I've had many leading experts on the show, including Matthew Walker and they've all said the same thing about sleep. They say it's the biggest positive investment you can make in your own performance. You can have the best strategy in the world, but you're consistently tired. Poor decision making will follow and eventually cause other things to fail in your life.
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And what we found is not only do patients lose an incredible amount of weight but they also get the best improvements we've ever seen in Liverpool. It's absolutely wild and I think this is going to be a trillion dollar drug when it comes out. And I'm probably here because your ex boss is subject to western. There was some significant news about this.
Correct. From the FDA saying that in July they are going to consider legalize it. Seven peptides and by farmer's estimate it might be the most dangerous thing to their entire business model. So do you think it is plausible that big pharma didn't want these in the hands of regular people because they can't patent this.
It was powerful 110% because the question isn't what peptides do, it's what can't they. And we've got several peptides here in front of us. I'm gonna go through all of them. Let's do it.
So this is probably the most well known peptide for skin complexion and it improves quality of hair and nails. And then methadone is maybe, maybe not going to be the fountain. Unary skeptical as far as that goes. Next we've got this and if you injected that at night.
It would improve your quality of your sleep. Next, Melania tan tu. And this will actually end up giving you a deep tan in response to just a little bit of UV sonic smoke. It'll also give you some of the most impressive reactions you've ever had in your life.
So if you warned, what else will we do? Oh my gosh, there's milling blue or people take it. Anything that'll make them live forever. Don't take this.
It literally will stain your nails blue and your hair blue. These two here stimulates building muscle. This one can aid with healing after an injury. And then is this, this, this, this crazy.
It's wild. So why do I take it? Well, we need to talk about it because fair trade offs. Also outside of the world of pep times per second, I've got these three vials genealogies on.
Yeah, this is unfortunately in our future if not careful. So what we got here is representing the fertility trajectory for young men. And I'm so scared, guys. I've got fake as possible.
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Alex Tatum, there's this word that has exploded in society in recent times. In fact, when I look at the data, people searching this word has increased by 400% just recently. And that word is peptides. I have no idea what peptides are.
I'm someone that wants to be healthy, that wants to optimise my health, wants to live long, doesn't love aging. Yeah. And I'm told that this word peptides are somewhat linked to it. So I've brought you here because you're expert on the subject.
Whenever I watch your videos on YouTube to start at the very beginning. Dr. Alex sure. What the hell is a peptide?
Peptides are a structural class of medications. The best way to think about peptides is that just like we have small molecules which are drugs that are very small, taken in a pill and have a wide ranging effect throughout the body. Peptides are derived from little pieces of amino acids which think of Them as the Legos that make up the human body. The Legos that make up proteins, these are fragments of proteins that are designed to specifically target certain receptors and affect cells in a very targeted fashion.
Organ or a best way to think about it, is a very specific targeted key to unlock a very specific lock. So instead of a small molecule that may have a wide ranging effect throughout the body, peptides are much, much more focused. So you've got different types of Lego cubes here. Would they be different types of peptides or are they different types of amino acids that come together to make a peptide?
The best way to think about it is my son loves Legos, which is why I'm glad we have these here. But he can take the same set of Legos and he can build a rocket ship, and then just a few minutes later, he can build a pirate ship and then he builds a race car. And he's using the same Legos, but he's creating very, very different things that all do very, very different things. And so peptides have become incredibly popular because, yes, we have some really fascinating peptides that can help with anti aging, with healing, and with tissue repair.
We'll talk about some of those, hopefully. But they can do so much more than that. The first peptide that was actually isolated and used in medicine was insulin back in 1921, and then all the way in 1985. In the world of urology, which is where I was trained, we had lubrolide, which is a different peptide that again, also peptide up insulin.
But instead of having wide ranging metabolic effects, it had endocrine effect. It was designed to shut down the production of testosterone for prostate cancer patients that needed to have their testosterone taken away. Interesting. Okay, so insulin's peptide.
Insulins peptide because it's a series of amino acids. Amino acids that are put together. Okay, so you said that the combination of amino acids forms a key. So what is the lock?
The lock could be a cellular receptor. It could actually be regulating a certain pathway within the cell. Okay, so let me repeat this back to make sure I understand it. So peptides are like a key, which you can make by configuring amino acids in a certain way.
And there's different locks in our body that these keys can go into. So if I take some hepatot. So a good way to think about it is this. If you've got a hammer, right, which is what a lot of small molecules are, you can do a lot with that, right?
Like you can hammer in a nail. But if you try to use that hammer, when you're trying to put in a screw or you're trying to put together, you know, a table that you got from Ikea, it may not always end the way you want to. And that's the problem that we have with a lot of small molecules, is that they don't do what we want them to. They do a lot of other things while they're at that job.
They can have significant negative side effects, which is why a lot of these small molecules actually don't make it all the way through the FDA approval process, because we find something that does what we want to do, but has significant safety concerns down the line. Right now, what we see with peptides, for example, I've got in my hand right now a little vial labeled BPC157. This is probably one of the most popular peptides that we're talking about right now, because BPC157 is a synthetic version of a naturally found peptide in the gut. What this actually does is it enhances blood vessel growth in areas of injury.
