What "the longevity stack" usually means
The anti-ageing shelf at Philippine research-peptide suppliers has settled on a recognisable set: epitalon for telomeres, MOTS-c for mitochondria and exercise capacity, SS-31 for mitochondrial membranes, NAD+ as the coenzyme that supposedly declines with age, and sometimes thymosin alpha-1 for the immune system. Manila wellness clinics sell the NAD+ half as a drip.
Each of these has a real scientific story, and one of them is now an approved medicine. What none of them has is a trial showing it slows ageing in a person, and no study has tested any two of them together. This page sorts the evidence so that the strongest claim, the weakest claim and the gap between them are visible.
The evidence, compound by compound
| Compound | Proposed target | Best human evidence | Lifespan or ageing outcome measured in people? | Tested with any other stack member? |
|---|---|---|---|---|
| Epitalon | Telomerase, pineal gland | Small reports from one Russian group | No | No |
| MOTS-c Stocked locally | AMPK in muscle | Exercise raises the body's own MOTS-c (10 men); an analogue's phase 1 | No | No |
| SS-31 | Cardiolipin in mitochondria | FDA accelerated approval for Barth syndrome, 12-patient trial | No (a genetic disease, not ageing) | No |
| NAD+ Stocked locally | Coenzyme for energy and DNA repair | 6-hour infusion pilot in 8 men; precursor RCTs | No | No |
| Thymosin alpha-1 | Immune modulation | Approved abroad for hepatitis B and C | No | Only as an extract, with epithalamin, in one Russian follow-up |
Epitalon: cells, mice and a mortality claim that used a different product
The telomere claim is the stack's headline. In 2003 Khavinson's group reported that epitalon switched on telomerase and lengthened telomeres in cultured human fibroblasts. In 2025 a Brunel University London group, outside that network, found dose-dependent telomere lengthening in normal human cell lines through telomerase, and in two breast cancer cell lines through a different route, alternative lengthening of telomeres. That is the first outside replication, and it is cells in a dish, with a cancer-cell finding that cuts both ways.
The lifespan data is in mice. Female SHR mice given epitalon for five days every month from three months of age until death, 54 per group, showed no change in food intake, body weight or mean lifespan. The longest-lived 10% lived 13.3% longer, chromosome aberrations in bone marrow fell 17.1%, and leukaemia was less common, while total tumour incidence did not change. The authors called this geroprotector activity; it is also a study in which the average mouse did not live longer.
The human mortality claim comes from a six-to-eight-year follow-up of people over 60 who received courses of thymalin, epithalamin or both in the first two to three years, published by Khavinson and Morozov in 2003 and reporting mortality 1.6- to 2.5-fold lower than control depending on the group. Epithalamin is a pineal extract, not synthetic epitalon, and the design falls well short of a randomised trial. It is the closest thing to a longevity stack that has ever been studied, and it used products different from the ones sold today.
MOTS-c: mouse endurance, human exercise physiology
MOTS-c is a 16 amino acid peptide encoded in mitochondrial DNA. In 2015 it was shown to act on skeletal muscle through the folate cycle and AMPK, and treated mice were protected from age- and diet-related insulin resistance and from diet-induced obesity. In 2021 the same programme gave MOTS-c to young, middle-aged and old mice and found better physical performance at every age, including when treatment started at about 23.5 months, very old for a mouse.
The human part of the 2021 paper measured what exercise does to the body's own MOTS-c in 10 sedentary young men: it rose in muscle and in blood during cycling. That shows exercise induces MOTS-c. It does not show that injecting MOTS-c does anything in a person, and no trial of native MOTS-c in humans exists. An analogue, CB4211, completed a phase 1 trial for fatty liver, reported by press release. The FDA's compounding list says of MOTS-c: no human exposure data identified.
SS-31: the one approved medicine, for one rare disease
SS-31, elamipretide, is a four amino acid peptide that binds cardiolipin in the inner mitochondrial membrane. On 19 September 2025 the US FDA granted it accelerated approval as Forzinity to improve muscle strength in people with Barth syndrome weighing at least 30 kg. Barth syndrome is an ultra-rare inherited disorder of cardiolipin metabolism.
