Latest / The Antisocial Doctors Podcast / Episode 12: What's the Deal With Peptides?

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Episode 12: What's the Deal With Peptides? · The Antisocial Doctors Podcast

• 1:27
  Sonia Singh MD: You are listening to the Antisocial Doctors Podcast, hosted by me, Sonia Singh, a board certified internal medicine physician with a Master's in nutrition and a special interest in health anxiety
• 1:38
  Rebecca Berens MD: and me, Rebecca Barons, a board certified family medicine physician with a special interest in disordered eating.
• 1:43
  Sonia Singh MD: We're also a millennial women anxious moms and curious humans navigating social media.
• 1:48
  Sonia Singh MD: We've seen firsthand how these platforms can be powerful tools for education and connection, but can also make us unwell.
• 1:56
  Rebecca Berens MD: This podcast is meant to be the antidote to your doom.
• 1:58
  Rebecca Berens MD: Scrolling, a, solve for the anxiety, stress, guilt, shame, and confusion.
• 2:02
  Rebecca Berens MD: That comes from social media's messaging around health.
• 2:05
  Rebecca Berens MD: In each episode, we discuss a health related talk, trending on social media with curiosity, nuance, evidence, humility, and compassion.
• 2:12
  Sonia Singh MD: This is not your average debunking podcast.
• 2:14
  Sonia Singh MD: We wanna explore not just what is trending on social media, but why?
• 2:18
  Sonia Singh MD: Why are so many people drawn to this?
• 2:20
  Sonia Singh MD: What is the nugget of truth here?
• 2:21
  Sonia Singh MD: What are the facts?
• 2:23
  Sonia Singh MD: What can we learn from this as patients and doctors?
• 2:25
  Sonia Singh MD: No shame.
• 2:26
  Sonia Singh MD: No blame, no snark.
• 2:27
  Rebecca Berens MD: We're so glad you're here.
• 2:46
  Sonia Singh MD: All right.
• 2:46
  Sonia Singh MD: Hi, Rebecca.
• 2:47
  Sonia Singh MD: Hey, Sonia.
• 2:49
  Sonia Singh MD: So today's topic is one that we've been meaning to cover for a while, and truthfully, before I did the research for this episode, I was clueless on the topic generally, it was a black box.
• 3:01
  Sonia Singh MD: I don't know how much you knew about this before.
• 3:03
  Sonia Singh MD: I don't know.
• 3:03
  Sonia Singh MD: I you haven't you just saw my outline one minute ago, so I dunno how much you know about the topic or coming to it.
• 3:09
  Rebecca Berens MD: Yeah, I haven't done a huge deep dive, but I have reper research specific ones that patients have brought up to me.
• 3:17
  Rebecca Berens MD: When people inevitably will send me like, Hey, what do you think of this thing?
• 3:20
  Rebecca Berens MD: And then I go read about it.
• 3:21
  Rebecca Berens MD: But yeah, I think the.
• 3:22
  Rebecca Berens MD: Reviewing the topic as a whole will be very helpful.
• 3:25
  Sonia Singh MD: Yeah.
• 3:25
  Sonia Singh MD: Okay.
• 3:25
  Sonia Singh MD: So the topic today is peptides.
• 3:28
  Sonia Singh MD: And I'm gonna start with a patient story, which was honestly one of my first interactions with the idea of peptides.
• 3:35
  Sonia Singh MD: And so the story I think happened about two years ago.
• 3:38
  Sonia Singh MD: So this was more early days before it was all over social media and.
• 3:42
  Sonia Singh MD: I had this patient who told me that he joined a, virtual longevity practice that he had heard about through some friends, and that they had sent him this whole new medication regimen and he wanted to have my thoughts on it.
• 3:56
  Sonia Singh MD: So I was like, yeah, send me over what they recommended for you and I'll give you my 2 cents.
• 3:59
  Sonia Singh MD: And he sent me this very long PDF and it had this table.
• 4:04
  Sonia Singh MD: And then on this, the side of the medications, there were just all of these acronyms and numbers and I just could not understand what any of them were.
• 4:12
  Sonia Singh MD: I was going on the list and there were some.
• 4:15
  Sonia Singh MD: Metformin that I was like, I recognize that.
• 4:18
  Sonia Singh MD: But then there was a bunch of things like BPC 1 57 and Motzi, and I just, I could not under my brain was what are all these letters and numbers?
• 4:27
  Sonia Singh MD: And I immediately you started looking all of them up and I was coming to the same conclusion, looking a lot of these up.
• 4:35
  Sonia Singh MD: But, I basically told them, look I don't prescribe any of these things.
• 4:38
  Sonia Singh MD: They all look like they have limited data.
• 4:40
  Sonia Singh MD: I don't know that much about them.
• 4:41
  Sonia Singh MD: I have no clinical experience with them.
• 4:43
  Sonia Singh MD: I really can't say I recommend these but, do what you wanna do.
• 4:47
  Sonia Singh MD: And since that time, that was probably like the first time I had really encountered these.
• 4:51
  Sonia Singh MD: Since that time, I have had so many questions about those same acronyms and numbers, and I've seen them talked about so much on social media and in podcasts that I, thought, okay, we have to cover this topic and it's time for me to maybe do a deeper dive.
• 5:06
  Sonia Singh MD: And I think what's really interesting about this topic in general is.
• 5:10
  Sonia Singh MD: The science gets a lot of coverage or the biology of some of these compounds gets a lot of coverage in YouTube and podcasts and social media and all these contents and people's own personal experiences with them do.
• 5:21
  Sonia Singh MD: But I haven't heard a lot of people zoom out and reflect on what is the bigger picture?
• 5:26
  Sonia Singh MD: Like what is going on here?
• 5:27
  Sonia Singh MD: Why is this thing such a big deal why are doctors not talking about it, but it's all over social media.
• 5:33
  Sonia Singh MD: Why is that happening?
• 5:34
  Sonia Singh MD: The claim is peptides are this cheat code for your health.
• 5:37
  Sonia Singh MD: They basically can help with everything that people most want.
• 5:40
  Sonia Singh MD: Losing fat, gaining muscle, having better skin, not aging as fast recovering quicker from illness or injury.
• 5:47
  Sonia Singh MD: And I think among the people who promote peptides and in that microcosm, there's this, belief that they're more natural than the synthetic chemical pharmaceuticals that you get from your regular doctor.
• 5:59
  Sonia Singh MD: There's definitely a claim out there that they don't have side effects or they have very few side effects.
• 6:04
  Sonia Singh MD: And I hear this description, a lot of, it kind of body function optimally and it allows you to just take matters into your own hands and not have to deal with your lame doctor and your insurance, go and get what you need and, help your body function optimally.
• 6:21
  Sonia Singh MD: The claim is vague.
• 6:23
  Sonia Singh MD: The biggest claim is that these are these really potent kind of cheat code biohacking tools that the medical community hasn't really woken up to and that you can go get on your own.
• 6:34
  Sonia Singh MD: Do you have something to add to what you've heard
• 6:37
  Rebecca Berens MD: about
• 6:37
  Sonia Singh MD: peptides?
• 6:38
  Rebecca Berens MD: I agree with you.
• 6:39
  Rebecca Berens MD: I think the, it is this sort of appeal to natural fallacy that we've talked about many times before.
• 6:45
  Rebecca Berens MD: I've definitely heard the same things from patients and I've heard people just they've just been casually recommended to them when they go to get Botox or go to get an IV after a hangover.
• 6:55
  Rebecca Berens MD: And they're like, Hey, do you want this peptide?
• 6:57
  Rebecca Berens MD: Just it's it's no big deal.
• 6:58
  Rebecca Berens MD: And I'm like if it's as powerful as you're claiming anything that has power to help you, has power to hurt you.
• 7:04
  Rebecca Berens MD: And it's just so interesting the way it's framed as this is the best thing ever and there's nothing possibly wrong with it and it's totally safe.
• 7:11
  Rebecca Berens MD: That obviously cannot be true and I know you'll get all into that with your with your deep dive here.
• 7:15
  Rebecca Berens MD: But yeah, it's just, it's so fascinating how that exact appeal to that fallacy of nature being safe is repeatedly brought up.
• 7:24
  Rebecca Berens MD: When with this marketing of so many things in health on social media, but particularly with peptides.
• 7:29
  Sonia Singh MD: It's so fascinating because depending on what sources you look at, you'll get a very different picture of what these are.
• 7:38
  Sonia Singh MD: So if you're a doctor and you're going straight to PubMed, open evidence up to like you're looking at, peer reviewed scientific sources, you're gonna get an impression about what the deal is with peptides.
• 7:49
  Sonia Singh MD: But then if you go on social media or listen to some of these biohacking podcasts, you'll get a completely different reality of what is happening, and I'm really glad we're doing this episode because I think there's very few sources that really just talk about both, that really bring together both sides of this, debate or world and explore why is there such a big gap between these two realities, so anyway, first before I dive into what is the negative truth of this claim?
• 8:17
  Sonia Singh MD: I need to lay some groundwork here of defining what is a peptide and give a little context for this.
• 8:22
  Sonia Singh MD: So first let's start with just what is a peptide?
• 8:24
  Sonia Singh MD: So the word peptide might be familiar to some people from high school biology.
• 8:28
  Sonia Singh MD: Basically a peptide is just a short string of amino acids.
• 8:32
  Sonia Singh MD: Classically a peptide is thought of as 20 or less.
• 8:34
  Sonia Singh MD: Although some of the peptides I researched were in the forties or even low fifties in terms of the number of amino acids.
• 8:39
  Sonia Singh MD: But when it's 50 or more or peptides get combined, then we consider that a protein.
• 8:45
  Sonia Singh MD: So you can think of a peptide as a micro mini version of a protein or like the simplest base ingredient of a bigger protein.
• 8:52
  Sonia Singh MD: We all know about protein and what it does in the body.
• 8:54
  Sonia Singh MD: Actually, we have a separate episode that covers protein in more detail.
• 8:57
  Sonia Singh MD: But what peptides primarily do is they act as.
• 9:00
  Sonia Singh MD: Signaling molecules.
• 9:02
  Sonia Singh MD: So a lot of our hormones are peptides.
• 9:04
  Sonia Singh MD: A lot of our neurotransmitters are peptides.
• 9:06
  Sonia Singh MD: Things like insulin, glucagon, growth hormone, oxytocin, stuff that you probably have a vague awareness of.
• 9:12
  Sonia Singh MD: Those are all actual examples of peptides that are endogenous, that are made by your body and that do all kinds of things in, various parts of your body.