And it kind of makes sense because if you think about it, our gut, our stomach is really just this bag of acid that sits inside of our abdomen, and yet somehow you and I here talk to each other and bodies are eating themselves. How does that work? Well, it's because we develop a lot of really robust systems to encourage healing of the gastric lining. And so the idea is, well, if this is one of the compounds that can help do that, it's been proven in multiple animal models.
For example, they have completely transected the Achilles tendon in rats. And then they transected. So they cut across the Achilles tendon. So not just a small injury that you, I might experience in the gym where we pull it or strain it, but actually surgically cut the Achilles tendon, and then they administer it to rats, and they are healing spontaneously with administration of BPC157.
If you have an Achilles tendon injury and you're a rat, BPC157 is one of the best things you can ever have. Now, that is now one translation to what we might in humans. But as we talked about earlier with our point on safety, when they were setting BBC 157, we try to look for something called LD1 or LD50. How much can I give this to someone?
Until 50% of the population that receives that dose doesn't do well or dies. Okay. That's called the LD50 dose. We have yet to figure out what the LD1 dose is for this, which is the amount it would take to hurt even 1% of the population because it is so incredibly well tolerated.
So just giving you an example of this is a compound that can have profound healing effects, at least in our animal models that we've seen so far. But so far we haven't seen any precipitous negative effects in human patients when taking this. Okay, but we need more data. I am mind blown and I'm very excited.
We've all set several peptides here in front of us. We want to go through all that and understand which ones do which things. There's a bigger question here, which is why now? Why have the subject of peptides suddenly explod society's consciousness?
What's going on? What's the big picture? So this is really interesting. In 2013, there was actually a court case in the United States.
It was called Myriad Genetics case. This was the company that actually patented the BRCA1 BRCA2 genes. They discovered the genes that cause breast cancer. This was mind blowing.
They identified the specific genes that would predispose patients to developing both breast ovarian and since we learned, also for prostate cancer, it was a fantastic discovery. But they patented it. And they said, we now own this electrical property. And then everyone else said, no, no, that's the human body.
You can't patent that. And the Supreme Court actually cited that argument saying that something is natural, it's found within us. Okay, I can't patent your muscle cells. Right.
Which is a wonderful thing. But the unintentioned, unintentional byproduct of that is all of a sudden pharma had no incentive whatsoever to pursue really promising compounds that they could not monetize. So that happened in 2013. At the same time, around 2012, 2013, there was a terrible event that happened in New England where there was a compounding pharmacy that was not doing the right thing.
And they ended up having a bunch of contaminated specimens that caused a fungal meningitis. A bunch of patients got really sick. It was a huge scandal. And all of a sudden the FDA stepped in, said, hey, historically, all right, states have been allowed to regulate compounding pharmacies themselves, but we need some federal oversight here because this is not acceptable.
Completely agree with that. And they introduced a new set of regulations on top of compounding pharmacies, basically saying what you can and cannot make. And what they eventually said is, well, you can only make three things. You can make things that are in the USP United States pharmacopeia, okay, Things that have been, well Described already published, things are already in drugs that are already on the market, or three things that are on a very specific list that we're going to give you.
And in that list, they actually included a lot of these very promising compounds that were stuck in drug development limbo. And you say compounding pharmacies. What is a compounding pharmacy? Just for sharp term attention, back in the 1800s or early 1900s, if you needed a medication, you could go to the pharmacist who had a shot down the road, and you actually make your medication in front of you, and you do that custom for every single patient that came by.
And it was only since the advent of modern factories that we had the modern pharmaceutical industry come about. But the truth is that, again, that's kind of pain by numbers. You're creating this one pill, and it always seems kind of crazy that the adult dose is one standardized dose for all adults. If you look at what your body composition is versus some of my patients, why is the dose in your blood pressure medicine the exact same?
It doesn't seem to be quite right, but it is what it is. So when patients fall outside of that, they need custom medication. We still have those people who make custom formulations, medications, but instead of it being just pharmacists who go mortar and pestle and create something in his back office, these are now large, sophisticated industrial operations that can make custom formulations for patients. I think the important context for people that don't understand how drug development occurs is that to get chemicals like ones we have in front of us on the table through FDA approval, you've got to spend millions and millions and millions of dollars, Tens of hundreds of millions, sometimes hundreds of millions of dollars.
An incredible amount of money. And. And if you know you can't protect it once you spend $100 million, you have no incentive to just do charity work. Absolutely not.
Okay. Because you have shareholders and you have to make payroll. And so because drug development is so expensive, there's no incentive for commercial pharmaceutical companies to pursue the development of these compounds. And then on the other side of that, well, we have compounding pharmacies that, you know, for them, it makes sense.
What if we could just make these compounds and then sell them directly? Patients, we make a small margin, we sell it. This makes sense for us. Well, they could do that starting about 2014, whenever that legislation finished.
All right, what did it do? Essentially what it did is it gave a. It gave a assignment to each one of these compounds. It was either going to be category can compound this Is our specific list of approved compoundable drug ingredients.
Number two was, hey, we see some negative safety signals here. You cannot make this. Okay, Something goes in category two. It's forbidden.