FDA's own summary is precise about the basis: the trial enrolled 12 male patients, knee extensor strength gains were not observed during the randomised period but were observed during the open-label extension, and a confirmatory trial is required. The 168-week extension report describes sustained six-minute-walk improvements in the eight patients who reached that visit, with injection-site reactions the most common adverse event; in FDA's figures every treated patient had a local reaction. A larger trial in primary mitochondrial myopathy missed its primary endpoints.
This is the strongest evidence on the page, and it says nothing about ageing. It says a mitochondria-targeted peptide can help a specific genetic mitochondrial disease. The leap from there to a healthy 45-year-old is the leap the stack asks you to make.
NAD+: fast clearance by drip, modest results by mouth
NAD+ is not a peptide; it is a coenzyme, and it is in the stack because it is injected alongside the peptides. The one published infusion study gave eight healthy men 750 mg over six hours and found no change in plasma NAD+ or its metabolites for the first two hours: the infused NAD+ was removed from the blood as fast as it arrived. Levels rose later and NAD+ appeared in urine. No published study has tested subcutaneous NAD+ at all.
The oral precursors have proper trials with modest results. Six weeks of nicotinamide riboside in 24 healthy adults aged 55 to 79 raised blood NAD+ and was well tolerated, with blood pressure trends the authors said needed a bigger study. Ten weeks of NMN in 25 postmenopausal women with prediabetes improved muscle insulin sensitivity, while glucose, blood pressure, lipids, liver fat and inflammation did not change. Raising the marker is established; a health outcome is not.
Thymosin alpha-1: an immune drug abroad
Thymosin alpha-1 is sold as Zadaxin for chronic hepatitis B and C, given as an immune modulator; a 2009 review counted approvals in more than 35 countries. Its place in a longevity stack rests on the idea that immune ageing is part of ageing generally, and on the Russian thymalin follow-up above. It has no ageing trial of its own. The FDA compounding list flags it for significant immunogenicity risk with inadequate safety information.
What has and has not been studied together
- No trial has combined synthetic epitalon with MOTS-c, SS-31, NAD+ or anything else.
- No trial has combined MOTS-c or SS-31 with anything.
- The only combined regimen in the literature is thymalin plus epithalamin, both extracts, in the Russian follow-up.
- No trial of any compound here measured ageing, healthspan or lifespan as an outcome in humans.
The claim that the stack "addresses ageing at multiple levels" describes the marketing logic, not a tested regimen. On the evidence as it stands, the stack is one approved rare-disease drug, one mouse peptide, one cell-and-mouse peptide with a single-group human record, and a coenzyme whose infusion pharmacology argues against infusing it. For how each ranks on its own, see best peptides for anti-ageing and best peptides for energy.
Safety information that does exist
SS-31 has the fullest record: injection-site reactions in every treated Barth syndrome patient, and a label warning on allergic reactions. IV NAD+ produced gut symptoms, a faster heart rate and chest pressure during the drip in a small 2026 clinic review, resolving afterward. Epitalon's and MOTS-c's human safety data are, respectively, single-group reports and an analogue's press release. The theoretical concern with any telomerase activator is cancer, and the 2025 cell study's finding that cancer cells also lengthened their telomeres after epitalon is a reason for caution rather than reassurance. The side effects hub links each compound's safety section.
Status in the Philippines
None of the five is registered with FDA Philippines for any use. Forzinity's approval applies in the US, and no Philippine registration was found. IV NAD+ is offered by wellness clinics in Makati, BGC and elsewhere; an injectable made outside a registered sterile manufacturing process carries contamination risk that matters most for a drip. None of the compounds is a controlled substance under RA 9165. The cognitive stack and sleep stack pages cover the two neighbouring shelves.
Storage
Epitalon, MOTS-c and SS-31 are lyophilised peptides: refrigerate before mixing, 2 to 8°C afterward, never frozen. NAD+ powder degrades with heat, light and moisture and should be used promptly once reconstituted. Plan for brownouts with a cooler and ice packs. The MOTS-c calculator, SS-31 calculator and NAD+ calculator handle the reconstitution arithmetic.
