Peptides – Medical Breakthrough for Anti-aging and Immune Health with Dr. Kevin Wallace

Today I speak with Dr. Kevin Wallace on the topic of peptides which have very promising potential for anti-aging and for immune system health.  We discuss this exciting field and how these simple amino acid sequences can help you feel more vital, energetic and even help dampen an overzealous immune system.

In This Episode

Episode Intro … 00:00:39
Protocol Prerequisites … 00:02:31
What Conditions Respond Best to These Protocols? … 00:04:15
The Role of Non-modifiable Factors … 00:06:13
Hormones and Overall Health … 00:09:01
The Thyroid-Cortisol Connection … 00:12:16
Cortisol Replacement with the Testosterone Protocol … 00:19:00
Prescription Cortisol: Fundamentals & Dosing … 00:20:33
Growth Hormone vs. Peptide Hormones … 00:23:58
What Is a Peptide … 00:26:12
Risks, Benefits, and Finding a Clinician … 00:28:22
Balancing the Immune System … 00:31:11
The Age Management Group … 00:36:01
Peptides for Increasing Growth Hormone … 00:36:55
Sermoralin, CJC1295, and Thymus Cost Comparisons … 00:40:36
Cycling, Side Effects, Dosing & Reactions … 00:42:46
Contraindications and Clinician Assessments … 00:50:10
Episode Wrap-up … 00:54:23

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Episode Intro

Dr. Michael Ruscio: Hey, everyone. Welcome to Dr. Ruscio Radio. This is Dr. Ruscio. Today, I am here with my friend and colleague, Dr. Kevin Wallace, no relation to William Wallace, although he does seem like he’s a pretty strong fellow.

Dr. Kevin Wallace: Yes.

DrMR: Speaking of strength, we’re going to be talking about how to use hormones and peptides for performance, antiaging, and maybe a few other odd places we end up traversing to. So, Kevin, welcome to the show.

DrKW: Thank you. Thank you very much for having me.

DrMR: Yeah, it’s a pleasure to have you here, and this is a topic that I’m both curious about clinically, but also personally, to learn more about. So I’m looking forward to having the conversation.

DrKW: Yeah.

DrMR: Before we get into the details, tell people a little bit about your background and then how you got into using hormones and peptides and the like in your clinical practice.

DrKW: Yeah, so I went ahead and graduated in 1998 with my bachelor’s in wellness management, so I did a lot of personal training, nutritional consultation back in those days. I worked a lot with athletes and nutritional dietary plans. I worked in physical therapy, rehabbing clients.

And then I decided at the age of 39 to go back to naturopathic medical school just because it fit with my philosophy a little bit better and how to better help people. So I graduated in 2014, and then from that point on, I’ve had my own clinic and basically specialize in life-enhancement medicine, trying to make sure people age gracefully, making sure people have better care in regards to their chronic disease. So that’s where I’m at now.

So I’m kind of like you. I go ahead and make sure that I go ahead and utilize all the products that I suggest. I test everything on myself in that regard. So I try to stay healthy and be a good example to the patients that I see, as well.

Protocol Prerequisites

DrMR: Awesome. Love it. So I want to ask you this first question which is who can best or who might most benefit from the use of things like peptides and hormones for either performance and/or for antiaging? But, quickly, let me just offer my two cents, and I’m thinking you’re probably going to agree with this. So this is maybe more so just a disclaimer for the audience.

I tell my patients when they come in, wanting to dabble with hormones for enhancement, that if we put hormones or other like things into an inflamed body, that they don’t tend to do what you want them to do. And I’m using the term inflammation kind of loosely, but essentially saying that if someone’s not healthy, we can’t just try to jam hormones and peptides into an unhealthy system and expect to have an enhancing effect.

And so, we have to start with this foundation of obvious diet and lifestyle factors and then potentially considering cleaning up an issue in the gut if that might be indicated or another like issue. And then, we can come to the pinnacle of the proverbial pyramid here and use these things as enhancement. So I’m assuming you would agree with that, but any other things that you would suggest, big-picture, as we wade into this conversation?

DrKW: Yeah. So I totally agree with you on that component.  So these things work better when everybody is detoxed, heavy-metal-wise, chemical-wise. And you’re an expert in regards to nutritional and gut health and assimilation. So when we give these people hormones and peptides and supplements just to help their cofactors and the biochemistry, everything works better, the patient’s happier, and we actually get better results.

I agree with you 100%.

What Conditions Respond Best to These Protocols?

DrMR: Good. So we’re on the same page there. There are a lot of different symptoms that people struggle with and they may consider hormones being implicated in that: energy, fatigue, sex drive, body composition, sleep, exercise performance. Would you say—and maybe there’s not—but would you say there’s some symptoms or conditions that really tend to respond well to this kind of work?

DrKW: Well, exactly what you said. So I like to use hormones and peptides and think of messenger systems. So a lot of times people just don’t have the proper messaging to turn on other bodily processes in their body. So in regards to people feeling stressed and people feeling, like I said, their body composition starts to change, increase body fat, decrease, like I said, sex drive. Then hormones play an important role in that because they’re the messengers that tell other systems to actually turn on.

So we can try the supplements, and I know the biggest thing with guys sometimes is using herbals like horny goat weed and all these things like tribulus. But a lot of times, you do need to go ahead and have the hormone itself. And if they’re low, obviously by proper testing, then those things need to be increased in order for these other processes to happen, for them to go ahead and maintain health.

So I see a lot of gentlemen, and a lot of females, exactly with that, andropause, menopause, but they don’t have to necessarily be 60 years old or 50 years old. We’re seeing more and more men in their early 20s and 30s have these symptoms of decreased testosterone. And so, like you said in the very beginning, do we necessarily give them testosterone? Not necessarily, but there’s other things that we can do to actually help with the pathways.

