Huberman Lab
Dr. Craig Koniver: Peptide & Hormone Therapies for Health, Performance & Longevity
Mon, 07 Oct 2024
In this episode, Dr. Craig Koniver, M.D., a board-certified physician trained at Brown University and Thomas Jefferson University, discusses the therapeutic application of peptides and hormones for enhancing physical and mental health and performance. We explore GLP-1 analogs for weight loss, BPC-157 for wound healing and reducing inflammation, as well as peptides that increase growth hormone, improve REM sleep, and enhance cognitive function. We also cover testosterone therapy, NAD, NMN, and NR supplementation, methylene blue for mitochondrial health, stem cell therapies, and supplements such as CoEnzyme Q10 and methylated B vitamins. Additionally, we discuss effective dosages, sourcing, safety considerations, and the importance of working with knowledgeable physicians. Whether you're currently using peptides or exogenous hormones, or simply curious about their potential benefits and risks, this episode provides the scientific rationale behind how peptides function, their potential to enhance mental and physical health, and how they can optimize performance. Access the full show notes for this episode at hubermanlab.com. Thank you to our sponsors AG1: https://drinkag1.com/huberman Joovv: https://joovv.com/huberman BetterHelp: https://betterhelp.com/huberman Function: https://functionhealth.com/huberman Eight Sleep: https://eightsleep.com/huberman Timestamps 00:00:00 Dr. Craig Koniver 00:04:52 Sponsors: Joovv & BetterHelp 00:07:40 What is a Peptide? 00:09:37 GLP-1 Agonists, Semaglutide Weight Loss, Brain Health 00:15:49 GLP-1 Microdoses, Muscle Loss; Inflammation 00:18:43 BPC-157, Inflammation 00:23:27 BPC-157, Injection & Oral Forms; Injury Repair 00:28:43 Sourcing, Anabolic Steroids, Testosterone 00:34:48 Black & Gray Market, Compounding Pharmacies, Purity 00:38:20 Sponsor: AG1 00:39:51 Partnering with a Physician, LPS 00:43:00 BPC-157, Pentadeca Arginate (PDA); Side Effects & Doses 00:46:35 Ipamorelin, GHRP-6, Sleep, Appetite; Tool: Sleep & Growth Hormone 00:54:17 Tesamorelin, Sermorelin, CJC-1295; Stacking Peptides 00:58:45 Sponsor: Function & Eight Sleep 01:01:54 Coenzyme Q10 (CoQ10), Mitochondrial Health 01:05:16 Prescriptions, Physicians & Trust 01:14:09 Agency in Your Health 01:17:13 MK-677, Appetite 01:19:32 Hexarelin; Growth Hormone Secretagogues Dosing 01:21:10 Methylated B Vitamins, Homocysteine 01:24:47 Peptides for Sleep, Pinealon, Epitalon 01:31:03 Glycine, Liver Detoxification; Dosage 01:37:19 GLP-1, Compounding Pharmacies 01:39:03 Stem Cell Therapy, PRP 01:41:18 Thymosin Alpha-1, Cerebrolysin & Brain Health 01:44:17 Peptides for Cognitive Function, Methylene Blue, Doses 01:50:20 Covid, NAD Infusion, NMN & NR Supplements 01:57:13 Nutritional Deficiencies; NAD Dose & Regimen, NMN & NR 02:07:53 PT-141, Vyleesi, Libido; Nausea 02:10:57 FDA Approval & Removal, Pharmaceutical Companies 02:20:17 Positivity, Mindset & Health 02:26:23 Zero-Cost Support, YouTube, Spotify & Apple Follow & Reviews, Sponsors, YouTube Feedback, Protocols Book, Social Media, Neural Network Newsletter Disclaimer & Disclosures
Welcome to the Huberman Lab Podcast, where we discuss science and science-based tools for everyday life. I'm Andrew Huberman, and I'm a professor of neurobiology and ophthalmology at Stanford School of Medicine. My guest today is Dr. Craig Conover. Dr. Craig Conover is a medical doctor who did his training at Brown University and Thomas Jefferson University.
He is a world expert in what he refers to as performance medicine, which involves the use of peptides and other therapies for improving mental health, physical health, and performance. Now, many of you have perhaps heard of peptide therapies. Perhaps some of you have not. A peptide is simply a small protein. So insulin is a peptide.
We have many different thousands of peptides in our brain and body, and they perform a variety of different roles. Dr. Conover's expertise is in the use of exogenous, that is, peptides that one takes, exogenous peptides for activating multiple pathways in the brain and body to augment health.
Now, of course, peptides such as insulin have been used for many years now to treat things like diabetes, but today we talk about novel peptides, including GLP-1, so these are glucagon-like peptide analogs, Things like Ozempic and Monjaro, which I realize are a bit controversial. However, today we talk about the micro dosing of those peptides.
We talk about those peptides combined with other peptides, as well as behavioral practices to offset the muscle loss associated with them. And then we dive into some lesser known peptides, but ones that are growing in use. For instance, BPC-157 or body protection compound 157, which is used to treat inflammation, to accelerate wound healing and a variety of other things.
Then we discussed the use of peptides specifically to increase growth hormone secretion during sleep as well as some peptides that can actually increase rapid eye movement sleep dramatically. Today, we also discuss testosterone therapies, not just for men, but for women. These are growing increasingly popular, as well as things like NAD, as well as specific supplements.
Dr. Conover, as he will soon tell you, is not a huge proponent of supplements, but he does mention several that he feels are of particular use, including things like coenzyme Q10 and some of the methylated B vitamins, and he explains why he takes that stance. So today's discussion is really for anybody interested in mental health, physical health, and performance.
And the reason I say that is that even if you aren't considering taking peptides or already taking peptides, peptides and some of these other compounds I've mentioned sit somewhere between doing nothing except diet and exercise which I sort of see as the next step up the ladder in terms of augmenting your health approaches.
And then of course, there are a number of prescription drugs, including hormone therapies, such as growth hormone therapies, testosterone therapies, and a number of other things that yes, can modify those hormone pathways. They are in fact hormones, but they actually can shut down one's natural production of those hormone pathways.
Peptide therapy sits somewhere between doing nothing and supplementation and those more advanced hormone therapies. And that's why peptide therapies, I believe, are growing in popularity. They can augment specific hormone pathways. They can augment specific, in fact, multiple processes within the brain and body to augment health.
but they don't tend to operate in that negative feedback cycle by shutting down one's own endogenous production. Now that doesn't mean that they aren't without some safety concerns.
And today we of course discuss the potential side effects and safety concerns of peptides, as well as the critical issue of sourcing clean peptides and working with a board certified physician if one is going to pursue peptide use. So by the end of today's discussion, you will be right there on the cutting edge of what's happening and where things are going with peptides.
And in keeping with that, you'll notice that during today's discussion, we talk a fair amount about what the FDA currently allows in terms of prescription peptides, what the FDA has recently removed from the market in terms of peptides. And as a very recent update, just prior to the release of this episode, I learned that three peptides, CJC1295,
both of which are in the growth hormone secretagogue family, meaning they promote the release of growth hormone, as well as thymus and beta alpha, which is in the sort of anti-inflammatory and tissue repair pathway. Those three are now re-allowed for prescription in the United States. So at the time of recording this episode, we discussed some of those as being recently banned by the FDA.
They are now approved again for use in humans by the FDA. So there's a brief and very recent update. So just to summarize this admittedly long introduction, today you're going to learn about this incredible area of science called peptide biology and how it can augment mental health, physical health, and performance. And you're going to do so from one of the world's leading clinical experts.
Before you begin, I'd like to emphasize that this podcast is separate from my teaching and research roles at Stanford. It is, however, part of my desire and effort to bring zero cost to consumer information about science and science-related tools to the general public. In keeping with that theme, I'd like to thank the sponsors of today's podcast. Our first sponsor is Juve.
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If you'd like to try Juve, you can go to Juve spelled J-O-O-V-V.com slash Huberman. Juve is offering an exclusive discount to all Huberman Lab listeners with up to $400 off Juve products. Again, that's Juve spelled J-O-O-V-V.com slash Huberman to get up to $400 off. Today's episode is also brought to us by BetterHelp.
BetterHelp offers professional therapy with a licensed therapist carried out entirely online. Therapy is an extremely important component to overall health. In fact, I consider doing regular therapy just as important as getting regular exercise, including cardiovascular exercise and resistance training exercise. Now, there are essentially three things that great therapy provides.
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And now for my discussion with Dr. Craig Conover. Dr. Craig Conover. Welcome.
Thank you, Andrew.
I appreciate the invitation to be here. I'm thrilled that you're here. We are going to launch ourselves into the space that is called peptides.
Yeah.
And it's an interesting space.
For sure.
Because I think most people probably don't know what a peptide is. They should feel no guilt or shame about that. Right. I'm sure you'll tell us. But this area of medicine... that people broadly refer to as peptides is picking up a lot of momentum, even though it's been around for a long time.
And I find it particularly interesting because there are many people using peptides for very specific purposes, but Most people haven't really heard of the various peptides that are out there. And if anything, we can be sure that in the years to come, peptides are going to be increasingly popular. And there's, of course, the incredibly popular peptide of GLP-1 agonist. For sure. Taking over.
So to drop into this and make sure everyone's on the same page, what is a peptide?
Yeah. I mean, just from a very elementary level, peptides are just chains of amino acids. So amino acids, all naturally occurring molecules. We call it a peptide if it's 40 amino acids or less. Call it a protein if it's 41 amino acids or more. The body makes, I think the last I read, 300,000 peptides. So it's a massive number.
We probably therapeutically are using closer to 150 over the years, which is obviously tiny compared to that. So to your point, this is blossoming. We've been using peptides for about eight years, a long time, but still very early in our understanding of how best to use peptides and how clinically we're going to get the most out of them. So it's exciting.
Maybe just to orient ourselves, we should talk about GLP-1 first, not because it's necessarily the category of peptides that I think people would want to consider for themselves, but because most people have probably heard of semaglutide and Munjaro and things like that. Sure. So how long ago was it that humans started injecting GLP-1 agonists in order to lose weight?
I think the weight loss aspect has only been a couple years. I mean, it's been tremendous how it's accelerated to, like, literally becoming the number one prescribed in America. You know, semiglutide ozempic was approved longer than that for type 2 diabetics, helping with, you know, glucose control and helping with glucose utilization.
And what they found as a side effect was that these people were losing weight. And then that word caught on. And what's interesting, and I don't think most people understand this, most of the medicines prescribed, particularly in America, are prescribed off-label, meaning they've never, ever been approved for what they're used. Isn't that right? Yeah, the vast majority. Yeah, are never approved.
So as a physician, I'm allowed to prescribe any drug for any reason I want as long as it's been approved for something, right? As long as we're safe, right? We don't want to be cavalier about this and renegade and do all these things that are out of bounds. But that is the truth. So semaglutide is a great example being used for helping people, diabetics, type 2 diabetics, lower their blood sugar
And then it got to, well, now let's help diabetics lose weight, right? Because diabetics struggle with weight, the insulin resistance. And then it became, well, even if you're not a diabetic, could you benefit from losing weight? Well, heck yeah, right? I mean, look at the amount of obesity and people who are overweight and having trouble maintaining healthy weight.
It's exorbitant in this country and certainly worldwide. So then it spread internationally. It did eventually get FDA approval specifically for weight loss. But, you know, at first, no, it's been just for type 2 diabetics to help with glucose utilization. And, you know, we've been using primarily trisepatide, which is like semi-glutide version 2.0, mostly for the past two years.
Have learned a tremendous amount. And my opinion's actually changed from working with people.
What is your opinion? My understanding is that, well, there's sort of two camps on this, it seems. Yeah. At least two camps. One camp seems really bullish on this. They seem very excited about this drug. The other camp seems to point to the fact that one may be creating a drug dependency. Mm-hmm. That it's very expensive.
And they point to the also potency of lifestyle factors like exercise and caloric restriction, eating mostly non-processed foods, et cetera, as a quote-unquote better alternative. I'm not necessarily saying that. I think they both have their place. To me, it seems very contextual. But as a clinician, I'm curious what you think.
Yeah, I agree. Both have their place. My philosophy is I want everyone to have access to things that are, number one, safe, that propel them to look, feel, and perform their best. And if that means, right, if it was just about if I can exercise my way out of this, eat my way out of this, meaning lose weight, change my body composition, why do we have an epidemic here?
you know, of so many people who struggle with that because it's really hard, right? And we don't totally understand it. I'm not saying that, yeah, the processed food thing is a massive problem. I mean, I know that's come to light recently with people pushing for us to take a look at food companies and the quality of our food, which is amazing.
But if people aren't interested in doing better for themselves and, you know, this is may not make sense, but I think it does. The analogy I use is I like to help people win the race first, which then helps them motivate to train for the next race. Right.
And this kind of goes against the grain of conventional medicine, which is, you know, if you want to train for the race, you have to, you know, run a certain number of miles. You have to sleep a certain way, have to eat a certain way. You have to do all the things, struggle to get there. Right. And losing weight is a struggle.
And the way I look at it, if I can help people lose weight first, literally, by using something like Terzepetide, semaglutide, and I've seen this, they're now excited. I mean, I met with a client yesterday here in Los Angeles, and she literally looked at me and said, you've changed my life. She goes, I am a super successful woman in my company, with my family, with my kids.
Everything's great, but now I love my life. My workouts are better. I look better. My clothes fit better. I am super excited about waking up every morning. Like she is there. And that is what it's about, right? And so for people, if you can help them achieve their goal first, then they're going to be motivated. The light bulb turns on, they're going to be like, wow, I want more of this.
And that's the aha moment that I love helping people with. So at first I was like, oh, we got to be really cautious with this. Same thinking. Like I don't want people to lose too much weight. Like this is a problem. Are they going to be dependent? Unlike the notion that you have to take something the rest of your life.
And I'm not saying it has to be the rest of their life, but when something works, and as far as I can tell, it's very safe, I think it's worth discussing. And I like people having those options at least.
Yeah, it sounds like from the story you just told us that it's not just about an aesthetic change that motivates people to lean into other aspects of their health and life when they lose some weight, that it's also just the sheer...
literal weight and also that adipose tissue, fat tissue, you know, produces a lot of hormones that we know impact the brain and brain function, which is not to say that there aren't people out there with a lot of adipose tissues who, aren't extremely bright and motivated, et cetera. But many people who are carrying excess body fat don't feel good. They report brain fog, et cetera.
