I had a patient come in who has severely elevated cholesterol as well as other cardiac related risk factors. The last few years I have been recommending addressing the elevations with medication but he has been reluctant to do so because of “what he has heard about statins”. As I was going through the remainder of his physical and when I asked about any family history changes he said, “Yes my brother died last Friday.” I felt awful for him. I expressed my condolences and asked how it had happened. He said he dropped dead suddenly while cooking dinner leaving a wife and two younger children behind. He was in his early forties. At that point I said, okay now we really need to start you on a medication and get proactive and he said he would think about it. He then proceeded to ask me my thoughts on peptides which prompted me to do a little research for myself and all of you. He is not the first one who has asked me about them. This is an up-and-coming trend that many in their forties and fifties are trying out to try and “hack” into the bodies aging process. Slowing down the inevitable. Look younger, lose weight and facilitate recovery, while at the same time increasing their strength. I find it funny because most of the information is coming from Instagram, Tik Tok and Facebook influencers. Celebrities which include movie stars, rock stars, reality television characters. Just the people you would expect to get vital information about heath and well being from. Doctors? Who needs doctors when you can go to your gym or salon or bar to get the information you need. So here is my take on the more common peptides that are out there and you can refer to your gym bros or ladies wine lunch group and see if they concur:)
So what are peptides? Peptides are short chain amino acids that act as signaling molecules to regulate various bodily functions. They work similar to hormones which are chemical messengers produced by specialized glands in the endocrine system (such as the thyroid, pituitary, adrenal and the pancreas) and the hormones are released into the blood stream or surrounding tissues. They travel to target organs or cells throughout the body where they bind to specific receptors to regulate various physiological processes, including growth, metabolism, reproduction, mood and stress responses. The levels are tightly controlled by feedback loops to maintain homeostasis (balance that your body need to perform as optimal as it can). One of the first peptides that was developed and mass produced was insulin and thank goodness for that. So this proves that there MAY be benefits in peptides for other issues as evidenced by the most popular peptide you are likely familiar with, the GLP-1 (Glucagon Like Peptide) Ozempic/Wegovy and Mounjaro/Zepbound which are being used for control of diabetes and weight loss respectively. It seems like when something is labeled a peptide it just feels better than saying one is on a GLP-1.
I find that when we are dealing with the endocrine system, which is controlled by hormones and peptides, you have to be extremely careful because it can result in changes that our body is not accustomed to after evolving for millions of years to get where we are today. For example, if I was to give a man testosterone, who did not need testosterone but he wanted it to look bigger, better and stronger (Like Steve Austin for all of you old timers out there and likely for less than 6 million dollars) 🙂 His body will stop producing testosterone because it senses that it already had enough and why would it waste its precious resources to make more of something it doesn’t need. WE have to be careful because we could be playing with fire around a powder keg surrounded by a moat of gasoline. That’s why studies are needed to verify its safety. Studies were utilized before insulin was made available to the masses. The same could be said about the GLP-1’s for diabetics (not so much for weight loss and that is my reluctance for its use in individuals who do not need it for obesity or diabetes but just for vanity sake).
Peptides are being used for multiple facets of health. I say used and not indicated here because they have not been adequately studied in humans. Most of the research is based on animal models and cell studies not placebo controlled double blinded studies that are the foundation for determining the safety and efficacy of a medication or supplement. Peptides typically are categorized into the following: (Weight Loss and Metabolic Health/Anti-Aging/Healing and Recovery/Dermatologic).