And then we have category three, which we just need more information. And all of these original compounds, these peptides we're so interested in now, were originally on that first list, category one. All right. And so they were able to be compounded.
We prescribed the patients. I prescribed them to patients from 2014 onward. But then in 2023, the FDA at that time switched all of those peptides, 19 of them that were popular, to category two, and then they were banned overnight. We got notifications in our email inboxes from our compounding partner saying, hey, we can't make this anymore.
We're sorry. So I've got two questions. The first is when you were prescribing these peptides to your patients when. Well, you said incredible results.
Very much so. Again, you have to use the right key for the right lock. Okay, but I think a really good example, right? So there is a compound that's not technically a peptide.
It is a small molecule, but it was lumped in with all these and was the victim of the same process, something called MK677, also known as butamoran. So this is a small molecule, but when a patient takes it, it's orally available, it binds this receptor called ghrelin, and it actually stimulates the release of significant growth hormone. But what was really interesting is that it would actually stimulate hunger a profound amount. And all of a sudden, patients that were struggling with cachexia, okay, so being very, very thin, very malnourished, maybe they're going through cancer treatments.
Ghrelin's the thing that makes us feel hungry. Absolutely. Yeah. So they were able to stimulate the hunger response, and patients were actually able to eat more to meet caloric goals.
And so this was a medication that was fantastically effective at that. Again, it had gone through some clinical trials, but was never taken all the way to commercial. And so it was never gonna be available from cvs or walgreens, but you could get it from a compounding pharmacy. And so that was one that made a big difference for us.
We also had other peptides. So GHRP2 and GHRP6 were some of the ones we were using at that time. Those are growth hormone releasing peptides that stimulate the release of your body's natural growth hormone, which can help with tissue repair, can also help with fat loss and with building muscle. We also had BPC157.
And we had derivatives like thyme and beta 4. These are also compounds that can help stimulate angiogenesis and making new blood vessels and tissue repair. So if we have a patient that's injured themselves, maybe we can help them get back at life faster. These are all things that were used, very commonplace for many years.
And truthfully, they weren't super popular at the time. We were just using them and then they were banned overnight. And they were working and they were working and they're working and we were not seeing adverse events. Which is the most.
What's an adverse event? An adverse event is a patient has a terrible side effect, they call you. They have an allergic reaction to something they call you got shortness of breath. And it's a direct result of the medication that you gave them.
It was working. It was working. And by all accounts seemed to be incredibly safe. And they banned it.
And then they banned it. Why? That's a great question. So officially what happened is there was a meeting where they brought together experts at the time and they said there is insufficient data for us to say that these are safe because again, they had not gone through the full FDA approval process.
And so as a result of lacking that data, we're going to say that they're too dangerous. Now, there wasn't any evidence of any of that in the population. These are why they use it. At the time, potentially we had commercial pharmaceutical companies saying, well, hey, this is people spending money on compound on something that isn't coming to us.
So, hey, like we love medicine, but maybe only one is our medicine. And so there's concern that that was at play as well. And so there's not great paper trouble, not great explanation why. And that's something that's been iterated by our current administration from RFK himself.
He himself has characterized that move down 2023 as being illegal. With everything we know about the medical industry, do you think it is plausible that Big Pharma 110% didn't want 110% these in the hands of regular people because they can't patent this. And it's powerful. So ultimately, the way to think about it is this pharma may not have a compound that directly competes for BBC 157.
BBC 157. So this is the medication or the peptide that can aid with healing after an injury. Okay, so it's not necessarily direct competition, but at the end of the day, your average patient going throughout their daily life only has so much money that they can spend on medicine. And $10, $15, however much money that goes to this doesn't go to a prescription drug from a commercial pharmaceutical company.
And so there is real concern that potentially I was at play during that decision and I said 110%. Yeah. Well, you know, it's interesting because, you know, I try to walk a very fine line between what I can prove versus what I suspect after being in the space for a long time. And, you know, ultimately, you know, I don't think it's accurate to characterize pharmaceutical companies or really any other entity as being, you know, evil or bad.
The truth is maybe a little bit more. The truth is, is that they are these large machines that are designed to prioritize profit over everything. Yeah. And that's everything.
I think this is one of the really interesting conversations I've had the higher up on my career is that oftentimes here we have about the Illuminati once. Grandpapa Illuminati. Yeah. And you think of it as these, like, shadowhooded people that get together and design evil things.
But at the further I've gone business, and I realized that the Illuminati or these evil forces are actually just machines that were designed to optimise for profit. Correct, Correct. So, like, corporations are Illuminati. Yeah.
And so I don't actually think that there's necessarily, you know, a group of maniacal individuals, you know, the Legion of Doom, plotting to, like, take away your health. But at the same time, I think that there are these large organizations that really couldn't care less about your health. You know, they are prioritizing what's important for them, and regular people just get caught up in the mix. And what's challenging is that as a physician, you know, I took a Hippocratic oath, I care about my patients.
And so those are the people in front of me every single day that are seeking to improve their lives, recover from injury. I have, you know, fertility patients that are just dying to start their family. And I have patients that are suffering from hormonal imbalances that haven't fall right in years. I can treat erectile dysfunction in men that have been struggling for years of prostate cancer treatment.