And I think now, thanks to Chris Palmer and actually at Stanford, there's also a program in metabolic psychiatry. We're starting to see or understand and appreciate the link between adipose tissue and brain health or lack of brain health in most cases. So in the case of GLP-1, People have criticized it, saying that a fair percentage of the weight that's lost is lean body mass, muscle loss.
But it seems to me that can be remedied pretty easily if people just do some resistance training.
I think part of that, yeah, resistance training. The other thing I would say is from what we've seen is when people are using the conventional dosages, they're losing weight too quickly. And so what we do is we get both semi-glutide, mostly triseptide compounded, and that allows us to use basically micro dosages and start very low in terms of dosage and go slowly with people.
And what we found is as long as people are losing less, two pounds or less a week, they're they're not losing the muscle mass.
We certainly encourage adequate protein intake, you know, resistance training, but that microdosing has been a game changer, like literally a game changer because then people don't feel like, and I've seen it where when we started, people were losing, you know, 15 pounds in three weeks. Goodness. Right? And then they're like excited.
But then they're not because then they come off of it and they just gain it right back. Or they lose a lot of weight and they lose that fat in their face and they look like skeletons. We've seen those called ozempic face. We don't like the way that looks. And that fat takes a while to come back. So if we just go slowly with this and we can really dial it in and nuance it,
That has had a tremendous impact. And now, beyond the weight loss, you know, we're seeing cognitive benefits. We're seeing, you know, inflammation benefits. A lot of people with autoimmune disease who their inflammation markers are coming down, and that's the only thing we can think is working.
Is that a direct effect of Ozempic on... the immune system and pathways related to inflammation, or is it indirect through the loss of adipose tissue, body fat, which then lowers inflammation?
Great question. Or I could say, is it the positive thoughts that come from looking at yourself in the mirror and feeling good? which transcends to feeling better about yourself, and that feeds forward to the momentum that you put forth in the world, all of those things. I think it's all of the above. I think that's going to be hard to dissect, but it's real. I mean, I have a patient, she's 50.
She has Hashimoto's thyroiditis, meaning she attacks her thyroid. She doesn't make enough thyroid hormones, so she takes thyroid hormone. Well, one of the challenges with that is they make a lot of thyroid antibodies, this antibody called thyroid peroxidase antibody. And when you have an elevated thyroid peroxidase antibody, you don't feel good. You feel inflamed, your joints hurt, you get rashes.
Life is just not easy. And it's a challenge to get that number down. I mean, it's certainly a challenge for me. You traditionally use probiotics, a lot of things to help bolster the immune system. Well, now we're starting to use the GLP-1s and we're seeing that those antibody levels come down. And I don't have a great way of explaining it, but there's something going on that's very positive.
Very interesting. Well, I suppose moving from most widely known, peptides are still fairly unknown to most people, even the concept, but that's why you're here. You're changing that right now. But moving from things like GLP-1 to what I would probably call the second most popular peptide, the one that we're hearing more and more about all the time, and that's BPC-157, body protection compound 157.
Yeah. which, to my understanding, there are a lot of animal data, very few, if any, clinical studies on humans. Agreed. But a lot of people now taking BPC in various forms. Yeah. What are some known uses for BPC? Let's just say within your clinic. Sure. And then we'll get around to the fact that BPC has, let's hope, temporarily been taken off market. Yep. And what some of the alternatives are.
But... What is BPC? What instances or people have you found it useful for?
So many. So I think with BPC, for me, kind of the most utilized peptide that we've used. So we'd like to use BPC almost with every patient. It is very anti-inflammatory. And so just from a very general perspective, most people walking around who are adults, they're stiff, they're sore as they get older, they work out. We work with athletes of all levels. There's that element of inflammation.
Maybe they have some chronic disease, diabetes, heart disease, autoimmune disease. Inflammation is paramount, we understand that. And BPC, I've observed with so many patients, we're talking thousands upon thousands of patients, where their inflammation comes down, so they feel better, they're not as stiff, they're not as sore, their knee doesn't hurt as much, their shoulder's improved.
So we've learned, you know, that we start with a dose, you know, based upon these, like you said, animal studies, which is conservative, make sure it's safe. And then we've seen over time that we can get to higher and higher dosages and have even more of an impact, you know. And I think so for people understanding using BPC, we started with a dose of like 500 micrograms a day.
We got up to 5,000 micrograms a day, you know, and we'd like a protocol five days on, two days off. And that's been very helpful for a variety of things from post-viral, you know, with the pandemic. Had a lot of success with BPC to, again, you name it.
Honestly, almost everyone I could think of, particularly as people are engaging more fitness-related lives, they're working out more, I would argue that anyone who's working out on a regular basis, BPC is going to benefit. It's going to help, you know, improve the inflammatory status but also help with recovery. And it doesn't seem to be one of these agents that's going to be detrimental.
Like we were talking earlier, Rob and I, for the starter, like, you know, they found that people are working out hard taking antioxidants. There seems to be a negative consequence to that because you don't allow the body to kind of repair itself. I don't think that's happening with BPC.
That's interesting because my understanding is also that BPC, part of the specific and general adaptation of exercise is triggered by inflammation.
This is why indeed it is true that doing ice bath or really cold water immersion, cold shower seems fine, but cold water immersion in the four to eight hours after resistance training can limit some of the hypertrophy and strength gains from resistance training because what you're inducing when you actually go into the gym that leads to the hypertrophy and strength training is an inflammation response that triggers the compensation.
or the hypercompensation. So it's interesting, you're saying that BPC By the way, I must say this because then forgive the editorial, but that is not to say that cold plunges and cold immersion is bad. It's just in the hours following resistance training, specifically for hypertrophy and strength training. If those are your goals, probably best to do it outside of that window.
Other times it has some tremendous benefits. Be safe, but there. Okay, back to the topic, and forgive me, but this can set off a complicated... storm of sorts, if I'm not ultra clear about the details. BPC-157, strongly anti-inflammatory.
Yes.
My understanding is it also may upregulate growth hormone receptors.
It does, right. And so it works well if you're, you know, we'll get into taking a growth hormone-releasing peptide. It pairs very well with that because then you're working both sides of the equation, meaning if you're using a growth hormone-releasing peptide like semirelin or ipramirelin, GHRP6, whatever, you're helping your pituitary put out more growth hormone.
Well, if you combine it with BPC, which upregulates the growth hormone receptor, you make the process of growth hormone binding more efficient. So you get more out of it. Then you can use less of the growth hormone-releasing peptide with the same result.
Got it. Yeah. BPC-157 comes in many different forms, or it used to when it was FDA not disallowed. Sure. So I could imagine how the oral forms would allow for a... just general anti-inflammatory response. It's a gut peptide. So we don't have to worry about it being destroyed by the gut. Most peptides that go into the gut are broken down.
But this peptide, when it's naturally occurring, occurs in the gut. So it survives in the gut. So if somebody is taking BPC-157 orally through a capsule or tablet form, My guess is that has a general anti-inflammation response.
I think it can. What we've observed is it's more limited to the gut. So people with any sort of gastrointestinal issue, whether that's inflammatory bowel disease like Crohn's or ulcerative colitis, irritable bowel, you name it, leaky gut, I think oral BPC is more effective there. Has it been shown to be effective for those conditions or have you observed that clinically?
I've certainly observed that clinically. But interestingly, I've observed a better clinical response when people inject it.
even for gastrointestinal related things so i think injecting and then so people injecting subq which is right under the skin we use the tiniest of needles like an insulin needle 30 or 31 gauge we're talking super small um and so i know a lot of people like i'm never injecting yeah this is less painful than a um than a texas mosquito bite there you go super easy once you do it once or twice it's really easy and we walk people how to do how to do that but interestingly i we started thinking okay if you've got something going on your gut you should take oral ppc because it's going to target it right then and i found
Now, if we're injecting, it actually works better than the oral. And then it came up, well, what if I've got an elbow injury? Should I inject it in my elbow? And we found actually don't. It's going to work systemically. You can inject it in your abdomen or your rear end.
You're still going to get benefit in your elbow, but now you're going to get benefit in all your joints, all over your body systemically.
How do you think that's working? And my understanding is BPC-157 can initiate fibroblast migration, some of the cells that make up the various connective tissues that when injured or sore, other things can make us injured or sore, of course, but when injured or sore, that those need repair.
So it always was perplexing to me why one could put BPC-157 in such a small volume under the skin, just a few centimeters off the belly button, and it would somehow...
seek out the the injury site in an elbow or an achilles and there are all these wild anecdotal tales of you know lore of let's just say uh there was this olympic athlete not this last olympics but the previous summer olympics that had a torn achilles who came back a few weeks later and everyone was and meddled people were talking about you know took podium um
That is – and people were talking about BPC-157. There was kind of this – and who knows? That's just shatter and fog, as they say. But kind of wild, the idea that you could just inject something systemically, put it into the systemic circulation, into the bloodstream, and it would – ferret out the location in which the injury took place and initiate a recovery response.
But we've seen it with, not to get off topic, we've seen it with stem cells. So they've taken stem cells, they've tagged them radiographically so you can see them. And the study I read, which I can find for you, someone had a wrist, broken wrist, and they gave them intravenous stem cells.
And 24 hours later, when they visualized radiographically, those stem cells had aggregated at the site of the fracture. So there's a lot, you know, about our bodies. Obviously, we don't know. There's a kind of innate human-like design and intelligence, which I believe in. I see it because we've done a lot of IV therapy over the years.
Yeah.
one has ever gone into the hospital for a surgery and got a cold saline infusion. You realize how quickly it hits your toes. You know, they're putting it in at your elbow. It's almost instantaneous. Yeah, within a few seconds. It also makes one appreciate how we're all generally a little bit dehydrated.
When you start getting a real proper saline infusion, all of a sudden you feel yourself come to life in a way that, oh, this is what it feels like to have just the right amount of salt in my bloodstream. Exactly.
So going back to BPC, where I think it shines is in these ligaments and tendons, right? I think this is where most of these injuries happen is where muscle is connecting to the bone, you know, and there's, you know, people, you know, grow their muscle, but we don't stretch the tendons and ligaments well. And that's where we get pull, sometimes strain and sprain and tearing.
And I think that's where BPC shine. That's certainly where it's been studied in animal studies. And I know that because we can inject it directly into tendons, which is unlike steroids. We would never inject steroids into a tendon. You damage the tendon. BPC, we mix with things like PRP, PRF, which is platelet-rich fiber and a little bit different than PRP. And you'll get healing within days.
Like, it's awesome. Wow. Super safe. And it's amazing for people.
BPC is definitely, shorthand for BPC-157 that is, is certainly in widespread use. I have been concerned, just personally, about gray market sources that contain contaminants and the fact that many people are obtaining BPC-157 not from a physician, not from a compounded pharmacy. but just kind of on, quote unquote, on the internet. Sure. You're a physician.
I'm guessing that until the recent ban by the FDA, you were able to prescribe clean BPC as it were. Yeah. What's the story with BPC now? And maybe we could talk about gray market versus- I think it's a great question. Versus prescribed and made it a compounding pharmacy versus pharmaceutical company, pharmaceutical. And then of course there's black market, but let's just leave that out.
There are people that are going to tell you, hey, this is BPC and sell it to you. That's obviously bad and dangerous.
Well, we see that with the anabolic steroids, right? So anabolic steroids are in the black market. You can't really, I mean, there's one anabolic steroid, which is nandrolone, which is DECA. which can be officially prescribed. We use it, you can combine it with testosterone, all in the up and up, totally above table. The rest, things like Trenbolone, others, you can't get them from a physician.
In fact, it's very hard to get them from a reputable website. the United States.
So as long as we're here, my understanding is decadarabalin and testosterone cypionate can be prescribed, or testosterone enanthate, things like that, by physicians. That's because it's been FDA approved for the treatment of various things, hypokinatal syndromes, testosterone replacement therapy in both men and women, et cetera.
So those categories of testosterone-like compounds, cypionate, enanthate, et cetera, and Decadrobilin, which is basically like, is it similar to DHT? Is it?
A little bit. Yeah. I mean, it's the generic name is Nandrolone. Yeah. I mean, it has the flavor of helping with joints. I think it works synergistically with things like testosterone, different, you know, whether it's testosterone, cypionate, and anthonate.
And I like it for people who, particularly people who've been on testosterone, men who've been on testosterone replacement for a long time, which is many men, they tend to get less out of testosterone, become less potent, like anything, right? If you use something for a long time, you're going to get less out of it over time. Anything you expose yourself to continually doesn't work as well.
And so, you know, like to make this really real, I had a patient who was in the Marines and served at Secret Service for several White Houses. And he had a lot of, you know, osteoporosis, osteopenia, you know, bone loss. And, you know, this is where I learned about using something like Nandrolone because we combined Nandrolone with testosterone. It changed his life.
You know, this guy in his 80s who had to use a cane, who came back to life, who started, you know, becoming super mobile and working out again. And synergistically, I think it works really well, not to get too far off topic.
No, it's interesting. And I think another sort of brief editorial from me, if I may, is, You mentioned this patient was in their 80s. I think nowadays, unfortunately, a lot of younger males in particular, guys in their, gosh, even teens, but 20s and 30s, even early 40s, think that they need to look to synthetic testosterone in order to look a certain way, perform a certain way.
in the gym, libido, etc. And I'll go on record again, and again, and again, saying that it's absolutely not necessary for most people of those ages, provided that they are taking good care to sleep well, eat well, take care now, but I realized that there are a growing number of use cases where People, for whatever reason, aren't able to recover from exercise. They're struggling.
This is a little bit like the Ozempic conversation, right, where there are things that can help move the needle in the right direction, pun intended. But here with testosterone, synthetic testosterone and DECA, there's a real concern about loss of fertility.
Totally. Right. I think it brings up a larger point, which is, and obviously I'm biased, but I think it's super helpful for people to have a physician help them in this course. Mm-hmm. particularly with testosterone. It is just known that people get it from their trainers, their bros from the gym, right, who are saying, oh, you got to use this.
I mean, I have so many patients who started using testosterone in their late teens, early 20s. Goodness. Yeah. I mean, not goodness, meaning badness. That does not seem like a good idea. And it's still very common. Goodness gracious. Still very common. And, you know, one in particular, this is probably 10 years ago, came to see me. He's 25. He got married.
