How to Get the Most Out of Peptides for Cognitive Performance

Intro:

Welcome to Dr. Ruscio Radio discussing the cutting edge in health, nutrition, and functional medicine. To make sure you’re up to date on this and other important topics, visit drruscio.com and sign up to receive weekly updates. That’s DrRuscio.com. The following discussion is for educational purposes only and is not intended to diagnose or treat any disease. Please do not apply any of this information without first speaking with your doctor. Now let’s head to the show.

DrMichaelRuscio:

Hey everyone. Today I speak with Dr. Daniel Stickler in a part two follow-up on peptide therapy. Peptides are these compounds that can stimulate certain receptors in the body, including those for growth hormone, but also for the immune system. There are some pretty attractive perspective benefits from this line of therapeutics. We discuss that and we also discuss some of my personal experience using peptides. I share my thoughts that this may all be placebo, then making a few changes and getting the signal that was pretty clearly not placebo. It feels validating to have gone through enough experimentation with the peptides personally, to be able to say, yes, there there’s clearly something here that can move the needle. So we’re talking about peptides for performance, for cognition, for immune and auto-immunity as well as other facets of care that they’re incorporating at Dr. Stickler’s clinic, including some pretty interesting pairing of brain mapping, brain stimulation, and ketamine. Very interesting. I also want to just slip in a quick mention here of a study I recently read.

DrMR:

In this study, weekly sauna therapy was found to be as effective for depression as ketamine, which is pretty remarkable. This may have been in a cohort with PTSD. I don’t recall that detail off the top of my head, but I just wanted to juxtapose the mention of ketamine being something that’s shown fairly powerful results for prior trauma as in PTSD. Something as simple as using a sauna on a daily or weekly basis has a similar impact. Just to try to anchor us with foundations. Sauna, I would say, we could classify underneath the lifestyle intervention category, and we always want to make sure we optimize lifestyle before going to more of what I would consider a pinnacle intervention like ketamine. This was a very insightful conversation with Dr. Stickler about peptides, there are many of them, and the different facets that they may be able to help with such as mood, sleep, energy, auto-immunity. Also some of my personal experience kind of verifying that these are not all placebo, which at one point I was suspicious they potentially could have been. I hope you will find the conversation insightful. Also if the podcast has been something that you’ve learned from, please leave us a review on iTunes. Okay. Now we will go to the interview

DrMR:

Hi, everyone. Welcome back to another episode of Dr. Ruscio radio. This is Dr. Ruscio back again with Dr. Daniel Stickler, and we are going to do part two on peptides. This is something that admittedly I go back and forth on in my mind in terms of clinically efficacious, not clinically efficacious, which I think is totally the way anyone should be thinking about any new therapeutic. Open to it on the one hand, questioning it on the other. I also have some personal observations of late that I kind of want to share and run through the much more clinically experienced filter of you Dan. So I’m really excited to have you back here, both for our audience, but also for some of my potential personal gain.

DrDanielStickler:

Awesome. I’m looking forward to it.

What is a Peptide

DrMR:

Do you want to tell people just briefly in case they didn’t catch the last podcast a little bit about your background and how you’ve kind of been interfacing in the world of peptides and maybe quickly what a peptide is?

DrDS:

Yeah, sure. So my background was as a general and vascular surgeon but that wasn’t where my passion was. My passion was really in health optimization, but there wasn’t much of an option for that when I went through medical school. So I kind of fooled around with the general vascular surgery for about 10 years, and then stepped into really what I would call optimization medicine. That progressed into more of a complex systems approach to health. That was back in 2005. In the past 15 years, we’ve been working with high performers that are looking to upgrade their human potential in different areas. It could be cognitive, it could be in body, it could be physical performance, it could be in consciousness aspects. So we work across the board with that, but we take that 360 approach with all of those, not just stovepiping one particular area.

DrDS:

So if somebody comes to me and says they just want to want something that’s going to upgrade their brain and not the kind of people that we typically work with. It’s gotta be somebody that understands that you have to work with all of it, not just the individual pieces because of the body just doesn’t work that way. Peptides have been a big piece of that for about the past six or seven years. Peptides are really interesting. They’re just these little amino acid sequences that are very similar to what the body makes. The cool thing about peptides is they’re very on target with very little off-target effects. What I mean by that is when we take a medicine or we take a supplement, there is an “on target” and a substantial “off-target” effect that affects the body.

