Many people try NAD+ injections hoping they'll experience a noticeable improvement in energy, only to come away disappointed. That was exactly the experience of the participant featured in this case study.

Despite completing a course of NAD+, she described the overall effect as underwhelming. Her day-to-day fatigue remained significant, and simply getting out of bed in the morning continued to be a struggle.

Her experience with MOTS-c, however, was very different.

Rather than producing a sudden burst of energy, the changes were gradual. Week by week, everyday life simply became a little easier.

This article follows her 60-day MOTS-c experience, combining her subjective feedback with quarterly TruDiagnostic TruHealth epigenetic testing to see whether those perceived improvements were reflected by measurable biological changes.

Background

The 52 year old female participant has ME/CFS and had experienced persistent fatigue for many years.

Before starting MOTS-c she frequently struggled to get out of bed until late morning. Even basic daily tasks could feel overwhelming, and regular exercise had largely fallen away because of poor energy levels.

Unlike stimulants, which often produce a temporary boost followed by a crash, her description of MOTS-c was much more subtle.

There wasn't a moment where she suddenly felt "full of energy."

Instead, she noticed that life gradually became easier.

Over the first few weeks she found herself:

• Getting out of bed earlier.

• Feeling more functional throughout the day.

• Beginning to reintroduce exercise.

• Experiencing steady improvements rather than dramatic highs followed by crashes.

For many people living with chronic fatigue syndromes, those kinds of incremental improvements can have a meaningful impact on quality of life.

Measuring More Than Symptoms

Subjective improvements are important, but objective biomarkers help determine whether meaningful biological changes may also be taking place.

To assess this, she completed quarterly TruDiagnostic TruHealth testing, allowing direct comparison before and after approximately 60 days of MOTS-c.

Several biomarkers moved in a favourable direction.

Dose Disclosure: We won't be sharing the exact MOTS-c dosing protocol used in this case study. The participant selected a protocol based on her own biology, personal circumstances, and a review of the available anecdotal reports and emerging research. The purpose of sharing this case study is to document one individual's MOTS-c results and MOTS-c experience, not to encourage others to replicate the same dosing regimen, as individual responses and risk profiles can vary considerably.

Glucose Regulation Improved

One of the clearest improvements was in glucose metabolism.

Her Glucose biomarker improved from the 73rd percentile to the 58th percentile, representing a notable 15-point improvement and movement further away from the higher-risk end of the distribution.

Her HbA1c biomarker also improved from the 83rd percentile, where it was flagged as high, down to the 71st percentile, bringing it back within the normal reference range.

Together, these findings suggest improved long-term glucose regulation over the course of the study.

This is also one of the more biologically plausible findings. MOTS-c is a potent activator of AMPK, one of the body's key energy-sensing pathways. AMPK activation is known to enhance glucose uptake and improve insulin sensitivity, making improvements in glucose metabolism one of the expected physiological effects of MOTS-c. While this single case study cannot establish causation, the laboratory results are certainly consistent with that proposed mechanism.

Mitochondrial Function: The Biggest Story

Perhaps the most interesting findings occurred within the mitochondrial biomarkers.

DRP1 (Dynamin-1-like Protein)

DRP1 regulates mitochondrial fission, allowing mitochondria to divide, recycle damaged components and maintain healthy energy production.

Prior to treatment, this biomarker sat well outside the optimal range.

Following the 60-day MOTS-c cycle, DRP1 improved by an impressive 24 percentile points, moving from the 20th percentile to the 44th percentile, effectively normalising the marker.

This is particularly noteworthy because previous MOTS-c case studies have shown an average improvement of approximately 13 percentile points.

In other words, this participant improved by almost double the average response observed previously.

One possible explanation is her underlying ME/CFS. Individuals with more pronounced mitochondrial dysfunction may simply have greater room for improvement, potentially explaining why some participants appear to hyper-respond to therapies targeting mitochondrial metabolism.

Although this remains speculative, it is certainly an interesting observation worthy of further investigation.

ATP5B (ATP Synthase)

ATP5B forms part of mitochondrial ATP synthase, the enzyme responsible for producing ATP—the body's primary energy currency.