And to your point, he said, I'm ready to have kids. I have zero sperm left, right? And that's a real thing. And so he had been using, and I would say abusing, both testosterone and growth hormone for years. Now what he told me was, and I get it, he was Superman. He could wake up, do a hard workout,
know crush it wake up the next morning was not sore crush it again and just kept going kept going it was super fit super happy in that regard and how he looked how he felt how he performed but then he got to a point where he's a little bit wiser mature and he was like oh my goodness now there's a repercussion for this and i've seen that time and time again and the repercussion is big you're not making any sperm and the sperm quality is super poor
now what do you do? Well, now you got to come off the testosterone. You got to rebuild your system, which we can do. You know, we can use things like clomiphene and clomiphene HCG, lots of different agents to help in that regard, even certain peptides. But I think it brings up the large point, even getting into peptides, which is having a physician who's knowledgeable to me is super helpful.
The challenge for people is they don't know where to get the right information, right? And they're getting it from websites and they're getting it from people saying, oh, just try this peptide. And I've had lots of people talking about the, you know, websites or whatever, not to name any names who've had anaphylactic reactions to research type peptides, which are not for human consumption.
And I'm not saying that there's bad companies or whatever. You just got to be careful. You got to be selective at least.
Right. Well, what brought us on to the conversation about testosterone was this black market issue. There's also what I would call this dark gray market issue, which is that there are a number of companies that will sell all sorts of things, but peptides in particular, and listed on their website, it'll say not for human or animal consumption, for research purposes only.
And one of the major issues is that the potency and cleanliness, so to speak, of purity of those compounds is not established. Many of them have LPS, lipopolysaccharide in them, which is inflammatory.
Earlier, before we started recording, you mentioned that you have heard of or interacted with, not your patients, but people who have come to you saying that they had really serious life-threatening consequences for using these black market, certainly, but dark gray market peptides.
Yes. Yeah. And so to tell the story further is back in October of 2023, the FDA put many peptides, BPC, and we can name them out on what's called a category two list, meaning they are no longer allowed to be compounded. Right. And that excludes then research companies who are not under the purview of the FDA.
But these compounding pharmacies, it's been a huge blow because they've been told they cannot use these agents.
the compounding pharmacies are distinct from these other black and dark gray sources in that they actually can establish purity they are designed to be injected into humans and they have a totally different standard right so they and i think it's confusing for people when they hear compounding pharmacy they thought fringe they're not friends they're fda regulated they're board of pharmacy regulated in every state they are monitored they are inspected all the time i've worked with compounding pharmacies my whole career
which is going on close to 25 years now. Just like anything, there's some amazing compounding pharmacies and there's some not so amazing compounding pharmacies which cut corners. The ones we work with don't cut any corners. And I know that because they're inspected all the time, right? And it's a big deal to them. And they want to do it right with purity, with processing and making sure that
that anything they make, especially a sterile compound, which is going to be anything injected, you know, eye drops, things you inject in yourself, whether it's IV, sub-Q or intramuscular, they're considered sterile. They have to then be tested by an outside lab to make sure purity, make sure that there's no endotoxins, things like that. It's highly regulated and it's a big deal for them.
And it's a big deal for the physicians who prescribe with them, which I appreciate because the advantage of a compounding pharmacy is we can tweak the dosage. We don't have to use a standard set dosage. We can combine things synergistically to get one plus one doesn't equal two now, it equals four. And that to me is a huge advantage.
Just like we were talking about with the GLP-1, semaglutide and terazepatide, we get those compounded. So that, you know, we have the compounding pharmacy we're using now, we're making a unique combination of terzepatide and semirelin, right? Which will address some of this muscle loss that people are getting. So we can combine that.
So semirelin to stimulate growth hormone release, offset some of the muscle loss from terapazide.
Exactly. Yeah. And so you can do things like that with a compounding pharmacy. But again, just to make sure people understand, compounding pharmacies are highly regulated, highly regulated. Again, there's always going to be bad apples.
But physicians who know how to work with compounding pharmacies, I think, provide access to things that these conventional, both pharmaceuticals and conventional pharmacies can't.
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So is it fair to say that if one is interested in exploring the use of peptides for what you refer to as performance medicine, mental, physical health, and performance falls underneath that? Yes. essentially only put peptides into their body, maybe even on their body surface that they're obtaining from a physician who's obtained the peptides from a compounding pharmacy.
Yeah, and who's developing a relationship. So we, for any peptide that we use, we meet with the patient. We make sure they're a good fit. We make sure that there's no contraindications.
We also can recommend and specifically dial it up or down, whatever it is, come up with this is what we think you should use based upon your life experience, the medicines you're taking or not taking, the conditions you're treating or not treating. I think that's really important. Again, I'm biased being a physician. My whole goal is to get to know patients.
That's why I'm here is to kind of walk that walk and help people in that regard. And if someone's out there on the internet doing it themselves, they're walking in kind of on their own. And so not to make it like everything bad is going to happen, but when you have the help of someone who has experience, that goes a long way. I think particularly with something like this.
Yeah, I agree. And it worries me very much that people are buying PPC from dark gray market or black market sources. I mean, anything that says on it, not for animal or human use, for research purposes only, you can pretty much... guarantee the endotoxin, the lipopolysaccharide, at least has not been removed.
And that can be really problematic, especially since my understanding is that it can be cumulative over time. It's not that one injection causes somebody to go into anaphylactic shock. It's that some of this LPS can build up an inflammatory response over time. And then you don't know where the tipping point is. And then somebody can have a really terrible reaction.
Well, and then taking a step further, you know, getting away from just peptides. But I remember this was, I don't know, 15 years ago, someone was taking advice from a very famous doctor on TV about taking an oral compound to lose weight. And they called me up and they said, I'm having terrible headaches, terrible headaches for days. They came in, their blood pressure was through the roof.
You know, like, I don't remember the specific numbers, but let's just say 220 over 140. And normally it's 120 over 80. Well, did you take anything differently? Yeah, this doctor recommended I take this weight loss compound, right? So the problem is people have access to all this information.
But if they're not under the guidance of a doctor to help clean up the mess, and we clean up the mess, and not that there's always mess, but this is what we enjoy doing. As a physician, we've seen the darkest of dark. We're able to help people when things don't go perfectly planned, right?
And I think that's a big deal, you know, particularly when there's lots of these tools and they're exciting tools and they're great tools.
And fortunately for me, I've been in this space longer than most that I've just, you know, built up a large repertoire of experience of observing people and working with people and seeing we got to tweak this, we got to nuance this, or sometimes we don't ever want to use this again. You know, this is not for most people. Yeah.
So given that BPC 157 has been effectively removed from the legitimate market, what are people's alternatives? Again, working with the caveat that People should work with a physician.
Yeah.
Where can physicians get something similar enough to BPC-157?
So there's a new compound, newer, peptide called, shortened for PDA, pentadeca-arginate. It's basically the same molecular structure as BPC, except they've swapped out an acetate for arginate. One amino acid substitution. Correct. One amino acid substitution. And so we're using that and having really good results.
Certainly, it's early in the game of using PDA, but it seems very close to BPC in the clinical responses we're getting from our patients who are reporting back decrease in inflammation, all these wonderful things that we used to see with BPC. And I think... I surmise that this is how it's going to be with all of these peptides, right? Because again, peptides are just chains of amino acids.
Certainly a lot of people smarter than me trying to figure out how do we then create other types of amino acid combinations, i.e. peptides that do similar actions to BPC, to thymus and alpha, to ipamirone, to TB500, on and on and on. So I'm hopeful in that regard. And I also, you know, some of my patients work at the very highest level of the U.S. government.
They are well aware of this and who have assured me they're going to look at this, that this is serious, you know, because they've been using peptides. And they're concerned that, oh my goodness, the FDA came in and changed the game. It's been a huge setback. for all of us?
I definitely want to circle back as to what the motivation was by the FDA for doing that at some point. I think in the meantime, however, I think there's a lot of interest in BPC-157, a lot of use of BPC-157. The sources of BPC-157 are now drying up. And That's why I'm personally concerned that people are going to start going to the dark gray market and black market.
I'm excited about the pentadecarginate. Yes. So let's put that on people's ear map, brain map. Pentadecarginate may be a good physician-prescribed substitution for people that can benefit from BPC-157.
And a good starting dose, so to make it really clear for people and helpful, 250 micrograms to 500 micrograms. We're using 500 micrograms injected daily. Daily, again, we like Monday through Friday, take the weekends off. That's a good dosing schedule. We'll see how that goes. We probably can use larger dosages. That's conservative. But that's a good starting point for people.
And thus far, you haven't mentioned any side effects of BPC-157 or pentadecarginate. That's kind of remarkable. It's been tremendous.
Yeah, and we were using BPC intravenously as well. Patients would come in and, oh, tweak my knee, tore my ACL, tore my meniscus, whatever. You can give them BPC essentially as a bolus intravenously. my goodness, that made a difference. Now that using something intravenously from the pharmacokinetic standpoint, it's not going to last in the system very much. It's more of a spark.
Whereas if you use an agent subcutaneously, you're going to get more of a long lasting, you know, again, not terribly long lasting with peptides, but longer than using something intravenously. Kind of the sweet spot was certainly using both. You could use something as a spark to initiate that anti-inflammatory cascade, then follow up with a subcutaneous dose.
And even though earlier we were talking a little bit about some hormone replacement therapies, before that, off microphone, you mentioned that you prefer peptides to direct hormone manipulations in most cases. So I think while peptides can be hormones, there are things like – oxytocin is sometimes called a peptide hormone.
In general, when people think about hormone therapies, they're thinking testosterone, estrogen, pregnenolone, thyroid, et cetera. It sounds to me like much of your practice is built up around the notion that there are things that one can use, peptides, to kind of push and pull on these various systems without getting into them directly.
My understanding is the advantage of that is you don't get the negative feedback. You don't gain the shutting down of natural production.
Yeah. You know, testosterone is a great example because, like we were saying, I don't ever want to manipulate hormones. You know, growth hormone is another example. I don't ever want to manipulate that, meaning, you know, providing it to people more than they would get in nature.
This is why I actually don't, a little bit off topic, like when people use testosterone pellets or any sort of pellet therapy because you're exposing people to a concentration of hormones we would never, ever see in nature. I would prefer people inject it where you're going to get some variation in dose on a day to day basis, which we're humans.
So we do get some day to day variation or topically or under the tongue or something. Peptide, same thing. I don't want to manipulate the hormones, right? I want to just stick within kind of the highways of the lane, swim lanes for how they should operate and then take advantage of that.
And that's been a safe way to do it as opposed to and I've seen it, you know, talking about another peptide, which is Ipermorelin, a growth hormone releasing peptide. Ipramirelin, you inject under the skin, travels up to the pituitary, the posterior pituitary in the brain, which is responsible for putting out growth hormone.
That growth hormone then leaves the pituitary, enters the bloodstream, travels to the liver, where we make insulin-like growth factor one, which then enters the circulation, is very anabolic, meaning growth, healing, mending. You know, as we get older, we make less growth hormone. As we get older, we wear down. Obviously, we get, you know, degenerative conditions.
Part of that, I don't know what part, for everyone it's a little bit different, is because of our hormonal decline. And so when you can give something like ipamorelin, and we can talk about others, you're actually helping not only push out a little bit of growth hormone for people. We are directing when you push it out, right?
We think that's why it's important for people to be asleep by 10 p.m., between 10 p.m. and 2 a.m., because we think that's the largest pulse of growth hormone during the 24 hour period. Is that right?
So I've long wondered whether or not the The tale I was told when I was growing up, which is that every hour before midnight is worth two hours of sleep post-midnight. That feels true to me. Then again, feels true is often misleading, but feels true to me. But it makes perfect sense if the largest pulse and growth hormone is occurring in that couple of hours before midnight.
Yeah. I mean, that's how I learned it. I agree with you. It feels true to me as well. But taking advantage then of, you know, injecting something like ipramirelin at bedtime, then you're going to, you know, within a few minutes. And with ipramirelin, it's interesting because people will get a little flushing, tingling at times.
And what I've seen with the point I'm making is there are some physicians and some pharmacies which, you know, the dosage of ipramone and most of these growth hormone-releasing peptides should be 100 micrograms. That's the max dose to bind the receptor. And, you know, what I've seen is with ipramone, rare, but some people do get anaphylaxis. And it's happened.
And I think that happens when people are pushing it and giving more than they should. And I've heard of that. And they're giving 200, 300, 400 micrograms at a time, which is a big dose. Now what they're getting is the client, the patient is like, oh my gosh, I feel this amazing flushing. It must be working.
But then you could spiral into, oh, my goodness, I don't feel so good, and your circulation system collapsing.
Yeah, using side effects as an indicator of whether or not something's working just seems like a terrible idea. But it's very common.
Yeah.
I tend to be very conservative about these things. And by the way, I've tried various peptides for short periods of time because I like to experiment very safely. And some things like sermorelin, and we'll talk about other growth hormones, secretagogues, for me, for whatever reason, gave me great sleep, but only in the first part of the night.
It nuked my rapid eye movement sleep in the second half of the night. It spiked my prostate specific antigen. It was a very consistent effect. I came off it and it went back down. That went back on, it went back up. And so I just found I couldn't take it. And it didn't take me very long to figure that out.
But I know that there are some people who love sermorelin and don't see any of the same issues. So it seems like it can be very individual.
I agree with that. I agree with that. And that's why I think it's, again, helpful to work with a physician who has experience who can kind of, you know, I think of these peptides as having flavors, particularly the growth hormone-releasing peptides. Ipramerone, very clean.
You know, as long as you stay within 100 micrograms or less, people are going to lean out a little bit, sleep a little bit better. There's no real side effects. They take it pre-sleep. Pre-sleep at bedtime. Without carbohydrates ingested in the previous two hours, correct? Yeah, or 45 minutes technically. Yeah, but that's right.
And then they're saying like growth hormone release in peptide six, GHRP6, which is also going to bind. So I think of ipramarone being the most specific for the growth hormone receptor, but the weakest. So when you inject it, you will get growth hormone to come out and only growth hormone, but it's not going to be a big burst of growth hormone. You inject GHRP6, now you may bind some prolactin.
Now you may bind some ACTH, which is going to have your adrenals put out cortisol. Now you're going to get a hunger response, right? And maybe even have trouble sleeping if you're getting them. You may have trouble sleeping. But where that's beneficial for is if you're looking to put on mass or get strong, GHRP6 is your go-to, right? Because you will increase your appetite.
And if you're smart, you'll eat a lot more protein.
you know and the building of muscle is not necessarily complicated right it's resistance training sufficient protein which is where i think most people fall off and then having some anabolic kind of hormone in the background like growth hormone or testosterone or both helps that process that's where ghrp6 can shine i mean within weeks people will get big and strong increase their bench press whatever stuff flat out works but
But you got to know how to use it and understand the flavor. So the point I'm making is these different peptides have different flavors. And to your point, there's individual responses. That can be a good thing.
