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Are Peptides Like BPC-157 Worth It If You're Lifting Weights? · Wits & Weights | Strength & Fat Loss Over 40

• 0:00
  Philip Pape: If you lift weights and something starts to hurt, maybe your elbow, your shoulder, the outside of your hip, maybe you experience an injury, maybe you're going through recovery, and you've heard about BPC 157.
• 0:10
  Philip Pape: Peptides are all over the news, all over social media right now.
• 0:14
  Philip Pape: It supposedly heals tendons.
• 0:16
  Philip Pape: The FDA supposedly just approved it.
• 0:18
  Philip Pape: We're gonna get into all of these claims today.
• 0:21
  Philip Pape: You'll learn what the FDA did and didn't do, how much human evidence there is for peptides in the context of tendons, and what the research showed actually helps people the most with stubborn tendon pain.
• 0:34
  Philip Pape: Hint hint, no injection required.
• 0:41
  Philip Pape: Welcome to Wits& Weights, the show that puts a popular piece of fitness advice under the microscope, finds the hidden reason it doesn't work, and gives you the deceptively simple fix that does.
• 0:51
  Philip Pape: I'm your host, certified nutrition coach, Philip Pape, and peptides are everywhere right now.
• 0:56
  Philip Pape: In fact, the latest episode of South Park made fun of listening to podcasts to get your health advice, and peptides are a big part of that.
• 1:04
  Philip Pape: Now, BPC 157 is the big one that everybody knows.
• 1:09
  Philip Pape: Uh, I've actually tried that myself.
• 1:11
  Philip Pape: You'll hear it called the Wolverine Peptide, which kind of tells you how it's being marketed.
• 1:16
  Philip Pape: And then in July of this year, 2026, there were headlines that an FDA panel had voted for it.
• 1:23
  Philip Pape: And I've seen people talk online about it, like, hey, this is an approved drug now.
• 1:27
  Philip Pape: So that kind of, you know, gives us the full legitimacy and credibility we need.
• 1:31
  Philip Pape: But it isn't, it isn't.
• 1:32
  Philip Pape: And we're gonna go through exactly what happened there.
• 1:34
  Philip Pape: Now, I saw a post recently from a woman in her 50s that I keep thinking about in the context of peptides.
• 1:42
  Philip Pape: She's had tennis elbow for over a year.
• 1:44
  Philip Pape: She did physical therapy, she did shockwave, she did BPC-157, and she still has trouble gripping a dumbbell.
• 1:52
  Philip Pape: And I want to answer her directly today through this podcast without revealing specifics on her identity, uh, because I think a lot of you are somewhere on that same path.
• 2:02
  Philip Pape: You're trying the next thing and then the next thing.
• 2:04
  Philip Pape: Just is this gonna work?
• 2:05
  Philip Pape: Uh, and I have some skin in the game because back way back, I think it was episode 255 in December of 2024, I talked about my own BPC 157 experiment for my left shoulder.
• 2:17
  Philip Pape: So part of this episode is what I tried then and what I think about it now.
• 2:21
  Philip Pape: Stick around to the end because if you've ever been offered a cortisone shot as an option for something like a sore elbow, I'm gonna share some data from a JAMA trial that might help you out.
• 2:33
  Philip Pape: Again, this is not medical advice.
• 2:35
  Philip Pape: It's just what did we see in actual research when this is done on populations and larger sample sizes versus anecdotal experience and just listening to influencers or podcasts about uh, you know, what worked for them.
• 2:48
  Philip Pape: So, first we're gonna go through what the FDA was all up into this summer, why the details matter a lot more than the headlines, as they always do.
• 2:55
  Philip Pape: Nuance is so important.
• 2:57
  Philip Pape: Then the actual evidence for BPC 157, which is mostly in rat studies, like a lot of this stuff is, plus what I learned from my own experiment, and then what works for tendon pain in reality, if you're lifting weights, especially on the older side, you're over 40, including what I would tell our friend who has the elbow issue.
• 3:15
  Philip Pape: Okay, let's start with what BPC 157 is.
• 3:20
  Philip Pape: It's a short chain of 15 amino acids.
• 3:23
  Philip Pape: It's originally based on a protein found in stomach juice.
• 3:27
  Philip Pape: A research group in Zagreb, Croatia has been publishing on it for a long time, since the early 90s, since I was a kid.
• 3:35
  Philip Pape: People inject it usually under the skin, near whatever hurts.
• 3:39
  Philip Pape: It's a local injection.
• 3:40
  Philip Pape: You know, I did mine in my shoulder area.
• 3:42
  Philip Pape: And the claim is that it speeds up healing of tendons, ligaments, muscle, and even the gut.
