Urolithin a vs NAD+ for Muscle and Mitochondria

No study has tested Urolithin A against NAD+ head to head, so neither one can claim to work better. In placebo-controlled trials, Urolithin A improved leg strength in middle-aged adults and muscle endurance in older adults. Oral NAD+ boosters such as nicotinamide riboside raised NAD+ levels, but muscle and exercise results did not improve. Injected NAD+, one form telehealth clinics prescribe, has not been tested on muscle in these trials. None of the studies measured recovery after a workout.

Do Urolithin A and NAD+ work the same way?

No. Urolithin A comes from your gut bacteria. It switches on mitophagy, which is your cells' way of recycling worn-out mitochondria, the parts of cells that make energy (Urolithin A trial in middle-aged adults).

NAD+ is a helper molecule your cells need to make energy, and levels fall as you age (2025 review of NAD+ boosters and muscle). NAD+ products aim to top those levels back up.

You can get NAD+ two ways. You can swallow a precursor such as nicotinamide riboside (NR) or nicotinamide mononucleotide (NMN), which your body turns into NAD+. Or a clinic can prescribe compounded NAD+ as an injection, nasal spray or pill. None of the prescribed forms is FDA approved for treating anything (NAD+ program comparison). Results from one form do not carry over to another.

No trial in this research compares Urolithin A with any form of NAD+. Any claim that one beats the other comes from comparing separate studies, and those studies measured different things.

What does Urolithin A do for your muscles?

In a 4-month trial in middle-aged adults, people taking 500 mg or 1,000 mg a day had stronger legs than people on placebo. Strength improved at both doses, and the researchers put the gain at about 12%. Their lean mass and body fat did not change, so the result shows up in what your legs can do, not in how your clothes fit.

That trial's main measure was peak cycling power, and Urolithin A did no better than placebo on it. People on the 1,000 mg dose walked about 33 meters farther in six minutes than they had at the start. That gain was not significantly bigger than the placebo group's.

In a trial in 66 older adults taking 1,000 mg a day, muscles in the hand and leg could contract more times before tiring after 2 months than with placebo. By 4 months the placebo group had caught up, so the difference was no longer significant.

For mitochondria, Urolithin A lowered blood markers of mitochondrial strain and of inflammation (C-reactive protein, or CRP). It did not raise the maximum energy (ATP) the hand and leg muscles could produce.

Both trials report that Urolithin A was well tolerated over 4 months, and safety blood and urine tests did not differ from placebo. The middle-aged trial's corresponding author works at Amazentis, the company that makes Mitopure.

None of these trials measured how fast muscles recover after a workout. They measured strength, endurance and fatigue.

What do NAD+ supplements do for your muscles?

Oral NR does raise NAD+. In a 6-week trial in healthy middle-aged and older adults, 500 mg twice a day raised NAD+ in blood cells by about 60% compared with placebo, and people tolerated it well.

The higher NAD+ in that trial did not change fitness, treadmill time, body fat or motor function. People who started with lower NAD+ had a bigger rise.

In 40 middle-aged men with obesity and insulin resistance, 1,000 mg of NR twice a day for 12 weeks did not change how their muscle mitochondria worked, how many they had or how they looked. NAD+ levels in their muscle did not change either.

A 2025 review of 10 trials in adults over 60 found that NMN and NR did not improve muscle mass or strength.

All of these results come from oral precursors. They do not tell you what NAD+ injections do. Injections were not tested for muscle in this research, so ask your clinical team what evidence exists for your goal.

How do Urolithin A and NAD+ compare on cost and how you take them?

Urolithin A and oral NR are supplements you buy without a prescription. Compounded NAD+ injections need a prescriber.

Mitopure's dose is two softgels a day (500 mg), and a 60-softgel bottle lasts a month. The brand recommends taking it for at least 4 months, the same length as its trials. Tru Niagen Pro is two 500 mg capsules a day (1,000 mg). Published monthly prices for NAD+ injections run from $93 to $249 across 13 priced providers, and providers rarely publish the vial size, so the amount of medicine each price buys varies (NAD+ program price comparison).

Which one should you pick for your goal?

If you want stronger legs and more stamina, Urolithin A has the human muscle results so far. Expect a 4-month timeline. Its trials did not show changes in body fat or lean mass.

If NAD+ is what you are curious about, the trials show a raised NAD+ level. They do not show bigger muscles or better workouts. Go in with that expectation.

Hot or Nothing offers NAD+ in its energy and aging plans. Our clinical team can prescribe it if it fits your goal, and your clinical team decides whether it fits. Tell them about any supplements you take, including Urolithin A or NR, before you start a plan.

You want more energy by the afternoon and a body that keeps up with you. Take the quiz so your clinical team can see your goal and tell you whether an NAD+ plan or another treatment fits.