I think for most of our audience, the interest in growth hormone secretagogues probably relates to the better sleep and the overall feelings of vitality. And probably most people are seeking to...
not spike their appetite or put on muscle really these days we're hearing more and more from people both men and women who want to be strong without being big yeah and they prefer to be lean as opposed to not lean which i think is a great goal frankly that's my goal at this stage of life i just turned 49 yesterday and i happy birthday oh thank you thank you yeah thanks for coming out to the the birthday oh yeah that was a lot of mini bash the other day it was a lot of fun um
You know, I want to be strong and capable. I also want to be able to run and have cardiovascular fitness, but I don't want to be large. I don't want to take up a lot of space. I'm not interested in taking up a lot of space. And I think most people fall into that category.
I agree.
So if GHRP-6 can spike appetite, which for a subset of people might be useful, but probably most people will want to avoid it. ipamorelin, I've always been calling it ipamorelin, but ipamorelin at 100 micrograms dosage or less per night sounds like it's an interesting tool. What are some of the other growth hormone secretagogues? And I should just brief, I'll take the liberty of defining it.
These are peptides that stimulate the release of your own endogenous growth hormone. This is not taking growth hormone. Right.
Yeah. Two other main ones that we use, one would be tesamorelin. which is similar to semirelin in that it also is going to work on the growth hormone-releasing hormone aspect, a little bit higher up in the chain of how these hormones are released. So both semirelin and tesemirelin You don't necessarily need to add anything else to it.
Classically with ipramarone, hexarone, GHRP6, we would add this other compound, CJC1295, which is going to work on the GHRH, which allows the peptide and then the growth hormone to stay in your system a little bit longer.
The growth hormone releasing hormone. Correct. Yeah. But we can almost set aside CJC now because CJC-1295.
That's on the same list as BPC.
The FDA just came in and let's just say one acronym took out another. There you go. The FDA took out CJC.
That's right.
And BPC. And BPC. People are probably getting a little dizzy with these acronyms, but I think we're doing a good job of guiding people along. So Sermorelin and Tesamorelin are similar enough.
Similar in that regard. Testamerelin, again, talking about flavors, testamerelin works on visceral fat reduction, so fat around the organs. And it's been FDA approved for that purpose. Yeah, with HIV patients having this lipodystrophy, which is abnormal accumulation of fat, in particular visceral fat around organs. So testamerelin works well for that.
My observation from using it for lots and lots of people, it seems to work better in females than males.
Or does it lead to this feeling of enhanced sleep as well?
Yeah, so I think any of the growth hormone-releasing peptides, anytime you're going to make growth hormone more active in your world, that's how I think about it, better sleep, better skin tone, texture, right? You're more resilient. I think growth hormone is a resiliency hormone, durability. You know, people find that, oh, I do a hard workout, but it takes me days to recover.
I sprain my ankle, it takes me a week to recover. I cut my skin, it takes me forever to heal. They've got a durability issue. And that's how I think about where growth hormone can shine Not that you've got to go all the way to growth hormone, but these peptides can be a really nice push.
And this is taken before sleep, no food within 45 minutes of the injection.
And then kind of the magic in what we do is, you know, when we first started about eight years ago, we'd use one peptide at a time. And then what we learned is let's combine these peptides. Let's stack peptides. And that's how we do it. At lower dosages? Sometimes lower dosages. But, for example, we had a great combination, BPC, ipramarone, and tesamarone all together taken at bedtime.
And you're going to get subcutaneous fat reduction from the ipramarone, visceral fat reduction from the tesamarone, upregulation of the growth hormone receptor from the BPC. It was a wonderful peptide. We kind of labeled it as a fat loss peptide, but people would put on lean muscle mass. They'd sleep better. Their skin would be better. They'd be more durable. Their thought process would be better.
Awesome stuff. And that's where I think that's where we enjoy it is stacking these peptides together. So it's not, again, just one peptide at a time, but able to do it. And that's why, again, working with a compounding pharmacy, we can put these together. So you're only doing one shot a day. You may be doing three to seven peptides, but it's still one shot.
Trevor Burrus, Jr. : Got it. And if one is combining tesamorelin or sermorelin, ipamorelin and well, not BPC anymore, but pentadeca arginate instead because you can't get BPC-157 compounded. Is that done every night, five days a week, three days a week? What's the rationale of this five days on, two days off?
Yes, five days on, two days off, I came up with because of how we would dose growth hormone. So the traditional growth hormone dosing cycle would be five days on, two days off, taken at bedtime. Yeah. And that's where it came up. And then I personally, with patients and myself, I like to take breaks. So even with supplements, I won't take them on the weekends. Yeah.
Because I think, again, anything you expose yourself to on a regular basis is going to decrease the potency. We see that with exercise. We see that with food. If you're eating the same food every day, it seems to become less valuable for you. Change it up. We have to throw on the crazy switch every now and then. But change it up. And so then you're going to make it more potent for you.
I do the same thing with supplements. So that just resonates with me, with people, to take a break from stuff.
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I'm a huge fan of taking massive amounts of supplements that you are a big fan of taking CoQ10, coenzyme Q10, 200 milligrams per day in the morning. I also take CoQ10. I think I started taking it for quote unquote general mitochondrial health. I don't know that I thought very carefully about exactly what I was trying to accomplish with it.
But what is the rationale of taking CoQ10? So if I can break it down, try to keep it simple. People are familiar with the mitochondria. It's the battery of the cell, these little organelles inside each cell. And they're responsible for doing many things, but primarily making ATP, chemical energy. And so how do we make energy? Well, there's three main ways the body uses it or makes it.
First is glycolysis. We take glucose, which is a six-carbon molecule. We break it in half to make two pyruvates. When we do that, we make a little bit of ATP. That pyruvate then is converted to something called acetyl-CoA. We run that through the Krebs cycle. where we're also making ATP, but then we're making these intermediate products.
One of those intermediate products, and the main one is something called NADH. That NADH is then shuttled to the mitochondrial membrane for, you know, this is the magic where we make the most ATP, and there's five different hubs, or we call cytochromes, right? And this is how I think about it, because I just like to simplify. Cytochrome one is where we use NADH.
And what the different hubs are doing is we're exchanging electrons for protons. And that's a kind of an electrical process. We're exchanging electrons for protons, going down the assembly line to eventually turn this wheel, the ATPase wheel, to make ATP. The way I understand it is the five different hubs, different nutrients hit them. So cytochrome 1 is NAD.
Cytochrome 2 is riboflavin, vitamin B2, and succinic acid. Cytochrome 3 is CoQ10, vitamin K2. Cytochrome 4 is methylene blue, which we can talk about. And then cytochrome 5 are things like magnesium, vitamin A, and copper. So if you're thinking about mitochondrial health, if you include any or better all of those, you're going to maximize how your mitochondria can work and make energy.
It's the strongest way to do it. And it's, again, not necessarily complicated. So when I think of CoQ10, and again, we use a lot of NAD, which we can talk about, where I think most people, the traffic congestion happens on cytochrome one, right?
And so when we give people or upregulate their NAD production, it's essentially we're allowing for more electron flow at cytochrome one, which has a downstream effect on the other cytochromes, so the traffic jam opens up. And now you can move electrons to exchange for protons and make way more ATP. But that's not true for everyone.
And so some people, it could be at cytochrome three with CoQ10, it could be at cytochrome two, A lot of people have cytochrome 4, which is, again, cytochrome, we call it cytochrome C oxidase, which is where methylene blue binds. But that's just a simplistic view. We just, people, we run into traffic jams, right? These electron flow gets stuck. We're just trying to open up the traffic jam.
So 200 milligrams a day of coenzyme Q10 can be... can facilitate some of that.
For sure. And CoQ10 has been studied very safe, up to 2,400 milligrams a day, no harmful effects. Sometimes I'll take more, like I was telling you earlier, it's been dramatic for me with migraine headaches and basically reducing them to zero.
You know, as people are hearing this, they're probably thinking, okay, well, these are just, you know, this is what I call anecdata or whatever. I, you know, I don't have to remind people that you're a board certified physician.
I think that what was still ringing in the back of my mind this entire conversation, even though I'm paying very careful attention, is that most of the drugs that are prescribed in this country are off label. Yeah. I think that just like, I don't think I've ever heard that stated out loud. Yeah. Yeah. It's wild. Yeah, yeah.
So the idea that people would take something that wasn't shown in a clinical trial to be effective for purpose A, that it gets approved for purpose A, but then can be prescribed by doctors for purpose B, C, D, or E. Right. I mean, you're not telling me this is commonplace. You're telling me this is the majority of prescription drugs.
But it makes sense if you think about it, right? So if you took an antibiotic, right, like we can just an antibiotics can be very specific what it gets approved for in terms of like working against a specific bacteria. But then through clinical use and just experience, you know, we learned that, oh,
I can use doxycycline or a Z-Pak, azithromycin or whatever it is for a variety of bacterial infections that extend well beyond just what it's approved for. Well, that makes sense.
And does that ever cycle back to the clinical trials or no, this just becomes physician understanding and lore like, hey, yeah, you know, I've got patients that, you know, they get on azithromycin and their acne clears up. By the way, I'm not saying that folks, I'm not a physician, but But for instance.
Exactly what happened with semiglutidinazempic, right? Approved for helping glucose utilization or lowering, you know, blood glucose in patients with type 2 diabetes. And they found through use only people were losing weight. Mm-hmm. And now it's become blockbuster. And we see it with, you know, things like, you know, repurposing drugs for cancer, right?
There's a lot of that going on, a lot of the repurposing. So, you know, doxycycline is a very common one that's used in cancer therapies, I think by sophisticated oncologists. I don't treat cancer, but by sophisticated oncologists to use things like doxycycline, metformin, mabendazole, which is an anti-parasitic drug, right, to help with cancer. That's amazing.
So interesting. It is amazing. I think also I'm reminded that medicine, as beautiful a field as it is, I have tremendous respect for it, of course, is a field of fairly siloed training. And I love the idea that now, thanks to public education efforts like this one,
that you're providing us that physicians learn from each other in a much broader way and can potentially hear about what drugs can be useful for this or that. The other thing, and this is not editorial, this is a real observation. Pharmaceutical companies are very interested in the other uses of already approved drugs. Sure.
The research and development process for a drug, the safety evaluation is incredibly expensive. So they want nothing more than to take a drug that's already been approved for one purpose and to take that already safety approved drug and find other uses. How are they not circling back to the off-label use and understanding of these compounds and
and then essentially marketing them for these other purposes. Or I guess with Ozempic, that's exactly what happened.
That's what happened with Ozempic. I mean, it's again, I write prescriptions. I think there's a time and place. I think it's challenging for me, though, right? And I think for a lot of physicians, it's become challenging operating in a paradigm
When we talk about chronic disease, which is essentially failing, I mean, and we all know this statistically, we're not making huge dents in heart disease, cancer, autoimmune disease, neurodegenerative. We're not at all, but we're spending exorbitant amounts of money. Right. And this is, you know, something that I had to learn over time.
And I don't know how I got into it, but when I started my practice. Back in 2006, I started, it was traditional family medicine practice, but I started using these nutritional IVs. And this is before hangover IVs, this is before it was popular. This is, you know, 20 years ago. And what I learned was that these nutritional IVs help people feel better quickly.
And I developed this model for my patients, which I think is a better model, which is I want to help people feel better first, like we were talking about earlier in this podcast. Because if I can get people to feel better first,
What we learned through COVID, and honestly, what I want to say to you, Andrew, which is really true, your podcast and what you do has been so successful at a time during the pandemic when people lost so much trust in people like me, right? People lost that trust of, what do I do? This is a scary time. I don't know what's going on.
And you guys come along, you in particular, providing this very stable, vetted information that people can trust and have a starting point and be like, this is what I want to do. Because health, one of the gifts of COVID was it put our health on the forefront of most people's mind and life. And so what you're doing is tremendous work.
And I can tell you personally, no, literally like as a physician, I am just, it's such an honor to be here and to talk to you because every day, every day my patients come to me and said, I heard this on the Huberman Lab podcast. What do you think of it? And I am not joking. And I love that.
I think it is awesome because people, one, taking their health seriously, but two, they have a stable resource that they can trust. The problem with physicians, and I'll tie this back in, is physicians are hard to trust, right? And it's this paternalistic model, which is, and that's how I was trained, which is, you know, you're going to do this because I'm going to tell you to do it, right?
And I remember being in medical school, which was in the 90s. And I can't remember the exact specifics of the study, but they would go, they did a study where they collected the trash outside of physicians' offices, found that greater than 30% of prescriptions written that day were thrown away. Greater than 30%. Wow. And I remember learning that and I was like, what is going on? By the patients.
Correct. Like you came to the doctor because you wanted a prescription, right? No. No. You came to the doctor because you weren't feeling good. You came to the doctor because you wanted to be listened to. You came to the doctor because you wanted to be validated.
And most of the time, and this still happens to today, the vast majority of doctors will just write you a prescription or they'll write you two prescriptions. And that's not what most people want. Sometimes it is, and I do it, and sometimes it is, but there are so many other tools that we can use. And so when I help people feel better first,
Why I've been successful and I work with the peak people on this planet, whether the athletes, the best athletes, celebrities, the Royal family, you name it, I'm so privileged. It's because they trust me. And that trust is really important. I take that really seriously. You know what I mean? And so, you know, tying it back in is we've lost a lot of that with the pandemic.
It's actually come to the forefront. And so that's why I want to help people feel better first. You know, the traditional model of medicine is just get a diagnosis, write a prescription. If that prescription doesn't work, write another prescription. And so, yes, there's a time and place for that, but there's also time and place for just helping people.
It only works when people value themselves enough. Like we were talking, I can tie this back to weight loss, right? Why do people have such trouble losing weight? I would argue that most people don't value themselves enough to actually care enough to make the hard disciplinary choices in their life to get away from emotionally eating, you know what I mean?
To do the right things that they actually, it's going to be a struggle to get the right food for themselves, get away from processed foods, to be disciplined, to go to the gym on a regular basis. They don't have the right people that they trust. This is where you've been such a gift. Tremendous gift.
Well, thank you for the kind words. I mean, the birth of the podcast did take place during the pandemic and in large part because I saw, everybody getting very anxious, their circadian rhythms disrupted. And those were focuses of my laboratory.