• 9:20
  Sonia Singh MD: So they're also involved in immune, pro immune responses, tissue repair, cell growth.
• 9:24
  Sonia Singh MD: Some of those don't have names that are familiar to us, but they are involved in all of those processes.
• 9:29
  Sonia Singh MD: A lot of peptides occur in nature, naturally in your body, in animals', bodies, You're full of peptides right now.
• 9:35
  Sonia Singh MD: When people are talking about peptides in the wellness space, they're really talking about therapeutic peptides and peptides.
• 9:42
  Sonia Singh MD: Peptide based drugs.
• 9:43
  Sonia Singh MD: So that's what, the topic of conversation is today.
• 9:46
  Sonia Singh MD: So the first therapeutic peptide, which we all know and love, was isolated and sold commercially in 1921, and that was insulin.
• 9:54
  Sonia Singh MD: Initially they were getting the insulin from the carcasses of pigs and cows, so it was a naturally derived insulin.
• 10:01
  Sonia Singh MD: Later they developed the ability to synthesize actual human insulin by identifying the gene in humans that codes for the insulin, and then putting that gene in bacteria or yeast and having them then create the insulin and then harvesting it and purifying it from that process.
• 10:17
  Sonia Singh MD: So since the creation of insulin, there's been 70 or 80 other peptide drugs that were developed and approved.
• 10:24
  Sonia Singh MD: The biggest, most recent blockbuster peptide that's been approved or peptides are the GLP one agonists.
• 10:30
  Sonia Singh MD: So those are like semaglutide, which is wegovy or ozempic or tirzepatide, which is the same as zep bound or manjaro.
• 10:37
  Sonia Singh MD: And so those are essentially peptides that are designed to activate the GLP one receptor, which is in various parts of your body.
• 10:46
  Sonia Singh MD: So most of the time, the way these medicines work, or the way these drugs work is that the peptide is gonna bind to a receptor on the outside of a cell and it triggers some process to happen inside the cell.
• 10:56
  Sonia Singh MD: So most other drugs are either classified as small molecules, so they're not quite a peptide or there's also biologics, which are larger proteins.
• 11:06
  Sonia Singh MD: Small molecule drugs are easier and cheaper to synthesize, and they're better able to get inside the cell membrane so they can do more stuff inside the cell.
• 11:15
  Sonia Singh MD: The downside of small molecules is that they're not as specific.
• 11:19
  Sonia Singh MD: The peptides are more like a lock and key where they're very specific to bind to a very specific receptor where small molecules might go and start doing other things in the cell that you don't intend them to do.
• 11:29
  Sonia Singh MD: The other big category besides small molecules is biologic, which are biologics, which are usually larger proteins or antibodies, which are actually also proteins.
• 11:37
  Sonia Singh MD: And then in contrast to a small molecule or a biologic, the peptides do tend to have fewer unintended effects because of this kind of lock-in key mechanism.
• 11:47
  Sonia Singh MD: The downside of peptides, I mentioned one of them already, which is that it can't do a lot of stuff intracellularly'cause it's too big.
• 11:53
  Sonia Singh MD: It's bigger than a small molecule and can't go through the cell membrane.
• 11:56
  Sonia Singh MD: But the other big problem with them is stability.
• 11:58
  Sonia Singh MD: Because they're such a simple structure, those bonds between those amino acids can be broken down very easily.
• 12:04
  Sonia Singh MD: And so keeping them stable enough and around long enough for them to have a therapeutic effect has been one of the challenges in developing peptide based drugs.
• 12:15
  Sonia Singh MD: So the reason.
• 12:16
  Sonia Singh MD: There's been such a huge advancement in, or there's, the reason you're hearing so much more about peptides now is just over the last 20 or 30 years, there's been a lot of technological advancements in terms of how they identify peptide sequences to, the potential drugs and how they manufacture them.
• 12:33
  Sonia Singh MD: So basically the drug development and manufacturing has advanced such that these drugs can be developed and produced much more quickly and much cheaper than they ever have in the past.
• 12:45
  Sonia Singh MD: So there's this rush now of all of these drugs being investigated and trying to develop them into something commercially available.
• 12:53
  Sonia Singh MD: But the regulatory process for drugs in the US is very slow.
• 12:58
  Sonia Singh MD: So there's hundreds of drugs currently in the pipeline, but what we've seen with peptides is that.
• 13:06
  Sonia Singh MD: There's been this explosion of consumer demand and awareness about these drugs that has outpaced the regulatory process.
• 13:14
  Sonia Singh MD: And so this unique phenomenon has occurred where people are really clamoring for these drugs and they're getting them from places and using them before they have gone through that process of rigorous study and safety testing and approval and all of the things that normally happen with a drug.
• 13:33
  Sonia Singh MD: So from a legal standpoint, there's three broad categories.
• 13:36
  Sonia Singh MD: There's FDA approved peptide drugs.
• 13:39
  Sonia Singh MD: So those are things like insulin and wegovy, manjaro, ozempic, those.
• 13:43
  Sonia Singh MD: Then there's compounded versions of FDA approved drugs.
• 13:47
  Sonia Singh MD: So those are things like compounded semaglutide, compounded tirzepatide.
• 13:52
  Sonia Singh MD: Those are still in illegal gray area, but you can still do that.
• 13:55
  Sonia Singh MD: Many places are still selling compounded versions of those GLP.
• 13:59
  Sonia Singh MD: One interesting thing to note is that, between 2023 and 2024, the FDA took a bunch of pep.
• 14:06
  Sonia Singh MD: And moved them into a different safety category for compounding pharmacies.
• 14:10
  Sonia Singh MD: So prior to 2024 compounding pharmacies could actually, even though a lot of these had never been tested on humans and had no FDA approved indication, they could still create compounded versions of these and sell them to clinics or doctors to then prescribe to patients.
• 14:25
  Sonia Singh MD: In 2024, I think the FDA got concerned about the amount of these that were being prescribed and used without having done clinical trials and without having gone through the regulatory process.
• 14:35
  Sonia Singh MD: So they moved them to a list that is considered unsafe for compounding pharmacies to use as ingredients.
• 14:40
  Sonia Singh MD: And those included some of the most popular peptides like BPC 1 57 and TD TB 500.
• 14:45
  Sonia Singh MD: And so now those have all flooded the gray market, which is like the primary way you can get a lot of the.
• 14:52
  Sonia Singh MD: Peptides now and then the last category would be things that are considered research chemicals and are clearly marked as not for human use because they have not been yet studied in human settings that can be purchased on the gray market.
• 15:05
  Sonia Singh MD: So a lot of those things that were in the compounded category are now, have now been pushed to only available on the gray market, not really any obviously legal way that you can prescribe them or buy them.
• 15:15
  Sonia Singh MD: So that is a rapid fire overview of the definition of peptides and the legality around peptides.
• 15:23
  Sonia Singh MD: So now I wanna dive into a little bit about why this is so viral and why peptides have really take had such a big moment in, social media and kind of pop culture generally.
• 15:33
  Sonia Singh MD: I'm curious before I launch into my theories, what you think.
• 15:37
  Rebecca Berens MD: Yeah, I mean I think I'm sure we'll get into a lot of this, but I think it's like you said this, we've talked about this many times, this sort of new obsession with optimization.
• 15:46
  Rebecca Berens MD: And with one, like there's more drive for not just being generally healthy, but optimizing your health, somehow making it more perfect, more, doing the absolute most best thing that you can.
• 15:59
  Rebecca Berens MD: That I think was really driven partially by social media and partially maybe by COVID and a lot of things colliding at the same time.
• 16:07
  Rebecca Berens MD: And I think that's really been co-opted than by people who have things to sell that are not available anywhere else.
• 16:14
  Rebecca Berens MD: So yeah.
• 16:15
  Rebecca Berens MD: I'm curious to hear what you came up with.
• 16:17
  Sonia Singh MD: Yeah, I totally agree.
• 16:18
  Sonia Singh MD: I think optimization culture, as you said, arose out of this perfect storm of a lot of different factors.
• 16:24
  Sonia Singh MD: We talked a little bit about in the protein episode about how fitness culture has become mainstream over the last decade or so.
• 16:32
  Sonia Singh MD: A lot of these peptides were.
• 16:34
  Sonia Singh MD: Talked about and used in bodybuilding circles for years before they ever were talked about on social media.
• 16:39
  Sonia Singh MD: But now because of social media, I think a lot of these things that you would only hear about, in the back of the gym, like suddenly suburban moms are now seeing on their algorithm.
• 16:49
  Sonia Singh MD: And so it's just the way information can spread now is very different.
• 16:54
  Sonia Singh MD: Like you said, there's a lot more interest in longevity optimization, peak physical fitness.
• 17:01
  Sonia Singh MD: And then I think, in a lot of ways GLP ones were like the gateway drug.
• 17:05
  Sonia Singh MD: I don't know that a lot of people even realize that GLP ones are peptides.
• 17:09
  Sonia Singh MD: So I'm not saying it necessarily made people interested in peptides, but.
• 17:12
  Sonia Singh MD: I think it's this thing where we've watched this phenomenon where, almost everybody probably knows somebody who has had a visible result of being on a GLP one.
• 17:22
  Sonia Singh MD: Yeah.
• 17:22
  Sonia Singh MD: And so it's this thing where you're seeing it happen all around you and you're seeing this medicine change people's appearances and their lives and they seem to be not having a lot of bad side effects.
• 17:34
  Sonia Singh MD: And I think with a lot of these peptides, there is potential for.
• 17:39
  Sonia Singh MD: Really notable visible change and especially social media being such a visual platform, the power of before and afters or before and after stories even is, It's really good content that, is, it's inherently viral.
• 17:54
  Sonia Singh MD: When you talk about those types of those types of anecdotes.
• 17:57
  Sonia Singh MD: So I think, fitness culture, social media, GLP ones being a gateway.
• 18:02
  Sonia Singh MD: And then also we talked about this on multiple episodes in the past, this growing kind of antip, pharma, anti medical establishment sentiment.
• 18:10
  Sonia Singh MD: So I think for people who have this belief that, doctors are just money motivated and they're all in bed with big pharma.
• 18:18
  Sonia Singh MD: The FDA is also in bed with big pharma, and when they perceive that all of those organizations.
• 18:24
  Sonia Singh MD: Hoots to just make Americans sick, keep them sick.
• 18:27
  Sonia Singh MD: Then you know, the idea that these drugs are not FDA approved or that your doctor is not recommending them, goes out the window.