WEIGHT LOSS AND METABOLIC HEALTH PEPTIDES: These are the ones we are all familiar with thanks to the magic of advertising EVERYWHERE!!! T.V., Internet, Instagram, Facebook, TikTok, sporting events, radio, bus stops. You name it and it is there. They are “Huge” to quote our president that 51% of us like and 49% of us hate. Believe it or not the first GLP -1 agonist that was available to the public was Byetta (exenatide) which was used for diabetics in 2005. Over 20 years ago. This class was refined and it was Ozempic (semiglutide) that showed significant weight loss occurred as an unknown side effect and Mounjaro (tirzeptide) soon followed. Semiglutide and Tirzepetide were found to produce weight loss of 15-23% in studies. They work by slowing down digestion and therefore reduces ones appetite. As a result the main side effects that cause patients to stop using them are nausea, gastroesophageal reflux (GERD-“heartbun”), constipation and diarrhea in some. Another side effect, that has been mentioned in previous posts is sarcopenia (muscle loss). I am sure you have seen the individuals with the muscle wasting face “Ozempic face”, or loss of muscle in the buttocks (rear end) and small arms and legs. It can look like a prisoner of war look so that’s why you absolutely need to exercise (aerobic and resistance training) if you are on the medication. It appears that since semaglutide and tirzepatide are well known and many individuals who do not like the stigmata on being on them for their weight loss they are moving on to another “peptide” Retatrutide, which is the next generation triple agonist peptide that activates the GLP-1/GIP/ and Glucagon receptors. This is not even available yet from the manufacturers but is being compounded and touted as “promoting significant sustained weight loss.” Improving insulin sensitivity, reducing appetite and cravings” “May increase energy expenditure and metabolic rate” “Supports cardio-metabolic and liver health”. All this from a flyer that was given to me from a patient who got it from their trainer/Physical therapist. Now I know that a physical therapist is considered a Doctor as my daughter Gabrielle “G” obtained her doctorate from Duke University (Yes, I’m bragging like a proud father should) but as she states all she can prescribe is an exercise plan, not a substance that may have benefits but also may have serious health side effects. AOD-9604 is another peptide which is a modified growth hormone peptide that is touted as targeting fat metabolism without affecting blood sugar or tissue growth. Tesamorlelin is a peptide that targets reducing visceral fat.
HEALING AND RECOVERY PEPTIDES: BPC-157 and TB-500 (Thymosin Beta-4): These are the ones that the trainers and supplement shops are pushing and yes, I’m saying pushing like a drug dealer because there is a lot of money made on these agents. These are also the peptides that have potentially the most side effects and they really have not been studied in humans. You will hear this set of peptides as being “the repair peptides”. They are touted as aiding in healing tendons, ligaments and muscle tissue and may even improve gut health. These are still classified as experimental synthetic peptides which were actually derived from human gastric juice (at least BPC–157). The difficulty with the use of these agents is that we do not have any well studied trials in humans the only studies we do have were from investigating issues for inflammatory bowel disorders (Crohn’s/Ulcerative colitis) as well as tissue healing studies but due to lack of published data we cannot say with certainty the benefits or the risks. This is considered an “experimental compound”. The lack of published clinical trial data is because studies appear to have been canceled or stopped without published conclusions which makes one consider whether or not safety issues were a concern or the studies were not showing the benefits that are touted. The counter argument that is often given by those who are recommending these are “studies take too long and are too expensive”. This argument really does not hold weight because if pharmaceutical company ran on this premise, we would never have new drugs or therapies available because they would “take too long and are too expensive”. If the study showed that the product did what it intended to do and did so without side effects, it would be a gold mine for the company equivalent to a goose that lays the golden leg. This is a field that is starving for results and people are willing to pay anything for better health and longevity. Another issue without studies is not knowing what a safe dose is. The supplements are actually banned by the WADA (World Anti-Doping Association) and those who recommend these supplements will likely use that to try to verify the benefits of these supplements. As stated previously, there may be benefits but we need to know the risks as well.
The side effects that are known include cancer and angiogenesis risks: The substances promote angiogenesis (new blood vessel formation) which is where the benefits come to healing tissues. But this side effect can possibly accelerate growth of undiagnosed tumors or even cancer. There are immunogenic risks as well as these can trigger immune responses and severe allergic reactions. There are neurodegenerative concerns because these peptides produce high levels of nitrous oxide (NO) which is linked to increased neurodegenerative disease which includes Parkinson’s, Alzheimer’s and other neurologic issues. Another risk, when it comes to the utilization of “research chemicals” is a high risk of impurity, improper dosing, mislabeling and sterility issues because this substance can be contaminated with heavy metals, bacteria or other synthetic elements.
Any substance that is injected to produce health benefits or prevent a medical condition CANNOT be sold without FDA approval. These are available because they are marketed as “dietary supplements”, again with no regulation. Also the FDA is a federal agency and sometimes these will be approved by the state similar to why marijuana and THC is available in California, as well as other states, but not recognized as being legal federally. Just because it is available does not mean that it is safe. Which is similar to the motto eyelid by “just because you can does not mean you should”. The TB–500 (thymosin Beta–4) has similar side effects to the BPC 157 but additional side effects include severe allergic reactions, hormone imbalance due to excess growth hormone and associated acromegaly (enlargement of the head-similar to when Barry Bonds -professional baseball players hat size increased from 7 and 3/8 inches to 7-5/8 inches during his career. This was attributed to hGH usage. The same can likely be said about Dana White, of UFC fame and Troy Aikman the Hall of Fame NFL quarterback). But I digress. It can also result in fatigue and kidney issues as well as nausea, increased appetite and associated weight gain, dizziness and headaches.