I mean, these are people that are broken and hurting. You want to be able to help them. And so I feel that is a very strong personal calling, that I should be an advocate for that patient, both in the room, whenever I'm treating them, taking care of them, but also when I'm talking to others and speaking out about these issues, like, I want access to these medications Because I care about the patients who benefit from them. So they banned these peptides that we have here.
Correct. And we sat here two years after the ban. Two years after that ban, yeah. And suddenly they released.
Talking about peptides again. Yes. Why, what's going on? So I think what we're seeing is the forbidden fruit effect because this was banned and all of a sudden.
Oh, why they banned it would have banned if it weren't working. Right. And we're also seeing the effect of TikTok and short form content being spread very rapidly, very virally. And that's been going on for two years now.
Combined with new emphasis from administration leadership and AJ Jeslin rfk. What is the most incredible impact that you've seen peptides create in a patient? Oh my gosh. I have a best story for you.
So one of the most frustrating things about my practice is treating infertility in young men that has significant metabolic dysfunction. These are young men that have a low sperm count. Right. So they can't get pregnant because they just don't have the numbers to make it happen.
And you're looking at them and they're morbidly obese. Okay. They have high insulin resistance and their endocrine system has been damaged by that obesity. So they don't have low testosterone levels.
And their brain is not making enough the signals to stimulate their testicles. Now we have medications that we can use to help stimulate that, to make more that signals stimulate the testicles. Right. But really what is eating at them, what is causing this is not that chemical amount.
That's the symptom, it's not the problem. Okay. And treating symptoms doesn't look at you very far. And so I would have patients that I would take care of and we would never see a significant improvement in their numbers because losing weight is really hard, regardless of all the education and resources I try to give them.
But now we have peptides in the form of GLP1 drugs like semaglutide and tirzepatide. And I saw a patient last week who increased his sperm count 10 times over and is now in a normal range because he's lost 100 pounds due to using Tirzepatide, exercising and improving his diet. He has totally changed his life. And that started with a peptide.
So when we call lots of peptides and take a different frontier, we'll go into them individually. But just can you give me a high level view of the types of areas in our health and life that these peptides can help with? So we talked about infertility as a downstream consequence of like weight loss and fixing massive weight health. What other parts of the body do peptides touch?
The best way to think about it is like this. So peptides are almost like an app on your phone. So imagine before we had apps, I'm old enough to remember trying to log on and do my banking online before we had apps. And gosh, it was so painful, right?
Like there are ways to accomplish things, but they were very inconvenient in a roundabout way. And now all of a sudden we have these apps on our phone that can do just about anything except older laundry. Right. There's some limits to it, but I mean really the sky's the limit from an electronic standpoint.
And really that's what peptides are. So the thing is, is that we have peptides that can help you lose weight, like the GLP1 drugs. We have peptides that can improve skin quality, like GHKCU. We have peptides that help heal your gut, like BBC157, particularly effective in ulcerative colitis, which is something that's being investigated at the FDA's plan to come meeting on it.
We also have peptides that can help with sleep and with recovering the gland in your brain that's responsible for melatonin and regulating your sleep wake cycles. So the question isn't, you know, what can peptides do? It's kind of, well, what can't they do? And if they can't do that yet, can we develop a peptide that can accomplish that task?
And the answer is probably. And simultaneously, while there may be resistance from pharmaceutical industry in these peptides, the ones that we're most interested in right now, they have signed multiple billion deals with other pharmaceutical companies that are involved in peptide development, aided by AI to try and fast track their own peptide products. Interesting. And so we are going to see exponentially more of these products come down the pipeline from pharmaceutical companies in the form of commercial products.
And it's worth saying that there was some significant news today. Correct. What happened today? Also, what's going on?
And just for you to let us know, it's April 15th. Yes. So today we got a press release from the FDA saying that in July they're going to consider seven peptides for removing from category two back to category one. Legalizing them.
Legalizing them. Okay. And some of the heavy hitters from that list include BPC157, which is what we talked about too, is like repair and injury. Absolutely.
Okay. And then we have the brother to that, which is TB500. This vial over here, this improves blood flow to an injured area. You can think of this as sending a.
Sending the cells that are required for rebuilding that tissue matrix that was damaged by a tear or a cut. All right. On top of that, we're also getting something called kpv. May not have it here, but that is another peptide that's been linked to angiogenesis and tissue repair.
We're also getting MOT C and you know, some patients will call exercise and vial. It improves your VO2 max and your exercise tolerance by up regulating the energy pathway. Basically more ATP. The energy that we all use to move it makes more of that available.
All right. We're also going to get dcep, Epithalon, and cmax, which are all peptides that affect cognitive function. So improving thinking like C Max is a great option for that. And then DCEP and Epithalon both have roles in regulating sleep and recovery.
Wow. Yeah, Pretty wild. And I've got to say, how does so some of them become legalized, but even the ones that aren't legal. Right.
A lot of people are taking them anyway. Correct. So my question is, how are people getting them? Listen, I don't want to promote illegal drugs here.
No. I just want to know what's going on. No, this is important to talk about. Right.