• 18:34
  Sonia Singh MD: 'cause the perception is who cares what they say?
• 18:36
  Sonia Singh MD: Because they're all corrupt anyway.
• 18:38
  Sonia Singh MD: And there's this idea now that all of those agencies, regulatory agencies, doctors, other experts, that they're all just gatekeeping.
• 18:46
  Sonia Singh MD: And it's very conspiracy theory ish, but it's this idea that they don't want you to have access to these things that are going to make you healthy or that they're imposing these 10, 15, 20 year delays on people getting their hands on these things that could make their lives so much better.
• 19:02
  Sonia Singh MD: And why would we do that when we could just take matters into our own hands and have them today and use them now and feel better tomorrow?
• 19:09
  Sonia Singh MD: And I think that's a really big part of what's pushing peptides.
• 19:12
  Sonia Singh MD: I listened to three.
• 19:14
  Sonia Singh MD: Different biohacking type podcasts as context for this, because I just, I felt, I was only looking at medical, scientific resources and I was like, I don't feel like I am understanding what, people are really thinking about this.
• 19:30
  Sonia Singh MD: So I thought it was important context.
• 19:33
  Sonia Singh MD: It was hard.
• 19:33
  Sonia Singh MD: It was,
• 19:34
  Rebecca Berens MD: I was gonna say good for you.
• 19:35
  Rebecca Berens MD: 'cause I don't think I could do it.
• 19:36
  Sonia Singh MD: I was rage texting you yesterday.
• 19:38
  Sonia Singh MD: I was doing it it was rough, but I had to be done.
• 19:42
  Sonia Singh MD: I, what I really got from listening to a lot of those was I think if this is your worldview, that institutions and expertise and organizations like this cannot be trusted, it's really hard to change your mind with anything that I'm gonna say or any facts that I'm gonna present.
• 19:58
  Sonia Singh MD: I don't know how we, change those people's minds ultimately.
• 20:02
  Sonia Singh MD: But I do think that's a big part of what's driving interest in this and, what makes them so popular.
• 20:07
  Sonia Singh MD: Yeah.
• 20:08
  Sonia Singh MD: And then lastly, one of the big take home points I got from listening to this podcast is that they're really presented in a way that makes them seem like they're not drugs, that they're natural, that they're safer than a the phrases I heard them use were like, this just helps your body heal itself.
• 20:25
  Sonia Singh MD: This just gives you the building blocks you need to function optimally.
• 20:29
  Sonia Singh MD: This is for people who don't wanna wait to get a disease and wanna optimize today.
• 20:33
  Sonia Singh MD: Now don't wanna wait 10 or 15 years for this to get approved and then for pharma to mark it up by 200%.
• 20:40
  Sonia Singh MD: They wanna get it now.
• 20:42
  Sonia Singh MD: And one of the podcasts like actually claimed in the title that 75,000 people have used this with no adverse effects.
• 20:48
  Sonia Singh MD: So why wait for FDA approval?
• 20:51
  Sonia Singh MD: What other safety data do you need?
• 20:54
  Sonia Singh MD: That's like the I think the messaging that's happening in a lot of the circles and just searching for content on peptides it's amazing how, almost everything that comes up in the top 10 hits is from people who are selling or promoting them.
• 21:12
  Rebecca Berens MD: Yeah.
• 21:12
  Rebecca Berens MD: So
• 21:13
  Sonia Singh MD: it's, i'm glad we're doing this episode'cause I just don't think there's a lot of people presenting both sides of this, this topic.
• 21:19
  Rebecca Berens MD: I'm very curious, after all your searching what your Facebook and Instagram ads are gonna look like over the next couple months, please screenshot those to me because I'm fascinated.
• 21:28
  Sonia Singh MD: I'm getting a lot of get fit now and it's like a guy with a really big muscle, like bulging veins and muscles, so yeah, I don't know.
• 21:36
  Sonia Singh MD: I think my algorithm is wow, what She's really taking a turn.
• 21:41
  Rebecca Berens MD: Something I was thinking about as two things I was thinking about as you were saying this.
• 21:45
  Rebecca Berens MD: So I recently, and maybe I'm behind the eight ball on this, but I recently learned the term, the KS shaped economy as,
• 21:51
  Sonia Singh MD: I don't know that term
• 21:52
  Rebecca Berens MD: what's going on right now.
• 21:53
  Rebecca Berens MD: So basically the Ks shaped economy is it's a K, right?
• 21:55
  Rebecca Berens MD: So the rich are getting rich richer and the poor are getting poorer.
• 21:57
  Rebecca Berens MD: And that's the economy that we're in right now.
• 22:00
  Rebecca Berens MD: And it strikes me that's exactly what's happening here is healthcare is becoming increasingly unaffordable.
• 22:06
  Rebecca Berens MD: So the people who have the most money can afford to spend extra on all these extra things to maximally optimize.
• 22:14
  Rebecca Berens MD: Meanwhile, the people who can barely keep their head above water and afford the basics are even struggling to afford that.
• 22:20
  Rebecca Berens MD: And they are forced to take matters into their own hands because they're not able to even access healthcare through the traditional channels in an affordable way.
• 22:29
  Rebecca Berens MD: And so I can definitely see how that exact mindset that both on whichever side of the K you're on, if you're on the upstroke or the downstroke,
• 22:39
  Sonia Singh MD: that peptides would
• 22:39
  Rebecca Berens MD: be attracted.
• 22:40
  Rebecca Berens MD: The peptides fit in.
• 22:40
  Rebecca Berens MD: It's like optimize, make everything great or can't afford it.
• 22:44
  Rebecca Berens MD: Let me just do the best I can and this is available online and I don't have to get a prescription for it or see a doctor or pay a lot of money.
• 22:51
  Rebecca Berens MD: And yeah, it's.
• 22:53
  Rebecca Berens MD: Just as you were talking, I was like, wow, this is colliding with everything I've just read about the khap economy.
• 22:58
  Sonia Singh MD: Very anecdotally, the people that have come to me asking about peptides are on the two, like Yeah.
• 23:04
  Sonia Singh MD: Of the K
• 23:05
  Rebecca Berens MD: exactly.
• 23:05
  Sonia Singh MD: There's, this patient I had who was in this super fancy exclusive longevity practice that looked like a secret society when I tried to look at their website.
• 23:14
  Sonia Singh MD: And then I've also been asked about it by my 20 something year old cousin who's oh, I go to this place for my facials and everywhere it says they have a sale on rta.
• 23:22
  Sonia Singh MD: Try, BBC one.
• 23:23
  Sonia Singh MD: She was.
• 23:24
  Sonia Singh MD: What is it?
• 23:25
  Sonia Singh MD: What is a peptide?
• 23:26
  Sonia Singh MD: And she was like, all these people are using it and on it.
• 23:29
  Sonia Singh MD: And they just say yeah, it just makes you feel so good, and my 20 something year old cousin does not have, unlimited funds to just be throwing at these things, so
• 23:37
  I
• 23:37
  Rebecca Berens MD: probably getting dropped off their parents' insurance imminently.
• 23:40
  Sonia Singh MD: That's right.
• 23:41
  Sonia Singh MD: Can barely afford to live in the Bay Area.
• 23:43
  Sonia Singh MD: Yeah.
• 23:43
  Sonia Singh MD: I.
• 23:44
  Sonia Singh MD: I, I do think there is something to that.
• 23:46
  Sonia Singh MD: It really is not the middle, middle of the population who seems to have an established PCP and good insurance and whatever.
• 23:52
  Sonia Singh MD: Those are not so much the people that are coming to me with questions about these.
• 23:56
  Sonia Singh MD: It really seems to be more at the extremes, people who are really online or people who are like in that kind of extreme optimization, longevity, biohacking, mindset.
• 24:05
  Rebecca Berens MD: But that middle is disappearing, right?
• 24:07
  Rebecca Berens MD: Even middle class, the middle is disappearing.
• 24:08
  Rebecca Berens MD: The middle is disappearing in everything in politics and the economy and everything.
• 24:12
  Rebecca Berens MD: And it is so interesting that this is something that appeals to both ends.
• 24:16
  Rebecca Berens MD: Yeah.
• 24:16
  Rebecca Berens MD: And there's a market for it on both ends.
• 24:18
  Rebecca Berens MD: So I, I don't know that just.
• 24:20
  Rebecca Berens MD: Maybe just'cause I've just read all these articles recently about the kha economy.
• 24:23
  Rebecca Berens MD: I was just like, oh my gosh, this is it.
• 24:25
  Rebecca Berens MD: The other thought I have is going back to insulin.
• 24:28
  Rebecca Berens MD: I know we'll talk about this when we talk about adverse effects, but you can definitely kill yourself with insulin.
• 24:33
  Sonia Singh MD: I know.
• 24:34
  Rebecca Berens MD: To say there's no adverse effects.
• 24:36
  Rebecca Berens MD: And then
• 24:38
  Sonia Singh MD: I have a thing or
• 24:39
  Rebecca Berens MD: two to say about, I'm sure you do, but I'm just like, it's so fascinating to me that people are like, what do we need?
• 24:44
  Rebecca Berens MD: Safety data?
• 24:45
  Rebecca Berens MD: I'm like, you can definitely kill yourself with peptides.
• 24:48
  Sonia Singh MD: But Rebecca insulin is natural.
• 24:50
  Sonia Singh MD: It's natural.
• 24:51
  Rebecca Berens MD: It is natural and it will also kill you in the wrong test.
• 24:54
  Rebecca Berens MD: I'm curious if there, and in inappropriate situations,
• 24:56
  Sonia Singh MD: is there a movement around you know how so many patients will be like I want, arm or thyroid or np, I want a natural, a porcine thyroid.
• 25:04
  Sonia Singh MD: Are people out there being like, I want a porcine insulin, or because it's more natural.
• 25:08
  Sonia Singh MD: It didn't come from this weird recombinant DNA you made in a fungus.
• 25:12
  I
• 25:12
  Rebecca Berens MD: mean, people aren't so much clamoring for insulin because insulin doesn't make you lose weight.
• 25:17
  Rebecca Berens MD: So I think that one is less of a, less, people aren't really clamoring for that one so much.
• 25:22
  Rebecca Berens MD: It just, it is so fascinating to me that, that term, that phrase was said, what safety data do we need?
• 25:28
  Rebecca Berens MD: We need to know what is a safe and appropriate dose of anything, even if it is we have potassium naturally occurring in our body.