DrDS:

There’s a give and take with all of it. With the peptides, because they’re taken from existing proteins in the body and we just take segments of them that we know interact with certain receptors, we’re able to really get specific on what we’re trying to achieve. So if we have the growth hormone, this protein, we can take actual segments of that. I like to look at the proteins in the body like a ring of keys. Each key will interact with a specific receptor on a specific tissue type. So the growth hormone protein will interact with fat cells, with muscle cells, with liver cells, with heart cells, with brain cells. You just have to have the right key to see because it’s not the same receptor that it bonds to in every place. We can actually take segments of that protein and have a highly specific target that we can go after.

DrMR:

There’s a lot of potential gain from using peptides. I look at them very similar to using hormones. You know, your classical kind of steroid hormones, testosterone, estrogen. A lot of times patients are wondering, well, when is the best time to use these? Some patients are philosophically opposed. Other patients may be really gung ho to get them on board perhaps before they’ve gotten some of the other fundamentals in place. I think we’re definitely in agreement that these things can be used, like any type of anti-aging intervention. However, we shouldn’t take a guy who’s sedentary, overweight, ostensibly very inflamed and start injecting him with testosterone because in an inflamed and altered physiology hormones don’t always tend to do what you want them to do.

DrMR:

It seems better to look at this very much like you’re describing as a kind of global holistic or 360 approach to this optimum outcome. So I definitely really agree with that perspective that you bring. If you don’t mind, I’ll insert a little bit of my personal experience there because I think it would be a good springboard to answer a few questions for our audience. So as I kind of moved down my health journey, I did a lot of heavy lifting in the realm of the gut. I had a parasitic infection which really caused a whole cascade of issues with neurological, brain fog and sleep. Over time I got those things sorted out, as well as getting my lifestyle tucked away. Then I started looking for, well, how can I push the performance needle more so forward?

Pushing the Performance Needle Forward

DrMR:

I started tinkering with peptides and I went on this protocol of CJC paired with ipamorelin paired with 5-Amino 1MQ. Good or bad, at almost the same time, everything went into lockdown for COVID-19. So that really indirectly allowed me to do a better job with lifestyle because social opportunities being able to go out and have a few drinks and socialize was really kind of kiboshed. So I definitely noticed when I was consistently going to bed at 10:30pm and not really doing anything social, my performance increase. I wasn’t sure if it was from the peptides or from the lifestyle intervention, but clearly I hit a high point. I ended up moving later to Austin, Texas, really derailed a lot of my rhythms and routines and felt like I took a few steps back. Then I got back on all those routines and I didn’t necessarily feel like my performance got back to where it was.

DrMR:

I was kind of forming this soft conclusion that maybe these peptides are a lot of placebo and not a lot of actual benefit. That was until I reached out to a friend of mine who’s also been on the podcast before, Dr. Kevin Wallace. I said, do you ever see resistance to the peptides build up over time? I do have a partial feeling and if I’m trying to be objective here, I can’t rule out that perhaps the peptides did help and I just developed a resistance to them. He said, yes. Typically we’ll go to a different protocol, Tesamorelin with ipamorelin. Now the signal to me is irrefutable where I’ve probably gained maybe five pounds of muscle in two weeks. My explosive strength has all of a sudden just gone off the charts. That could just be coincidence, I suppose, with maybe my training’s all clicking. It seems much more likely that this is a peptide derivative effect and also having higher energy at the same time. So just throw that out there for whatever maybe you want to offer for people who are thinking about tinkering with peptides. Was my experience a common one, or any other thoughts that you have?

DrDS:

Yeah. I mean, what you’re describing, I see quite a bit of when people come to us. When we’re typically managing this, we’re making sure that we’re watching out for a lot of these processes. It can be a number of things. I mean, there are some people that will actually develop antibodies to some of the peptides. That requires a shift for a time period to let those antibodies cool down. But when you’re talking about CJC versus Tesamorelin, there’s a big difference in the two of those, even though they’re very similar in structure. Tesamorelin, for some reason has a really large boost on IGF-1 that we’ve seen as opposed to CJC, which you don’t see much of the IGF-1 elevation. CJC interacts with receptors inside of muscle cells.