We have to understand what's going on in the marketplace. The moment that these drugs were banned or these medications were banned in 2023, it was kind of like the United States experimented banning alcohol. It didn't go very well. Right.
All of a sudden, the mob came around and we started seeing unregulated saloons and unregulated alcohol production, and it was contaminated in one. So people are troubled. Yeah, exactly. It's not a good idea.
Right. And so what happened is we banned these and the gray market stepped in. And so these are companies that will sell peptides that have on the label for research use only. An idea is that that takes them out of FDA jurisdiction because they're not selling people to INJ out of FDA's hands.
I'm just creating a vial of this magical juice that you can use for your rat. Okay. That's the idea. We all know that's not what's really happening, but because there isn't any quality control, it's kind of like in gas station sushi.
Like, yeah, you can do it, but you don't really know if it's sushi and it may not end very well for you. So again, not saying that there aren't Some people who have gotten good results with research use only peptides. But again, it's not standardized, which is why I think moving this back into the 503, a compounding world is the best thing for everyone, which is legal for. Okay, so how does one take a peptide?
That's a great question. So what's interesting is that as we mentioned, your peptides are just made up of a building blocks of amino acids. And you know, if you were to go make yourself a protein shake, you know what that's going to look like a Lego sample. It just looks like this, a handful of Legos in your hand, right.
All ground up in individual pieces, Right. The thing is, is that your gut is designed to break up any sort of protein that you ingest orally into these little pieces. And so if, if you were to say, I don't know, drink some of, you know, this TB500, your body wouldn't be able to tell the difference between that and piece of chicken because it would break it apart. It would break it all apart.
There are some various unique exceptions to that. There's a form of BTC one by seven that actually is tolerated in the gut. But by and large, the overwhelming majority of these have to be injected either subcutaneously or into the muscle. And that's usually a preference.
Subcutaneous thing just underneath the skin. You know, as I tell patients, just injecting the skin. We do that for a lot of other medications as well. Is that what this is?
Yeah. So this is a prescription Manjaro pen. So Mounjaro is the brand name for Tirzepatide. All right, Tirzepatide being the leading GLP1 product right now from Lilly.
So this produces more weight loss per milligram than any other product that we've got out right now. Is this the mechanism in which people inject peptides a little bit different? This is an auto injector pen. And so what you do is you're able to actually ratchet the dose there on the right side.
And then you pinch an inch in your skin and then push up against. It'll auto deploy. There's nothing that you need to do. You don't have to learn how to drop medication, inject.
Whenever you're administering peptides at home, especially for patients that have obtained them from research use only markets, they usually come in just little vials that need to be drawn up with a needle. Okay. Now the benefit of that is that you can do custom dosing, right? But the drawback is that, well you have to know how to calculate that and put it together.
This may be the most controversial thing we have on this table. And by pharma's estimate, it might be the most dangerous thing to their entire business model. Because this is tirzepatide, the exact same thing that you had in that pen, but this is made by a high quality 503A compounding pharmacy. And the reason why this is so controversial right now is because it offers an incredible amount of flexibility, because what you have in your hand there is very standardized, and you administer it once a week.
Possesses for Rubio. Exactly. But think of that as paint by numbers. Okay.
You are this section is this color. This as that color. All right. Think of this as depending upon your hands right now.
Yeah, exactly. Just a vial of tirzepatide as being able to have infinite permutations and dosing ability, because you can draw this up with a small syringe and do microdosing. So instead of one large dose once a week, because what many patients will experience is they'll have a return of their hunger by the end of the week, and they end up losing ground, you can actually, instead of doing a full dose once a week, you can do multiple mini doses throughout the week with this formulation and with this presentation of medication. But the challenge is that that is the benefit that allows this to be compound by compound pharmacies, because they're able to provide something that is similar to what's in your hand, but it offers more flexibility.
That may be the right choice for some patients. So personalization medicine. Okay. But the challenge is that if you spend however much money on this, you're not giving it to Lilly.
And so, as a result, we have seen an unprecedented crackdown in the United States from the FDA in trying to shut down compounding pharmacies and prevent them from making these medications, even though that ability to customize. The fact that this is not an exact copy of what's in your hand right now should protect it under current legislation. But there's now enough pressure from the powers that be and from lobbyists from both Lilly and Novo Nordisk, that which are the two companies that make the GLP1 medications that we're seeing. Marty Macri, the FDA commissioner, has now tweeted more about cracking down on compound GLP1 medications than he tweeted about diabetes or heart disease in his entire town office.
And just so I understand, I want to play this back to which I understand. Sure. In my hand here, I have trizepatide on my left Yep. And this is made by Lilly, which is a corporate company.
Patented. So he got my form. In my right hand, I have triazepatide with niacinamide. With niacinamide.
Yep. And this is not patented. So Lilly has a patent on the tirzepatide molecule in that formulation in your hands. Okay.
And if anyone violates a patent that can be pursued in U.S. court. Yeah, patent law. Right.
But what's interesting is that Lilly and Novo Nordisk know that that's different. In your right hand, it doesn't look the same. You can dose it differently. And they know that if they were gonna fight that in court, it would cost a lot of money and take a lot of time.
