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MOTS-c is an exercise-induced mitochondrial-encoded regulator of age-dependent physical decline and muscle homeostasis

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Johns wort, a nutritional supplement, may interact with it, raising the risk of serotonin syndrome

However, if medications lose their effectiveness over time or cause significant side effects, surgical treatment may be considered

For patients seeking weight loss who request B12 injections, GPs should: Assess for genuine deficiency through appropriate blood tests rather than empirical treatment Provide education about the lack of evidence supporting B12 for weight loss in non-deficient individuals Explore underlying concerns about weight and energy levels, addressing these through appropriate channels Signpost to evidence-based resources such as NHS weight management services according to local pathways Patients should contact their GP if they experience unexplained fatigue, neurological symptoms (numbness, tingling, balance problems), or signs of anaemia (pallor, breathlessness, palpitations), as these may indicate B12 deficiency requiring investigation