• 3:48
  Philip Pape: Okay, now the regulatory story, the regulatory reality, I should say, or story, depending on the narrative, is where a lot of the confusion comes from that I hear.
• 3:58
  Philip Pape: So I'm gonna go through it in order so we can piece it all together.
• 4:01
  Philip Pape: Okay, in 2023, the FDA put BPC-157 on a list of compounding ingredients that present significant safety risks, or may present significant safety risks.
• 4:14
  Philip Pape: Then in February of this year, 2026, good old health secretary RFK Jr.
• 4:19
  Philip Pape: went on Joe Rogan's podcast and said that about 14 peptides would now become more accessible.
• 4:26
  Philip Pape: And then in April of this year, 2026, BPC 157 came off the safety risk list.
• 4:34
  Philip Pape: It didn't come off because the FDA decided it was safe.
• 4:37
  Philip Pape: It came off because the companies that nominated it withdrew their nominations, and the FDA's own page still has the safety language.
• 4:48
  Philip Pape: And then on July 23rd, an FDA advisory committee voted eight to six, there was one abstention, to recommend adding BPC 157 to the list of ingredients that pharmacies can compound.
• 4:59
  Philip Pape: Now, I remember way back when talking to some folks who were helping their patients with this, some clients and uh, you know, aestheticians and things like that.
• 5:06
  Philip Pape: And they were talking about the nuances of compounding pharmacies and when it went on this list, how they could no longer compound it, and you had to buy the research grade version of it on your own and take that risk.
• 5:18
  Philip Pape: You know, it was a whole mess.
• 5:19
  Philip Pape: And so this supposedly clarifies all of this and makes it easier to access, but not necessarily for the right reasons or having gone through the right process.
• 5:27
  Philip Pape: So I want you to know this is not a political assessment on my end.
• 5:30
  Philip Pape: This is the reality of the steps that were taken that was probably highly unusual.
• 5:36
  Philip Pape: And it results in, hey, the FDA approved these peptides, which is technically true, but not per the normal process where it goes through a consensus scientific, you know, approval via safety, uh, you know, agreement on their safety.
• 5:52
  Philip Pape: So when we look at the vote, an advisory committee doesn't approve anything.
• 5:57
  Philip Pape: Okay, they make a recommendation and then the FDA has to publish a proposed rule, they take public comments, and then they publish a final rule.
• 6:04
  Philip Pape: I checked the Federal Register on October 12th, and there is no proposed rule.
• 6:09
  Philip Pape: There's no deadline for a rule either.
• 6:11
  Philip Pape: In a previous round of the same process, if you look at how this is done in the past, it took a little over two years to get from the proposed rule to the final rule.
• 6:19
  Philip Pape: So as I record this, a pharmacy still can't legally compound it.
• 6:25
  Philip Pape: The second thing is that the FDA zone scientists recommended against it.
• 6:28
  Philip Pape: And that's, I guess, the bigger issue here.
• 6:30
  Philip Pape: They had a briefing document, it said the evidence weighed against adding it to the list, and they approved it anyway, or they they recommended it anyway.
• 6:37
  Philip Pape: And that's where there's the political piece of this.
• 6:40
  Philip Pape: The third thing about this, and maybe it's the most interesting, is the committee wasn't looking at tendon health.
• 6:47
  Philip Pape: The only use the FDA evaluated was ulcerative colitis, and that's a bowel disease.
• 6:53
  Philip Pape: I've actually had some clients with that.
• 6:54
  Philip Pape: It's pretty awful.
• 6:55
  Philip Pape: It's kind of like IBS and some of these others, or it really messes with your gut.
• 6:58
  Philip Pape: Tendinitis was on the nomination, but the FDA didn't evaluate it because the nomination didn't include enough information to do so.
• 7:05
  Philip Pape: So the one that everything, everybody cares about, you know, its use on tendons wasn't even included in the scope, let's say.
• 7:13
  Philip Pape: The FDA also notes that if it does get listed, the listing may not be limited to a specific use.
• 7:19
  Philip Pape: So that opens the door where a doctor could eventually prescribe it for your elbow, your tendons, based on this review, which had to do with the gut with ulcerative colitis.
• 7:29
  Philip Pape: Now, that's very interesting.
• 7:30
  Philip Pape: Now, again, I I don't know what to make of that.
• 7:32
  Philip Pape: I'm not a doctor.
• 7:33
  Philip Pape: I know there's always off-label use of things.
• 7:35
  Philip Pape: Does this qualify?
• 7:36
  Philip Pape: I'm not sure.
• 7:37
  Philip Pape: Again, I'm not a doctor, but it's it always it's very, very interesting.