But if they do need it, then we can go ahead and put them on a proper dosing that will actually go ahead and help like these other symptoms actually dissipate.

The Role of Non-modifiable Factors

DrMR: Sure. And just something I like to offer as maybe a reassurance for people is that sometimes you need some support. And it’s something that early in my career I was very overly idealistic, thinking that natural medicine could cure the world and this sort of thing. And then, you see patients long enough and you realize there are some people that do everything right and still don’t get the outcome that they would like.

Part of that is because there are non-modifiable factors. We talk a lot about early life development of the gut microbiota and the gut immune system and how if someone didn’t have a great opportunity for those factors to develop the way that we want them to, they may have to work around that later in life. And they can’t go back and change that, and that’s ok.

And I think the same thing happens in the hormonal realm, and I know that there’s some evidence, more so I believe in rat models, where they’ve shown that things like environmental toxins can cause essentially a lower weight of testicles in male rats. And so, yes, some of this may be because—and when I say some of this, men needing these things earlier in life, and women—maybe because people are stressed, not eating well, and not exercising, yes. But don’t be overly idealistic in thinking that that’s going to be a cure-all because there may be things… There may be toxins that you’re exposed to or your mother may not have had the best diet when she was pregnant with you.

And so, you may only be able to get so much out of those natural optimization things like diet, lifestyle, exercise, what have you. And I would just caution people not to beat themselves up because you may be able to feel a lot better if you just open your mind to the fact that some other support may be beneficial for you.

DrKW: Correct. And the whole life enhancement paradigm, that that’s where we’re meeting patients where we’re at, it’s like does someone at 25 need testosterone? Yes. If their symptoms show it. So a lot of times, I think we just go by labs, and we’re actually not investigating the people or we’re not actually putting our hands upon the patient anymore by actually checking physical symptoms, checking different signs that they have this, listening to their story.

So I deal a lot with, like I said, younger men, putting them on testosterone, learning how to keep the pathways open with HCG which helps, like I said, keep that pituitary luteinizing hormone axis going as we’re cleaning them up. And as we clean them on up, like I said, their testosterone goes on up, and then we can slowly wean them off testosterone, see if they keep it naturally in regards to now they’re healthy, less body fat, like I said, more exercise.

So we’re helping them and meeting the people where they’re at and doing it physiologically, correctly and as well as being, like I said, proper medicine.

Hormones and Overall Health

DrMR: Right. Ok. So some of the hormones that are often part of this discussion: testosterone, estrogen, progesterone, thyroid, cortisol, growth hormone, and there’s also peptides. And I really want to dig into the peptides a lot because I think this is something new and exciting.

DrKW: Yes.

DrMR: But let’s talk about the hormones, maybe even just briefly. But testosterone—I’m sure everyone’s heard about—helps with drive, with libido, with muscle mass, with body composition. Estrogen and progesterone, of course, more important for women. Not many men are put on estrogen and progesterone. In fact, sometimes men are put on estrogen blockers as a technique to try to increase their testosterone.

DrKW: Yep.

DrMR: But any thoughts that you think people should be aware of outside of the obvious of sometimes men benefit from some testosterone. Sometimes women benefit from a balance of estrogen and progesterone. Anything with those three that you’d like to mention?

DrKW: Yeah. So, again, it’s like I think with testosterone in men and women that we always think that it’s just a sexual hormone as well as estrogen and progesterone. But we’re talking mental health. We’re talking keeping the brain function proper in regards to estrogen. Estrogen has now been linked to—when I say estrogen, low estrogen has been linked to Alzheimer’s, dementia. So we’re not just talking keeping the sexual characteristics and keeping our sex drive. We’re talking heart health, bone health. Obviously, women and osteoporosis.

I think a lot of times conventional medicine will say, “Just take calcium.” And that’s actually, I think, an improper thing. We need to have a balance of progesterone and estrogen to actually open up the receptor site to actually utilize calcium and break down bone and all those things properly because we don’t want to have risk for hip fractures in that regards.

Progesterone works very well for all the anxiety that females have, especially at night. They can’t sleep. Their brain’s always functioning. And so, progesterone, obviously depending on how you dose it, in an oral form actually helps decrease the anxiety, helps with, like I said, that stress cascade. Because if anybody’s seen the adrenal cascade, they call the pregnenolone and DHEA steal and it goes down to cortisol. So we’re decreased on progesterone. So those will really help with a lot of anxiety problems.

All those things can be corrected. It’s not just, like you said, about sex drive.

DrMR: Absolutely. And even Dr. Satish Rao, a gastroenterologist motility specialist, when he was on a while ago kind of corroborated and provided a mechanism for something I have observed which is sometimes when you balance a woman’s female hormones—estrogen and progesterone—their constipation improves.

DrKW: Oh, absolutely.

DrMR: And unbeknownst to me at the time, there are many receptors for progesterone in the colon and they partially regulate colonic motility and, therefore, bowel function. And also, like you said, progesterone and GABA and estrogen also functions very similar to an SSRI. So mood is another big one.

So absolutely there with you 100% that the effect of these sex hormones goes beyond just things like sex drive and body comp. For a woman, it can prevent her from wanting to strangle her husband or whatever.

DrKW: Yes.

The Thyroid-Cortisol Connection

DrMR: So there’s also thyroid and cortisol. And thyroid hormone, in my belief, is really over-utilized sometimes. And unfortunately, I think it’s because—this is from my vantage point. Other people may have different vantage points. But the amount of patients I see coming in, thinking that the cause and, therefore, corresponding with the solution to all of their problems is some sort of mystical thyroid imbalance that hasn’t yet been found.

It’s staggeringly high. And unfortunately, I think it’s because marketing for thyroid is very effective. So people very effectively get swept into marketing things for thyroid.

DrKW: Oh, gosh. Yes.

