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NAD⁺ is involved in the electron transport chain, which is the process by which cells generate energy in the form of ATP. NAD⁺ levels decline with age and this has led to the hypothesis that NAD⁺ is a key regulator of the aging process, with some studies suggesting that healthy NAD⁺ levels are a critical factor for cell survival with low levels associated with a variety of health problems, including insulin resistance, fatigue, inflammation, poor stress resistance, and neurodegeneration.

NAD⁺ serves as the main substrate for the sirtuins to perform their enzymatic activity, with sirtuins having been shown to regulate gene expression, improve insulin sensitivity, reduce inflammation, and protect against age-related diseases, with some research even suggesting that sirtuins may play a role in regulating the aging process itself.

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