• 25:34
  Rebecca Berens MD: But if you give yourself just some IV potassium, you're just gonna die.
• 25:37
  Sonia Singh MD: Yes.
• 25:38
  Sonia Singh MD: Yes.
• 25:39
  Rebecca Berens MD: So there is a safe and appropriate dose of everything.
• 25:42
  Sonia Singh MD: IV vitamins.
• 25:43
  Sonia Singh MD: You're just like catching stray from us.
• 25:45
  Sonia Singh MD: Okay.
• 25:45
  Rebecca Berens MD: I know.
• 25:45
  Rebecca Berens MD: That's a whole other episode.
• 25:47
  Rebecca Berens MD: IV vitamins.
• 25:47
  Rebecca Berens MD: But anyway.
• 25:48
  Sonia Singh MD: I'll also say that a lot of people use the term peptide very loosely.
• 25:53
  Sonia Singh MD: They'll just start calling NADA peptide.
• 25:54
  Sonia Singh MD: It's not a peptide, it's just kinda lumped in as one of these other things that you can get sold at a med spa for no side effects apparently, and lots of benefits, it's not actually a peptide.
• 26:04
  Sonia Singh MD: So anyway now let's talk, let's move on to the nugget of truth.
• 26:08
  Sonia Singh MD: Okay.
• 26:09
  Sonia Singh MD: So it is true that there are many peptides that have a well-proven therapeutic benefit.
• 26:15
  Sonia Singh MD: GLP one agonists are an example.
• 26:18
  Sonia Singh MD: There are likely many others that do have therapeutic effects.
• 26:22
  Sonia Singh MD: And in this case, I've seen some conversations in physician groups where people will immediately just roll their eyes and say, it's snake oil, it's a scam, just placebo effect.
• 26:30
  Sonia Singh MD: This is not one of the cases where I'm like, yeah, it's all placebo effect, I believe these do things and they probably do have therapeutic effects.
• 26:37
  Sonia Singh MD: I do not doubt that there are some people who are taking these and experiencing very positive outcomes from them.
• 26:43
  Sonia Singh MD: And it's also true that compared to small molecule drugs, which is a lot of the drugs we think of and are prescribed and biologics, it does seem like peptide based drugs have lower immunogenicity and fewer drug interactions, just by the nature of how they work and what they are.
• 27:00
  Sonia Singh MD: And it's also true that the regulatory process, especially in the US, is extremely slow.
• 27:06
  Sonia Singh MD: Doing studies requires funding and requires time.
• 27:09
  Sonia Singh MD: And, it takes a long time from the point where something looks like it's promising to the time that it actually becomes available for human consumption and gets on the market and gets prescribed and doctors are aware of it and start giving it to people.
• 27:23
  Sonia Singh MD: And so it's true that once some of these things are ultimately approved, they may get harder to access, they may get more expensive, once it becomes an FDA approved drug and it's patented, you have to get a doctor, you have to get a prescription, it has to be covered or then you have to pay some crazy cash price.
• 27:41
  Sonia Singh MD: And as we've seen with GLP ones, for example, I think there's a lot of patients out there that would clearly benefit from being on a GLP one, but they simply don't have access to it because, they don't meet their insurances very narrow, not medically driven, but just financially driven criteria for who they're gonna cover it for.
• 27:58
  Sonia Singh MD: And they can't afford the cash pricing.
• 28:00
  Sonia Singh MD: And again, that's why the compounded and gray market for those products exists.
• 28:05
  Sonia Singh MD: So I think all of those things are true.
• 28:09
  Sonia Singh MD: But that is not the whole truth.
• 28:12
  Sonia Singh MD: To move on a little bit to the facts.
• 28:14
  Sonia Singh MD: The biggest fact that I want people to take home from this conversation is that these are very much drugs.
• 28:21
  Sonia Singh MD: Anyone who tells you that this is not a drug, or this is more like a supplement, or this is natural, or this has no side effects or has no risks, is just lying to you.
• 28:30
  Sonia Singh MD: A drug is defined as any substance intended for use in the diagnosis, cure mitigation, treatment or prevention of disease, or to affect the structure or function of the body that is a drug.
• 28:42
  Sonia Singh MD: So you know the fact that right now you can buy it online without a prescription.
• 28:46
  Sonia Singh MD: I don't know if, I think for some people maybe that feels, because that's so easy, like one click by now, it comes to my door that maybe it's.
• 28:55
  Sonia Singh MD: Safer than a pharmaceutical.
• 28:56
  Sonia Singh MD: It is not, it is just a, that, that is a gray market that, that actually you're taking on quite a bit of risk and liability yourself when you do that.
• 29:04
  Sonia Singh MD: The fact that it does not come with that crazy long leaflet that folds out with 800 risks and side effects, including death, is not because that thing doesn't have it, it's because it has not gone through that regulatory process and rigorous testing to determine what all of those things are and to write them down and be forced legally to have you see that before you take the drug.
• 29:26
  Sonia Singh MD: It does not mean it's any safer or that it doesn't have those things.
• 29:30
  Sonia Singh MD: They most definitely have potential adverse effects and risks.
• 29:35
  Sonia Singh MD: Any biologically active compound that does anything in your body has potential risks.
• 29:41
  Sonia Singh MD: A huge red flag that you should look out for.
• 29:43
  Sonia Singh MD: When any practitioner, provider influencer says that something has virtually no risk or no risk, they are lying they are lying or they do not know.
• 29:54
  Sonia Singh MD: Because that is just not true of any substance that does anything in your body.
• 30:00
  Sonia Singh MD: Consider GLP ones as an example.
• 30:02
  Sonia Singh MD: They are a peptide.
• 30:03
  Sonia Singh MD: They come with that same long leaflet of potential risks and side effects.
• 30:07
  Sonia Singh MD: It's as you mentioned, insulin, like plenty of risks and side effects that you've probably, observed other people having or, heard about from them.
• 30:16
  Sonia Singh MD: So it the idea that peptides are so safe and so well tolerated and they don't have risks and they don't have side effects that is not true.
• 30:22
  Sonia Singh MD: That is not a fact.
• 30:23
  Sonia Singh MD: The other thing to consider is because they're not going through the regulatory process because at this point, even compounding pharmacies are limited from making a lot of these, most of them are being purchased on the gray market, in which case purity and contamination are huge concerns.
• 30:38
  Sonia Singh MD: So even though peptides themselves are highly specific and not as immunogenic as a lot of other drugs.
• 30:44
  Sonia Singh MD: The manufacturing process for peptides and because they have such low stability, it's very specific and the storage and transportation needs to be very specific.
• 30:53
  Sonia Singh MD: Otherwise they can accumulate these impurities and the impurities are very immunogenic.
• 30:59
  Sonia Singh MD: I tried to look for more recent data, but this is such a new phenomenon.
• 31:02
  Sonia Singh MD: I feel like we haven't caught up to find studies on this.
• 31:06
  Sonia Singh MD: There was a 2018 study in Belgium, and this was looking mostly at peptides sold on the gray market, they were all in the bodybuilding and fitness type community.
• 31:15
  Sonia Singh MD: So this was kind of a different scenario than, what's happening now.
• 31:18
  Sonia Singh MD: But they basically purchased a bunch of these and then they tested them for purity and contamination.
• 31:23
  Sonia Singh MD: And so in terms of purity, they found that they contained five to 75% of what the, expected purity based on the labeling was.
• 31:31
  Sonia Singh MD: And then they also, gosh noted, high levels of heavy metal contamination, particularly arsenic and lead in a lot of the products.
• 31:37
  Sonia Singh MD: And if you think about it, people who are selling these things on the gray market, what incentive or motivation do they have to give you a pure product, they have labeled it, in most cases, a research chemical, not for human use.
• 31:50
  Sonia Singh MD: So if you use it in yourself and have any sort of problem.
• 31:53
  Sonia Singh MD: They labeled it as not for human use.
• 31:56
  Sonia Singh MD: So I, this whole thing is like a big charade of plausible deniability.
• 32:00
  Sonia Singh MD: The online seller sells it to you with labeling that says humans are not supposed to use this.
• 32:05
  Sonia Singh MD: If they sell it to the clinic, it's maybe listed as a research chemical only.
• 32:09
  Sonia Singh MD: And the clinic just says, yes, we're using it for research studies.
• 32:12
  Sonia Singh MD: Maybe the doctor never writes you a prescription, but they just direct you to some online pharmacy where you purchase it.
• 32:17
  Sonia Singh MD: I think part of the reason now that when that patient came to me and I tried to look up this thing, he was a part of it was so secretive.
• 32:24
  Sonia Singh MD: I think part of the reason they didn't advertise, what they do or what they give is'cause they probably wanna keep their supply chain really secret because it's probably a little shady and some of these things are in very legal gray areas.
• 32:36
  Sonia Singh MD: So anyway, you have to worry about all those things when you're buying something from the gray market.
• 32:41
  Sonia Singh MD: Additionally, because a lot of these things have not been studied in humans.
• 32:44
  Sonia Singh MD: There are no dosing guidelines for humans.
• 32:46
  Sonia Singh MD: And so people are just extrapolating from animal studies and, telling each other on TikTok and Reddit what is an appropriate dose?
• 32:53
  Sonia Singh MD: And they're going with that.
• 32:55
  Sonia Singh MD: That's another potential safety issue.
• 32:57
  Sonia Singh MD: And then, the bigger picture.
• 32:59
  Sonia Singh MD: So there's so many different peptides.
• 33:00
  Sonia Singh MD: I can't cover all of them in this episode.
• 33:02
  Sonia Singh MD: I basically handpicked a few that I think are the most talked about and are the most interesting to, to review.
• 33:08
  Sonia Singh MD: But the actual evidence for them varies dramatically depending on which one you're talking about.
• 33:13
  Sonia Singh MD: So I'm gonna go through what I would say are three broad categories and then give a couple examples of each and talk through what is the data for them and what I would say, and what I want you to notice is in, in those podcasts I listened to another theme was they spend 75, 80% of the time, like the majority of the content is talking about the biological mechanisms and exactly what is happening in the cell.
• 33:38
  Sonia Singh MD: They're like, this thing binds to this receptor and then it turns on this ribosome and then this happens.
• 33:42
  Sonia Singh MD: And they're spending all their time talking about that and the benefits and they spend basically no time telling you what are potential side effects, what are potential risks or contraindications or sharing any information on what the studies were and what the quality of those studies were That's just, there was only one podcast I listened to where he even made the caveat of saying, yes, this is mostly animal studies and preclinical data.