DrMR: So definitely there’s a time and a place. And we’ve talked a lot on the podcast about more comprehensive ways of—or I shouldn’t even say comprehensive—more accurate methodologies for testing thyroid hormone to get a true representation of if you need to start therapy or not. And this is kind of drawing a strict delineation between are you truly hypothyroid or not. Do you have a medical condition or not?

DrKW: Correct.

DrMR: So that’s a different conversation.

DrKW: Oh, yeah.

DrMR: There’s also the conversation of using this as a support, as an antiaging support, which I’m open to. I have made the criticism that if you’re going to do that as a doctor, you need to explain to the patient you’re doing it as such because sometimes patients come in telling me that they’re diagnosed hypothyroid. And I look through their medical records and I say, “Who the heck told you you were hypothyroid?”

DrKW: Yes.

DrMR: And their doctor didn’t tell them that they were just using it as a support.

DrKW: Correct.

DrMR: So for the clinician listening to this, tell people that you’re using it as a support and they’re not hypothyroid because people can carry that diagnosis with them and it’s not healthy to give someone a diagnosis that doesn’t have it because there’s psychological burden associated with that.

Getting off my soapbox here, one of the things I’ve seen happen to some people when they go on thyroid, they become fatigued.

DrKW: Yes.

DrMR: And it’s likely because—or at least the posit is—that you’ll increase your metabolism and one of the things you’ll metabolize more is cortisol. And that can exacerbate someone that doesn’t have optimum cortisol levels.

DrKW: Correct.

DrMR: So I think what happens in some antiaging circles is people are begin given either adrenal support and/or cortisol whenever they’re being given thyroid hormone because of that potential interaction. So I’m curious what your thoughts on this are, what you’ve seen, and what you do in lieu of that.

DrKW: Yeah. So I agree with you. So anybody that comes in and they’ve been diagnosed with hypothyroid or upon our examination we think that their thyroid might be sluggish, we always check the symphony of hormones. So cortisol, obviously, is important to open up the receptor site to allow T3 to enter the cell.

And so, when people are testing thyroid in conventional realms, TSH and usually T4 are the only hormones that are really tested. So we like to kind of go past that and check like free T3, free T4, reverse T3, the cortisol levels. And this gives us a better understanding of what is happening biochemically as well as co-factor wise what they need.

Like you already know, everything needs support. So are these people deficient in just selenium and iodine and tyrosine that you can actually easily give through dietary means. Their body now starts to convert better to free T3. Their cortisol levels go up with proper sleep. And they’re only diagnosed with hypothyroid because a doctor just checked their TSH.

I’m with you. I’m kind of like poor medicine in that regards. Cortisol can be increased or decreased again, just checking their history and how that relates to blood sugar problems, inflammatory problems, and then that leads to a myriad of other things like autoimmune that can also just be from a hormonal constituent. And as well as, like, say cortisol-estrogen relationships, high cortisol decreases estrogen. High testosterone actually will decrease cortisol.

So all of those things have to be tested appropriately along with appropriate back history of the patient in that regards. Heavy metals. Obviously, if they smoke, cadmium displaces iodine on the thyroid. Fluoride, bromide, brominated flours, all of those things. So if we remove those, all of a sudden, poof! The thyroid gets better. They’re happy. They’re not diagnosed with hypothyroid. They just have, like I said, a dysregulation that their body can take care of if you take care of the body appropriately and meet the proper practitioner.

DrMR: Right. And this is why I have two different gears I shift into when tackling hormones with my patients. If it’s something like true hypothyroidism, it’s fairly straightforward from my training. And if it’s something like a female hormone imbalance, again, pretty straightforward.

If someone wants to go into the other gear of antiaging medicine, I tell people I’m really not your guy because of exactly what you just said. If you start giving testosterone and someone feels good for a little while and then they start feeling like garbage, and unbeknownst to them, they’ve now suppressed their cortisol.

DrKW: Yep.

DrMR: So there’s this interplay, and oftentimes, more of a support of the whole symphony, as you put it, of hormones needs to be undergone in order to achieve that true, long-lasting, balanced antiaging result. So you want to work with someone who’s really focusing on doing this day-in and day-out.

So I’m glad that you made those remarks because I do think it is important for people to understand that. If they’re really going to do an antiaging approach, oftentimes, they need the symphony.

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Cortisol Replacement with the Testosterone Protocol

How often do you find that if someone, let’s say, male or female who’s using testosterone and then maybe testosterone, plus or minus if it’s a male or female, estrogen, or progesterone, they need to have cortisol replacement along with that? Is that something you find fairly commonly?

DrKW: Yeah. I do just because, unfortunately, we’re just in such a high stress society that we no longer have proper sleep. We no longer have proper exercise, proper dietary means. So cortisol will usually go up and down. Obviously, people haven’t heard about Hans Selye and the stages of stress. So a lot of people are right now, unfortunately, crashed.

But, again, it’s like if we test their cortisol and their cortisol is very low, a lot of times you can just correct that and it corrects everything else in regards to different hormones being low. So sometimes we have a hierarchy of treatment of let’s start somewhere, build that on up. In a couple of months, retest, see where your other levels are at with these other interventions that we don’t need to go into, technically, other replacements in that regard.

And in today’s society, I would always sit there and say that the hierarchy for us is really making sure that their adrenal glands are functioning well. And that relates, like I said, a lot to some of these other testosterone and estrogen deficiencies. So getting some of that corrected corrects the other hormones, as well.

Prescription Cortisol: Fundamentals & Dosing

DrMR: Now, I’m assuming you’re sometimes achieving this with basic, but fundamentally important of course, items like healthy diet, blood sugar regulation, sleep, exercise, what have you.

DrKW: Yeah. Correct.

DrMR: And then, other cases, you’re using things like adrenal adaptogenic herbs or potentially pregnenolone and DHEA. But then, how often are you using something like Hydrocort or some sort of prescription cortisol? How often do you find you need to go there?