• 7:40
  Philip Pape: If you, if your conspiracy hackles are up, probably for good reason, you know, in in all different directions here.
• 7:46
  Philip Pape: So if the shortcut isn't there for BPC 157, we're gonna get into more of the evidence on this.
• 7:52
  Philip Pape: What do you do when your elbow or your hip hurts?
• 7:56
  Philip Pape: I'm gonna get to the evidence-based answer, but for many of you, when a joint starts hurting, this is what I see.
• 8:02
  Philip Pape: The instinct is to stop lifting completely or go find some sort of quick fix because you think it can be, you know, fixed or healed quickly, whether that's a peptide or shot or cord, you know, it could be a cortisone shot, could be some new gadget, could be a massage thing, could be any number of treatments.
• 8:19
  Philip Pape: What usually works better is the boring stuff.
• 8:22
  Philip Pape: Okay.
• 8:22
  Philip Pape: It's following a training program that works around and with your injuries in a smart way, where you're not letting scar tissue form and you're not over-resting where it actually gets worse, where you're actually using the tissue and using the tendons in the right way.
• 8:40
  Philip Pape: It's also having enough food to recover.
• 8:42
  Philip Pape: See, many of you, you go into these situations where, well, I'm not training as much, so I shouldn't eat as much food because I'm gonna get fat.
• 8:48
  Philip Pape: Well, the problem is it both of those go against each other.
• 8:50
  Philip Pape: If you're not eating enough food to recover, your body doesn't have what it needs to rebuild the tissue.
• 8:54
  Philip Pape: And then, of course, you need enough time and patience.
• 8:56
  Philip Pape: Maybe that's the hardest for many of us.
• 8:59
  Philip Pape: So, just as a quick aside, that is exactly what we do.
• 9:02
  Philip Pape: You know, I'm always pitching my stuff here because I really care about helping people find the right path to do this.
• 9:08
  Philip Pape: We have something called Eat More Lift Heavy.
• 9:10
  Philip Pape: It's a 26-week coaching program where when you join, the week you join, you get a training program matched to your schedule, your equipment, your injury status, all of that, and guidance to adjust for that, right?
• 9:23
  Philip Pape: So within a few days, you get a launch plan that has that, your protein targets, your first steps, and then the lessons walk you through week by week with support from a community, from coaches, from live calls, however, you want to take advantage of that, no pressure, where we can work through things live or we can work through things asynchronously, as they say in the business.
• 9:42
  Philip Pape: Okay, and then we have different tiers where you can get your own coach.
• 9:45
  Philip Pape: It's not physical therapy, obviously.
• 9:47
  Philip Pape: If something is injured, you should definitely go see a physician or get imaging or talk to a physical therapist.
• 9:53
  Philip Pape: But if you want to work around stuff smartly and work on rehab, work on recovery from that perspective and stick with them, be consistent, and actually deal with that, you know, elbow tendinitis or that hip issue you have, check us out.
• 10:05
  Philip Pape: Go to eatmore liftheavy.com.
• 10:08
  Philip Pape: Go to eatmoreliftheavy.com.
• 10:10
  Philip Pape: All right, let's get back to BPC 157.
• 10:14
  Philip Pape: And I want to cover two things before we get to the evidence.
• 10:16
  Philip Pape: The first is who voted yes on the FDA panel.
• 10:20
  Philip Pape: Health affairs went through the each of the committee members and they found that at least seven of the eight yes votes came from people with ties to peptide clinics, telehealth companies, or compounding pharmacies.
• 10:30
  Philip Pape: This is not news.
• 10:31
  Philip Pape: You guys have seen this in the news.
• 10:33
  Philip Pape: The no votes included the patient representative, the consumer representative, and a physician from MD Anderson.
• 10:41
  Philip Pape: One of the yes voters even said publicly he was disappointed in how incomplete the data were, and he voted yes anyway.
• 10:50
  Philip Pape: There was a publicly traded telehealth company that sells this kind of product whose stock jumped more than 10% during the day of the vote.
• 10:58
  Philip Pape: Now, I'm not saying anybody did anything illegal.
• 11:01
  Philip Pape: I'm saying that there's massive conflicts of interest here, and this is no surprise to anyone.
• 11:05
  Philip Pape: This is kind of old news at this point, but it's really good to get refreshed on what happened and when we make health decisions for ourselves that we are truly informed.
• 11:13
  Philip Pape: The second thing is how many people are using BPC 157 and peptides in general.
• 11:18
  Philip Pape: It is not a niche thing anymore, niche, whatever word you prefer.
• 11:22
  Philip Pape: There was a data company that searched more than 15 million medical records, 15 million, and they found that documented use went up 33 fold from 2020 to 2026.