• 34:08
  Sonia Singh MD: So take it with a grain of salt, and everybody else focused heavily on the biological mechanisms and not at all on what have studies actually shown.
• 34:16
  Sonia Singh MD: So the first category I'm gonna talk about is I've already mentioned this and I'm not gonna spend a lot of time talking.
• 34:21
  Sonia Singh MD: I'm not gonna spend a ton of time talking about the biological mechanisms,'cause you can Google those things.
• 34:25
  Sonia Singh MD: But the first category is just.
• 34:27
  Sonia Singh MD: Peptides that are FDA approved and have very clear proven benefit in humans based on phase three clinical trials.
• 34:33
  Sonia Singh MD: Those are things like insulin and the GLP ones.
• 34:36
  Sonia Singh MD: The second category are ones that do have clinical data in hu in humans, and some are approved in other countries for use in humans.
• 34:45
  Sonia Singh MD: Some are FDA approved in the US for very specific conditions.
• 34:49
  Sonia Singh MD: So a couple examples of this would be one is thymosin alpha one.
• 34:53
  Sonia Singh MD: So this is actually a peptide that's been studied extensively for the treatment of Hepatitis B and C.
• 34:59
  Sonia Singh MD: It's also been studied as a cancer adjuvant.
• 35:01
  Sonia Singh MD: It's presented on social media as the immune booster peptide.
• 35:05
  Sonia Singh MD: It's used in other countries as a vaccine booster.
• 35:08
  Sonia Singh MD: There is no FDA approved product in the US but it's used in a lot of other countries, especially where hepatitis is more prevalent.
• 35:14
  Sonia Singh MD: So this is one where.
• 35:15
  Sonia Singh MD: We do have a substantial amount of human clinical trials and safety data, but they're really around very specific indications.
• 35:24
  Sonia Singh MD: So not really studied in a general population who's just I feel like I need an immune boost, which is perhaps who might be using it.
• 35:31
  Sonia Singh MD: I think it's popular in the chronic disease fibromyalgia, chronic fatigue communities at the moment.
• 35:37
  Sonia Singh MD: Okay, so that's one where there is human data, no FDA-approved product in the US but used in other countries.
• 35:41
  Sonia Singh MD: Another one in kind of in the similar category is Tessa Morlin or Smolin.
• 35:47
  Sonia Singh MD: Which both stimulate the release of growth hormone.
• 35:50
  Sonia Singh MD: So Smolin is not currently FDA approved, but I guess was FD approved at some point to be used in diagnostic testing for pediatric growth hormone deficiency.
• 35:59
  Sonia Singh MD: So it had human studies and human safety data in very specific circumstances.
• 36:04
  Sonia Singh MD: Teim morlin is FDA approved still for a very specific purpose, which is reduction of visceral fat in HIV patients with lipodystrophy.
• 36:13
  Sonia Singh MD: So very highly specific clinical scenario.
• 36:16
  Sonia Singh MD: It's interesting because we do have phase three clinical trials on it.
• 36:20
  Sonia Singh MD: And it is an FDA-approved product, so it does have one of those big leaflets that tells us about all the adverse events and safety data.
• 36:27
  Sonia Singh MD: And so if you look at that, which I did there's all kinds of side effects.
• 36:31
  Sonia Singh MD: So arthralgias happen in 13% of patients injection site reactions in 17%, pain in extremities, 6%.
• 36:39
  Sonia Singh MD: Peripheral edema, which is swelling and like the legs are arms, 6% muscle pains in 6%.
• 36:45
  Sonia Singh MD: They talk about how higher percentage of patients in treatment groups with chest morland developed glucose intolerance or diabetes.
• 36:52
  Sonia Singh MD: They talked about fluid retention.
• 36:53
  Sonia Singh MD: They talked about hypersensitivity, and there's theoretical concerns about it, possibly accelerating active malignancies.
• 36:59
  Sonia Singh MD: So it's contraindicated in active malignancies.
• 37:03
  Sonia Singh MD: So I say all that to show you that when one of these products goes through the trials and gets studied and gets labeled and gets approved, you will find that there are not no side effects, that there are in fact side effects.
• 37:19
  Sonia Singh MD: And when they say, oh, we've put 75,000 people have used this with no adverse effects.
• 37:24
  Sonia Singh MD: I think a lot of that has to do with the framing and the design of how you are capturing those side effects.
• 37:30
  Sonia Singh MD: If, for example, somebody goes on one of these things and then you know, they have a cancer, if they've been primed to believe that this could not possibly do that, they might view that as a completely separate event.
• 37:43
  Sonia Singh MD: But I, if you've studied enough people to have some clue that maybe that's something you should be looking out for or concerned about, you might view that, event as possibly related.
• 37:52
  Sonia Singh MD: So I just think without a well-designed study, I don't know how you can possibly say oh, there's no adverse events.
• 37:59
  Rebecca Berens MD: Yeah.
• 37:59
  Rebecca Berens MD: You have to ask about adverse events in order to.
• 38:02
  Rebecca Berens MD: Know about them.
• 38:03
  Rebecca Berens MD: You have to be, they have to be reported to you,
• 38:05
  Sonia Singh MD: And you have to have a control group who is not on the thing to determine what is not, what is a noci bone and what is not actually related, or what is related and not related to the drug that you're okay.
• 38:15
  Sonia Singh MD: It
• 38:16
  Rebecca Berens MD: strikes me, sorry.
• 38:16
  Rebecca Berens MD: It strikes me that several of these side effects are things that people worry about and refuse to take statins over.
• 38:23
  Sonia Singh MD: Uhhuh.
• 38:25
  Sonia Singh MD: Yeah,
• 38:25
  Rebecca Berens MD: right.
• 38:26
  Rebecca Berens MD: This actually looks like a much worse increased risk of glucose intolerance or diabetes than there is with statin therapy theoretically.
• 38:32
  Rebecca Berens MD: And then myalgias.
• 38:34
  Rebecca Berens MD: And statins have a very clear clinical benefit for a large population of people.
• 38:38
  Rebecca Berens MD: Yet they're almost universally hated, on the internet.
• 38:41
  Rebecca Berens MD: But yeah, this one is oh yeah, this is great.
• 38:43
  Rebecca Berens MD: Definitely take this.
• 38:44
  Rebecca Berens MD: But for what?
• 38:45
  Sonia Singh MD: Yeah, and the caveat I will say is that this was obviously studied for a very specific population.
• 38:51
  Sonia Singh MD: Sure.
• 38:51
  Sonia Singh MD: So these risks may not look the same.
• 38:53
  Sonia Singh MD: And I'm young, healthy person who's just taken this to get swoll, so I don't, I can't say that this is true for all of it, but this, I, again, this is a great example of when.
• 39:02
  Sonia Singh MD: The studies have not been done, and it is not on anyone's radar.
• 39:06
  Sonia Singh MD: It is perceived as safer.
• 39:07
  Sonia Singh MD: But then once the study is done, as in statins, and there's decades, and decades of data, and you hear that, oh yeah, your friend did say that they got sore, and they, they felt bad after their statin.
• 39:17
  Sonia Singh MD: Then it turns into a different thing.
• 39:19
  Sonia Singh MD: So okay, so that's Testim, Molin or Molin.
• 39:22
  Sonia Singh MD: Then there's Reddit, Tru Tide, which that's really, I feel blown up in the last few months.
• 39:27
  Sonia Singh MD: So Reddit, Tru Tide is a, another peptide that acts on the GLP one receptor, but it also acts on the GI P and the glucagon receptor.
• 39:34
  Sonia Singh MD: It's a triple acting on three different receptors.
• 39:37
  Sonia Singh MD: It is currently being produced by Eila Lilly, and it's in phase three clinical trials.
• 39:40
  Sonia Singh MD: So it is almost there.
• 39:42
  Sonia Singh MD: But it is not yet FDA approved.
• 39:44
  Sonia Singh MD: What they found in the phase two trials were that people were having unprecedented weight loss.
• 39:49
  Sonia Singh MD: So even more than the current.
• 39:51
  Sonia Singh MD: Currently available GLP ones, so 24% weight loss at 48 weeks for patients with obesity, which is less, that sounds, and they had not, and they had not plateaued.
• 40:00
  Sonia Singh MD: So they were still losing weight at the end of that study.
• 40:03
  Sonia Singh MD: That
• 40:03
  Rebecca Berens MD: sounds very scary to me.
• 40:04
  Rebecca Berens MD: I, I'll be very interested
• 40:05
  Sonia Singh MD: to see
• 40:06
  Rebecca Berens MD: this data when it comes out.
• 40:07
  Rebecca Berens MD: I'll be very curious to read this data when it comes out.
• 40:10
  Sonia Singh MD: So anyway, it is coming down the pipeline, but a lot of people cannot wait and are buying this on the gray market and using it.
• 40:18
  Sonia Singh MD: Okay, so that is, that's category two where some human data exists and it may or may not be FDA approved.
• 40:23
  Sonia Singh MD: If it is FDA approved, it's usually for very specific indications.
• 40:26
  Sonia Singh MD: Last category is stuff that has no FDA approval and has virtually no, like little to no human studies.
• 40:34
  Sonia Singh MD: And that's actually the vast majority of peptides that are talked about on social media.
• 40:37
  Sonia Singh MD: So the, that includes BPC 1 57, which I'll talk about.
• 40:40
  Sonia Singh MD: And TB 500.
• 40:42
  Sonia Singh MD: So that combination BPC 1 5 7 and TB 500 together is known as the Wolverine stack.
• 40:47
  Sonia Singh MD: And so a lot of people talk about stacking peptides and what stack is right for you.
• 40:53
  Sonia Singh MD: This is probably the most popular stack that you will hear talked about.
• 40:56
  Sonia Singh MD: So let, I'm gonna talk about those two.
• 40:59
  Sonia Singh MD: So BBC 1 57 stands for body protection compound.
• 41:02
  Sonia Singh MD: It even sounds nice.
• 41:03
  Sonia Singh MD: And it's a small peptide that's derived from a larger protein that's actually found in human gastric secretions.
• 41:10
  Sonia Singh MD: It has a lot of preclinical and animal data that supports its use for gastric protection, tissue healing, angiogenesis.
• 41:18
  Sonia Singh MD: So on social media you'll see it marketed as like a magical drug for gut repair, for injury recovery.
• 41:25
  Sonia Singh MD: It's unique in that it can withstand the gastric secretions'cause that's where it normally lives.
• 41:30
  Sonia Singh MD: And so it can be taken orally, which is rare among peptides'cause they're usually broken down so quickly.