DrKW: Quite frequently. So if anybody obviously is—it’s like we’re testing them on now and they’re at such a point that no adaptogenic herb is going to build them up… Again, so our goal here is to meet the patient where they’re at. It’s like build them on up and build them up sometimes quickly because a patient has a certain deficit; they want to have a certain goal. So the safe uses of cortisol are, like I said, using hydrocortisone. Very safe. You just have to know appropriately how to dose it on out. Build that curve on up.

And then, after they’re built on up and then after some of the interventions, then we can sit there and go to adaptogenic herbs or just lifestyle changes or go to a glandular. Then work on the glandular for a while, check their levels again. And then, like I said, just go to simple adaptogenic herbs and just lifestyle changes.

DrMR: So what do you think is happening with giving prescription cortisol and it no longer being needed in a longer term? Do you think the predominant factor driving that is the other work that you’re doing, meaning diet, lifestyle, what have you? Or do you think it somehow has a beneficial effect on the body by administering the cortisol?

DrKW: Well, if they’re so low—obviously, different labs have different levels. But with us, if we reach a certain level of lab and it’s so low on that test, they’ll need a little bit of support.

So cortisol’s obviously important with blood regulation, inflammatory markers, just wellbeing. So if we utilize it appropriately and safe, I think anything over 40 mg actually shuts off adrenal glands. And so, if you utilize it safely, which it is very safe, you can actually build them on up quicker, take the burden off the adrenal glands from having to produce that for a while. It gives them a little bit of a break, as you’re starting to build on up.

I don’t have people on it long term. It can be utilized long term, but we found it’s like if we go ahead and actually correct some of these other lifestyle behaviors, it’s like we only have them on it for about three months. But again, that patient has to fit that specific case that we view that it’s going to be important for them, as well as meeting them where they’re at. So, again, everything’s personalized to what a patient wants.

DrMR: Gotcha. And are you assessing the total cortisol load through something like a 24-hour urinary cortisol or are you using kind of like a four-point cortisol rhythm assessment?

DrKW: Yeah. So we can use an adrenal stress index. A lot of times if we think that they have problems converting and are building some cofactors or some of the metabolites, we can sit there and do a urine just to check to see where some maybe enzyme deficiencies are at.

But again, all of that, like I said, is personalized to them in that regards to see if we just need to possibly do some things to help support that enzyme for working, seeing if there is possibly a heavy metal that might be interfering with that conversion. If that’s the case, sometimes removing that and they’re A-OK.

Growth Hormone vs. Peptide Hormones

DrMR: Sure. Ok. The final of the list we went through a moment ago was growth hormone. And you, of course, can give growth hormone as injections and I want to get your take on that and then use that as a springboard into peptides, which can be used to stimulate one’s own natural production or endogenous production of growth hormone.

But the peptides aren’t limited to that. There’s some cool stuff happening with research in immunity and autoimmunity. So let’s first start with just growth hormone injection, and then we can transition into the peptides.

DrKW: So I’m kind of a… I’m very stringent in regards to growth hormone use. It’s like if someone comes in and they have a growth hormone deficiency, then I think growth hormone is important. As being naturopathic doctors, it’s a slippery slope to sit there and put someone on a growth hormone, especially for antiaging, just because there can be a lot of other repercussions just because of giving someone a growth hormone kind of interferes with the natural negative feedback mechanism.

So I don’t like technically to go ahead and just inject growth hormone. But the peptides, I absolutely love just because it has basically no side effect profile, very safe. So I’m not a big fan of utilizing growth hormone. We have with a couple of patients just because they’ve had, like I said, pituitary abnormalities that wasn’t releasing growth hormone releasing hormone. And so, growth hormone was needed. So they would have to go ahead and go through an injection process.

But if someone wants to use growth hormone and the benefits of growth hormone for antiaging, then the peptide therapy is going to be much more beneficial for them.

DrMR: Gotcha. And just like you said, the thing that I think is most—I don’t want to say exciting. That might be too strong of a word. But I think attractive about the peptides is you’re supplying a sequence of amino acids essentially that help to stimulate the body’s endogenous process. So you are intervening, but you’re intervening in a milder way to get that spike of the growth hormone.

DrKW: Oh, yeah.

What Is a Peptide

DrMR: So you mentioned something about side effects. So I guess let’s start there: side effects that have been reported or that you’ve seen using peptides that help to increase growth hormone. I’m sorry. Let me take an even bigger step back. Tell people what a peptide is just in case they haven’t heard that term before.

DrKW: So a peptide is a short chain of amino acids. So it’s like a messenger system. So proteins are linked together, creates an amino acid, and it goes to receptor. Basically, docks with the receptor. Creates a cascade and you have another messenger going on. So basically, it’s a short chain of amino acids that are linked together and can be thought of as like a small protein.

And so, basically, what they are, again, so they’re just simple messengers that are basically made in a lab, obviously, a compounding lab, a sterile lab. And they’re utilized in different sequences in the body, utilizing hormones, actually getting the certain protein from that that’s actually the messenger protein or proteins in amino acid sequences. And so, they’re finding that there is a myriad.

So right now, I think there’s over 7000 naturally-occurring peptides that have been identified. And so, there are basically 7000 peptides that are in clinical development. So anywhere from growth hormone to increasing brain function to decreasing Alzheimer’s symptoms to increasing melatonin, increasing mood. So all of these messenger systems are natural in the sense of they’re made in a lab, but how they respond to the body is a natural means so the body understands it, turns on sequences, knows how to turn off sequences.

So really, there are no side effects in regards to its use. So the doctors that I speak with… Again, so this is a newer kind of realm of medicine. So they don’t have an enormous amount of studies, which they are now, because it’s basically exploding onto the scene. And so, they’ll be coming up with more studies probably every month.