DrDS:

It will interact with specific cells. This is a growth hormone releasing hormone so we used to think it’s only working in the hypothalamus. That just wasn’t true. It’s very pleiotropic so it affects things throughout the body. Tesamorelin is the same way. It tends to be more specific for the liver to increase IGF-1. So we have seen that people that are looking to get bigger, like raise bulk on their muscle or to treat sarcopenia Tesamorelin works really well. When we’re talking about longevity, general health and modest improvements in muscle mass, then the CJC tends to do better. Then you have ones like the oral form, which is Ibutamoren or MK 677, which actually isn’t a true peptide, but it’s a peptide-like chemical. You can take it orally, but it has a pretty specific effect.

DrDS:

It works a little better when people are looking for fat loss and looking for sleep improvements, because there are sleep centers in the brain that respond really well to a growth hormone, releasing hormone of some sort. One other thing I did want to mention is the epigenetics piece. This is something we’ve seen in past years from people going on testosterone, but we’re seeing it now with the peptides. The body is constantly assessing environment and making adaptations. So when we put somebody on testosterone and they haven’t had any in a while, there is this three month golden period when they first start where they can set the stage for what’s going to happen or what they’re going to maintain. They can make gains in areas of fat loss and muscle gains in a very easy way with just minimal efforts during those first three months.

DrDS:

If they’re not really leveraging that three month period and they wait until they’re after three months the response goes down dramatically. We attribute this to the fact that the body tries to maintain a homeostatic state. When we push ourselves outside of that normal state that we’re in, it forces our genetics to change expressions. It’s just the nature of it. Like when you go on a diet and you stay on the diet for three months and you lose 20 pounds. Then you continue the diet for another three months and lose nothing because the body’s adapted to that new state and it just doesn’t respond as well. That’s why you have to shift things around, to keep the body off guard. We see this with fasting. If the best weight loss fasting comes when you randomly throw out different types of fast. A 16 hour fast, and then a 24 hour fast, and then a two day fast. The constant intermittent fasting tends to lose its effectiveness in a short period of time. Really working with the body in these adaptation phases and understanding what it’s going through is really a key part of your approach to a plan to help.

DrMR:

That’s something that, I suppose, should be more discussed in the realm of peptides. Although that being said, I certainly am no expert in peptides. Is this something that you feel most peptide providers are factoring in or is it something that isn’t being given enough attention?

Attention to Epigenetics

DrDS:

No, I think in all of healthcare, epigenetics is not given enough attention. We were so thrilled about mapping the human genome, which was a spectacular project. Now we understand epigenetics. We always say that genetics are the hardware of the computer, but the epigenetics are the software. You can’t do much about the hardware, but you can do a lot about the software that’s running and that is constantly adapting to environmental pressures.

DrMR:

One of the things that when I was looking into Tesamorelin that I found interesting was that it’s FDA approved to treat lipodystrophy in HIV patients. So there is some sanctioned use and some benefit. Is Tesamorelin one of the more well studied of the growth hormone impacting peptides?

DrDS:

You know, most people don’t study peptides because there’s no financial gain with them. That is the problem. Pharmaceutical companies are making attempts to modify them so that they can patent a different sequence. Peptides that the body makes you can’t really patent. I see this with Dihexa. It was developed at the University of Washington, but it’s just one that you can’t patent. So the pharmaceutical company that bought up the research, even though it works really well, they’re not doing anything with it, they’re waiting until they get a modification, they’ll make it work a little bit better so that they can then charge the price that they paid for the research.

DrMR:

One other question. There are a lot that I have on peptides. I’m wondering, how often do you see people have side effects? One of the things I did notice the first week I was on Tesamorelin, was insomnia. It got better each successive night. Probably took four or five nights until I got back to normal. I did try MK 677 a while back. I was just buried in fatigue and brain fog for three days or so and I couldn’t push anymore because it was just too disruptive to my work. I don’t think that means that peptides are bad. There are certainly things that any good clinician needs to personalize to the individual. Just like with probiotics. Some people will occasionally react to one type of probiotics so we use another one. It doesn’t mean we throw out the entire baby of probiotic therapy with the bath water. What should people be thinking about regarding side effects, short term or longterm with peptides?

