September 18, 2026 
3 min read
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William "Wes" Alden, MD, PhD | Clinical Education Series
Mitochondrial Health Beyond NAD
By William “Wes” Alden, MD, PhD
Mitochondria produce most of the cell’s ATP. They also handle calcium, generate reactive oxygen species, and help decide when a cell should die. When they falter, high-energy tissues such as brain, heart, and muscle feel it first. Primary genetic mitochondrial diseases are uncommon. Secondary stress from aging, insulin resistance, inflammation, or certain medications is far more frequent.
What actually moves the needle
Exercise remains the strongest proven stimulus for making new mitochondria and improving the ones already present. Both endurance work and resistance training help. No pill reliably copies that effect.
Elamipretide is a short peptide that binds cardiolipin on the inner mitochondrial membrane. It is FDA-approved for Barth syndrome, a rare mitochondrial cardiomyopathy. That approval is narrow, but it shows that a peptide can be developed into a real mitochondrial medicine when the data support it.
Coenzyme Q10 sits in the electron-transport chain and has useful data for statin-related muscle symptoms, some cardiomyopathies, and migraine prevention. L-carnitine shuttles fatty acids into mitochondria and is used in specific deficiency states or in dialysis patients. Alpha-lipoic acid acts as both cofactor and antioxidant; it has evidence for diabetic nerve pain in several countries and is sold as a supplement in the United States. Each of these has a defined niche rather than a universal role.
Research-stage ideas
Mitochondria-derived peptides such as MOTS-c and humanin look interesting in animals. They are not FDA-approved for aging or neurodegenerative disease, and claims of proven benefit in people run ahead of the data. The same caution applies to most “mitochondrial support” stacks sold online.
Membrane lipids
Cardiolipin is a specialized phospholipid unique to mitochondria. Oxidative damage to it appears in several disease models. Keeping overall fatty-acid balance reasonable is sensible, yet it should not be sold as a mitochondrial cure.
Bottom line for practice
For most patients the highest-yield steps are still movement, sleep, treatment of insulin resistance, and control of ordinary vascular risks. Targeted supplements and the one approved mitochondrial peptide have narrower uses backed by clearer evidence. Wide-ranging protocols that mix many unproven agents deserve skepticism.
William “Wes” Alden, MD, PhD, is a physician-scientist and internist. His career has included academic medicine, federal clinical research, community practice, and medical philanthropy. He works in the Greater New Orleans area, including Metairie, New Orleans, and the Northshore communities of Mandeville and Covington. His interests include metabolic health, integrative approaches, neurodegenerative conditions, and practical whole-person care. He emphasizes honest evidence and clear communication with patients and families.
This article is for general education and reflects Dr. Alden’s professional perspective. It is not medical advice and does not create a doctor-patient relationship. Results vary from person to person. Many peptides, NAD products, and specialty lipids mentioned here are not FDA-approved for anti-aging, cognitive enhancement, or most of the wellness uses sometimes promoted. Material labeled for research use only should never be given to people. Please consult a qualified clinician about your own situation before starting any evaluation or treatment.