But the doctors that I’ve worked with and the FDA basically has these as what is called a GRAS, which is Generally Recognized as Safe. And so, a lot of the doctors that I learned with and I go ahead and speak with on a daily basis that have been doing this for over 20 years, basically have no patients that have had side effects with their use.

Risks, Benefits, and Finding a Clinician

DrMR: That’s great. Now, we may come to learn of side effects later. And I want to have full disclosure here that this is a new therapy that we don’t know a lot about.

DrKW: Correct.

DrMR: And I’m assuming that we’re really lacking kind of long-term studies here. But like with anything, there’s a risk/reward you have to balance. And so, this is why we would not recommend someone who’s not taking care of themselves start using loads of peptides to try to get to the same level of improvement someone who ate better and got more sleep could get.

DrKW: Correct. Yep.

DrMR: Because there may be an implicit risk. We’re hoping and based upon everything that’s available to us in terms of data, the inference looks pretty solid…

DrKW: It looks very good.

DrMR: That there’s not going to be any sizeable, long-term, negative side effects. But it’s important to understand this is new. Similar to like we’ve had conversations about fecal microbiota transplant therapy, we don’t know what the 15-25-year results may be from that. Likely, not going to be anything bad, especially when you give it to a patient with inflammatory bowel disease that’s ravaging their bowels and they improve. But again, just to give people full disclosure on that point.

DrKW: Yeah. And just to go ahead and say this. Again, so making sure they see a qualified person that knows peptide, goes to a proper compounding pharmacy because they do have sites that are on the internet where basically you can go ahead and order and there’s no regulation in that regard.

DrMR: Great point.

DrKW: So meet someone that’s actually taken training, knows exactly what these things are used for, how it fits your case rather than just buying something, hearing about it, and wanting to inject yourself.

DrMR: Yeah, not Vinny at the gym.

DrKW: Yeah.

DrMR: Who’s got a connection from China or something like that. Don’t do that. No matter how persuasive Vinny is.

DrKW: Exactly.

DrMR: So growth hormone is one application and you’ve sent over a number of papers here. And really, what I’m seeing is a number of studies on these different compounds and most of these compounds seem to have at least one study, if not a few, that have at least shown that they have some measurable physiological effect…

DrKW: Correct.

DrMR: Usually increasing growth hormone and there are no adverse events reported.

DrKW: Correct.

DrMR: So we’re showing a favorable shift physiologically, and we’re showing safety. And that’s, in my mind, the most important first step. What I’d like to see, second to that, now we’re tying that physiological increase in growth hormone to decreased body fat, increased muscle mass, better perceived wellbeing. But I think we’ll get there. The first thing you’re going to do is establish safety and establish some kind of measurable effect.

DrKW: Correct.

Balancing the Immune System

DrMR: So I want to get more into detail about the growth hormone once here, but there’s a couple other areas. Immune balancing is one that seemed interesting. So what do you know about how these are being used for immune/autoimmunity and what have you done? What do you think there is novel or noteworthy?

DrKW: Yeah. So immune function, we talk about antiaging or life enhancement. People think of the immune system as just fighting off disease, but an imbalanced immune system will increase our aging faster I think than any other system that we have.

DrMR: Not to cut in too much, but there’s been something that I have noticed is that when people have progressed autoimmunity or immune dysregulation, I oftentimes will notice they do look older than you would expect them to look.

DrKW: Yes.

DrMR: So it makes perfect sense. And if we think about immune activation produces inflammation and inflammation will age you, then that makes complete sense. So it’s actually a very befitting, I think, topic, the immune system, in aging. So, yeah, this is actually fantastic. So please continue.

DrKW: Yeah. So when we’re born, we have this lovely gland called the thymus gland that basically helps our immune system. And as we age, the thymus gland has a tendency to actually shrink. And obviously, increased autoimmunity, it helps increase basically natural killer cells, T helper cells. Those kinds of components. It actually keeps us in what is called more of a humoral or an innate rather than a humoral. So it switches it from what is called a Th2 to a Th1, so we’re not attacking our system.

So they found that in the thymus gland there is a different hormone called thymosin. And so basically what they did is they made it. They broke it down, found the amino acid sequence for it, and so they basically now have peptides. Two of them are called thymosin alpha-1 and thymosin beta-4.

And so, these peptides are utilized a lot in autoimmune conditions. They’re actually finding it more for actually repair and growth, hair restoration. But it’s actually has great studies in regards to decreasing hepatitis C, helping with, like I said, the cure from hepatitis C, hepatitis B. So anything in regards to somebody comes in with any kind of autoimmune disease and you want regulation of the immune system, these two peptides can be of an extreme benefit.

DrMR: So when you say hair, is that for something like alopecia, like autoimmune hair loss?

DrKW: Yes.

DrMR: Ok. Gotcha. And what about some of the more common autoimmune conditions like thyroid autoimmunity, rheumatoid arthritis, lupus, inflammatory bowel disease? Do you know of any studies being done there or any anecdotal findings?

DrKW: They are. So you see Crohn’s disease, anything that has to do with basically dysregulation of the immune system from attacking itself. So Hashimoto’s, fibromyalgia, all these things have been shown to have positive benefits in both subjective as well as measurable blood marker tests, like a high-sensitivity CRP, inflammatory markers, a lot of the RA factors. Obviously, an ANA cascade and those kinds of things will actually go ahead and show benefit from having basically the immune system not attacking itself, increasing the natural killer cells.

And so, they’ve actually had very good anecdotal evidence, as well as actually objective evidence as well in regards to blood markers, subjective markers, actually doing tests with patients in a placebo where nothing was given, thymosin was given, checking their hepatitis C titers. So they’ve actually been shown to have, like I said, very good effects and, like I said, no side effect profile.

Dr. Ruscio Resources

Hey, everyone, this is Dr. Ruscio. I quickly wanted to fill you in on the three main resources that are available to you in case you need help or would like to learn more. Of course, I see patients both via telemedicine, via Skype, and also at my physical practice in Walnut Creek, California.