• 11:34
  Philip Pape: The average new user was 49 years old.
• 11:37
  Philip Pape: So this is our age group.
• 11:38
  Philip Pape: I'm turning 46 in a couple weeks.
• 11:40
  Philip Pape: So, you know, I'm in that age group.
• 11:42
  Philip Pape: Now, the report itself hasn't been peer-reviewed.
• 11:45
  Philip Pape: It's probably under counting, let's be honest.
• 11:48
  Philip Pape: Okay, it's probably under counting because we just don't know how many people are using these who will not disclose it or admit it.
• 11:54
  Philip Pape: So, what does the human evidence look like?
• 11:57
  Philip Pape: Well, I went looking, I went searching on your behalf for every human study of BPC-157, and it didn't take very long.
• 12:05
  Philip Pape: It didn't take very long.
• 12:07
  Philip Pape: There are not many.
• 12:08
  Philip Pape: There is a chart review where they looked at people's charts in a clinic of 16 people that had different kinds of knee pain, and they got BP BPC 157 injected into their knee, some of them alongside with another peptide.
• 12:22
  Philip Pape: 14 of the 16 said, Hey, I felt better.
• 12:24
  Philip Pape: There was no control group.
• 12:26
  Philip Pape: The patients had different diagnoses, and the authors were connected directly to the clinic doing the injections.
• 12:32
  Philip Pape: Okay, so take a, you know, take that for what it's worth.
• 12:36
  Philip Pape: There was a pilot study of 12 women with a bladder pain condition.
• 12:40
  Philip Pape: There's a safety report that had two people.
• 12:42
  Philip Pape: There's an abstract from 2005 of a colitis trial using an enema, never published.
• 12:48
  Philip Pape: That's pretty much what I could find.
• 12:50
  Philip Pape: So I don't think there's much research, and it makes sense, right?
• 12:53
  Philip Pape: Because you don't get much, you know, people say, well, of course there's not research because it wasn't approved or wasn't available.
• 12:58
  Philip Pape: I get all that.
• 12:59
  Philip Pape: I it's just like with herbal remedies or something like Ashwagandha, or even like Western Ayurvedic, Chinese medicine, I get that there are potentially legitimate treatments and all of that that the science hasn't caught up to or will not look at for various, you know, reasons or incentives or lack thereof.
• 13:17
  Philip Pape: But when the FDA themselves added up all the research, because the FDA, guess what, has to look at this stuff to identify safety, they counted about 81 people who've been given BPC 157 in studies.
• 13:29
  Philip Pape: And the longest anyone took it was for two weeks.
• 13:31
  Philip Pape: So kind of useless, is my point.
• 13:34
  Philip Pape: A 2025 systematic review looked for every study relevant to orthopedic and sports medicine.
• 13:40
  Philip Pape: They found 35 animal studies and one human study.
• 13:43
  Philip Pape: And the human study wasn't on tendons.
• 13:46
  Philip Pape: So there really is no controlled trial of BPC 157 for any tendon, ligament, or muscle injury in people.
• 13:53
  Philip Pape: There is a trial registered for people recovering from rotator cuff surgery, but it hasn't posted results yet.
• 14:00
  Philip Pape: So there may be results eventually.
• 14:02
  Philip Pape: The more this is used, the more this is studied.
• 14:03
  Philip Pape: Totally fair.
• 14:04
  Philip Pape: Now, I want to be fair to the work on animals because there is a lot of that and it's pretty consistent.
• 14:10
  Philip Pape: In rats, BPC 157 does seem to speed up healing of tendons that were surgically cut.
• 14:16
  Philip Pape: The proposed mechanisms involve growing new blood vessels and nitric oxide signaling.
• 14:24
  Philip Pape: But two things we okay, nuance.
• 14:26
  Philip Pape: Let's get into nuance, guys.
• 14:28
  Philip Pape: First of all, a surgically cut rat tendon is a little bit different than a 52-year-old woman's elbow that's been irritated for a while.
• 14:36
  Philip Pape: All right.
• 14:37
  Philip Pape: Very different problems.
• 14:38
  Philip Pape: Oh, you always have to look at how they did these things.
• 14:40
  Philip Pape: I get a little bit skeeved out actually when I look at how they how they treat rats in some of these studies.
• 14:45
  Philip Pape: You know, maybe I'm a bleeding heart in that context, but I have two daughters and we talk about these things around the dinner table, and they're like, they would they do what to animals in research?
• 14:54
  Philip Pape: So yeah.
• 14:55
  Philip Pape: And then more than 80% of the BPC 157 papers are by the same researcher, or at least they had the same researcher in common, Pedrag Sikerich, I think that's how you pronounce it, who first described it and has been named inventor on patents for it.