• 41:36
  Sonia Singh MD: There is extremely little human data.
• 41:39
  Sonia Singh MD: So I found one study of 12 patients with knee pain, poor methodology, poor study, not something that I would base any kind of decision on.
• 41:48
  Sonia Singh MD: There were rumors in a lot of different sources about phase two clinical trials in ulcerative colitis and multiple sclerosis, but those were industry studies and they, it doesn't look like they were ever fully published.
• 41:59
  Sonia Singh MD: So basically, no, no human data.
• 42:03
  Sonia Singh MD: TB 500 is a peptide derived from Thymosin beta four.
• 42:08
  Sonia Singh MD: So Thymosin beta four is a naturally occurring protein that's produced by the human thymus and has been studied actually in phase two clinical trials for things like venous stasis ulcers, and.
• 42:20
  Sonia Singh MD: Epidermolysis below.
• 42:22
  Sonia Singh MD: So like some skin conditions.
• 42:23
  Sonia Singh MD: And it's shown benefits for wound healing and tissue repair.
• 42:27
  Sonia Singh MD: But TB 500, I think a lot of people think they're synonymous.
• 42:29
  Sonia Singh MD: TB 500 is actually a peptide derived from the larger protein.
• 42:34
  Sonia Singh MD: Like it's a part, it's a small part of that protein that binds to a specific receptor.
• 42:38
  Sonia Singh MD: And TB 500 has no human data, none.
• 42:42
  Sonia Singh MD: So that is the conclusion I could have gone through several others like Motzi or whatever.
• 42:47
  Sonia Singh MD: The conclusion you will come to when you search a lot of, scientific resources about these is that you will find that a lot of them have sometimes good, sometimes robust preclinical or animal data, but little to no.
• 43:02
  Sonia Singh MD: Human data, and that is partially why they've been removed from the list of things that can be used in compounding pharmacies.
• 43:09
  Sonia Singh MD: That's why they are still considered investigational and research drugs.
• 43:13
  Sonia Singh MD: That's why they're labeled as research chemicals because we have not studied them yet in humans.
• 43:18
  Sonia Singh MD: So that's I'm covered some of the highlights in this big one.
• 43:21
  Sonia Singh MD: There's so many other peptides for so many other specific indications, but the conclusion you come to from all of those is the same.
• 43:28
  Sonia Singh MD: I'm assuming that is the conclusion that you came to when you have done your
• 43:32
  Rebecca Berens MD: Yeah.
• 43:33
  Rebecca Berens MD: So interestingly I can't remember which one it was that I looked up what it was called now, but there was one that I was asked about that was specifically for skin.
• 43:40
  Sonia Singh MD: Oh yeah, that's it starts with a G and it ends with copper to C.
• 43:44
  Sonia Singh MD: Yes.
• 43:44
  Rebecca Berens MD: Okay.
• 43:45
  Rebecca Berens MD: Yes.
• 43:45
  Sonia Singh MD: I can't remember the name.
• 43:46
  Sonia Singh MD: Yeah.
• 43:46
  Rebecca Berens MD: Yeah.
• 43:46
  Rebecca Berens MD: But same thing you look at, it's just like there's nothing on this.
• 43:49
  Rebecca Berens MD: Like I can't actually give you any information.
• 43:52
  Sonia Singh MD: I think for that one there's human.
• 43:54
  Sonia Singh MD: There is, I think for that one there's some human data for topical use.
• 43:57
  Sonia Singh MD: I could be wrong.
• 43:57
  Sonia Singh MD: Yes.
• 43:57
  Sonia Singh MD: Topic.
• 43:58
  Rebecca Berens MD: Yes, that's right.
• 43:58
  Rebecca Berens MD: It was, it did have topical.
• 43:59
  Rebecca Berens MD: You're right.
• 44:00
  Rebecca Berens MD: It did have topical.
• 44:01
  Sonia Singh MD: Yeah.
• 44:01
  Rebecca Berens MD: But yeah, but this was, it just, but even then it was not a lot, it was a little bit and I think the underlying thing for me is it I can't answer the questions that patients have.
• 44:13
  Rebecca Berens MD: And I, because I don't, the data's not available.
• 44:16
  Rebecca Berens MD: And it's just really hard to rationalize how people are so openly recommending, giving this medical advice to people over the internet or through their podcast with no data.
• 44:29
  Rebecca Berens MD: And most of them are not even medical professionals.
• 44:32
  Rebecca Berens MD: And even if they were, they wouldn't be medical professionals that had experience using that medication, properly in humans with proper study and controlled studies.
• 44:42
  Rebecca Berens MD: And it just, yeah, it's baffling to me.
• 44:44
  Rebecca Berens MD: But I think it really highlights the fact that there is this disconnect of we have this regulatory process for a reason, and I totally understand that it does really hurt some people who could potentially access a medication faster if it was faster.
• 44:58
  Rebecca Berens MD: But we have to do it.
• 44:59
  Rebecca Berens MD: There's a reason.
• 44:59
  Rebecca Berens MD: We have the process, we have.
• 45:01
  Rebecca Berens MD: So I'm curious what your thoughts are about how this might inform our regulatory processes going forward.
• 45:06
  Rebecca Berens MD: Since this is happening anyway.
• 45:08
  Rebecca Berens MD: Do we need to change something?
• 45:11
  Sonia Singh MD: Yeah, our regulatory process is painfully slow, and some of these regulatory agencies are flawed, like they they're not perfect.
• 45:19
  Sonia Singh MD: But I just think the idea that we then take matters into our own hands and then just go about it ourselves and based on the information we gather from like TikTok or Reddit or, an influencer is so dangerous, and it forces you to rely on your own, intuition and vibes and the limitations of your own fund of knowledge and your own intellect.
• 45:44
  Sonia Singh MD: And this is not to say that anybody is not smart, whatever.
• 45:48
  Sonia Singh MD: I don't like doing that.
• 45:49
  Sonia Singh MD: I don't like to feel like it's up to me to decide, what is the right decision about a drug or a vaccine or whatever.
• 45:56
  Sonia Singh MD: I want people who are experts in those fields to share that expertise with me and inform my decision.
• 46:02
  Sonia Singh MD: And so when you throw all the regulatory, stuff and all of the expertise and all of that out of the window and say no,, all of that stuff is too flawed and corrupt and money motivated and not.
• 46:14
  Sonia Singh MD: Not looking out for my best interest, and I'm just gonna take this into my own hands.
• 46:18
  Sonia Singh MD: That's a wild west.
• 46:19
  Sonia Singh MD: You're entering.
• 46:20
  Sonia Singh MD: Yeah.
• 46:20
  Sonia Singh MD: That's hard.
• 46:21
  Sonia Singh MD: I think that's a, that would be a scary place for me to try to, make decisions from.
• 46:25
  Sonia Singh MD: So I don't know how, somebody without medical training or knowledge or whatever can do that, so yeah.
• 46:30
  Sonia Singh MD: I think this is a really interesting the next thing we like to talk about is what are, what should we learn from this?
• 46:36
  Sonia Singh MD: What can we take from this as humans and as doctors?
• 46:38
  Sonia Singh MD: I think what I take from this as a human is just people are really desperate to feel well.
• 46:46
  Sonia Singh MD: Or to optimize and we can talk about why.
• 46:49
  Sonia Singh MD: People want to optimize.
• 46:51
  Sonia Singh MD: I think some of it is fear or fear of our own mortality, fear of unexpected bad things happening to us.
• 46:58
  Sonia Singh MD: I don't know.
• 46:59
  Sonia Singh MD: But that drive right now to feel better is so strong that people are willing to take on these risks and to do these things and to go against the advice of, their doctor and to go and purchase these things.
• 47:12
  Sonia Singh MD: That's how strong that desire is.
• 47:14
  Sonia Singh MD: I don't know if you would say something similar about,
• 47:16
  Rebecca Berens MD: yeah, the other thing that I think about is there are some, like when we talk about optimizing, I think you and I will have a similar feeling is like diminishing returns and Right.
• 47:24
  Rebecca Berens MD: Increasing risk.
• 47:25
  Rebecca Berens MD: But when we talk about something like fibromyalgia or chronic fatigue syndrome or, these conditions that are poorly understood, there's really not good treatments for them.
• 47:33
  Rebecca Berens MD: The patients who have them often have horrific experiences with the healthcare system.
• 47:38
  Rebecca Berens MD: I can totally understand the drive if I'm a patient who's living with that every day to just try anything because it is like, could it be wor, is it gonna get worse?
• 47:48
  Rebecca Berens MD: And I think this is a really.
• 47:50
  Rebecca Berens MD: Place where we as physicians have to be very careful because I think with a, even in the co context of this conversation, I've been guilty of this.
• 47:56
  Rebecca Berens MD: It's just that's crazy.
• 47:57
  Rebecca Berens MD: But is it in some situations when we have nothing to offer you.
• 48:01
  Sonia Singh MD: Yeah.
• 48:02
  Rebecca Berens MD: And you feel terrible all the time.
• 48:03
  Rebecca Berens MD: Yeah.
• 48:04
  Rebecca Berens MD: Is it really that crazy to try something online?
• 48:07
  Rebecca Berens MD: 'cause you already feel terrible anyway.
• 48:09
  Rebecca Berens MD: And so I think it's important when we're working with these patients to, to acknowledge the risks, but also ultimately patients have autonomy to do whatever they want to do.
• 48:17
  Rebecca Berens MD: Yeah.
• 48:17
  Rebecca Berens MD: And our job is to, provide objective education and information to help them make an informed decision.
• 48:25
  Rebecca Berens MD: And I think part of that is saying there's not a lot of information to inform this decision.
• 48:30
  Rebecca Berens MD: Yeah.
• 48:30
  Rebecca Berens MD: And assessing the information that you are receiving, is it biased?
• 48:33
  Rebecca Berens MD: Is the person selling you something?
• 48:35
  Rebecca Berens MD: All of that goes into.
• 48:36
  Rebecca Berens MD: To how you're making a decision.
• 48:37
  Rebecca Berens MD: But I think that is the key thing that I'm taking away from this is like when you do see a patient who's struggling with a disease that we don't have good treatments for not being dismissive and not being the way that it often comes across, I was very just minimizing of the struggle that they've had and why they've been driven to that, what feels to us very extreme place.
• 48:57
  Rebecca Berens MD: And I think that's another way that this kind of market grows is when we as physicians don't offer that openness to patients and listen to them.