And frankly, when I was a postdoc and graduate student, but especially as I got a little older in my years, I couldn't believe that I was reading these papers about how important it morning sunlight is and all these things. But then my colleagues were all getting sick and dying around me or getting what we call the tenured look where they show up, you know, start their job.
And five years later, they look like they've aged 25 years. And I realized that I wanted to avoid that. So I've always just enjoyed learning and sharing science and health tools. And so thank you for the kind words. I've, I've certainly, um,
been kind of both astonished and positively amazed in the ways that the pandemic and the post pandemic years, I like to think we're in the post pandemic years. I think we can safely say that now. how they've drawn people's attention to this idea that they need to take agency into their own healthcare. That no one, no pill, potion, injection, et cetera, can replace good behaviors.
Pills, potions, and injections can potentially augment those good behaviors and get people going down the right path, which is what we're talking about today. But that it's really a personal responsibility. I mean, no... No one can give us a calmer mind. No one can give us a healthier body. No one can do that, right?
It's interesting that some of the wealthiest people in the world, the new thing isn't for people to boast about their yachts or their properties. It's about... It's about their vitality, their longevity, because that's the thing that I suppose in some sense money can start to buy, but it doesn't require a ton of funds to take great care of one's body and mind.
It doesn't. And what I've learned, and I've had to learn this over time, and I think the wisdom is – And this is why it's even more challenging because I think people go on social media and they listen to podcasts and they listen to influencers. And a lot of the messages is additive, right?
If you're not doing a high intensity workout every day and then doing sauna for X amount of time and then cold plunge and all this kind of dieting, you're not doing it well. I know that that that stress of that is cumulative to people.
And so what I've learned, and I have a really good friend, probably the most affluent, successful, but also the most generous and smartest person I know who lives on the big island. And he says to me, which is worth repeating here, I look for every opportunity to surrender. And it is that surrender to people who you can trust to guide you right?
So you don't have to be the quarterback of everything, right? And that takes off the pressure. And I think finding it's not always about adding, it's actually creating space for us to just be in that flow, right?
Like it's to be in like, and I know you've talked about this a lot, that kind of active rest place where it's not about being super focused and it's not about just going to sleep, but almost the best parts of our day is when we're in that flow state where things just click. And to me, helping people with those types of times and figuring that out is the most valuable.
And I don't think people talk about that enough. So I appreciate that you do a lot.
Yeah. Well, and I appreciate that you're bringing up this notion that, you know, just stacking more and more behaviors, like you got to crush a workout and do sauna. And that is not the message. You know, sometimes we get teased and there's some good comedy takes on me that make me chuckle now and again. Yeah. But that's not the approach. These are tools that people can... It's a buffet.
And I think most everyone agrees that sleep is key. Most everyone agrees that exercise is key. Nutrition is key. Great social connection is key. When it comes to... because I want to make sure that we circle back to this. When it comes to the peptides, it seems that one of your approaches, if I may, is to kind of raise the tide so that the boat can get out to sea.
And we were talking about these growth hormone secretagogues. We covered... GH-RP6, which is the one that stimulates appetite, it's probably going to be a niche case condition that people would want to use that. Ipramirelin, tesamirelin, sermirelin. I get a lot of questions about, is it MK-677? Yeah. What in the world is MK-677? It sounds like a weapon.
It does. I think of it just like GH-RP6. However, it's absorbed well orally. So it's basically the same. I see it working this very similarly. To GHRP6.
So it stimulates appetite. It does. It can stimulate cortisol prolactin. It sounds like a not good situation for most people.
Not for most people. Although, you know, let me give you an example where I have a client, very successful guy, and he's been on testosterone. He's doing all the things, right? He's in his early 60s. He's working out well. He eats well, super well, all these things. Yeah. He can't put on muscle mass well, right?
And actually, as people get older, that does become an issue for a lot of people is maintaining healthy muscle mass. MK-677, before it was taken off the compound list by the FDA, it's another one that was included. Oh, another acronym taken out by the FDA. There you go.
But you can take it orally, which, again, removes the stigma or burden of having to do a shot, and you will increase your appetite. And that actually is a very useful agent metabolically for people as they get older. And I know this, my kind of approach with this, and both personally and professionally, I try everything I can.
And I remember MK-677 I took at bedtime and it was an hour later, I was in a dead sleep and I woke up and I had to go eat. It sounds like puberty. It was. I was like, what is going on? Because I didn't totally understand. I was like, what? Oh, I took that cap. Oh my gosh, I should never have taken it right before bed. And I had to go up and eat and destroyed my sleep that night.
But I learned, and I'll always learn, and I'm grateful for it, but don't take that one at bedtime. But it absolutely will stimulate your appetite.
Which are the growth hormone secretagogues that your more typical patients who don't want to stimulate appetite, both male and female patients prefer? What are you compounding for them?
Testamarillin, I don't see any appetite stimulation from that. Hexarellin, we haven't talked about that. I don't really see it. It's also about hexamerole. Yeah, hexarellin. Hexarellin. Yeah, sure. Hexarellin, I think of as more, again, if we talk about the flavor of these peptides, how I kind of look at it in my head, is more of the energy endurance growth hormone releasing peptides.
I like it for people to use it in the morning. They get a nice burst of energy. They feel it's a clean energy. It's not a caffeinated energy or jittery or anything like that. And it's good for more endurance type, you know, athletics are working out. So people in that, you know, field of competition or whatever, I think Hexerone is a great choice.
Does not spike appetite.
I have not seen that.
So this is taken first thing in the morning. You get an additional growth hormone release. Yes, you do. Yeah, you do in the early mornings when you're waking up. And you used to compound it with CJC-1295 to get the other pathways involved that can help. But now CJC has been taken out by the FDA. Right. But hexarone still exists.
That can be compounded. What's the dosage on hexarone that you typically prescribe? 100 micrograms. It's the same as these other like ipramoron GHRP6, 100 micrograms. The two that are different would be tesamoron. Ideal dose is 2 milligrams per dose, which is 2,000 micrograms, so quite different. And then semoron has actually a very broad dosing range, anywhere from 200 micrograms.
I've used it up to 3,000 micrograms, depending on your goals.
We were talking about coenzyme Q10 and the Krebs cycle. And I forgot to close the hatch on supplements more broadly. Again, doesn't sound like you're a big fan of taking lots of pills and capsules. I think some people will take that as a relief. I think a lot of people get tired of... taking a lot of pills. Some people don't like to do that.
What are some of the other things that you do take besides coenzyme Q10? Earlier, we were talking about methylated vitamins. Methylated B vitamins. Yeah. This is becoming increasingly popular. We're starting to hear more about methylation and methylated compounds. Could you educate us on methylated B vitamins?
Yeah. And I think people are familiar with it. You know, some people are talking on podcasts about the MTHFR SNP. We've not talked about that on this podcast. So it'd be nice. Sure. So a SNP is a single nucleotide polymorphism, meaning that genetically things don't flow as easily. Again, that's an oversimplification.
And, you know, you could be homozygous for that, meaning you have both genes making you, you know, influencing you more. You could be heterozygous, meaning it's just one gene. One copy from one parent. Yeah. Or homozygous copy from each parent. Yeah, you said it way better than I did. And so what that means is, and where we see that reflected, homocysteine is a marker we use, a lab marker we use.
It's an emerging marker for looking at one's cardiovascular risk profile. And so if one's got an elevated homocysteine, and elevated by some labs can be greater than seven, by most labs greater than nine, means you're at an increased risk. What that is, I don't remember, but you're at an increased risk of having a cardiovascular event, which would mean a heart attack or stroke.
And so we want to lower that number. And the best way to lower that number is taking ample methylated B vitamins. Methylated means you're adding a methyl group. So methyl B12, methylfolate, trimethylglycine, methionine. These are all methylation donors. which just metabolically and through your detoxification pathways in your liver is going to help you lower that homocysteine.
I'm sure it's more complicated than that, but that's most people. If you're going to take a B vitamin, take a methylated B vitamin because then you overcome. Again, we've done a lot of MTHFR testing. I don't think it's as profound as some people make it out to be like it's going to change their life. I've never seen that. Can it help you?
Sure, but you're going to overcome it by taking sufficient methylated B vitamins anyway.
And again, those methylated B vitamins are methylated B12.
B12, folate. There's a methylated B6. And then trimethylglycine. TMG is a good compound. Methionine is a good methyl donor. It's an amino acid. Are these taken in the morning or in the afternoon? I like taking them in the morning, although... I think, you know, for people to play around with, because I've certainly seen it, you know, people get that 3 p.m.
kind of slumber as opposed to reaching for the coffee or the donut. Take some more methylated B vitamins and see what happens. Or just the coffee. No, sorry.
You're not supposed to drink caffeine too late in the day. Lately what I've – I don't know. This is wrong to bring up on this podcast, but I can't help myself – I love yerba mate in the morning and afternoon. Coffee in the morning now makes me feel nauseous. I don't know if I'm pregnant or something, but it makes me feel nauseous. But I love the taste of coffee in the afternoon.
This is like a midlife thing. I don't know what it is. So now in the afternoon, like around 1 or 2 p.m., even just the smallest amount of coffee, it's like,
the most delicious thing i've ever tasted yeah i love coffee um it can mess with your sleep too late in the day but um that's a perfect segue to talk about sleep sure um because one thing that i know you've done a lot of work on and with are these peptides that can improve sleep not just by virtue of enhancing growth hormone release but um you know i'll just be very direct i um i
For the last, gosh, like four to six months, I've had the opportunity to try pinellin and injectable pinellin combined with glycine. Goodness gracious, in the positive sense of the goodness gracious, you're from the South, so I don't know where people have it.
Never before have I found something that can improve the amount of rapid eye movement sleep that I get besides rapid eye movement sleep deprivation. You know, sleep deprivation, the next night you'll get a compensatory effect. That's not the way to increase your REM sleep, folks. You know, there are a lot of things like high intensity exercise that improve my slow wave deep sleep.
Cold plunge early in the day improves slowly. Deep sleep. There have been a few other things. But with pineal, and by the way, I'm not doing this every night. I do this occasionally. I ran a little experiment and I track my sleep using the sleep tracker that's in eight sleep. And it's doubling the amount of rapid eye movement sleep that I'm getting. Yeah. Doubling. Yeah.
Which is, so like from an hour to two hours or from an hour and 30, it's like nearly three hours, you know? Even I posted a picture of a sleep score with some rapid eye movement sleep. It's not something I typically do. Yeah. But even the... the most competitive of biohackers, Brian Johnson, was like, oh, nice sleep score, you know?
Now, he touts a sleep score that's perfect every night for, you know, for every night, but, and I'm kind of poking at Brian, because we like to poke back and forth. We're friendly with one another. So the point being that Pinelan is a remarkable, way to increase rapid eye movement sleep.
I have very little knowledge about it, except that my understanding is that it might stimulate some regeneration or stimulation of the pineal sites of the pineal.
That's exactly it. You've nailed it. Yeah. I remember when you messaged me after starting it and you were like, This is amazing. It's amazing. Yeah, you were saying it's amazing.
I hope the FDA doesn't nuke it as a consequence of this conversation.
I hope so too. No, but I mean, your response is what we see with our other patients who are loving. And I think that combination with glycine, I'm a big fan of glycine and injecting it seems to work really well. But back to your question about Penelon, Yeah, I mean, it's one of the smallest peptides, but I think it's one of the most profound.
We used to combine it with epitalin, the Russian peptide that was used for circadian rhythm.
And for my understanding, epitalin also is involved in DNA repair and has been explored in animal studies for... trying to offset vision loss and some retinal degenerative conditions.
Yeah. Again, put on the do not compound list with all the others. That's a shame. That's gone. But Penelon stays and remains. And yeah, your response to it and experience with it has been very commonplace from working with patients and seeing that. I think there's a sort of circadian rhythm aspect with it as well, you know, and helping with melatonin production.
Obviously, that comes from the Penel gland. This is just, I'm postulating. I think there's more to the pineal gland than we understand.
Oh, yeah. Yeah, it makes things other than melatonin. That's for sure.
Yeah, and I think it's kind of elusive, but I think there's something to it. And I say that having used a lot of pineal gland with people over the years and having very similar responses, which is awesome. Like, everyone knows, like you said, when you sleep better, your entire day is better. When you sleep better, your life is better. Like, exponentially better.
I think of... The millions of people that suffer from lack of rapid eye movement sleep, the lack of neuroplasticity that can be the consequence of that, the lack of healthy removal of emotional labels on previous day memories.
that is the consequence of REM deprivation, the enormous impact on depression rates, the enormous impact on pretty much every mental health issue is made worse by, by lack of REM sleep. So I, I say, or I raised this conversation about pineal and with a little bit of trepidation, because I do worry that on the one hand, people will see it as a miracle drug. That's not what we're talking about.
It has this effect, but at the same time, I, Okay, I'll just say that there's another drug that was released recently. This is an FDA-approved drug in the category of sleep drugs called the DORAS. So it works a little differently. It doesn't push on the sleepiness system, so to speak. It suppresses the wakefulness system. And the idea is that it's supposed to increase REM sleep.
It was by name Quivivic and things like that. I tried it. It was a total disaster for me. I fell asleep, woke up three hours later, couldn't fall back asleep. I tried it. It was lower dosage. It's extremely expensive as well. So I'm going to piss off whoever makes Quivivic. I forget who makes it. It was a complete disaster for me. Pinelan has been incredible.
And here's what's really interesting about it to me is that it seems to improve my sleep on the nights when I don't take it, which makes total sense if it indeed is providing some regeneration of the pineal sites that make melatonin and others.
Yeah.
So here we're talking about something that one could potentially pulse with now and again and get improvement in sleep every night. Yes.
Yeah. Wild. Yeah. And it's, I mean, I think it's worth noting that you, you also take care of your health on many other aspects and that's probably why you were sensitive to it, but it worked really well for you. Right. And some other people, it's going to take longer, you know, if they're
you know, having to work on their diet and having to work on their exercise and having to work on their thought patterns. We don't talk about that enough, having positive thoughts. But yeah, it's been, it's so safe. We've never, ever seen, I mean, I never, ever have seen a side effect or negative side effect from Penelon. It's, and, and your response has been uniform.
You know, people don't always get there as quickly, but people get there with their sleep. Love it. And you compound it with glycine? Yeah. What's the rationale there? I really like glycine as an inhibitory neurotransmitter. It's calming to the nervous system over the years. I tend to start with that when people are having trouble settling down at night.
Not that it's going to sedate people, but just transitioning from being active. You know, 8 p.m., 9 p.m., wanting to settle down, glycine in pretty large dosages, at least most people think they are, starting with 3,000 or 5,000 milligrams orally, kind of tones down the nervous system. People relax a little bit, and then they tend to sleep better from it. And then you can dial it up.