• 15:10
  Philip Pape: A 2025 review said that that that kind of self-replication raises the risk of confirmation bias.
• 15:18
  Philip Pape: And his group, the researcher's group, published a rebuttal saying, hey, all the criticisms should be dismissed.
• 15:24
  Philip Pape: So there's an ongoing disagreement in the literature.
• 15:26
  Philip Pape: It's interesting to see it happen publicly like that, but the disagreement is about the rat studies.
• 15:31
  Philip Pape: There's no human studies, so it's good to know.
• 15:33
  Philip Pape: Safety.
• 15:34
  Philip Pape: What about safety?
• 15:35
  Philip Pape: Same story.
• 15:35
  Philip Pape: The big theoretical concern is that the blood vessel growth that people are looking for here with healing their tendons runs through the same mechanism that some cancer drugs try to block.
• 15:49
  Philip Pape: That's kind of the paraphrasing of how this might work.
• 15:53
  Philip Pape: But it hasn't been tested in humans in either direction.
• 15:56
  Philip Pape: If you are, you know, let's say a breast cancer survivor, which a lot of women listening might be, I'd want you to have that conversation with your oncologist, right, before doing anything else.
• 16:05
  Philip Pape: The FDA's other concerns were immune reactions and of course the quality of the drugs or the material.
• 16:12
  Philip Pape: You know, when they look at certificates of analysis from the people selling this stuff, the documents are limited in what they show.
• 16:19
  Philip Pape: Sometimes they'll show a purity percentage and not much else.
• 16:22
  Philip Pape: They won't list impurities, they don't do any testing for endotoxins.
• 16:25
  Philip Pape: So even if the molecule worked, you don't really know it's in the vial that you bought.
• 16:30
  Philip Pape: And again, it would often say for research purposes only or only use in animals or something like that.
• 16:36
  Philip Pape: And that's that's what I used a few years ago when I tried it.
• 16:39
  Philip Pape: If you compete in tested masters lifting, be aware, BPC 157 has been on the World Anti-Doping Agency's prohibited list since 2022, banned at all times.
• 16:53
  Philip Pape: And that doesn't change based on the FDA decision.
• 16:56
  Philip Pape: So let's quickly talk about my shoulder because I mentioned I use this in the past.
• 17:00
  Philip Pape: I described injecting BPC-157 five days a week for six weeks after my first rotator cuff surgery.
• 17:06
  Philip Pape: Uh, then later I had to have a cortisone shot for bursitis.
• 17:09
  Philip Pape: My shoulder did feel a little tiny bit better, hurt less, felt stronger, bench overhead went up.
• 17:15
  Philip Pape: But I also was eating more.
• 17:16
  Philip Pape: I went into a surplus, I switched into a higher volume strength program.
• 17:21
  Philip Pape: You know, I was still recovering from the cortisone shot.
• 17:23
  Philip Pape: I was doing mobility work, I was using a sling shot, I was using pressing variations that were easier on the shoulder.
• 17:28
  Philip Pape: Talk about so many variables, you can't possibly make sense of it all.
• 17:31
  Philip Pape: I wanted it to work, even the placebo effect in my head, like I wanted it to work.
• 17:35
  Philip Pape: So my conclusion back then was I'm not really sure if this did anything.
• 17:39
  Philip Pape: And in hindsight, I was having issues where the rotator cuff wasn't fully healed to begin with.
• 17:45
  Philip Pape: So would it have worked better if it was fully repaired in surgery and helped me recover faster?
• 17:49
  Philip Pape: Who knows?
• 17:50
  Philip Pape: I do know that now, after my second surgery, I've recovered fast.
• 17:55
  Philip Pape: I recovered way faster than the first time, and I did not take it.
• 17:58
  Philip Pape: And that's because the surgery went better.
• 18:00
  Philip Pape: So, see, it's hard to tease apart the variables.
• 18:03
  Philip Pape: Now, how I see that experiment on myself back then is like useless because I changed so many things at once.
• 18:10
  Philip Pape: It's basically the same as the quality of human research on BPC 157 in general.
• 18:15
  Philip Pape: Okay.
• 18:16
  Philip Pape: So when someone says, hey, it worked for me and I feel great, and you see on Reddit and you see online or people on YouTube, the hate hater comments that are like, yeah, no, this is a, you know, I took it and my cousin took it, and we recovered so much faster.
• 18:28
  Philip Pape: How do you know you wouldn't have recovered fast without it?
• 18:30
  Philip Pape: How do you know something else like lifting weights wouldn't have helped?
• 18:33
  Philip Pape: You just don't know.