• 49:05
  Rebecca Berens MD: So yeah, I can I'm thinking of several of my patients who I'm like, you know what?
• 49:09
  Rebecca Berens MD: I think they would probably be willing to take the risk.
• 49:12
  Rebecca Berens MD: Yeah.
• 49:12
  Rebecca Berens MD: I can't, I wouldn't recommend it to them.
• 49:13
  Rebecca Berens MD: And obviously I don't know that it's actually gonna make a difference, but I can definitely see the drive.
• 49:18
  Rebecca Berens MD: And so I also think for, from our regulatory standpoint, yes, it's important for us to have.
• 49:23
  Rebecca Berens MD: The proper process, but I think we also do have to have some openness to, to trying things in an experimental way on for individual patients as part of that process.
• 49:32
  Rebecca Berens MD: Yeah.
• 49:33
  Rebecca Berens MD: So that they're not waiting necessarily years.
• 49:35
  Rebecca Berens MD: And I know that there's a lot of patient driven movements for patients with rare diseases for these sorts of like compassionate use and things like that.
• 49:41
  Rebecca Berens MD: To try newer medications and I think that's something that would be.
• 49:44
  Rebecca Berens MD: A worthwhile discussion to have going forward in our regulatory systems.
• 49:48
  Rebecca Berens MD: But yeah, I think it's it's a really tricky spot to be in as the physician when patients are asking you about these things and you don't have anything to tell them.
• 49:56
  Sonia Singh MD: No, I think you're absolutely right and I'm really glad you brought up that point.
• 50:00
  Sonia Singh MD: I actually think what you described, these situations where people are struggling with a chronic condition for which we don't have a lot of good treatments.
• 50:06
  Sonia Singh MD: I really think that's like where.
• 50:08
  Sonia Singh MD: There really is a role for alternative and complimentary therapies.
• 50:11
  Sonia Singh MD: When people reach the end of the road of what conventional medicine can offer.
• 50:15
  Sonia Singh MD: I get and I'm supportive of them, looking outside of that.
• 50:18
  Sonia Singh MD: And I, again, like you said, I would probably say this is not something that I'm gonna prescribe or that I'm necessarily recommending for you, but I completely understand if you wanna try that.
• 50:27
  Sonia Singh MD: And I am willing to learn with you and try to help you navigate this and determine if it's reasonable or safe or plausible that this thing might help.
• 50:35
  Sonia Singh MD: So yeah, that's a really good point and I'm glad you're reigning me back in.
• 50:37
  Sonia Singh MD: 'cause I,
• 50:38
  Rebecca Berens MD: I could feel myself doing it too, but it is hard to be a patient in that situation.
• 50:43
  Rebecca Berens MD: And especially so many of these patients that I have, every time they go to the doctor, it's just a horrible experience.
• 50:48
  Rebecca Berens MD: Yeah.
• 50:48
  Rebecca Berens MD: And, I think it's it's important that we have that caveat and that we are looking at the other side of it as the physician.
• 50:54
  Rebecca Berens MD: But yeah, I think the, as you mentioned the complimentary and alternative treatments when we don't have something within conventional medicine, I think a lot of times for these patients the poor interactions with healthcare providers is actually negatively reinforcing of the condition.
• 51:10
  Rebecca Berens MD: Yeah.
• 51:10
  Rebecca Berens MD: Because it increases that interpersonal stress and that relational harm.
• 51:14
  Rebecca Berens MD: And that I think makes the condition worse.
• 51:15
  Rebecca Berens MD: So I also think even just the act of, as a physician being like, Hey, you know what?
• 51:20
  Rebecca Berens MD: I hear you.
• 51:20
  Rebecca Berens MD: I think this is a reasonable decision you're making given your current
• 51:25
  Sonia Singh MD: Yeah.
• 51:25
  Rebecca Berens MD: Concerns.
• 51:26
  Rebecca Berens MD: I understand why you're looking at this.
• 51:27
  Rebecca Berens MD: I understand why you're asking this.
• 51:28
  Rebecca Berens MD: I don't think you're crazy.
• 51:30
  Rebecca Berens MD: Even just that conversation is probably beneficial to that patient Yeah.
• 51:33
  Rebecca Berens MD: From a relational healing way.
• 51:35
  Rebecca Berens MD: And it doesn't mean that they necessarily.
• 51:38
  Rebecca Berens MD: Should or will go and inject themselves with something that they buy on the internet that is marked not for human use, but if just feeling heard about it, I think could make a huge difference for a lot of patients.
• 51:48
  Sonia Singh MD: No, I totally agree.
• 51:49
  Sonia Singh MD: And that, transitions as well into the question of what can we learn from this as doctors?
• 51:54
  Sonia Singh MD: I think the biggest thing for me is a lot of these conversations boil down to informed consent.
• 52:00
  Sonia Singh MD: Does this person have informed consent about the intervention that they're choosing to go forward with?
• 52:05
  Sonia Singh MD: And if we.
• 52:06
  Sonia Singh MD: It's really the job of whoever is selling them the thing Yeah.
• 52:10
  Sonia Singh MD: To provide that for them.
• 52:11
  Sonia Singh MD: But the reality is thousands and thousands of people are using these things.
• 52:15
  Sonia Singh MD: I think without full informed consent, and I mean from the content I've consumed, it's very rare, in fact for someone to really have, and in some cases it's impossible to fully give it,'cause we don't have the information to really give it.
• 52:28
  Sonia Singh MD: So the best you can do is say this is investigational this we don't have data for this.
• 52:32
  Sonia Singh MD: But I think just the framing of it as somehow safer or not a drug or having no adverse effect, that part is really dangerous.
• 52:39
  Sonia Singh MD: So I think.
• 52:40
  Sonia Singh MD: For us as doctors to just be aware of the, of what these are, that a lot of people are using them, why they are so popular, why they are not available, that they're not just probably placebos, but that there's risks of impurities and contamination.
• 52:55
  Sonia Singh MD: And having those conversations with patients to shore up those gaps in informed consent is really the best we can do.
• 53:01
  Sonia Singh MD: And to try to do it in a way that is, not shaming or judgmental, but just is Hey, I understand why you do this.
• 53:06
  Sonia Singh MD: My, my intention here is just to make sure that you're fully aware.
• 53:11
  Sonia Singh MD: 'cause I know that, a lot of the places that sell and promote these may not be completely upfront with you about the realities of what these are,
• 53:17
  Rebecca Berens MD: yeah.
• 53:18
  Rebecca Berens MD: And I've seen.
• 53:19
  Rebecca Berens MD: Even some physicians who are jumping on the bandwagon with this a little bit'cause they're seeing the financial potential benefits.
• 53:26
  Rebecca Berens MD: And you and I both, I think have had the experience of patients going for to a med spa for something and getting offered some other random thing that they weren't going in for that day.
• 53:35
  Rebecca Berens MD: And again, it's framed to them as oh yeah, you could just add this on.
• 53:37
  Rebecca Berens MD: No big deal.
• 53:38
  Sonia Singh MD: Yes.
• 53:38
  Rebecca Berens MD: Booster or whatever, and and that's obviously not informed consent.
• 53:42
  Rebecca Berens MD: And what some of the best conversations I've had with my patients is when that happens to them, they come back and they're like, Hey, this is what they told me.
• 53:48
  Rebecca Berens MD: What do you think about this?
• 53:50
  Rebecca Berens MD: And again, it's approaching that conversation from a place of not judgment and honesty and yeah, this is the limitations, this is how much I know, which is not much.
• 54:00
  Rebecca Berens MD: They don't know that much either.
• 54:01
  Rebecca Berens MD: But because we have that relationship, they're able to question it when it's.
• 54:05
  Rebecca Berens MD: Pushed at them by someone who's doing it from a profiteering sort of way.
• 54:08
  Rebecca Berens MD: And so I think that's what we really need to be fostering as physicians in our relationships with patients.
• 54:13
  Rebecca Berens MD: And the only way to do that is to have a respectful conversation and to not be judgemental when people are asking you these very reasonable questions based on all the things that they're seeing.
• 54:22
  Sonia Singh MD: No, I think that, the framing of it and the context of where the person is hearing or learning about it just makes such a huge difference.
• 54:29
  Sonia Singh MD: So what's funny is going back to the same patient that I talked about at the beginning of the episode.
• 54:34
  Sonia Singh MD: So he ultimately left that program that he was in.
• 54:37
  Sonia Singh MD: I think he told me at one point he wanted to come off some of the things and they were very pushy about no, you've gotta be on the whole regimen.
• 54:43
  Sonia Singh MD: And then he was a little spooked by that and left.
• 54:46
  Sonia Singh MD: But, much later, a year later, he went through a stressful life event and he was having a lot of anxiety.
• 54:51
  Sonia Singh MD: And at this point, he had tried exercise, he was in therapy, he was doing all the lifestyle stuff.
• 54:56
  Sonia Singh MD: And I brought up the idea of maybe taking a medication and, just put it on the table.
• 55:00
  Sonia Singh MD: What do you think about doing an SSRI?
• 55:02
  Sonia Singh MD: And I talked him through a couple options.
• 55:04
  Sonia Singh MD: I talked him through the risks and benefits and then, I messaged him a little later and was like, what do you think?
• 55:08
  Sonia Singh MD: Are you still thinking about it?
• 55:10
  Sonia Singh MD: And he was just like, I am just so nervous about the side effects.
• 55:14
  Sonia Singh MD: And I had to remind him and be like, two years ago you were on these things that are completely investigational.
• 55:20
  Sonia Singh MD: And, I just, it amazed me how the same exact person, in one context could be sold this like huge package of peptides and.
• 55:31
  Sonia Singh MD: Take them unquestioningly, and then in a slightly different mindset, a year later was so nervous to take this pharmaceutical that, has a long list of potential risks and side effects, and that I had told him about.
• 55:46
  Sonia Singh MD: But that, I think in part it was like me having that conversation and being like you could have this and that and this, and it could not work.
• 55:51
  Sonia Singh MD: And, we could also have to change the dose and, then you'll have to taper it off and I that, that context and that framing just makes such a huge difference.
• 56:00
  Sonia Singh MD: And so I think just having the awareness of just okay, what am I being fed about this thing?
• 56:05
  Sonia Singh MD: Yeah.
• 56:06
  Sonia Singh MD: And, where is that information coming from and am I getting the full picture, is really, and that's not to say he should or should not have taken the medication or he should or should not have used the peptides.