DrDS:

You really have to be monitoring what you’re doing with them. Even though they’re somewhat natural substances that the body is familiar with, and it does have feedback loops that prevent things from getting excessive. It’s why all of us switched from using growth hormone to using growth hormone releasing hormones because there’s a feedback system in place. There are potential side effects with that. Any time you’re boosting growth hormone, if you’ve got existing cancers or other things that are going to be negatively impacted by improving anabolism, you’re going to run risks. With Tesamorelin I see more side effects than with the CJC, for sure and the MK. With Tesamorelin, because it’s so strong. I see a lot of joint and muscle aches when people start on it. Hunger is a big deal when people were on it, it really up regulates hunger.

DrDS:

CJC I’d like as a kind of baseline because it keeps the IGF-1 in the “Goldilocks” zone. Too much IGF-1 is not good and too little is not good, so it kind of keeps it there. I’ve had some experience using CJC with DAC. That combination is not available, but I know some people that have used it with ordering it from the internet and we would monitor for them when they would do that. It’s an interesting one because it keeps the receptor stimulated constantly. You only do a once a week injection, but I’ve seen really good results with it. I’m surprised that some of the compounding pharmacies haven’t started manufacturing the CJC with DAC.

DrMR:

I know we hashed some of this out last time that we spoke. Are there a handful of peptides that you think are the best for people to consider, assuming maybe a general health application? Cause I know the peptides are kind of nuanced. Obviously it sounds like CJC is the one that you tend to favor.

DrDS:

You know, it really depends on what their goal is. Is it a rejuvenation? Is it performance improvement? Is it losing body fat? Is it gaining muscle? You have to tailor it to what the goals are. As far as foundational, unless your labs are showing problems, I don’t think there’s any foundational peptides. I say that, but there are some that are theoretically foundational, like Epitalon. Epitalon is from the studies that Khavinson did. They are beautiful. He did 6-year and 12-year studies on it, but unfortunately it’s not been replicated. If you look at that and you say, wow, with those results doing 20 days, twice a year of the Epitalon, it seems pretty reasonable and safe to utilize because the benefits are outstanding with it from general health and longevity purposes. So as far as a baseline or foundational one, that would be one I would consider.

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Auto-Immune Application for Peptides

DrMR:

Well, one area I know our audience is probably interested in, would be immune/auto-immune. We have a number of people in our audience who are grappling with some kind of gut health issue, which may have a varying degree of immune upregulation and/or auto-immunity associated with it. We may have some people who have overt auto-immunity via inflammatory bowel disease. Hashimoto’s thyroiditis. I know there’s a few there. The thymosins kind of come to mind. What are you finding for, or maybe lack of finding for those who have autoimmune conditions, in terms of peptides there that seem to offer significant clinical benefit?

DrDS:

There are plenty of them. We put a lot of our clients on Thymosin Alpha-1 alpha one during the strong outbreaks of COVID. We just have them do twice a week injection with it, just to keep the immune system healthy. We also saw that thyroid antibodies and Epstein-Barr antibodies plummeted when they were doing the Thymosin Alpha. So there’s obviously some kind of auto immune benefit there. You really tailor everything to the process you’re dealing with. So if we’re dealing with somebody that’s got CIRS (chronic inflammatory response syndrome), we’re typically going to use a combination of thing, depending on what their symptoms are like. We like Melanotan II, to mitigate the symptoms. So a lot of the symptoms from chronic inflammatory response syndrome comes from the suppression of alpha MSH.

DrDS:

When we use Melanotan II, it tends to really mitigate the symptoms. It’s not treating anything, unfortunately, but it’s at least taking care of the symptoms while they’re going through treatments or trying to get the system to recognize this and get rid of it. We like LL 37, another one that works well in the COVID realm. LL 37 identifies cells that are abnormal. When mold toxins get into cells, or when Lyme gets into cells, they tend to hijack the system and don’t let the cells put messages on their surfaces to let the immune system know they’re infected. For some reason, LL 37 bypasses that and it allows the immune system to recognize the cells. So you can be treating it with that during the time that you’re at least mitigating symptoms with it. So combinations work really well. I mean, VIP nasal spray also works really well with treating chronic inflammatory response, especially in the mold patients. But you can’t use it too long. You just have to time it right with the combination of other things that you’re doing.

DrMR:

So it sounds like you’re seeing a fair number of CIRS patients?