So you know what's a lot easier? Calling your friend at the FDA and getting him to step on the competition so you don't have to. And then who's paying for that enforcement? It's not the lawyers that the pharma company is paying for.
It's the taxpayer paying for the FDA 3 taxes. You seem to imply that this was actually better because you can take it in more flexible doses. You can take a little bit. You can take what you want.
Whereas this is kind of once a week. Well, I mean, what is better? Right. So I like this option for many of my patients because it's flexible.
All right, so that is something that works for most patients. Then again, this works great for patients, too. But what you want is you want an ecosystem where you have choice, so you make the right choice for the right patient. For a lot of patients, they're do exceedingly well on this, and there's so much data to support that.
But I also have a lot of patients who get really ill after they do a large dose of manjaro or of GLP1 then. And if we take that same dose and we just cut it into multiple doses in a week, we can avoid those side effects. So you've told me that these peptides have been taken in front of us can improve your skin, weight loss, muscle energy, chronic illnesses. You talked about the cognitive upsides, and you talk about it very passionately.
Yeah. So should I ask you, presumably you're taking Zepatides. I am, yeah. So I will tell you that as of right now, the only peptide I'm taking is a small dose of tirzapatide.
Right? Yeah. Because back a couple of. Couple of months ago, I was probably close to about 240 or so, and I was in powerlifting, and I still am, but, you know, it's really great to be able to deadlift £100.
But then stairs become really hard when you're trying to walk up. You're like, I don't know, I kind of like being able to not take a break after two or three flights of stairs. And so I was like, okay, all right. Longevity is a priority of mine.
I'm slowing down a little bit. Let me just try this for a little bit. And what I found is that it is incredibly potent at a very low dose. Very, very tolerable.
Why don't you take some of the others? Honestly, because right now there's not a legal framework for me to obtain them. And the truth is, is that I want to be an example for my patients. And that's why I'm out here advocating that we get access to these peptides in a legal, safe way again.
All right? And because it's the best thing for everyone. If they were legal, which ones might you consider? Oh, man, I will tell you this.
As some, I don't know how old you are seeing them. I'm 33. God bless you. I will tell you once you get over 35, man, and it's bruh, all right?
I sleep on my neck in the wrong way and I need like a frickin brace for like two weeks. And so if someone who spends a lot of time in the gym, you know, working out, like, you start to accumulate like little aches and pains. And so, for example, I have a very finicky right shoulder. If I try to do a really heavy bench and I haven't warmed up, I can tweak this and it takes me out of the fight for at least a month.
Okay? I have to do other things. I would have killed at various points in time in the past few years to have had BPC and TB500 to hopefully speed that sort of healing. All right?
Also, for example, I suffer from really bad rosacea. It flares constantly. So just redness of the face, okay? That makes me look like I'm sunburned.
And then I come in the office on a Tuesday and then my staff's like, oh my gosh, you got the argument. Some work this week. I'm like, it's just my face. For example, that's something that a lot of people have reported benefits from GHKCU from.
So again, another compound, another peptide that could be beneficial for a patient like myself. What about muscle mass and not gaining muscle? Yeah, so that is an interesting misnomer because that has been a common selling point you'll see on social Media. But as of right now, the only peptide that you might construe that way would be this guy right here in my hand.
IGF1 LR3. Okay. Now IGF1, LR3 is basically the longer lasting version of IGF1, which is the downstream effect of growth hormone. Taking growth hormones to increase size and you know, lose fat.
In higher doses it can help contribute to muscle mass. Right. But truthfully, if you're trying to gain significant muscle mass, this is, this is not the way to do it. And so the right now, one of the things that peptides can't do for you is independently put on significant amounts of lean mass.
You still go to the gym, believe it or not, and gas, I'll tell you. And something that blows my mind is that I have so many patients that think they can just take testosterone and just put on muscle naturally and it doesn't work that way. You might get a tiny little bit, but you still have this tough stimulus. You still have to get in the gym, you still have to put the work in.
And so I tell patients that I am not a replacement for a personal trainer. I'm your doctor. You also need your personal trainer and those of you need a nutritionist man. And so I'm lucky.
Work with some great people in the community who partner with me on that. But you know, it's a full pork press when you're trying to get people to, you know, live the highest quality life. What else are these metabolic disorders and diseases in terms of like insulin resistance? People on the diversity of your brains are very interested.
Learned about insulin. I see a lot longer section a lot of the data. Yeah. So how can, if someone's struggling with their insulin levels or glucose response, how does these peptides help?
Honestly, the best peptides for that right now are the GLP1 drugs. Okay. Hands down. Because what you're doing is you are slowing gastric emptying and so you have a slower absorption of that bolster food that you've eaten so your glucose doesn't spike.
And so as a result that increases insulin sensitivity significantly. Now again, you have to be careful about what peptide you're using. For what A lot of these peptides that boost growth hormone and boost, let's say IGF1, those can actually increase serum glucose and that may not be what you want. If you are someone that is trying to work on your insulin signal.
And did any of these peptides come as like creams or as pills or anything like that? If you look online, you can probably find a version of everything. But if we're talking about actual legitimate formulations, the best example of a topical cream is going to be ghkcu. And this is interesting because this is a copper tripeptide that has been found to decrease in expression and concentration as we age.