On this biomarker, lower percentile scores represent movement away from cellular stress.

Following the 60-day MOTS-c cycle, ATP5B improved by 11 percentile points, falling from the 79th percentile to the 68th percentile.

Once again, this exceeded previous observations, where the average improvement across earlier MOTS-c case studies was approximately 9.5 percentile points.

Taken together, the improvements in both DRP1 and ATP5B suggest that changes were occurring across multiple aspects of mitochondrial biology rather than affecting only a single biomarker.

Immune Regulation Also Improved

Another encouraging finding involved immune regulation.

Her CD4/CD8 Ratio improved from the 93rd percentile to the 77th percentile, moving away from the elevated range and back into the normal distribution.

While this marker can be influenced by numerous factors, movement in this direction may reflect improved immune balance and reduced chronic inflammatory signalling.

Given that immune dysregulation is frequently discussed within the context of ME/CFS, this finding is another interesting observation, although much larger studies would be needed before drawing any firm conclusions.

Objective Results Matched the Participant's Experience

One of the most compelling aspects of this case study is that the laboratory findings closely reflected how the participant described feeling.

Rather than observing biomarker improvements without noticeable changes in daily life, both appeared to progress together.

As glucose regulation improved, she reported feeling more capable throughout the day.

As mitochondrial biomarkers normalised, she gradually began getting out of bed earlier and found herself reintroducing exercise into her routine.

Importantly, these improvements were gradual. There wasn't a sudden surge in energy. Instead, everyday life simply became a little easier week after week—a description that many people with chronic fatigue conditions may recognise.

Disclosure

The participant independently chose to purchase MOTS-c from Elvian Labs, citing the company's third-party sterility and purity testing as one of the reasons for her decision. The purchase was made entirely on her own initiative, and she voluntarily agreed to share both her experience and her TruDiagnostic TruHealth results for educational purposes. Neither the participant's comments nor her laboratory findings should be interpreted as evidence that others will experience similar results.

www.elvianlabs.com

Other Factors to Consider

As with any case study, it's important to acknowledge that multiple factors may have contributed to these results. Outside of general lifestyle habits, the only other noteworthy changes during the study period were the addition of ubiquinol (Coenzyme Q10), zinc, magnesium, vitamin C, and a highly bioavailable vitamin B complex. These nutrients all play recognised roles in mitochondrial energy production, antioxidant defence and normal metabolic function, so it isn't possible to attribute the observed improvements solely to MOTS-c. Nevertheless, the combination of the participant's subjective experience and the objective biomarker improvements makes this an interesting case that warrants further investigation.

Final Thoughts

This MOTS-c case study highlights an interesting contrast.

The participant was underwhelmed by NAD+ injections, yet experienced gradual improvements during a 60-day MOTS-c cycle, with those subjective changes mirrored by objective improvements in multiple TruDiagnostic TruHealth biomarkers.

Her MOTS-c results included:

• HbA1c: improved from the 83rd percentile to the 71st percentile, returning from the elevated range to within normal limits.

• Glucose: improved by 15 percentile points, falling from the 73rd percentile to the 58th percentile, suggesting improved glucose regulation.

• DRP1: improved by 24 percentile points, substantially exceeding the previous case study average improvement of approximately 13 points and returning to the normal range.

• ATP5B: improved by 11 percentile points, again exceeding the previous average improvement of approximately 9.5 points.

• CD4/CD8 Ratio: improved by 16 percentile points, moving from the elevated 93rd percentile to the normal 77th percentile.

Although this represents the experience of a single participant, it adds to a growing collection of MOTS-c results suggesting that some individuals—particularly those with greater underlying mitochondrial dysfunction—may experience larger-than-average responses. The magnitude of the DRP1 improvement was especially notable, exceeding previous case-study averages by a considerable margin and raising interesting questions for future research into ME/CFS and mitochondrial-targeted therapies.

This article is intended for educational purposes only and should not be considered medical advice. MOTS-c is an investigational peptide and has not been approved as a treatment for ME/CFS or other chronic medical conditions. Individual responses can vary significantly.