DrDS:

Not a fair number. I mean, I have a low volume practice to begin with. I’ve had three or four in the last year that I’ve been treating with it. I’m certainly not a CIRS expert. I would never claim that.

Peptides for Specific Issues

DrMR:

I’ve heard about a peptide that I believe, through affecting melanin may affect sleep and testosterone, does this ring a bell for you? I can’t recall the exact name.

DrDS:

Not sure. I mean there’s kisspeptin which really boosts the LH production to help boost testosterone. I can’t think of one that would affect all of those. The growth hormone releasing hormones will do that. I mean, they will raise testosterone slightly they’ll work with sleep, and they do work really well with the melanin system.

DrMR:

Is there a certain peptide that you find helpful for those with various sleep impediments? I’m assuming that if someone has obstructive sleep apnea, you can’t necessarily peptide your way out of that because it’s more of a physical obstruction. For this ill-defined insomnia are there any peptides there that you find to be helpful?

DrDS:

We take a very different approach with that. We’ll typically do brainwave mapping on them and identify if there are any patterns that are locked in their brain that might be interfering with sleep. Then we can do brain stimulation protocols to reprogram those patterns. A lot of people are looking at DSIP for helping. I find that that works in about 10% of people. It’s not very effective and the ones that works in it’s fantastic. Delta Sleep Inducing Peptide is the name of it. In the people it works in, it works great. We’ve had better results using things like DHH-B which is one of our favorites right now. You can still get that over the counter. It’s not a peptide, it just works really well for sleep at the GABA receptors.

DrMR:

Yeah. I’ve heard of the DHH-B. It’s also used to help people with anxiety I believe. It kind of has a calming effect. Am I thinking of the right thing?

DrDS:

Yeah. We have people that will take it during the day for anxiety purposes then at night for sleep. It works really well. They actually did clinical trials with it and were able to help people get off benzodiazepine addictions using it.

DrMR:

Speaking of cognition or brain impacts the cognitive peptides are something that has appealed to me and I’m sure for many of the audiences, especially those who are healthcare providers. There’s always a new study, a new research finding and many things that you’re always trying to kind of hold in your working memory and look for connectivity between those. Any kind of cognitive edge could be quite appealing. There’s this Dihexa peptide, I think we covered this briefly last time Dr. William Seeds was on the podcast, but I’d love to get your short on cognitive peptides, which ones that you find to be the most beneficial, how you use them and what kind of effects you’re seeing in people from using them.

DrDS:

Yeah, there’s actually quite a few cognitive peptides and research chemicals out there right now that can be utilized very effectively to customize what somebody is looking for. Again, we always start off with the brain mapping and get an idea what kind of patterns they’re dealing with because we can also use brain stimulation protocols with that, which are highly effective. When we combine those with the peptides it’s game on. In the laboratory the dendritic growth that occurs with Dihexa is just outstanding. We’re seeing, in case studies that we’ve done, really good responses with Dihexa in combination with some type of training. This is the important thing. When you’re taking the cognitive peptides, most of these, the peptide versions, they’re going to really require that you’re actively learning or training something into the brain in order for it to achieve.

DrDS:

If you’re just taking them and you’re doing your normal routine, it’s just going to enhance the normal routine to be more embedded. That’s not what people are looking for. They’re looking to enhance something that they don’t have or want more of. They’ve got to be training that in order for that to work. You can’t just make dendrites grow and think that they’re going to grow in the place that’s going to give you benefit. They’ll go where you’re using utilizing brain. So if you’re learning a new instrument, a new language training on something, then you know, Dihexa works really well for that. We also like Cerebrolysin. Cerebrolysin is just a mix of four peptides where the combination works extremely well when people are going through learning processes. We’ve also seen it when people have some early cognitive decline, we’re able to get some reversal of that using Cerebrolysin. Then we have things like ARA 290 which is really good. It’s more of an inflammation blocker. So it allows repair of neurons and nerve endings when you’re dealing with some type of inflammatory process, that’s creating a bit of a problem. For like cognitive performance in general, you know, we really like C-Link and C-Max those work really well. One that we’ve had really good results with recently has been Rg3 and that one’s a nasal spray as well and it’s been working great.

DrMR:

The ARA 290 – is that something you would use with a patient with brain fog where you’re assuming there’s a degree of inflammation and is that the way you would go with that sort of a presentation?