But when it is applied topically, it's highly effective topically. So put on a cream on your face, all right? It's been found to be extremely beneficial in regenerating the quality of skin. So complexion, all right?
Increasing the amount of collagen and elastin. The things we need to keep our faces taut and youthful. The things that people pay lots of money to go get laser to get improvements. Not that it's a replacement for that, but that's a topical form that, believe it or not, you could go out and buy today.
Because topical GHKCU is regulated very differently than the injection of. Is it expensive? Usually. Growing up, I thought these anti aging creams are bullshit.
But you're telling me that this has actually been associated with improving signs of aging. I will tell you this. When I was going through college and medical school, I was the biggest skeptic. I did not believe any of the health or wellness claims that we saw coming out at the time.
Again, that was at a time where we were getting bombarded with stuff about Atkins diet and this, that or the other. But then all of a sudden, you start having patients come back to you and they're testifying the benefits they've seen from these things. You start actually look at the biochemistry behind them. You're like, there's a lot of science backing this up.
This isn't just mumbo jumbo. And so believe it or not, yeah, there are creams that can slow the process of aging, at least from a visual standpoint. When it comes to your skin, I have yet to figure out anything that makes me as energetic as I was in my early 20s. But, you know, working on it, on that point of energy incomplete.
I want to come on pasta. Yeah. And you might say here, sometimes. Sometimes you do in a day, which means I stay here for eight hours.
You've done three in a day. That's brutal. 12 hours of recording. Yeah, but what would you recommend, therefore?
To improve my cognitive performance. So again, as a physician, like keeping my license, how would you necessarily recommend. But I would say if we're looking at how these medications have been used, and potentially one that may be legal again, coming this July, depending on what the FDA says, intranasal C Max. And this is one that was originally studied Actually, in Russia many years ago.
And what they found is that this 7amino acid peptide, when it was administered after a TBI. So a traumatic brain injury or acute injury that patients tended to bounce back faster. Also, they saw evidence of improving alcohol, stroke. And it also seems to upregulate the same sort of factors that help with cognition and with connecting sentences and bits of data.
And so it's also, interestingly enough, one of the ones that is available intranasally because it goes through the mucous membrane brains and gets right where you need it. And so that's gonna be a really, really fascinating compound to see back on the market. And then we can actually get more data for growing efficacy and across a wide population. So interesting.
Yeah, you sniff that through your nose like you would for any nasally detean. Right. If you have allergies or something like that. Also, for someone like yourself, you travel a lot.
You know, you're going in between different time zones, you're balancing multiple applications at different times of the day. I shudder to think what your circadian rhythm looks like, my friend. But that is what we have. So these other compounds are gonna be available for it.
So if we look at dcep, okay, that has been shown to be helpful with regulating your circadian rhythm. That is one of the ones that's gonna be approved hopefully here soon again in July. Right. And then on top of that, you've got things like Salink, which is another one that can help calm you as you're going about an hour ahead of time, and again, help those, you know, deep delta wave brainwaves that are so restorative whenever you actually are, you know, resting.
Where will we be able to buy these when and if they are legalized? So from 503A con condors here in the United States with a prescription from a physician. So you still need a prescription? Still need a prescription?
Correct. Could be quite crazy world when everybody seems to be injecting themselves every day and we're already getting stuck quite now with this impact. But loads of people, my friendship group there. Yeah.
And they're doing great. Yeah, they're doing great. They're doing great. And that's what I like about, you know, the advent of these GLP1s is removing the stigma of a needle.
And I look at some of my friends who have been on it, I can't recognize them. They look awesome. Are you concerned with any of them? I've got a couple of friends in my circle where I'm a little bit concerned.
I don't even Know if I should be concerned, but it's just when you see someone, you know, change so dramatically so quickly. Yeah. I think there's something else which. Something prehistoric which goes onto this problem.
Yeah. One thing I am concerned about is the rapid weight loss of GLP1 medications. Because the problem is, is that when you go to sterratical caloric deficit, your body goes into catabolism, which is breaking down tissue. And you want to break down fat.
Right. But your body isn't that judicious. It's gonna break down muscle. And muscle is the most metabolically important tissue that any of us have.
And so if you really want to optimize your insulin sensitivity, we need to maintain your muscle. And right now, really, the only compounds that we have that are really good at preserving muscle with resistance training is testosterone. Right. But that isn't gonna be a good option for our male patients that wanna get pregnant.
Testosterone turns off fertility in men. It's also not a great idea for our female patients, depending on their age. Testosterone TRT is a thing in older, you know, women. Menopausal won't go.
But truthfully, testosterone is not the right answer for everybody. And so what we are going to see come down the pipe very soon is kind of the older brother of peptides, more complex form biologics called monoclonal antibodies that are specifically designed to inhibit the enzymes that break down muscle. So these are specifically called myostatin inhibitors. There are three that are coming down the pipeline.
There's one called the magmabab, which is owned by Lilly, that is going to bind to the peanut butter, to myostatin's jelly, which is called actin. And then you have heretosumab and trabogumab, which are two other compounds owned by every pharmaceutical company that are all designed to maintain muscle even in a significant caloric deficit. This is getting interesting matter. Yeah.
