We Added the Years. We Lost the Good Ones.
American life expectancy just reached an all-time high of 79 years (CDC, 2026 release of 2024 data).
That is a real achievement and it deserves saying out loud. It is also only half of a sentence.
The other half is the number nobody publishes beside it: how many of those years you spend well.
The gap nobody puts on the chart
It has a size, and ours is the widest in the world.
In 2024, researchers at the Mayo Clinic measured the distance between lifespan and healthspan across all 183 WHO member states.
- The global average gap was 9.6 years.
- The United States had the "widest gap" of every country studied: 12.4 years, some 29% above the global mean.
Twelve and a half years. Alive, counted in the life expectancy figure, and not well.
The same study found the gap runs 2.4 years wider in women than in men, tracking a heavier burden of chronic disease. (Garmany and Terzic, 2024).
- Among Americans aged 65 and over, 88% live with at least one chronic condition and 64% live with more than one (CDC, 2020).
- Eight conditions are now at the highest prevalence in the record: arthritis, asthma, cancer, cardiovascular disease, chronic kidney disease, COPD, depression and diabetes.
- The pattern researchers describe is a shift from fatal disease to disabling disease (IHME).
Medicine got very good at stopping you dying. It has been markedly less good at keeping you well while you are alive.
Somebody carries those years, and it is usually family.
This is the part that never makes the chart at all. Sixty-three million Americans, one adult in four, are now providing ongoing care to someone older, seriously ill or disabled. Those caring for an adult over 50 average 26 hours a week, up from 22 in 2020, and have been doing it for an average of five years (AARP and National Alliance for Caregiving, 2025).
That is what twelve and a half years looks like from the outside. Not a statistic. Somebody's daughter, most of a working week, for five years.
And the direction of travel is not good.
- A forecast in The Lancet covering all fifty states and 204 countries has US life expectancy still creeping up to about 80.4 by 2050,
- While the country falls from 49th in the world to 66th (IHME / GBD, 2024).
We are not getting worse. We are improving slower than almost everyone else, from a position that was already not first.
The IHME authors are blunt about the cause. The descent is driven largely by modifiable risk factors: diet, drugs, alcohol, tobacco. Not by anything mysterious.
What is measurably leaving in that window
We have spent three months writing to you about one molecule. This is why.
There is a molecule called NAD+ in every cell in your body. It sits inside some of the most basic machinery your cells use to turn food into usable energy and to run cellular repair. As levels change, those systems change with it.
It declines with age. In one human tissue study, the difference between the 30-to-50 and 51-to-70 age groups was substantial: roughly 61%.
In 2012, researchers took skin samples from 49 people ranging from newborn to 77 years old and measured NAD+ directly. In the 30-to-50 age group it ran at 2.74 nanograms per milligram of protein. In the 51-to-70 group it ran at 1.08 (Massudi et al., 2012).
NAD+ decline is not the sole explanation for chronic disease. What it is, is one of the few things happening in that window that we can actually measure, and one of the few we have any lever on.
And the reason is not the one people assume. The intuitive picture is a factory winding down: you get older, production drops, that is aging.
In mice, the picture looks different. A Mayo Clinic team studying an enzyme called CD38, which consumes NAD+ as part of normal cellular signalling, found CD38 levels climb with age, tracking the fall in NAD+. When they bred mice without the enzyme, the age-related decline did not happen (Camacho-Pereira et al., 2016).
If that mechanism translates to humans, the picture may be less like a factory winding down and more like a drain opening wider. In other words, increased consumption may be part of the problem, not simply reduced production.
That matters, because the part of this system you can actually reach is the recycling.
What is proven to move it, at no cost, today
If you keep one thing from this letter, keep this, because it does not require anything from us.
Skeletal muscle runs its own NAD+ recycling system, and the rate-limiting enzyme in it is called NAMPT. Think of NAMPT as the recovery crew: it takes the spent material and rebuilds it back into usable NAD+.
Researchers measured NAMPT in the muscle of 57 adults aged 18 to 84. It fell steadily with age, exactly as you would expect.
Then they trained them for twelve weeks:
- In the participants over 55, resistance training raised NAMPT by 30% and aerobic training raised it by 28%.
- And the finding the authors highlight: in the older group, training restored skeletal muscle NAMPT to the levels measured in the young participants (de Guia et al., 2019).
A separate study had already found that NAMPT protein was about twice as high in trained people as in sedentary people, and that it rose measurably in previously inactive people after just three weeks of training (Costford et al., 2010).
Twelve weeks. Consistent training. Back to where they started, on one part of this system you can reach without a prescription and without us.
If you do nothing else with this letter, do that.
Where we actually are
The protocol is not open in every state yet, and I am not going to dress that up.
If you took the founding offer before it closed on the 21st, read this part first. You locked 70% off at the founding price on the NAD+ protocol, and the wait does not cost you a cent of it. Whenever your state opens, you open at that price. Nothing about this delay touches what you bought.
We are a licensed medical practice. That means two things have to line up before we can see you:
- A physician licensed in your state,
- And our pharmacy approved to ship medication there.
We own the pharmacy, so both of those are ours to solve.
What I underestimated is that there is no single door to knock on. There are fifty.
- Every state writes its own rules for telehealth,
- Its own rules for compounded medication,
- And its own rules for what a physician licensed somewhere else may and may not do.
Some move in weeks. Some move in quarters. We are working every one of them we can, in parallel, and I have stopped looking for a shortcut, because there is not one.
None of that is glamorous and none of it makes for an exciting email. It is also the entire reason your state is or is not on the map today.
Grey does not mean no. It means not yet. If you want to know exactly where your state stands right now, the live availability map is here.
We are opening new states soon, and you will hear it from me before it goes anywhere else. I am a man of my word, and I keep my promises.
In the meantime, the twelve-week finding above is real, it is free, and it does not need our permission or anyone else's.
I would rather send you something useful while you wait than send you nothing and call it patience.
To your health,
Antonio Colmenares CEO, Black Forest MD
Black Forest MD is available to adults 18 and over in select states; the full list is shown on blackforestmd.com. State availability is confirmed at intake, and a licensed physician reviews every request before anything is dispensed. This letter is general information, not medical advice, and nothing here is intended to diagnose, treat, cure or prevent any disease.