• 56:15
  Sonia Singh MD: It's just a matter of how differently you can feel about something, depending on whether you've had a full conversation about it and been fully informed,
• 56:22
  Rebecca Berens MD: yeah.
• 56:22
  Rebecca Berens MD: Because that person, that group probably very confidently sold these things.
• 56:27
  Sonia Singh MD: Yes.
• 56:27
  Rebecca Berens MD: Versus, versus you had a nuanced conversations about risks and benefits.
• 56:31
  Rebecca Berens MD: If you're hearing something that seems totally one sided, if it sounds too good to be true, it probably is yes.
• 56:37
  Rebecca Berens MD: Yes.
• 56:37
  Rebecca Berens MD: If there's not a nuanced conversation happening, you probably shouldn't do it.
• 56:42
  Rebecca Berens MD: You should probably get some more information because there's nothing in the world that is risk free.
• 56:46
  Rebecca Berens MD: And it does make it harder to make a decision.
• 56:50
  Rebecca Berens MD: And it, it makes it harder.
• 56:52
  Rebecca Berens MD: As the physician to quote unquote sell a treatment to a patient because we are acknowledging the risks and benefits, but we have to do that.
• 56:58
  Rebecca Berens MD: That's the only ethical way to proceed.
• 57:01
  Rebecca Berens MD: And I think it's important that patients be fully informed.
• 57:05
  Sonia Singh MD: Yeah.
• 57:06
  Sonia Singh MD: Do you have any final thoughts on the topic of peptides?
• 57:11
  Rebecca Berens MD: No, I'm excited to, to learn more as they come out.
• 57:15
  Rebecca Berens MD: I do think there's great potential with these.
• 57:18
  Sonia Singh MD: Yes.
• 57:18
  Rebecca Berens MD: That is the one encouraging thing is it does seem like in terms of development of medical treatments, this could be really huge for improving some treatment options.
• 57:28
  Rebecca Berens MD: We've already seen that for GLP ones in patients with diabetes, like it is.
• 57:31
  Rebecca Berens MD: Really revolutionary to see the glucose control people are able to achieve with fewer and lower doses of medication.
• 57:38
  Rebecca Berens MD: Yeah.
• 57:38
  Rebecca Berens MD: With less side effects compared to before.
• 57:40
  Rebecca Berens MD: And we're gonna have a whole GLP one episode.
• 57:42
  Rebecca Berens MD: We're gonna get a deep dive into all of that'cause it's not all rosy either.
• 57:45
  Rebecca Berens MD: GLP ones are not all rosy either, but I do think I'm really excited about it and I hope that this overselling of them initially doesn't then end up harming the potential benefits of it when they finally did go through the normal regulatory processes.
• 57:59
  Rebecca Berens MD: 'Cause I could definitely see some negative fallout from inappropriate use tainting the results in the future of appropriately prescribed
• 58:08
  Sonia Singh MD: pep.
• 58:08
  Sonia Singh MD: Yeah.
• 58:08
  Sonia Singh MD: It's so funny'cause I'm wondering if these people who are currently like, it's so natural, are this same crew does not think GLP ones are natural.
• 58:17
  Rebecca Berens MD: So I dunno.
• 58:18
  Rebecca Berens MD: It's I think some of them the, like you said, the GLP one was the gateway director oh.
• 58:23
  Rebecca Berens MD: That's a peptide that's working out.
• 58:25
  Rebecca Berens MD: But yeah, there are definitely some people who are like, that one is evil, but all these other natural ones are not evil.
• 58:31
  Rebecca Berens MD: It just, it's all in, it's all in the way it's marketed too.
• 58:33
  Sonia Singh MD: No, but the point you brought up about this is from a medical and biomedical pharmaceuticals, like this is exciting.
• 58:39
  Sonia Singh MD: We're on the verge of a lot of new exciting therapeutics.
• 58:42
  Sonia Singh MD: And I think actually acknowledging that at the beginning of a conversation about that with people can go a long way because
• 58:49
  Rebecca Berens MD: yes.
• 58:49
  Sonia Singh MD: I think there's a perception that doctors just they don't get it.
• 58:52
  Sonia Singh MD: They're not on the cutting edge.
• 58:53
  Sonia Singh MD: They're just not following their stuff.
• 58:55
  Sonia Singh MD: They're just stuck in the, the stone age and they're still, prescribing their metformin's and not even, they don't even know anything about this.
• 59:02
  Sonia Singh MD: So I think just acknowledging yeah, this is a really exciting category of new therapeutics and I'm excited to see what comes out from them and they look really promising, but we don't have the human data yet.
• 59:14
  Sonia Singh MD: And
• 59:15
  Rebecca Berens MD: yeah,
• 59:15
  Sonia Singh MD: anecdotal data and all the data and data on social media, that is a different thing than, the type of data that we have to make decisions, about our patients.
• 59:26
  Sonia Singh MD: Basically.
• 59:26
  Sonia Singh MD: Yeah.
• 59:27
  Rebecca Berens MD: Yeah.
• 59:27
  Rebecca Berens MD: Exactly.
• 59:28
  Rebecca Berens MD: And it's, if I'm gonna be recommending something to you, I wanna know.
• 59:31
  Rebecca Berens MD: What I'm putting you in for.
• 59:33
  Rebecca Berens MD: And I definitely don't have that information right now but it is exciting and and I think it, in the next several years we're gonna have a lot of new options, hopefully for some conditions that currently we don't have other options for, or the options are terrible.
• 59:45
  Rebecca Berens MD: So yeah it's overall exciting and if we can get past this little hump, hopefully we have some better options for patients that are affordable also.
• 59:54
  Sonia Singh MD: Yeah, I kind of wonder, I would hope one of the podcasts I listened to was I don't, the guy was I dunno if he was a lobbyist or what, but they were talking a lot about politics and regulation and will they widen the lane for some of these therapeutics and make it easier for them to get to the market and all these things.
• 1:00:09
  Sonia Singh MD: I really think.
• 1:00:10
  Sonia Singh MD: Investing in this research and trying to find ways to accelerate it is if you are excited about these therapeutics and you are like people, these should be in the hands of people.
• 1:00:19
  Sonia Singh MD: I think you can have this one route of burn it all down and get it ourselves and there's some people arguing that nothing should be a prescription and people should be able to buy everything.
• 1:00:27
  Sonia Singh MD: I guess that's one approach, but like another approach is okay, just fund the studies.
• 1:00:31
  Sonia Singh MD: Invest the studies.
• 1:00:32
  Sonia Singh MD: Yeah.
• 1:00:33
  Sonia Singh MD: Accelerate the pro, get rid of some of the inefficiency of the regulatory process and accelerate these things and get them out to the public.
• 1:00:39
  Sonia Singh MD: I.
• 1:00:39
  Sonia Singh MD: I also would like an immune boost.
• 1:00:41
  Sonia Singh MD: I would also like to have more energy and to have less visceral fat, I love those things, but I want to be able to do it in a way that's safe, and that's been studied and so I, we want these things too.
• 1:00:53
  Sonia Singh MD: I just think we have to be clear that it's like we are not trying to gate peak keep, or holding people back from these things.
• 1:00:58
  Sonia Singh MD: It's we want these things and it's just like, how can we as a society get there?
• 1:01:04
  Rebecca Berens MD: Yeah.
• 1:01:04
  Sonia Singh MD: And I think, going at it yourself, is one way, but it has a lot of risks, which we've, talked about.
• 1:01:09
  Rebecca Berens MD: Yeah.
• 1:01:09
  Rebecca Berens MD: And like you said, if we can reduce some of the regulatory hurdles or, fund it better upfront, that ultimately will drive down the cost for everyone because so much of the cost.
• 1:01:18
  Rebecca Berens MD: Is coming from all of the hoops.
• 1:01:20
  Rebecca Berens MD: Yes.
• 1:01:20
  Rebecca Berens MD: Yes.
• 1:01:20
  Rebecca Berens MD: And like you said, we all want the same things.
• 1:01:22
  Rebecca Berens MD: Yeah.
• 1:01:23
  Rebecca Berens MD: We just need to advocate to the people in charge of these decisions to make it a little bit more of a human process that will better serve our patients.
• 1:01:31
  Sonia Singh MD: Yeah.
• 1:01:32
  Sonia Singh MD: All right.
• 1:01:32
  Sonia Singh MD: Thanks for joining us.
• 1:01:33
  Sonia Singh MD: Hope you guys enjoyed this episode.
• 1:01:35
  Sonia Singh MD: If you want more information on this topic or the other topics we cover, you can go to the antisocial doctors.com which is our substack.
• 1:01:43
  Sonia Singh MD: And if you're interested in reviewing some of the sources for this, I have a ton of them for this episode.
• 1:01:49
  Sonia Singh MD: You can also find that on the substack because it's too long to put in the show notes.
• 1:01:53
  Sonia Singh MD: And our next episode, hopefully we'll cover GLP ones, which are of course the most blockbuster peptide that's out there.
• 1:01:58
  Sonia Singh MD: And so stay tuned for a deep dive on that.
• 1:02:01
  Rebecca Berens MD: Yeah, thanks Sonia.
• 1:02:02
  Rebecca Berens MD: Thanks, Rebecca.
• 1:02:05
  Sonia Singh MD: Hey guys.
• 1:02:06
  Sonia Singh MD: Last but not least, we have a very important disclaimer.
• 1:02:09
  Sonia Singh MD: This podcast is intended for educational and entertainment purposes only.
• 1:02:14
  Sonia Singh MD: The content shared on this podcast, including but not limited to opinions, research discussions, case examples, and commentary, is not medical advice and should not be considered a substitute for professional medical evaluation, diagnosis, or treatment.
• 1:02:28
  Sonia Singh MD: Listening to this podcast does not establish a physician patient relationship between you and the hosts.
• 1:02:33
  Sonia Singh MD: We are doctors, but not your doctors.
• 1:02:36
  Sonia Singh MD: Any medical topics discussed are presented for general informational purposes and may not apply to your individual circumstances.
• 1:02:43
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• 1:02:48
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• 1:02:56
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• 1:03:09
  Sonia Singh MD: Please note that this podcast includes discussion of emerging research, evolving medical concepts, and differing professional opinions.
• 1:03:16
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• 1:03:20
  Sonia Singh MD: We, the hosts make no guarantees about the accuracy, completeness, or applicability of this content, and we disclaim any liability for actions taken or not taken based on the information provided in this podcast by listening to the Antisocial Doctors Podcast, you have agreed to these terms.
• 1:03:36
  Sonia Singh MD: Thanks again for joining us.