• 18:34
  Philip Pape: And until we have population-level human trials, we won't know, I'll say scientifically.
• 18:40
  Philip Pape: Now, I'm not saying that it definitely doesn't work, right?
• 18:43
  Philip Pape: Don't misconstrue one extreme for the other.
• 18:46
  Philip Pape: The lack of evidence is not proof that it fails, right?
• 18:49
  Philip Pape: Evident absence of evidence isn't evidence of absence, right?
• 18:52
  Philip Pape: Animal data, hey, those rat studies are interesting enough that I would like to see a real human trial and all this stuff.
• 18:58
  Philip Pape: I, you know, if we can find some magic compounds that can help people, awesome, go for it.
• 19:02
  Philip Pape: I'm not saying the FDA is always right, that's for sure.
• 19:05
  Philip Pape: I definitely have a lot of skepticism for our government in all directions.
• 19:09
  Philip Pape: You've got to be in control and you've got to make your own choices, right?
• 19:12
  Philip Pape: People are buying this stuff from gray market websites.
• 19:15
  Philip Pape: So a regulated compounding pharmacy, if you can get it through that, it's probably going to be cleaner, safer, et cetera, than the alternative.
• 19:26
  Philip Pape: But that's more of a safety or a harm reduction argument related to the quality of the product, not actually the evidence that this stuff works or helps with your tendons, et cetera.
• 19:35
  Philip Pape: I'm not judging anyone who's tried it.
• 19:37
  Philip Pape: I did it myself.
• 19:38
  Philip Pape: I'm just saying nobody has tested it in people like you for the problem you have.
• 19:42
  Philip Pape: And if you're gonna spend money and injections and months on this and we're, you know, take a risk with safety and everything, just go no go in knowing it's still experimental.
• 19:51
  Philip Pape: And even more important, it probably shouldn't be your first move, in my opinion.
• 19:55
  Philip Pape: So, what does work?
• 19:57
  Philip Pape: That's a good segue.
• 19:58
  Philip Pape: Like, what does work?
• 19:59
  Philip Pape: Well, the first thing is it helps to know that this isn't in your head, and it is also very common at our age.
• 20:05
  Philip Pape: Tennis elbow peaks in your 40s.
• 20:08
  Philip Pape: In one large study, women in their 40s had it more often than men did.
• 20:12
  Philip Pape: Pain on the outside of the hip from the gluteal tendons is about three times more common in women than men.
• 20:17
  Philip Pape: There's a reasonable theory that falling estrogen changes tendon tissue.
• 20:21
  Philip Pape: Although I'll say that the human data, again, human data on hormone therapy and tendons are pretty thin and sometimes mixed.
• 20:27
  Philip Pape: A trial in postmenopausal women with hip tendon pain found HRT helped only in a subgroup of leaner women, for example.
• 20:35
  Philip Pape: What I think is the best evidence is guess what?
• 20:38
  Philip Pape: Loading the tendon progressively over time.
• 20:40
  Philip Pape: That means lifting weights smartly with progression.
• 20:44
  Philip Pape: The best example I found is a Danish trial in people with tennis elbow published in 2022, where everyone did a 12-week home program using elastic bands.
• 20:55
  Philip Pape: Three times a week, they did wrist extension, wrist flexion, and rotating of their forearm.
• 21:01
  Philip Pape: Each rep was slow, about three to four seconds in each direction.
• 21:04
  Philip Pape: So you could assume there's some isometrics going on there.
• 21:07
  Philip Pape: They started with sets of 15, worked down to sets of six as the band got heavier, and they were allowed to feel pain up to about a five out of 10 during the exercise, as long as it settled down shortly afterward.
• 21:17
  Philip Pape: This sounds a lot like some of the lifting strength coach rehab guys I've had on the show, talking about a similar thing of like there's some level of pain that's acceptable, and then beyond that, probably not.
• 21:29
  Philip Pape: And that's where you have to find that balance.
• 21:31
  Philip Pape: Now, in this study, they were randomized to a cortisone shot, a needling procedure into the tendon, or a fake injection just under the skin.
• 21:39
  Philip Pape: And all three groups improved.
• 21:42
  Philip Pape: Adding the shot or the needling didn't help further.
• 21:45
  Philip Pape: So, guess what?
• 21:46
  Philip Pape: The exercise program did the work.
• 21:48
  Philip Pape: I actually really like how they designed that study.
• 21:50
  Philip Pape: I'm gonna come back to cortisone at the end of the episode, so stay tuned for that.
• 21:53
  Philip Pape: But I think it's fascinating the way they designed it so that you can see the improvement was the same, meaning you didn't really need this other stuff.