So you're telling me I'm going to be able to inject myself as EMPEC to lose the fat and then inject myself with something else to keep muscle. It's wild. It's wild. And I'll tell you, you know, one of the hardest things that I'm sure you've heard me on the receiving end of this is just the complexity of it.
And there are so many levers that are moving at once and trying to get your head around it and balance it all like it requires nuance and requires a thoughtful discussion with your doctor, who's well educated on them. And that's one of the challenges is that there isn't broad, great education on these products right now in the medical space. And so that's something that I'm very passionate about, is improving education across my colleagues so that they're not afraid of these anymore. What do you say to people that listen to this now?
Who fucking. Why don't you just like, eat your greens and go to the gym? Yeah. And just be more human and you'll be fine.
I love that. I love eating your greens and going to the gym. Okay. But the unfortunate reality is that here in the United States, it depends on what database you look at, but obesity rates are estimated to be 40 to 70%.
Okay. Whether you. Depending on what BMI cough you're using. Okay.
BMI is not perfect, but it is. And so the thing is that, well, eating greens and going to the gym are not working for us as a society. And we could talk about how we don't have real food anymore. We have food deserts.
We have this calorically dense but nutritionally poor food. I'll tell you the most disturbing thing I see as a surgeon is I'll see a patient come in the door and they're morally obese. They're a large individual, but I have to do surgery on them. But the connective tissue, the stuff that's made of protein that makes them them, that literally holds them together is paper, paper thin because they're eating an incredible amount of calories or gaining fat, but they don't have any protein in their diet.
And that's not something that's rare. I see it on a daily basis. And so the truth is that we're talking about this from the angle of biohackers and people are super engaged in our health. But the truth is that this is going to be able to be used to help our population at large and, you know, ultimately, hopefully avoid a lot of the terrible disease states that we're seeing over on the medical system right now.
How big is the peptide industry? If we look at the top four large language models companies, all right, so all the heavy hitters and how much revenue they're generating, it's estimated to be between 58 billion, up to maybe 62 billion. Yet the income and the revenue from just semaglutide and tirzepatide alone is going to be over 55 billion this year. And so what we have is peptides, without even considering all this happening in the research space or the research only space, without even considering the peptides that we'll see come from compounding pharmacies we're already approaching parity with what we're seeing in AI as far as revenue goes, that is the demand that we're seeing in the marketplace.
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When your patients come and see you, Dr. Alex, what are they asking you most frequently as it relates to peptides? What are the top three questions you get asked the most? The first thing I get asked is what peptides do I need?
And then I just look at them, I'm like, what's your problem? What's bothering you? And then they'll come in and they'll start talking about energy, sex drive and that sort of thing. I'm like, okay, if that's it, well, we should get your testosterone levels better.
Okay, so instead of looking for peptides, right, you know, you don't walk into a Home Depot or Lowe's, what tools do I need? You're like, what are you trying to do? Right? And then you start to talk to someone, they're like, okay, you need a cell, you need a spirit drug, you need this.
And some of those tools might be Peptides, but some of them may be hormones, some of them may be diet and exercise. And so peptides are just another type of tool that we can use. We all want a shortcut though, doctors. We all want a quick way to be better.
Yeah. And ideally, you have to do hard work. We give him fantastic results in skin, hair, muscle. Then we go fucking, what about me?
You know, I tell patients, I'm like, me too, man, you know? But my alarm's still on at 4:45 this morning. So I hit the gym before I made it to click because there are no real shortcuts. There are things that can help, right?
GLP1 is the best example of that. Right? This is the closest thing to a shortcut you're going to get. But the, the truth is that this isn't going to go the gym for you and it's not going to lift the weight so you can maintain that muscle mass so you get the best possible and try to hold on your muscle while losing the fat.
One thing I've learned from doing this podcast that is really growing with me. Also, the thing you learn from the podcast, one of the answers that I've never given, I'm going to give now, is that I've learned that there's no such thing knife as free lunch. No, absolutely not. What I mean by that is like, everything is a trade off.
And if you ever hear on a podcast or in any medium that something has tremendous upsides, the first question one should ask is, what's the trade? And that just with everything, you can apply this to having relationships with a partner. Huge upsides. Also.
Trade off. Trade off. Yeah, yeah. Kids.
I love my children. I have seven years. This is life, right? There are trade offs and even with great tools, there are trade offs.
So what are the trade offs of these peptides? The biggest trade off right now is you don't know if you're even getting what you want, right? Because you're ordering this from some research, you know, compound only. You don't know whether or not they've gotten an appropriate endotech because you don't know if you're getting what you actually paid for.
So that's the biggest thing. And also the thing is that, well, all right, these have a good example of, okay, preventing or helping heal injury. But the thing is that, well, we've got other compounds over here. You know, let's go ahead and like, let's just pull Tess Morland as an example.
So this is actually interesting. It's a peptide that is commercially available right now. I can write this before you can pick it from CVS or Walgreens. Okay.
This is available as a commercial product and people really like it because it'll help boost growth hormone. And it seems to be uniquely good at stripping abdominal fat. Okay. Or visceral fat.