Wow.
Interesting. We haven't done an episode of this podcast yet on heavy metals, but I'm very interested in this because many people write to me asking about metal toxicity and about mold toxicity.
Mold's become super big. Yeah, big. Yeah, I mean, it's very prevalent and it seems the more we talk about it, I mean, we've seen it for years and years and years. It makes sense, right? Like if you think about the amount of airplanes flying above us every day, pouring down heavy metals. I mean, it's massive. It's in the air, it's in the water, it's in the soil.
You talk about glyphosate or Roundup, same exact thing. So many chemicals and it's challenging for us as humans. The way I break it down, not to get too far off topic, is we're water-soluble organisms living in a fat-soluble world. It's the job of our liver
essentially to take the fat soluble stuff make it water soluble so we can excrete it right and that takes place in the liver in two phases phase one we're using the p450 enzymes like taking the trash putting the trash in the trash can putting out the side of the road you have phase two amino acid conjugation the trash truck comes and picks up the trash very few things in nature induce phase two independent of phase one meaning most of us have trash piled up on the side of our road
Those things are the polyphenols, right? And so things like the blues, the reds, the pigments. That's why it's important to eat a wide variety of colors in your diet. Matcha tea has a very strong inducing effect on phase two liver activity. Is that right? Yeah. I need to develop a taste for matcha. Yeah. I feel like it's kind of grainy. It is, and it's bitter.
But bitter things tend to be, again, helping that phase two. Glutathione helps phase two. We do a lot of that intravenously. And then glycine. is a wonderful agent for inducing phase two independent of phase one. And the trouble is, I don't think people realize, you know, people are told, well, you know, most pharmaceuticals induce a P450 enzyme.
And a misconception is, well, if I'm just inducing one, I'm good. If you induce one, you induce them all. So if you take any pharmaceutical, you're inducing your entire P450 system. You're speeding it up, meaning you're putting more trash out on the side of the road. And if you look at the amount of things we're being exposed to outside of pharmaceuticals, it's mounting. It's crazy.
We say on the side of the road, you mean in the liver.
Yeah, that's what I'm saying. I'm just using that as a metaphor. Yeah, yeah, yeah.
You're not about screening it in the, you're talking about, building up of debris, cellular debris with it, or excuse me, metabolic debris within your body.
Right. The trash, again, very oversimplification. You need to speed up phase two to get the trash trucks come to pick up the trash so that you can then take that compound and excrete it in your stool, in your urine, your sweat, your breath. I mean, it's the only way it works. It's not complicated per se, but I think there's a lot of misconceptions about it.
So when people take a peptide that's injectable, pineal and glycine, the ganglycine, obviously, but for let's say somebody doesn't have access to you or to for whatever reason, there's a barrier. to getting a hold of those peptides. Can people take glycine orally?
They can. Yeah, glycine is absorbed well orally. It has a really sweet taste. It's actually the smallest amino acid. A huge fan of it. We've been using it a long time. You can take big dosages of it. Very sick. Again, my starting dose is usually three to five grams at bedtime. And then the way I do this, recommend it, is try that for a few nights in a row.
You're not noticing a thing, double the dose. Go to 10 grams, literally. Most people at 10 grams of glycine will notice it. And again, it's not going to necessarily make you drowsy. You're not going to be sedated. But your nervous system is going to be toned down a little bit. It's going to help you fall asleep a little bit better.
And then while you sleep, where a lot of this detoxification process starts working, you're going to be more efficient in how your liver works. Everything ties together. Right.
I'm still a big fan of things like magnesium threonate, apigenin, which is a chamomile derivative. And I'll try glycine. I think a few years back I was using a little bit of glycine, but it was more like 1,000 milligrams. But now that it's in the injectable peptide, the pinelon, I don't take it. Is there an oral form of pinelon that works?
There's these bioregulator peptides, which were developed by this Russian scientist, last name Korvinson, I think. Done a lot of research, actually. There's published research about it. I think Penelon's one of the ones that... They say we'll survive the stomach acid and get through the gut and be absorbed. So I think that's true. We've always used it as injectable.
And I tend to like injectable things for the bioavailability. So yeah, but to your point, I think people can. Those are going to be harder and harder to find, actually. It's probably easier to find an injectable pineal than an oral one.
Yeah. And as we're talking about this, I'm realizing, unfortunately, just the way the internet works, that people are going to start selling likely as a consequence of this conversation, we'll start selling pineal. And, but you need to know that you're actually getting pineal. And I mean, it's very easy for somebody to just pop something up on Amazon and sell it.
And maybe they just throw some melatonin in there and call it pineal. And like there, there's a lot of like BS stuff out there. So this is why the compounding pharmacy component and working with a physician.
Yeah. And researching, right. Making sure that what you're taking is, is legit. A lot of illegitimacy out there.
Do you think the pharmaceutical companies are going to move into these other peptides? I mean, certainly ipamorelin for the reduction in visceral body fat, that's an FDA-approved drug. So is sermorelin an FDA-approved drug? Mm-hmm. The GLP-1 agonists, FDA-approved drugs. So the FDA is unlikely to pull those, but they're a blockbuster, especially GLP-1.
I mean, they're making not even a small fortune but a large fortune.
Big money. The concerning part about the GLP-1s is, to me, is what we're starting to see. They've been able to be compounded because there was a shortage. And the way it works with compounding pharmacies is because those are brand – named drugs, and they're not patented for the peptide, right? They're patented for the delivery system, which is the pen, which most people don't realize.
And they've been able to be compounded and then way more affordable because they're compounded. And there is rumors that the pharmaceutical companies now have supply back. They'll come back and they will remove the ability to allow these peptides to be compounded, which means we'll have to stick to traditional dosages and people will lose access because they're going to be way more expensive.
I mean, they are. If your insurance doesn't cover it, $1,500 a month for most people. Very expensive. That's a lot of money. Yeah. For a lot of people, that's rent and more. So I'm hopeful that doesn't happen. But that's in the works. That's in the works. And that would be a huge shame. And again, I'm not a pessimist by any means. I'm a perpetual optimist.
So we'll just make sure that stays this way. But again, if it does happen, we'll get creative and go other routes as well.
earlier you mentioned stem cell therapies. Those are not FDA approved in this country.
They are actually. You can use- Sorry, my mistake. Yeah. So I think that using the term stem cell is a problem, right? If we use the term autologous cell, right, which would be PRP, it's basically the same thing. Platelet-rich plasma. Right. They take your blood, they spin it down, they take the- Right. And so the ruling is, I understand it. As long as you're taking a cell from you,
and you give it back within four hours then that is allowed with under the fda guidelines interesting there was this clinic in um florida a few years ago was um touting stem cell therapies for macular degeneration injected some stem cells into these patients eyes and they went blind really quickly and they were not blind prior to the injections
That, to my understanding, caused a severe setback to the whole field. I'm old enough to remember when gene therapy was set back by about 10 years because a patient received gene therapy, which is now pretty common for certain diseases, and the patient died. It's unclear exactly why they died, but that delayed the field of gene therapy by at least a decade.
I mean, this country is very conservative when it comes to the approval of new therapeutics.
Sure.
Yeah.
Yeah, no, and I think, like anything, there's going to be people who get too aggressive. I've heard of doctors injecting stem cells into people's discs, and then they get discitis, an infection, and that can just spiral very quickly. I think you've got to be reasonable in what you're trying to accomplish.
I'm excited about stem cells and exosome therapy and PRP and PRF and using them as, you know, kind of biologics because I think there's a lot to learn. I think we only know very little from what we've seen from working with our patients. It's been tremendous from a rejuvenation standpoint.
Mm-hmm.
Well, certainly you have the clinical data to back those statements. Thymusin alpha-1, what is this peptide? But maybe before we discuss it, did the FDA nuke thymusin alpha-1? They sure did. Whoa. Okay. They're coming through with a howitzer and taking out all these peptides. They are. Okay. Well, then let's keep this relatively brief. What was thymusin alpha-1 being used for previously? Okay.
Yeah, I think it was, from my observation, the best peptide for immune modulation. So we would use it if you had an overactive immune system, like autoimmune disease. By definition, if someone has an autoimmune disease, their immune system is attacking their own self, right? That's classically lupus, rheumatoid arthritis, things like that, celiac disease, type 1 diabetes.
Those are all autoimmune diseases. We could use thymus and alpha-1, and we'd tone down the immune response. We'd also use it a lot in post-COVID, where you have an abnormal immune response or the immune system hasn't caught back up and you can kind of dial it up using thymus and alpha one in a very simple use a lot with long COVID.
And we were using 5,000 micrograms a day, sometimes intravenously, getting great results, very safe, had no issues with it. But unfortunately, it's off the table.
I hear a lot of complaints about brain fog with long COVID and brain fog generally. Cerebrolysin is a very interesting compound. Yeah. My understanding is that Cerebral Lysine is available in Europe more broadly than it is in the U.S. Is it still? It's available here. Did the FDA, is it taken out? No, it's still available. Okay, all right. Cerebral Lysine made the cut.
Yeah, it made the cut.
We'll see what happens after this podcast.
That's right. We've used a lot of Cerebral Lysine. I actually have a clinic that's open in London. We actually did use it. We've used it a lot more over there than over here. So you have a U.S. clinic and a U.K. clinic. We have one based in London and one in Charleston, yeah. Okay. And I think cerebral isin has been used for decades in the setting of post-stroke, post-traumatic brain injury.
The trouble with it, again, I've observed with people They get cerebral isin. We're talking about IV. You can also use it sub-Q. Is they will have a day or two where they feel really down and out. Like it's like their mood shifts to like this dark place. Scary. Yeah. And they come out of it. But most people don't like that feeling. And so we just, we stopped using it mostly. Yeah.
For that reason. My understanding is that cerebral lysin is a kind of a cocktail of brain-derived nootrophic factor, ciliary nootrophic factor, like some other things. It's not one thing.
Yeah. And I think, right. And I think, I think collectively it increases BDNF levels, right? Like there was dihexa too. You know, if you're familiar with dihexa, that's another one that was removed by the FDA. Supposedly the most potent way to increase, you know, brain-derived nootrophic factor is kind of the juice the neurons live in again, oversimplification. that's gone.
But I think cerebral isin did the same thing. Interesting.
So as long as we're talking about maintaining or boosting cognitive function, here's one I've never tried, but you and I have talked a little bit about. And it's still seen as kind of renegade, but it's becoming more commonplace. And that's methylene blue. And I always make the joke that I used to use methylene blue to clean my fish tanks. Because I'm a big fish tank aficionado.
At least I was when I was a kid. Right now, I don't have a tank, but it's empty. No pun intended. What is methylene blue and what are people using it for? And does it turn your tongue blue?
It does for sure. Not permanently. Not permanently. It's actually the first... pharmaceutical ever prescribed in this country in the late 1800 was methylene blue. Goodness. Here. So it sounds like really renegade, but it's not. Got it. Yep. But it's it's gained favor in the last five years.
That's certainly when we learned about it, particularly, you know, I learned about it through this doctor who was telling me with COVID patients he was getting immediate, like within a day of stopping of COVID symptoms from using methylene blue. That's what like piqued my interest. Like, wow, that's incredible.
And then he went on to say that then COVID tests were turning negative within a matter of like two days, which was unheard of. I've seen that with something else, but I'll get back to that. And so that's when I was like, oh, this is, you know, it started to be talked about and learned about it.
So methylene blue, when we talk about the mitochondria using that mitochondrial membrane binds to cytochrome C oxidase. And I think of it, you know, traditionally it's used when people have carbon monoxide poisoning. They'll still use it. You go in the emergency room, you have carbon monoxide poisoning, it'll give you methylene blue.
And it helps your red blood cells displace the carbon monoxide and put oxygen there. And so it's an oxygenator. That's how I think of it.
Is it used as a performance-enhancing drug in endurance sports? Because this sounds like the kind of thing that cyclists would really want to use. For sure. Check with your local governing body. This is always a question I get. People are like, they hear something on the podcast and they go, can I take it or am I going to get disqualified?
And I always say, I have no idea if you'll get disqualified.
Yeah, I don't believe it's on the water list. Okay. I don't believe. Or just look for the people with the blue tongues. Yeah, easy test. So methylene blue, absorbed very well orally. I think of it like NAD, the molecule NAD, because it works on those cytochromes. Different than NAD, though, because NAD is not, if you're taking NAD by itself, not absorbed orally well at all.
It's one of the trouble with it. Methylene blue is, and actually you can take way bigger dosages orally than intravenously. We've given it intravenously a lot, but we're limited in using it intravenously just because it'll start to cause some spasm of the vein. The arm starts hurting if you're giving too much methylene blue, either too much or too quickly. And so we can give it orally.
You can get a capsule of it. That's how we, our pharmacy- What dosages? So I think a good dose is no more than 10 milligrams. 10 milligrams. Yeah. Taken when? In the morning. It is, you know, it's a cognitive stimulant for sure.
I mean, I've had more people over the last five years because we make methylene blue, we combine it with some other agents, a little bit of caffeine, some B vitamins, and people say this is the best thing for, you know, my brain function, recall memory. Kind of quote unquote nootropic, a term I don't really like because-
There aren't circuits for being smart. There are circuits for task switching, et cetera.
I get it.
So it's 10 milligrams of methylene blue combined, and you've got some other things in the cocktail version that you make. Take it in the morning on an empty stomach.
Yeah, you could take it with food, though. Again, it's going to be well-absorbed. Interesting to people, I need to say, it will turn your urine green or blue. For how long? About 24 hours, depending. That could be kind of fun. Yeah.
Well, and a good caveat is if it doesn't, and I've had patients, then that's interesting to me as a clinician because it means that your mitochondria is not working well, right? The way I see this is you should get spillover. You shouldn't kind of use it all. And if you're not, there's something wrong there that you're using all
all of it, and you're getting no spillover back into your bloodstream, which gets filtered into your bladder, your urine, which you urinate out. And that's happened with a couple patients. So it's like, oh, wow, you had no green or blue urine. There's a problem with your mitochondria. So it's putting more oxygen onto... the blood cells? Correct.
Like your, your hemoglobin is able to pick up more oxygen. That's exactly right. But then there's the, you know, a mild MAOI inhibitor, which is monoamine oxidation. Yeah. Which can allow things like serotonin to work a little bit longer in that synaptic cleft. You know, and you've expounded,
way better than i can about serotonin and dopamine and how those work but um there is a cognitive enhancement from it for sure it's very real and we have a lot of people using it and love it it also seems to be an antiviral you know you get this again that's probably through the mitochondria making your mitochondria more efficient It's a prescription drug.