• 22:00
  Philip Pape: Now, I don't want to oversell this because there's another review from 2021 of 30 trials in tennis elbow that found that exercise beats passive treatments, but the effects are small.
• 22:12
  Philip Pape: And a lot of cases just get better on their own with enough time.
• 22:15
  Philip Pape: That's the key there is that you know, maybe trying to do something is the problem, like just let it resolve.
• 22:22
  Philip Pape: But on the other hand, you don't want to make it worse, right?
• 22:24
  Philip Pape: So not doing certain things and avoiding things that make it worse is also important.
• 22:28
  Philip Pape: That's actually the general philosophy I use today that works quite quite well is don't do things that aggravate it and do everything else as usual.
• 22:38
  Philip Pape: And generally it will improve over time.
• 22:40
  Philip Pape: There was a trial where 83% of the people in the wait and see group that just waited, just didn't do anything specific, they were successful at one year later.
• 22:50
  Philip Pape: So loading of the tissue isn't necessarily magic.
• 22:54
  Philip Pape: It's, I'll say, the option that has the most evidence behind it.
• 22:57
  Philip Pape: It's also cheap or free in the sense that you should be doing it anyway.
• 23:00
  Philip Pape: You're gonna be lifting weights anyway.
• 23:02
  Philip Pape: It's not like an extra thing you have to do or extra time you have to take.
• 23:05
  Philip Pape: You don't have to do special mobility work necessarily, although that could be part of it.
• 23:10
  Philip Pape: So let's go back to our friend with the year-old tennis elbow that I mentioned earlier.
• 23:15
  Philip Pape: She tried physical therapy, shockwave, and BPC 157.
• 23:19
  Philip Pape: Now, BPTC 157 has never been tested for this in a human, so I wouldn't have expected a lot from it.
• 23:25
  Philip Pape: I know a lot of people take it, it doesn't do anything for them.
• 23:28
  Philip Pape: Shockwave has mixed evidence.
• 23:30
  Philip Pape: There was an analysis that found no tennis elbow treatment beat placebo in the first six weeks.
• 23:35
  Philip Pape: And PT, physical therapy, can mean a lot of different things.
• 23:38
  Philip Pape: So my questions for her would be these: did the loading get heavier over time and keep progressing for at least 12 weeks?
• 23:45
  Philip Pape: Was your grip trained directly?
• 23:48
  Philip Pape: Did anything change about the daily tasks that keep irritating it?
• 23:51
  Philip Pape: So if you're doing all the right things in those, now when I say grip trained directly, that could be a pro or con, depending, because sometimes using your grip overusing your grip when you have a tenant issue could actually be a problem versus a looser grip, let's say, on something like a squat or press or pull.
• 24:06
  Philip Pape: So I would want a sports medicine doctor, somebody who's really good at all this stuff to take a look, somebody who understands athletes, somebody understands lifting, and also somebody understands, you know, tendon pain and physical therapy type things, and always rule out things like nerve problems or referring of pain.
• 24:24
  Philip Pape: And that's an important one, guys.
• 24:25
  Philip Pape: Referring of pain.
• 24:27
  Philip Pape: Something in your neck could refer pain to your arm.
• 24:29
  Philip Pape: Oftentimes a squat grip where your wrist is very extended, that refers the refers the load of the barbell sitting on your hand down into your elbow area and causes tendinitis for a lot of people.
• 24:42
  Philip Pape: So the simple version is forget about peptides for now.
• 24:46
  Philip Pape: Don't do anything fancy.
• 24:48
  Philip Pape: Pick one or two slow controlled exercises for the painful area.
• 24:52
  Philip Pape: Start light enough so you can finish your sets and add load every session or every week or two, depending on the frequency.
• 24:59
  Philip Pape: You know, let it hurt a little, up to about that five out of 10, as long as it settles down soon after.
• 25:06
  Philip Pape: And I was going through a little bit of golfer's elbow recently, and I thought, okay, I just need to not aggravate it.
• 25:12
  Philip Pape: I need to keep lifting.
• 25:13
  Philip Pape: If it's a little bit painful, that's okay.
• 25:15
  Philip Pape: If it's not, if it's more, maybe don't do that exercise, maybe do a set less.
• 25:19
  Philip Pape: And by taking that measured approach, it started to improve.
• 25:22
  Philip Pape: All right.
• 25:22
  Philip Pape: Keep lifting everything else that you can lift where there's no pain.
• 25:25
  Philip Pape: Don't make excuses.
• 25:27
  Philip Pape: And you got to be measuring and tracking things, right?
• 25:30
  Philip Pape: Like what load are you using?
• 25:32
  Philip Pape: What works better for you?