There is of course my book, Healthy Gut Healthy You, which gives you what I think is one of the best self-help protocols for optimizing you gut health and of course understanding why your gut is so important and so massively impactful on your overall health.

And then finally, if you are a clinician trying to learn more about my functional medicine approach, there is The Future of Functional Medicine Review, which is a monthly newsletter. Which is a training tool to help sharpen clinical skills. All of the information for all three of these is available at the URL  drruscio.com/resources. That’s D-R-R-U-S-C-I-O. And in case you are on the go, that link is available in the description on all of your podcast players. Okay, back to the show.

The Age Management Group

Now, do you know—and you can get back to me on this—but I would like to have a researcher or someone who’s really getting heavy into this on the podcast to do a whole show just on that. Do you know of anyone who would be worthwhile to reach out to?

DrKW: So the person that I went ahead and learned… So the Age Management Medicine Group is a conference that was here. And this is where I first learned of it. And there’s now a new society called the International Peptide Society. So PeptideSociety.org

DrMR: Ok.

DrKW: And you can actually join this group, and his name is actually Dr. Edwin Lee.

DrMR: Ok. Dr. Lee, I’m going to be coming after ya.

DrKW: Yeah, exactly.

DrMR: So, yeah. I think that will be a very interesting follow-up episode to do on this. Ok. So I will reach out to Dr. Lee. Dr. Lee, if you’re listening, hit me up.

Peptides for Increasing Growth Hormone

So let’s transition now to talk about the peptides that increase growth hormone. I know we’ve talked about some sermorelin. People may have heard of sermorelin. It’s one of the more popular ones.

And you’ve recently brought to my attention this newer peptide, CJ…

DrKW: CJC-1295. Yeah, correct.

DrMR: So tell us a little bit about these growth hormone peptides, how you’re using them, what you’re seeing, and anything else that you feel is worthwhile.

DrKW: Yeah. So I think sermorelin came out… I think it was almost 20 years ago that sermorelin came out. So I first learned about growth hormone releasing hormone peptides like I think everybody else by utilizing sermorelin. So I ordered it, tried it on myself, and found out the beneficial benefits of it in regards to better sleep, better muscle endurance, better recovery from exercise.

So with that, it’s like learning a little bit more about the peptides—there’s a lovely, again, a compounding pharmacy that we use. And they sent us more information on these other peptides that they utilize. So a little bit different in regards to the amino acid sequence, but they still dock at the same receptor site.

So we’re always trying to find out better efficacy with different secretagogues in regards to the growth hormone as well as maintaining cost, because we have a lot of patients that, unfortunately, could not afford the sermorelin. We wanted to try something different, so we tried these other hormones. And we went ahead and found out that they had a good benefit with these patients as well.

So it all depends on just the amino acid sequence, but they do go ahead and dock at the same receptor site as sermorelin. So they have the similar effects in that regards. In regards to when we say “life enhancement,” better sex life, better injury recovery. So I’m utilizing a lot of these growth hormone secretagogues to actually increase their healing time if someone has, like I said, a rotator cuff tendinitis or rotator cuff tear pre/post-surgery, all of those things that basically all the weekend warriors need assistance with.

So I’m finding that to be extremely beneficial as well as using the thymosin. So again, a proper-running immune system will actually go ahead and help the body repair from an injury much faster than an immune system that’s a little sluggish.

DrMR: So are you pairing a thymus peptide along with a growth hormone peptide as a standard practice or is that more case-by-case?

DrKW: Standard practice.

DrMR: Really? Ok.

DrKW: Yeah. So people that want to come on in… So, again, when we meet the patient and we talk about peptide therapy or they heard about peptide therapy, again, they don’t necessarily have to have an autoimmune disorder. They can go ahead and have, like I said, they want to have… When I say that age management or that life enhancement, again, a really proper-running immune system that’s running at a top level will decrease, like I said, our body’s aging process just because less oxidative stress, less telomere shrinkage, all of these other things that are incorporated with a proper immune system, proper repair.

Our body breaks down and repairs itself every day. The immune system is partly responsible for that. And so, oxidative stress as well, a reactive oxygen species. So all of these things are incorporated in thymosin, their growth hormone. Actually, peptides have been shown to reduce some of these ROSs: oxidative stress, hypoxia within the cell. So that’s all incorporated with what people want to do with the life-enhancement protocols.

Sermoralin, CJC1295, and Thymus Cost Comparisons

DrMR: Now, you mentioned cost, so obviously, that’s something that we all want to be cognizant of. And I think the audience knows that I’m very cognizant about cost because of some of the horror stories I hear people coming in with, being just raked over the coals financially by their provider.

And I think most providers are trying to help people, but we’ve been swept up in a model of functional medicine that’s a little bit excessive. So we’re trying to kind of course correct. But sermorelin compared to the CJC peptide, if you can give an estimate for what about a month of therapy would cost, one compared to the other. What are we looking at?

DrKW: Yeah. So I know CJC-1295 is $300 for a 10-week supply. So actually, CJC, what we get and then it’s $300 for a 10-week supply. So we can order it that way. Sermorelin, I do believe for a 30-day supply, you’re probably looking around $300-400.

DrMR: $300-400 for how long of a sermorelin supply?

DrKW: So I do believe for a month. It can be higher. So we work with these compounding pharmacies, and I try to find the cheapest one. So it can range anywhere from $300 all the way up to around $700. And so, we want to try to keep cost down.

So that’s why I like utilizing this pharmacy that we have just because I think sermorelin is more into the mainstream. So I think when people hear it, they think about that peptide only and don’t understand that there’s other, like I said, avenues that they can do to actually have the same benefit but not have, like I said, maybe the one that’s out there known more.

DrMR: Gotcha. And you’re using the Tailor Made Compounding Pharmacy?

DrKW: We are. Yeah. Tailor Made. Tailor Made works very well.