ANTI-AGING AND GROWTH HORMONE PEPTIDES: These include CJC-1295/Pamorlin which is a combination that stimulates pituitary gland to increase natural growth hormones (GH) and therefore promoting fat loss and muscle gain. It also could increase your risk of cancer by accelerating cell growth and hormonal imbalance. It has been found to have sterility issues by overproduction of growth hormones and insulin like growth factor–1 (IGF–1). When used for prolonged period of time there are negative hormonal effects which can affect the thyroid, overproduction of prolactin and therefore sterility issues and gynecomastia in males (breast enlargement) as well as elevated cortisol (stress hormone) resulting in increased heart rate, blood pressure and edema.
Copper Peptide (GHK-Cu): This is primarily used for skin care to help promote collagen production and increases skin healing. The main side effects with this peptide is generally based on skin irritation, inflammation with associated redness and itching. This makes sense because it is a heavy metal and too much of a heavy metal can cause acute inflammation. There can also be “Purging”-which is acne breakouts and associated skin discoloration (blue/green tinge) similar to the patina seen on old pennies (prior to 1982) old copper pipes, copper sinks etc…
Melanotan-II: Is a synthetic peptide which mimics skin tanning. The tanning typically takes days of use before it is appreciated. This one is used in the bodybuilding world. It does this by stimulating melanin production which mimics the skin tanning. It is commonly known as the “Barbie drug”. This 1 carries more significant risk factors including increased risk of skin cancer due to its excessive mole production by stimulating the pigment cells. It is found to increase the rate of kidney infarction by blocking blood flow to the kidneys. There are neurologic side effects which include encephalopathy because this agent actually crosses the blood-brain barrier. Studies have shown that it can cause rhabdomyolysis (breakdown of muscle cells) and ultimately kidney failure. The cardiovascular risks are increased because it increases blood pressure and heart rate as well.
As you can see, there are multiple options available. The bottom line is we do not know if they are beneficial but most importantly, we do not know what the potential side effects may be. We all know someone who swears by the effects and will tell you how great they feel. Do not be pressured to try them for the fear that you are missing out. We know what they can do but we do not know what they may end up doing. In general, they are considered to be safer than steroids but again if you do not need your endocrine system changed why would you. There may be serious long-term effects that include hormone imbalance with the growth hormone increasing agents by pituitary overstimulation, potential acromegaly, abnormal bone growth thyroid dysfunction and decreased sex drive. There may be metabolic disruptions affecting insulin resistance and ultimately diabetes. There are unknown cancer risks and the risk of contamination. Another issue that has not been studied is what happens when you use multiple peptides simultaneously, which is what a lot of individuals are doing. Again, we do not know.
I will tell you what we do know. If you want to lose weight it is difficult and you have to eat less, eat less frequently, and eat healthier. If you want to be stronger and prevent degeneration you need to exercise more, which includes not only resistance training (weights) but aerobic activity (anything to get your heart rate up). If you want to decrease your risk of appearing older you need to stay out of the sun, wear sunblock, wear hats (Thank you Dr. Storey-Dermatology) and avoid smoking. If you want to avoid cognitive decline you need to stay social, happy, exercise, avoid regular use of alcohol or alcohol altogether and make your sleep a priority ensuring you are getting at least 7 hours of sleep nightly. And even if you do all of this you will still get older, but you will be happier and healthier. You could do everything right and bad things can still happen. Death is not a bad thing, and it is not the opposite of life is just a part of it. Premature death, on the other hand is a sad event and that is why I would like you to try everything you can to side the deck in your favor to prevent this from happening.
I find it funny that this machine, which is our body, has evolved over millions of years or was created to be perfect by a higher power. Which view you believe to be true does not matter. What matters is the understanding there are no shortcuts or quick ways to “hack” into this amazing machine we have been gifted or blessed with. There is no backdoor or secret program that can get you there. It reminds me of the Candyland game. You know when someone was lucky enough to land on the spot that took you right to the top. That is true in games but not in real life. “If you do the work, you get rewarded. There are no shortcuts in life.” and “Hard work pays off if you are patient enough to see it through.”–Michael Jordan. I would recommend keeping these peps out of your life steps until we know much more about them. Stay healthy my friends.
Doug