• 25:33
  Philip Pape: What volume or rep ranges work better for the pain, et cetera?
• 25:36
  Philip Pape: So you're judging it by the data and not how it just quote unquote feels.
• 25:40
  Philip Pape: All right.
• 25:41
  Philip Pape: This is a habit that I have from coaching, but I always encourage it in you, dear listener, is to track things so that you can measure what's working.
• 25:49
  Philip Pape: Then finally, I have this advice.
• 25:51
  Philip Pape: When you're evaluating a peptide or supplement claim of any kind, ask three questions.
• 25:55
  Philip Pape: Number one, has it been tested in humans for my specific problem in people like me?
• 26:01
  Philip Pape: But definitely in humans, start with start there.
• 26:03
  Philip Pape: Number two, is it approved, listed, recommended by a panel?
• 26:07
  Philip Pape: Or is it more of a research, experimental chemical?
• 26:09
  Philip Pape: Like retatrotide or retatrutide, however you want to pronounce it, is still in the research phase.
• 26:15
  Philip Pape: So it's technically, you know, you're technically taking a risk and it's experimental until it's approved.
• 26:20
  Philip Pape: And then finally, is the person who is telling you about it also selling you it?
• 26:25
  Philip Pape: Okay.
• 26:26
  Philip Pape: Are they's the person telling it selling it?
• 26:29
  Philip Pape: Very important.
• 26:29
  Philip Pape: If BPC 157 had really good answers to all three of these questions, we would have a different conversation.
• 26:35
  Philip Pape: I probably wouldn't have to make this episode.
• 26:37
  Philip Pape: All right, before we wrap up, I promised you some advice when it comes to cortisone shots that I'll give you in just a second.
• 26:44
  Philip Pape: But first, if this episode is helping you think through or, you know, make choices or get inspired to lift weights and not waste money on peptides if you don't need them.
• 26:54
  Philip Pape: And you like this podcast, just leave a review.
• 26:57
  Philip Pape: That's all I'm asking for.
• 26:58
  Philip Pape: Leave a review on Apple Podcasts or leave a rating on Spotify.
• 27:01
  Philip Pape: Should just take 30 seconds.
• 27:02
  Philip Pape: Please do that right now.
• 27:03
  Philip Pape: Pause the show.
• 27:05
  Philip Pape: It's a great way to support us.
• 27:06
  Philip Pape: If you like the show, it's a great way to get to keep getting this free content and have others find it as well.
• 27:12
  Philip Pape: So again, a review on Apple Podcasts or rating on Spotify.
• 27:16
  Philip Pape: All right.
• 27:17
  Philip Pape: So if you do have tennis elbow or golfer's elbow or some other sort of, you know, tendon pain like that, and a person, I'll I'll just say it could be a medical professional, it could be a clinic, whatever, offers you a cortisone shot.
• 27:30
  Philip Pape: I'm gonna share some a couple pieces of information from the research that might help.
• 27:35
  Philip Pape: In a trial of 165 adults with tennis elbow, this was in Journal of American Medicine or yeah, JAMA, some got a cortisone shot and some got a placebo.
• 27:45
  Philip Pape: And at four weeks, the shot group was doing better.
• 27:50
  Philip Pape: But at one year, 83% of the shot group had recovered or were much better, but 96% of the placebo group had recovered or were much better.
• 28:00
  Philip Pape: And the pain actually came back in 54% of the shot group compared to only 12% of the placebo group.
• 28:07
  Philip Pape: Now, I'm not a doctor, this isn't medical advice.
• 28:09
  Philip Pape: There's a situation where a shot does make sense.
• 28:13
  Philip Pape: But it is totally fair to ask your doctor what the plan is for a year from now, because there some doctors are just like, we'll just give you a shot, see what happens, we can give you another one.
• 28:22
  Philip Pape: And then eventually they're like, well, we can't give you any more.
• 28:24
  Philip Pape: But what does that tell you?
• 28:25
  Philip Pape: Maybe that is just a band-aid for some of you, and that's not the best solution.
• 28:30
  Philip Pape: Now, whatever you decide to do, keep lifting what you can while it heals.
• 28:35
  Philip Pape: Because again, a gradual plan of loading and progression is still probably your best bet, has the most evidence behind it, and you should be doing it anyway to get stronger and build that muscle.
• 28:45
  Philip Pape: All right, until next time, keep using your wits, lifting those weights.
• 28:48
  Philip Pape: And remember, the best evidence for a cranky tendon is still lift some weights, load it, work around it, be smart with your routine.
• 28:57
  Philip Pape: I'm Philip Pape, and I'll talk to you next time here on the Wits& Weights Podcast.