DrMR: Gotcha. Now with the thymus, what’s the cost on that approximately?

DrKW: So the thymus I do believe runs around $200 for a 30-day supply.

DrMR: Gotcha. So yeah, this can get up there pretty quickly which is why, again—and I think we’re on the same page with this—every avenue you can save a little bit of money will add up very quickly.

DrKW: Yep.

Cycling, Side Effects, Dosing & Reactions

DrMR: And what about the length of time?… Two components to this. How long until someone will notice a benefit and then how long do you typically have people use this for? Or do you cycle? Do they stay on it for years? Do they come off and on? What does this look like?

DrKW: So you are correct. So a lot of times we do have people cycle. When it comes to some of the studies and just some of the empirical data that I’ve had from patients, sometimes people can feel within five days that they feel so much better in their subjective data. So sending them questionnaires in regards to how they feel pain-wise, in regards to how they feel mental-wise, recovery after injury or recovery after exercise. So all those things improve usually within about seven days.

I do have sometimes people I discuss with them what their goals are in regards to how they want to feel, how they want to when I say anti-age, and that’s when we usually come up with cycling. So usually, sometimes a month off or a month on, two months off, a month back on. And so, you can go ahead and cycle these peptides and what your goals are.

If they start to get sick, if they start to go ahead and have a little bit more memory loss, those kinds of things, sometimes it’s like we obviously switch on up to a different peptide. So there’s all kinds of basically customizable treatment programs you can actually go ahead and supply people.

DrMR: Now, when you say memory loss or some of these other issues, are these some side effects that you’re seeing after a while that people will develop or are you noticing that the benefit wears off and then you have to change your approach?

DrKW: No. So when I said that, it’s like if somebody is naturally aging. So usually, it’s like people actually have, like I said, an increased memory, but a lot of times, people if we’re working specifically with growth hormone and, let’s say, thymosin, they’ll notice like “I’m feeling better.” But they finally let us know that it feels like their memory is a little lost.

So, again, utilizing natural means, diet and exercise, they still sit there and have a little bit of cloudiness. You can actually go ahead and dose out certain peptides that will increase some of the factors within the brain to go ahead and help on out with memory function. Serotonin, dopamine levels, all that can be influenced, like I said, with peptides.

So I have not yet found anything that when I dose people with growth hormone, peptide to increase growth hormone, or thymosin, that, again, no side effects in regards to other systems actually faltering.

DrMR: Gotcha. Ok. And regarding dosing, and some of this might be challenging. I’m not sure if it’s based upon body weight or age or desired aggressiveness of therapy. But is there a standard, kind of rough dosing protocol you would lay out for the CJC and for the thymosin?

DrKW: Yeah. So usually thymosin, it comes in different, like I said, concentrations. So usually, it’s 300 mcg per mL and it comes in a 5 mL. So usually, we go ahead and dose out 0.25 or 25 units on an insulin syringe. They do subcu. They can do twice daily for 10 days, and then we check to see how they feel. Then they can go ahead and do another cycle. Then again, usually after a month, we have people see how well they’re doing. And then they go ahead and cycle off for two months. And then they can cycle back on, depending on where they are at.

If someone comes in, they have a 20-year history of an autoimmune disease, those things actually might be extended out for a longer period of time. If somebody’s coming in just because they want to feel like a stud, they want to go ahead and they want to climb Mt. Everest, so then we can sit there and dose it appropriately, depending on that. But that’s usually the standard dosing for thymosin.

For growth hormone, like I said, the CJC usually is, like I said, 25 units subcu, nightly before bed. And we utilize, like I said, 10 days for that as well.

DrMR: And you do 10 days on, 10 days off?

DrKW: You can. Sometimes what I’ll have people do is if they can do it for 30 days and see how well they do. My thing is, like I said, 25 units usually subcu. Do it, like I said, before they go to bed because growth hormone has its natural spike at night when we sleep.

So when I dose out different things and concentrations like sermorelin, they have different dosing. And so, usually, it’s like I have them do 30 units in regards to that after we reconstituted it. And then, I have them do that for 30 days. And they can do it for 30 days straight, see how well they feel. Then, like I said, you can sometimes go ahead and do it a couple days on, five days off. So you can dose it.

So there’s no like here is the set standard of dosing in regards to utilizing peptide therapy. We have to meet people where they’re at and see where the dosing strategies fit their lifestyles better as well as utilizing the proper dosing, the lowest physiological dosing and the lowest kind of cycling that actually gives them the benefit.

DrMR: Gotcha. So are there a couple principles here that we can take away in terms of… It seems like you start with a month of constant therapy and it sounds like you’ll see the result that someone’s going to see at that time. And they’ll kind of have a new baseline to compare against. And then, do you try to have people maybe go one day on, one day off or essentially decrease their dose to an extent and try to find the minimum dose that maintains them at that level of performance? Is that how you’re approaching this?

DrKW: Exactly. You hit the nail on the head.

DrMR: Ok. Good. If people understand the concept, then they can kind of steer the ship themselves, so that’s why I’m trying to get that for them. And then, regarding risks and side effects, we talked about that. They’re on the GRAS list, which is helpful. And they’ve had little side effects in your opinion. Is there anything that if this happens in terms of a reaction, someone should stop using it immediately? Anything you’ve seen there that’s noteworthy?

DrKW: Yeah. So I’ve never seen anything in regards to that. Obviously, giving somebody an injection, we always have to tell people. Sometimes we show them first, making sure the area is clean, making sure they know how to inject themselves, making sure they’re comfortable with a needle, making sure they’re not reutilizing needles, because I think that’s where the majority of the problem comes from. Making sure they don’t use expired product. A lot of times people will forget for a couple of days and go, “Oh, crud. I forgot. Let’s go ahead and inject myself double or inject myself past the expiration dates,” in that regards.

