scale, long-term data from humans.

Testosterone

Testosterone is primarily associated with male reproductive health, but it also plays vital roles in both men and women for maintaining muscle mass, bone density, and overall energy levels. Adequate testosterone levels are crucial for muscle growth and maintenance, can help maintain bone health and reduce the risk of osteoporosis, and can also improve mood, reduce fatigue, and enhance overall energy levels.

Testosterone is listed as a Schedule III controlled substance, meaning its use requires a prescription. Even though testosterone levels for both men and women decline with age, at this time testosterone replacement therapy (TRT) is only available for men in the United States, and typically only for men with clinically low testosterone levels. Its potential side effects include increased risk of heart disease, sleep apnea, and prostate issues.

Creatine

Creatine is composed of three amino acid (the building blocks of protein) that may be more important than testosterone for increasing muscle mass (and reducing sarcopenia–the loss of muscle mass) in women. Creatine is found in seafood and red meat — though at levels far below those found in synthetically made creatine supplements. The liver, pancreas and kidneys also produce about 1 gram of creatine per day. Athletes often take creatine supplements to increase performance, endurance, or intensity. And the Mayo Clinic reports that “creatine supplementation might help counteract age-related declines in skeletal muscle and bone mineral density.” In addition, some studies show that topical creatine might be beneficial for treating aging skin.

DHEA

DHEA (dehydroepiandrosterone) is a naturally occurring hormone produced by the adrenal glands that is sold in supplement form. The body uses DHEA to produce the female and male sex hormones estrogen and testosterone, both of which decline with age, resulting in lower sex drive, bone and muscle mass, skin tone, and greater frailty.

As a dermatologist, I have been particularly interested in DHEA because both estrogen and testosterone stimulate collagen production in the skin. Although some studies have suggested that DHEA supplements may help reduce or even reverse thinning skin, the studies have been small—and therefore, inconclusive.

Similarly, restoring estrogen levels is a possible treatment or preventive for osteoporosis (thinning of the bones, which is a problem in aging women especially). Here again, however, the relevant studies have been small. Moreover, DHEA supplementation is contraindicated in children, pregnant or nursing people, and people with a history of hormone-sensitive cancers.

Curcumin

Curcumin is the active ingredient in turmeric and has antioxidant and anti-inflammatory properties that may promote skin health, protect against cancer, and guard against Alzheimer’s and other forms of dementia. Because curcumin is not produced by the human body, it must be taken in food or as a supplement. The Cleveland Clinic recommends taking 500 to 1,000 milligrams per day for the general population.

CoQ10

Coenzyme q10 is an antioxidant that promotes the production of collagen, the protein responsible for the strength and elasticity of our skin. Because collagen production naturally declines with age, you’ll find CoQ10 in many topical skincare products, and it can also be taken orally, as a supplement. Although CoQ10 is found in meat, fish and nuts, the amount found in these dietary sources isn’t enough to significantly increase CoQ10 levels in your body. CoQ10 supplements are available in capsules, chewable tablets, liquid syrups, wafers and by intravenous infusion.

Collagen

As noted, collagen is the essential protein found in skin and other connective tissue. Although I recommend giving your body the nutrition it needs to make its own collagen (see my blog post here), some studies have found that taking a hydrolyzed collagen supplement each day can boost the skin’s elasticity and hydration. For example, A 2018 review of 11 studies found that people who took a hydrolyzed collagen supplement every day for at least a month saw increases in their skin’s elasticity and hydration level. (Hydrolyzed collagen has been broken down into the amino acids that make up proteins, making it more readily available to your body’s tissues.)

Vitamin C

Vitamin C does so many great things for the body—boosting the immune system, fighting oxidative damage to the skin, and even lightening dark circles and hyperpigmentation, or “liver spots.” While Vitamin C is readily available in foods, particularly citrus fruits, red peppers, and green vegetables, it can also be taken as a supplement. A 2017 review confirmed that consistent Vitamin C supplementation protects against premature aging.

Vitamins E, D, and K

These fat-soluble vitamins are useful in treating wrinkles, scars, dark spots, and skin elasticity. Vitamin E can be applied directly to the skin to aid in scar healing. Vitamin D also helps in calcium absorption, essential for the strength of bone, teeth, and nails, while Vitamin K is responsible for blood clotting (without which one could bleed to death from even a small cut). Nevertheless, because these vitamins are fat-soluble, they can be stored in the body’s fat cells and build up to toxic levels. Therefore, it’s important to not overdo one’s intake.

Selenium

Selenium is a trace mineral (meaning the body needs just slight amounts of it) found in many foods and supplements. According to a 2018 review of available research, selenium can fight aging and prevent degenerative health issues, including tumors, cardiovascular disease, neuropsychiatric disorders, and chronic inflammation, which is the underlying cause of virtually all of the degenerative diseases associated with aging.

The bottom line

My personal approach to the ever-evolving science on health and longevity is to follow my own comprehensive Modern Wellness (e.g. anti-aging) program. Based upon the Four Pillars of Modern Wellness, it includes:

Eating my water through a healthy diet emphasizing moisture-rich fruits and vegetables, whole grains, healthy fats, and embryonic foods (eggs, seeds, and nuts)—which supplies most of the nutrients listed above. As faithful readers know, I believe that hypohydration is the underlying factor linking all the various theories of aging.

Moving my body through a daily exercise program, incorporating mild aerobic exercise, regular weight-training, and movement I do “just” for fun. As the saying goes, “Motion is lotion!” Use it or lose it!

Being kind to my mind through daily contemplation of my Better Every Day Insights, good sleep habits, creative expression through painting, and regular in-person interactions with family and friends.

Nourishing my skin with cleansing, toning, and moisturizing skincare products (and, most importantly, sunscreen).

Supplementing my diet with nutrients my body can no longer produce in sufficient quantities. For me that includes monthly NAD and testosterone injections. Of course, one should consult with one’s own healthcare provider before starting any new supplement regimen to make sure it aligns with your health needs and goals.

The bottom line is that there is no “silver bullet” that can confer immortality. Nevertheless, we can optimize our health and longevity by making a practice of giving the body what it needs. That includes healthy diet, adequate exercise and rest, stress reduction and management, and nourishing care of our largest organ, the skin.

That’s #ModernWellness!