It's a prescription drug, but there's now, and I don't totally understand it, there's now strictly over-the-counter nutraceutical supplement options that are methylene blue. For sure. Anyone can go online and buy it. For sure. Trust me now that there are going to be a few. And you talked about turning your mouth blue.
If you take a liquid form, right, and we'll do that sometimes in the office when we're doing other treatments. We'll give a big dose of methylene blue to kind of help fuel, kind of quickly make a lot of ATP, which we want to do with some different IV treatments we do. So we'll give sometimes up to 50, 5-0 milligrams at a time. Their gums, teeth, lips are blue for about an hour or two.
And how often can people take methylene blue? Again, you could take it every day. I think it's a little bit longer acting. I don't take it every day. I take it about three times a week. I think that's about right. I do have people who need it more for whatever they're dealing with. I do think as a nutrient, if we're going to call it that, it's – It's an insurance policy for your mitochondria.
So earlier you mentioned a patient, or maybe it was patients, plural, that experienced a more rapid transition out of a COVID infection or maybe more recovery from long COVID symptoms, et cetera. It reminded me of the second time. I got COVID, far less intense than the first time. But the second time I got COVID, I had an amazing experience where my COVID test was very strong band.
It was very clear. Like I had COVID. There was no question about it. I didn't feel good. I was fatigued. wasn't super severe. I would put it kind of on a six out of 10 on the kind of malaise level. No fever. Okay. So I stayed in bed and stayed away from people, this sort of thing. But I did an NAD infusion. I of course told them I had COVID. They came over, they gave me an NAD infusion.
And
Correlation is not causation, but I think it was 750 milligram NAD infusion over the course of about 45 minutes. I had the usual feelings that one gets when you get an NAD infusion of you feel like an elephant is stepping on your legs. Your chest kind of cramps. And then when that stops, you feel much better than you go into the thing. The band was absent the next day. My symptoms were...
I went from, I don't want to say gone. I went from, you know, like a five, six out of 10, as I mentioned, to like a two out of 10. And within another 48 hours, I was good to go and better. Now this is correlation, not causation. I don't know what was going on. It could have been the saline bag, right? Could have been any number of things.
But the shift from a dark band to no band was so dramatic that I took another test after the no band. And then, of course, the next day and the next day, this kind of thing. It's interesting. I don't know what it means. But one wonders whether or not it's just a – global way of combating inflammation.
Anytime I think about a systemic effect, and the reason I raise this is that I don't want to give the impression that I think that NAD is specifically in the pathway that was targeted, but that by Brain and body were inflamed. Clearly, I had an infection. You could have a flu. You could have a cold. You're inflamed. What are your thoughts on that anecdote?
Again, it's just anecdote, but what are your clinical reflections?
We've seen it so many times. Yeah. I mean, the... for the longest time. And so we've been using NAD longer than most. I'm fortunate that I was given the original NAD infusion protocol, which came from Mexico. It's kind of a long story. I don't want to bore you, but that dose is to 750 milligrams is actually what we came up with in my office.
And that's what most people adopted just because we've used it more than probably anyone else on the planet. Huge fan of NAD, very biased, but that's only because I've seen it work over and over and over in inexplicable scenarios, just like you're describing, where it's not just you go from A to B, but you're going to A to Z.
very quickly and i used to use the word transformational talking about it not just okay going from a sick state to a well state but in most people going from a well state to a super well state really quickly and it's super impressive so there's a lot more to energy than we understand right because just very empirically giving someone this coenzyme this vitamin b3 derivative how is it
dramatically changing symptomatically how someone feels, but it does. And I've seen it with thousands upon thousands of people, certainly in the setting of COVID, certainly in other bio infections, you name it. I have been more impressed with the work of NAD than probably any other agent we've ever used.
Amazing. Yeah. I take sublingual NMN each day. It makes my hair grow ridiculously fast. I've done the control experiments. I'm a scientist. I know how to do control experiments. It's still just N of one. It's just me. Makes my nails grow really fast. Makes my hair grow fast. That's the major consequence. By the way, I want to be clear.
I don't have any stake in any company that sells NAD or NAD infusion. So I'm just reporting what I'm reporting. I think it's great. Somebody who's quite expert in the NAD Pathway, Charles Brenner, who I believe has a relationship to a company that makes NR supplements. I think that's correct. Encouraged me to try NR. I took these NR supplements.
This is what, it's NAD minus a phosphate group is my understanding. And those I took orally. I couldn't tell if I got the same or different effect because I was taking them together. I didn't continue to take them because compared to NMN, it was very expensive.
Yeah.
And I just stopped taking it. So that's why I use Sublingual NMN. But In brief discussions with Charles and forging online, it seems that there is some literature, human clinical literature, showing that NR can reduce inflammation. Is that right?
Yeah, for sure.
Less data that NMN can reduce inflammation, at least lack of human studies. Okay. So we're still kind of in the, it's still murky, foggy territory with respect to the research and clinical- And the biochemistry. Yeah.
Yeah. And like, what does the biochemistry do? And the way I think about it, again, because we kind of pioneered the infusions, the NAD drips, which for me, transformational, just observing lots of people who I never saw the same thing with NMN and R. You know, you're not having these transformational experiences within a week.
You know, I tell the story a lot is I had a patient, he was diagnosed with a chronic Epstein-Barr virus, which is rare, but it does exist. He was depressed and on disability just because he couldn't almost get out of bed. This is mono? But it was reactivation of Epstein-Barr. Yeah, yeah. And so very like fatigued and depressed and literally on disability, couldn't work.
And he, I said, before we do anything, the way I operate is I want to get you feeling better first before we start to tackle some of the bigger things. We did the loading dose of NAD, which we came up with five treatments in 10 days. Came back to my office. His wife was there. She was crying. She goes, in a week, my husband is back. And I've seen that so many times with NAD.
And I can't explain it, right? And if I just stick to the biochemistry, it doesn't make sense. Oh, you're increasing the NAD to NADH ratio, fueling the mitochondria, which are all over the body, thousands per cell. There's something that we just told, there's gotta be outside the mitochondrial effect of NAD that's not well understood.
So in the backdrop of our conversation today, there have been a number of themes. But one of the themes that seems to keep coming up is that there are a lot of things about medicine that we don't understand. Totally. And yet there are tools that seem to work for certain people extremely well. A few years ago, I went to a meeting. This is a foundation meeting, a foundation I was a part of.
where you get to see talks from really the best of the best laboratories, and they only show unpublished data. And at the time – I don't know if this paper is published yet, but at the time they were showing that they took people that were diagnosed with – major depression. And they start doing a bunch of metabolomics on them. Now this sounds pretty standard for social media.
It's actually pretty heretical. Not a lot of places have done this right. So a couple thousand patients blood draws, they're trying to figure out, they ask a simple question, are there any specific vitamin deficiencies that are associated with depression? And as I recall, they identified a few different types of vitamin deficiencies.
So it's not like one vitamin, it's not always methylated B6 or something like that, or excuse me, it's not always B6 or B12. But they found these clusters of patients that had major depression that were deficient in a particular B vitamin, they supplemented back the B vitamin and lo and behold, those patients showed remission of their depression.
So one could conveniently conclude, oh, well, all depression is a B vitamin deficiency, but of course that's not true, right? More likely depression like fever is just a raw description of symptoms. But what was so exciting about this talk, to me anyway, was that people were starting to look at nutritional deficiencies as a potential source of mental illness.
which now has a bit more traction, but at the time was like, whoa, what are we really saying here? I thought all of depression was a serotonin deficiency, right? This kind of thing. So when you talk about NAD having these transformative effects and the fact that NAD can kind of raise the tide on a number of different biological processes, to me, it makes perfect sense.
It might've kicked off some mitochondrial pathway or some cellular pathway that then fills in a blank that's desperately needed. Is that one way that we can conceptualize this? That makes total sense to me. Okay. I like how you've described it. So how often do you encourage your already healthy patients to do NAD infusions? What are the dosages?
I should mention the NAD infusions for most people are a little bit costly.
They are costly.
They're like anywhere from... $500 to $1,000. Or more. Yeah, or more. If you're in Los Angeles.
So assuming someone has the means.
Yeah.
So here's what we found. And again, just found it by treating a lot of people and learning is we do a loading dose for most people. We found the sweet spot to be 750 milligrams. Intravenous. Intravenous. When they were doing NAD in the 90s, and they were doing it for substance abuse, so alcohol, pain medicine, morphine. They used it for that? That's where it came from.
Actually, it was in the 90s, people traveling to Mexico for NAD infusions. That protocol was 10 straight days of intravenous NAD. The dose to use was 3,000 milligrams. 3,000 milligrams? Yeah, and that's why it took 6 to 8 to 10 hours per infusion. You could not get through it.
Putting 500 milligrams in over the course of 45 minutes is going to be very uncomfortable. Many people take an anti-nausea med.
So I'll tell you about that. So that comes from... There was a gentleman in the States in 2006, lived in Louisiana. He had a pain medicine addiction, went to Mexico, got the NAD protocol, changed his life. He then licensed the use of the only injectable NAD product, which was from a South African company at the time, brought it to the United States, opened a clinic in Atlanta.
All he did was addiction. And I got to know him because I'm in Charleston, not too far, involved in IV work. He was not a physician. I don't remember the time, but he came to me and said, hey, I need some help because I'm getting a lot of questions about this NAD stuff. And so he handed me the original protocol. And I'm super grateful and fortunate.
But what I realized is no one has time to spend six to eight to 10 hours in someone's office. You know, they may do that once, but they're not doing it more than once. So we started trialing, you know,
different dosages 250 500 750 000 on up and i just found collectively by watching people how they did 750 milligrams was a sweet spot meaning they'd get the benefits which we can talk about but then they could get through it in an hour or two hours and that was meaningful and then we found that we don't need 10 straight days that's too much that just is crazy we found that five treatments in 10 days again afforded people
The ability to have great benefits, which were uniform, probably 95% of people who do a loading test will come back and tell you their brain is getting bigger, they feel more creative, they have an elevated mood, they can sleep less but have more energy, colors look brighter, languaging is easier. I mean, this is all very real.
So I think it affects the nervous system first, just because of the concentration of the mitochondria for every single neuron in the body. The physical components, meaning recovery and helping with physical exercise, those come, but I think they come later. And so we settled on 750 milligrams. We settled on the loading dose.
And then what I noticed is that people were coming back between three and four weeks saying, hey, I don't feel as good as I did after I did that loading dose. And so we started doing a once a month maintenance dose. And that is what we still recommend to today. Some people will do less and some people do more. I have some people who do it once a week, but plenty of people do it once a month.
And then some people do it quarterly. Some people do it whenever they can. On average, once a month seems to work really well for people. Then during the pandemic and realizing this is growing, because again, we train practices kind of in the medicine that we practice. We've trained 300, 350 practices and kind of give them the playbook, so to speak.
People weren't coming to the office as much with COVID. So we started doing it subcutaneously. And actually that's worked out really well. We'll do 100 milligrams subcutaneously. Again, five days on, take two days off. You get a little bit of that stomach cramping from the 100 milligram injection. Like you said, can't really be absorbed well orally, not gonna really work.
So you're gonna have to inject it or infuse it. Agreed, there's a price point here. It's going to cost money. But like most things, it's to me, if I had to pick one thing for people, engaging in NAD would be it. Really? Yeah, yeah, I would.
Of all the things we've discussed?
Of all the things. I've just been so impressed over the years. Now, peptides are amazing. Not to knock peptides. There's so many peptides, and we'll get there, right? Because you can take this peptide for the nervous system, this peptide for the immune system. But collectively, one agent, one thing, it's NAD has been the most impactful from where I sit working with patients.
Well, that's a significant statement. So 100 milligrams injected subcutaneously, you get a little bit of stomach cramping.
Yes.
As compared to the 500 milligrams to 750 or 1,000 milligrams that one brings in IV. The fastest I've ever dripped it in was... I think like 40 minutes. I can tell you the record. What's the record? Three minutes and 26 seconds.
Is that you? No, no, no, no, no, no, no. For a 500 milligram? 750 milligrams. Two separate people did it. 500 cc's of saline. Three minutes, 26 seconds. Wow. It's insane. Yeah. I don't recommend it. No, no, we wouldn't allow it to happen. It's too much. You've got to have a lot of experience with anything.
Yeah. I found that because you have to sit there for a while, you could think, okay, well, you organize the... the plumbing correctly that you could type or something, but you feel garbage enough during the infusion that you get irritable. It's actually a very interesting window into empathy for people who have pain.
Totally.
You know, when you're in this kind of whole body kind of systemic pain and discomfort and you're getting that saliva, I'm kind of sensing it now. I have a distinct memory of this. Kind of like for people that get seasick, you think about being on a boat and walking back and forth. Get a little nauseous. Someone would walk in the room and you're like, why are they walking like that? Right.
You know, and it's your own, it's your sense of pain. I normally don't have that response to people. I'm not a moody person in general. But then, you know, when you remove the infusion, you feel great. And all of a sudden, people seem delightful. The irritating person. It's a very interesting experiment in social empathy.
It is. And this is just what I postulate is that a lot of people are challenged because a lot of people are numb. Right. to the world they live in. They don't feel things. And when you do NAD, there is nothing like that experience and that feeling. And so you are going to just psychologically say, something is changing inside of me.
And it's something powerful because when I receive it, it's a lot. And to your point, what we do is we have kind of an IV room where we have like eight chairs and we make it social. Because when you're talking to people and learning about their experiencing it, there's actually a lot of healing that occurs just from that community. That's a rebonding experiment. It is.
Yeah. For people that can't afford the infusions, the injections would be the next best bet. If they can't afford those? Would it be the sublingual NMN or NR?
I think so. I think the NMN, I would choose over NR.
Yeah. So going from most expensive to least expensive, most expensive would be IV, then it would be subcutaneous, then it would be NR, and then it would be a sublingual NMN.
Yeah. That's about right. I mean, you could do NAD topically. It's a little bit wildcard doing it topically. You could do it under your patch. The antiphoretic patches. Those give me a really terrible... The problem is the patch.
I get this itchy thing.
It's the patch. It's adhesive. It's too strong. Lots of people get irritated. Their skin gets irritated. I think the NAD gets in well, but the patch itself is a hindrance, obstacle.