So those are the things that I think we obviously convey to the patient or the client, to sit there and say, “No, don’t…” You definitely have to, like I said, like you’re in the military. If you’re going to do it at a certain time, we want to make sure it’s at the same time, all the time. Just so then we know that the data that we do possibly collect is going to be appropriate. If people go to bed at 11:00, I want them to dose it all the time at 10:00 pm.

So I always want to schedule those dosings so that I know it’s like they come back, we can go back through their history and sit there and say, “Every day at 10:00, this worked for you.” So I don’t want to see people at 8 o’clock, and then they inject it at 11 o’clock. It has to be, like I said, a pretty stringent dosing schedule.

Contraindications and Clinician Assessments

DrMR: Gotcha. Ok. And are there any known contraindications? I’m assuming some obvious ones like if someone’s pregnant, they shouldn’t.

DrKW: Correct.

DrMR: But anything besides pregnancy that’s an established contraindication?

DrKW: So in regards to the growth hormone, usually with cancers or anything like that because we don’t want their growth hormone to actually have the tumor or anything grow. But with that being said, it doesn’t contraindicate in the use of thymosin or these other ones that actually help the immune system actually function better.

So again, they can be utilized in different disease states, but the normal contraindication with the growth hormone secretagogues is anybody that does have, like I said, a known cancer. We don’t want to obviously increase growth hormone in that regards.

DrMR: Gotcha. And then, I’m assuming there’s not really great testing to guide this. Perhaps one could test—I know or at least I’ve heard that insulin-like binding protein 3 gives you a more representative or it’s a longer, more stable measure of growth hormone status. At least that was what I picked up from some antiaging study a couple of years back. Are there ways of assessing this that you’ve found to be helpful?

DrKW: In regards to the growth hormone, like you said, the one test, IGF-1, like I said, not as well in regards to the right growth hormone. Or you can test growth hormone specifically. But, again, it’s like I like to do a lot of, when I say proper lab testing, a lot of proper finding of where people are at. Asking them the appropriate questions, actually doing an interview and not a 10-minute just wham-bam, you’re out of the office. What their goals are.

A lot of times, obviously immune system if we’re going to use thymosin or these other components, you can check their immune functions, their ANA cascade, all those things that they do have immune markers. That will go ahead and, like I said, decrease with the use of thymosin.

And then, a lot of times, the peptides are utilized for people just for injury recovery. So there’s a lot of stuff that’s out there specifically for injury recovery that we don’t necessarily have tests to go ahead and run in that regards. It’s just that’s what the function of the peptide is for. It’s for you to recover from tendon injuries, from ligament injuries in that regard.

DrMR: And are these different peptides from the growth hormone ones? Are these healing-specific? Or are you using the natural healing abilities of the growth hormone bolstering?

DrKW: Yeah, so the growth hormone one and then there’s a lovely one called BPC-157. So body protection compound, and that’s what we use specifically for people that have had injuries, repair. And it actually goes ahead and helps, like I said, exponentially increase their healing time.

So they did a great study with a rat. Cut its Achilles tendon, gave it BPC-157. Approximated the Achilles tendon and actually healed itself. So again, with those studies, they’re finally starting to understand let’s utilize these studies to find out. Obviously, I’m not going to cut somebody’s Achilles tendon, but they are going to go ahead and, like I said, use these other studies to find out how well or how fast somebody recovers from a rotator cuff or in that regard.

DrMR: Awesome. Very interesting. This is definitely a very interesting field of study. I’m curious to continue to dig into this because it sounds like a really exciting emerging field for medicine.

DrKW: I love it. So like with you, it’s like “first do no harm,” one of the things that we take as physicians. So a lot of times when we’re utilizing hormone therapy, I know we’re very well astute of understanding like too much testosterone in the system, making sure that estrogen is leaving the system, to make sure that you’re not having, like I said, proliferative events from too high of an estrogen.

So even though we utilize a lot of hormone to help balance people, I really like the peptides because it does intrinsically understand that the body will see that amino acid sequence, do what it needs to do. There’s no basically build-up of, like I said, improper messenger cascades that’s going to go ahead and create dysfunction in the body. So it’s a very safe means.

Episode Wrap-Up

DrMR: Sure. Yeah, I like it. Well, thank you, my man. This has been a great conversation. Any closing or parting thoughts that you want to leave people with? And I do want you also to let people know—I’m not sure if you have a blog or anything like that—where people could kind of track you down or contact you if they were looking to connect.

DrKW: Yeah. So InfusionHealth.org is our website. Our email address is [email protected] So we’re actually in the process of learning more actually on peptide therapy. We’re based here in Arizona, but we do see people telemedicine-wise throughout the United States. So we do help a lot of people in other states go ahead and actually achieve, like I said, their goals in life enhancement.

So please check us on out. We’d love to go ahead and, like I said, speak to you more about what we do. And I just want to say thank you for, like I said, allowing me to come on, man. I got your book, so I’m going to read your book. I love that. I think Dr. Ruscio has it right on track with having, like I said, gut health. Gut health is extremely important in regards to antiaging and just health in general.

DrMR: Absolutely. And now we’ve got some nice information about another piece that can be stacked on top of the optimization of gut health, which is peptides, which was a fantastic conversation, Kevin.

So again, thank you again for coming on, for taking some time, for your tinkerings and musings and sharing what you’ve learned with us. Until I see you around town again… And I guess I’ve got your next drink.

So back story. We met through a mutual friend of mine who’s a pharmacist and actually met over a beer.

DrKW: Yes.

DrMR: I had no clue you were kind of a biohacking nerd, but it worked out really well for the benefit of the audience. So your next drink’s on me.

DrKW: Excellent, man. We’re coming back in April, so I’ll look forward to seeing you.

DrMR: Cool. Thanks again, buddy. See you soon.

DrKW: All right.

DrMR: All right. Bye-bye.

DrKW: Bye.