And for those that are listening to this and They may recall I did an episode of this podcast with Dr. Peter Attia where we talked about NAD and NMN and NR. that was mainly focused on the research literature. You're not gonna find much. So what we're talking about here is clinical experience.
Yeah, full disclosure, I'm a clinician through and through. So my experience is observing people. You're interested in what works. Well, but I'm confident about it because I've done a lot of it. I've seen a lot of how peptides work because we've done a lot of it. It's NAD because we've overseen, again, a lot of NAD tests here and in London, all over, and the providers we work with.
So we get a lot of feedback about what works and what doesn't work, you know.
Speaking of clinicians and science and all of this, there are a couple other peptides that have received FDA approval that are commonly in use. Things like PT141, which is in this melanocyte hormone pathway that's used... One of its FDA-approved uses is, I think the brand name is Vileci, is for female hypo-libido. So it stimulates libido in women. It's also used to stimulate libido in men.
Is that right?
It can be. And it can be helpful for, it's like a neurogenic mechanism for erectile dysfunction.
So it's not just related to blood flow?
It's not, actually. And PT-141, yeah, like a fragment or derivative of the peptide melanotan, which stimulates alpha-melanocyte-stimulating hormone, which is becoming more in play, I guess, in the environment I operate in just because of mold toxicity. And we think of mold toxicity being a biotoxin and hitting MSH being kind of the general in terms of a lot of these hormonal pathways, actually.
Mm-hmm. And melanotan can bolster by putting out more melanocytes. Stimulating hormone seems to bolster immune response. I think there's an element with energy, too. The downside of melanotan is it stimulates melanocytes, so you're going to get this tanning. And it's not like a... It's like an orange-looking tanning. From the inside out. Yeah, you see it. You recognize it.
So PT-141, what they found is in rats, I think it was, female rats were copulating more when they got this compound. And they're like, oh, cool, and let's try it in humans. And it's led to that. Our trouble with it is a very small or narrow therapeutic window. And if you give too much, you're going to get nauseous pretty quickly. Yeah.
And some people don't like, particularly women, don't like that tanning look.
It's not a very- It can look very unnatural.
Unnatural is the word.
Yeah. The medial pituitary, which at least my understanding is the origin of these peptides that we're talking about now is super interesting. And you mentioned the nausea. These peptides hit multiple pathways. When we had Dr. Zachary Knight from University of California, San Francisco, on to talk about GLP-1 in a lot of detail, he mentioned that
some of the nausea associated with Ozempic and Manjaro and things like that relates to the fact that there are receptors for these things, not just in one
hypothalamic structure, but also in like areopostrema and areas of the brain that are these quote unquote primitive areas that are associated with generating nausea when you need to rid yourself of a poison that nature conveniently engineered us with neurons that when they detect chemical changes in the blood make us vomit.
Yeah. And to touch on that is what we found is if we start with, again, a microdose and go slowly with the GLP-1s, The knowledge is virtually unheard of. Not saying it doesn't occur, but it's super rare if you just take your time with it. I think when people have most problems, they're shotgunning the dose, essentially. You're overwhelming your system.
So I have two more questions. The first one is a bit of a controversial one. Okay. Today, we've talked about a lot of peptides that you've observed incredible clinical utility for. We also talked about a lot of peptides that the FDA has banned, basically, to be blunt.
We've also talked about peptides that at one point not too long ago were considered part of kind of niche culture, like fitness or bodybuilding culture that are now approaching what will probably be trillion dollar industries over the next 10 years. things like GLP-1 agonists. So any listener with their neurons firing, we'll put two and two together and say, okay, what's the deal?
Obviously the FDA, I like to believe, has a genuine interest in our safety. They don't want us taking things that are dangerous for us. At the same time, there seems to be a kind of clawing back of what's out there and then a handing off to pharmaceutical companies to put out compounds for which there are tremendous profit margins. I mean, the profit margins on these are insane.
We can't comprehend it. You can't comprehend it. So, you know, MK-677, I crossed out, right? The FDA grabbed that one. Thymusin Alpha-1, crossed out. Okay, a bunch of other things that have been... BPC-157. clawed back. So how should we frame this in our mind?
In other words, do you think that the FDA is of genuine good intentions of trying to protect the general public and that's why they're doing this? Or is this a plan to kind of make that appear to be the case so that these can then be sold at a very, very high profit margin? And perhaps it could be both, right? It's not an either or. And I want to be very clear. Sure.
I work at a major medical school, but I'll speak freely anyway, right? As would my colleagues. I like to think that these governing bodies have some people there at least with very good intentions. I don't think it's a bunch of bad people like writhing their hands together with getting kickbacks on pharma. I don't believe that. In fact, I know that not to be the case.
But what's really going on here? Because this is kind of weird. There's this huge class of compounds we call peptides that clearly have immensely – Beneficial uses in the right dosage in the right hands with the right physicians. They're being clawed back Why it's confusing.
I think it's probably both I think You know, I would say that unfortunately a lot of times when the government acts they overreach, right? Like I do think they probably have good intentions I think there's a there's probably sound reasons to want to have oversight of things that seemingly is the wild wild west right and there's truth to that and Right?
Because peptides came on the scene and people started using them. They're recommended here and there. People could get them from, still can, research companies. And there's not a lot of corralling of understanding, well, what is going on? So I'm sure there's an element to like, hey, let's understand this better. But on that side, I think they went too far, right?
Because I think if you really look at data or if you were really interested in that, there's ways to understand how things work without removing them from the marketplace. So the other side of me is like, just like we're talking about. Ozempic and Mangiorno, semaglutide and terzepatide, are blockbuster drugs.
If you're a pharmaceutical company and you see that there's 15 to 20 other peptides which are really working and really working because, again, we've just seen the clinical response over and over and over, It's not a large leap to think, hey, if we're a pharmaceutical company, what if we turn that peptide, which was available to the commoner, for lack of a better term, into a drug? Like Vilisi.
That was done for melanocyte-simulating hormone pathways.
Yeah. And so I'm sure I think it's both. And that's why I go back to it. We have to operate within certain boundaries, right? Like that's great. We have to understand those boundaries. It would be, and I say this sincerely, I don't, when we're talking about healthcare and we're talking about people's health, we're not even close to talking about the truth for most things, right?
We're not talking about why people get chronic disease. We're not talking about how our food is really over processed and the availability of high quality nutrients and what that means. We're not talking about all the toxicities. We just look at Roundup. glyphosate and its interference with so many pathways in the body.
And people say, you know, and Monsanto and whoever runs that now saying it's so safe and it's just not true. So I think it's in line with, and what I support is unfortunately and fortunately as an individual, you have to be your own best advocate. You can't rely on someone to say, particularly the government, that you have permission or not permission to do this.
I think it's best for people to do their own research. you know, seek out reliable information, right? Start here. I mean, you guys vet so much stuff, very safe place for people to be like, this is where I wanna start. And then life is, you learn by exploring and seeing what works for you. It's like, you start with a recipe to cook, right? But some people like it saltier.
Some people like it spicier. You gotta see what works best for you. And that's why I seek out other people, people like myself, other physicians, other people who have experience saying, hey, we'll help you, guide you in this. And that's where the magic happens. But to be honest, we're not being truthful on many levels when we talk about health. We're just not. We spend so much money for what?
We're not making a dent in chronic disease. We're not making an impact. We're not helping people lead better lives. Medicine is great for life and death things. It really is. In August of 2020, I had terrible abdominal pain. I had just come back from visiting our friends in Hawaii. I kind of tried to treat myself unsuccessfully. Eventually, it was on Labor Day. I had so much pain the next day.
I called my friend who was a radiologist and said, I need to do a CAT scan. I did the CAT scan. He called me on the way back to the office. I had a blood clot in the vein going to my liver that had completely cut off. I almost died. It was really serious. I had to be hospitalized. I'm on blood thinners now. I am forever grateful. for pharmaceuticals saved my life, right?
But those same medicines aren't probably gonna help me lead my best life, right? And it's challenging. Having been educated in a very formal conventional medical system, which is dominated by the pharmaceutical industry is a problem, right? We go back to the Flexner Report, which is like 1917, 1915 or something.
where they studied medical education and basically said, if you're a medical school and you're not promoting pharmaceuticals and inline, and we're gonna kick out alternative remedies and modalities like chiropractic and acupuncture and nutrition, they don't count anymore. And that's where we are.
The only thing that matters, and we see it as a society, we're deemed healthy by the pills we take, right? If we're gonna be really honest, those pills aren't making us healthy. And by and large, they're not even making us well anymore. You know what I mean?
And so I think it's time, and it's wonderful to have this forum to be able to talk about, and this is why I support so many other people talking about it. We need to make a change in that. We need to start being honest about what we're doing. Our health is not gonna be coming from doctors saying, taking this pill or that potion. It's not, not at this stage.
And it's more likely that people are gonna feel healthy from seeing their trainer in their gym, right? This is why these things go to the gray market or black market, because people actually get results. You know what I mean? And it's just sad but true. And so to answer your question, I think it's both. I think the pharmaceutical companies are greedy. I think they like making money, right?
I think they also like helping people. Right. They want to help people. But it comes with a big cost. And the government's there to kind of corral that. But like most things, the government does that go too far. Right. And I think we need to be honest about those discussions. And it's not threatening and it's not harmful just to be saying, hey, how do we make this better?
And how do we even agree to disagree? Let's just start there.
I really appreciate your take. I too rely on prescription drugs now and again. I don't know, maybe I'll lose some following for saying this, but I've had some situations where it made sense to take an antibiotic after a surgery or something. I'm not like anti-antibiotics, right? I also don't eat them like M&Ms. I also... I believe that, well, everything you said, I generally agree with.
I don't have the clinical expertise or the nuance to really understand these governing bodies. That's one of the reasons why I'm asking today and really appreciate you shedding light on this. I think you're clearly a truth teller. You're telling us your truth from the clinical perspective, but it's clear you also have a broad optics here. And we appreciate that. Sure.
This podcast has always been about bringing in a diverse audience. outlooks on the same things. And it's been wonderful today to be able to explore peptides, NAD, and this issue of FDA approval and FDA removal, as the case may be. You said something earlier a couple of times that I'd like to finish up on. You talked about positive thoughts.
You're a physician, not a psychologist, but you're a physician. and you're in the business of making people feel better. And it's clear to me that among your many talents, you have great powers of observation. So what is this thing about positive thoughts? I mean, there are a lot of neuro immunological data out there showing that, you know, stress makes us sick.
If we stress too long for you repeatedly for too for too long, stress in the short period is actually good for us, right? There are some data showing that positive thoughts can enhance immune system function, et cetera. The data are pretty cool. Clinically, however, what's your observation about mindset and health?
I think we're just scratching the surface. And I think it is the most profound way to affect your life, right? So there's a couple of things I'll say about it. One, no good has ever come from a negative thought. Nothing ever good has come from a negative thought.
And because all of us have a choice about every decision we make, to me, it's always best to make a, to slant that decision in a positive frame. Now, it doesn't mean you're fake about it, right? People really suffer. People really go, I mean, it is a very stressful time right now, maybe the most stressful time in human history.
And there's no need to gloss over it and saying life is, you know, peaches and cream, because it's not for a lot of people. But what I know just personally and professionally is that when you start pivoting towards positivity, you get more positivity, right? And all of us, every single human has that opportunity to do that. Some people, it's way harder choices.
They are dealt a much more challenging and difficult hand, lots of people. But if we think about it, we didn't get to choose our eye color. We didn't get to choose our family. We didn't get to choose where we were born or how we were brought up. But we do get to choose how we respond to those things. And so what I've learned is the more, there's never enough positivity I can exude.
There's never enough positivity I can be around ever in my life. It is just the most amazing thing and it can never be taken from you, right? And so when we talk about success and longevity and health span, To me, positivity has to be a part of that because the mindset of positivity will override almost everything, literally.
And I can't tell you how that happens on a biochemical or physiologic basis, but I know it to be a truth. I know it in the core of my being that the more positive I am, the more I can influence other people and plant seeds and help people be more positive. And that is something that I cherish and just love. And it's not talked about enough.
You know, especially as a physician, we're talking about the science and, oh, this study and, you know, putting people on this medicine. But really the value, and I made this decision back in 2010, because I had my own practice, and I decided to stop taking insurance. And it wasn't a money thing.
It wasn't like, oh, it was because I was no longer valuable taking five to seven minutes with each person and seeing 40 patients a day. And for me, I felt like I'm not fulfilling my purpose here when I'm just writing prescriptions. That my purpose will be fulfilled if I can really have conversations where I get to know people.
And peptides and NAD tie into that because they are gateways to build trust with me so that I can actually help you, an individual, learn how to be more positive and to slant yourself and have that posture. Because ultimately all of us need the energy and want the energy to find our purpose, right? And once you find that purpose, oh my goodness, life gets magical, right? Because we're all unique.
We all have a different DNA structure. God gave us that to be unique, to shine our light, to contribute, to help others. Most people don't know about that because they're in pain or they're tired or whatever, they're suffering. And if we can help walk people through that and help them heal that, that's going to get really good. And that's just what I enjoy doing.
beautifully said and so grateful to you for doing that within your clinical practice for making that decision a few years back to shift over to being you know aligned with your purpose and and the way that you've now expanded your practice to public education will provide links to your practice and to your public education efforts and for coming here to do this
significant public education effort about peptides and other compounds and regulatory bodies and also just the field of medicine. And also just, you know, I think so often we hear from scientists or from physicians and we forget the human component and what's what's so What's so beautiful about what you do and the way you do it is that your humanity really comes through.
Oh, I appreciate that.
So it really does. I can tell you really care. And I know our listeners and viewers can tell as well. Thank you. As this field evolves and advances, please come back and talk to us again.
I would love to.
Meanwhile, again, we'll provide links so that people can find you and some of the resources that... back up what we've discussed today. And Craig, Dr. Conover, thank you ever so much.
Well, thank you, Andrew. No, it's really, I'm so honored to be here. I respect and love the work you're doing and the light you're shining. You're helping so many. You have such a wide audience that trust you. And it's amazing. Like I said, I see it every day with people coming to me and bouncing what you do and saying, hey, is this good for me? And that is amazing. I love that.
That's how we get better, right? We help support each other. And I just appreciate what you're doing. And being here is truly an honor, really a big deal for me. So thank you. Thank you. I'll take that in and right back at you.
Okay. Come back again. I appreciate it. I appreciate you. Thank you. Thank you for joining me for today's discussion with Dr. Craig Conover. To learn more about his work and his clinic, as well as to find links to some of the things discussed in today's episode, please see the show note captions.
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