DrDS:

If we suspect that the symptoms are relating to inflammation. We can see some of that on the cues then ARA is one that we’ll go for just because it works so well at really antagonizing that inflammatory process and stimulating tissue repair.

DrMR:

As I understand it, many of the cognitive peptides needed to be cycled. You have to be more, I guess, diligent about cycling on and off. Is that a general truth for this type of peptide?

DrDS:

Yeah. They certainly aren’t things you do on an ongoing basis. I mean, we typically do three to six weeks stints of it, and then we reassess cognitive performance at the end of it. Then we’ll reassess cognitive performance a couple months later. Sometimes we repeat the cues to see what kind of impact it’s had but it just depends on what we’re working with.

DrMR:

Now, juxtaposing that with something like a growth hormone potentiator, maybe your CJC paired with Ipamorelin are those things that you’re leaving someone on more of a long-term fashion?

DrDS:

Typically. I still like to take breaks from the chronic use ones, even with testosterone now. I mean, we used to have the mantra that continuous use was ideal, but now we’re kind of cycling people on testosterone with Enclomiphene. It keeps the testes healthy and keeps the body stimulating its own production and we’re seeing good results with Enclomiphene. I think with anything, we have to consider the impact of continuous use. It goes back to what I was saying about that familiar state of the body, having the movement around that familiar stay, where you take a little bit of stress. This is good stress. This is stress that induces some change. When we look at a systems-based approach to the body, the body is a complex adaptive system and we’ve practiced medicine in the linear model for years. It’s just the wrong model to be using at all when it comes to the human body. In a complex adaptive system, you make a change that takes it out of its familiar state, and it will gradually adapt and new properties will emerge of that. So that state becomes common state again. That’s why doing something continuously tends to lose its effectiveness over time. You just got to jump it around a little bit and keep the body off guard from getting settled into that homeostatic state.

Brain Stimulation

DrMR:

That makes a lot of sense. That’s something that we discussed with Mike Nelson recently about temperature exposure extremes, and how a lot of this kind of parallels back to the experience we’d have as paleolithic hunter gatherers, where we would have periods of heat exposure, periods of cold exposure, periods of feeding periods of fasting. There certainly seems to be this somewhat general biological need for shifting terrain so that the system can continue to adapt. Adaptation seems as if it’s the norm in human physiology. Now, what does this brain stimulation look like? Is this something that they have to come into the clinic to do? Are there home devices that can be used?

DrDS:

We’re trying to identify some good home devices, but they’re difficult to place. We have a suite of different approaches. We have the transcranial magnetic STEM. We have AC stimulation, we have DC stimulation. We have global PMF that we use. This is important because this is something a lot of people aren’t aware of. When you get a qEEG, your brain is mapped in relation to a normative database. That means the normal. What’s the average IQ of the normal person? It’s a hundred. Okay. But most of the people that we deal with are people that are on that higher end. They’re not normal in that sense when you’re comparing to a database of just all normals. So when it comes to a qEEG, you don’t want to just look at it and say, Oh, based on normative database, you’re outside of the range where you should be an activity in this frequency pattern.

DrDS:

You’ve got to look at it in relation to what is their gift and what is hindering them in what they’re talking about., What they complain about, what they would like better and correlate those with the brainwave patterns you’re seeing. We have a lot of high performers that work with us. The biggest insult they can get is that they have a normal brain. You don’t want that because there are people that have really abnormal patterns that are their true gift that helps them to be that creative type or that person that can see things that other people can’t see. So it’s important to really pay attention to what you’re doing there, because a lot of the neurofeedback clinics will just use the normative database and try to normalize everybody’s brain. That typically is not ideal. We use a clinical grade qEEG and we actually have it read by people who read qEEGs all the time.

DrDS:

So we contract out the reads, even though we can read them ourselves. We want somebody who reads them a lot. We talk with them about what the patient’s experiencing, their history, what medications they’re on. Then we come up with an idea of what might be limiting them. So at that point, then we say, is it a pattern we need to remove? Is it a pattern we need to induce in the brain to correct this? And we set the stimulation protocols accordingly, and they can be an AC protocol. It can be a DC protocol. That can be a combination of the two, but we use that and we got completely away from neurofeedback. With brain stimulation, we were able to achieve in 10 30-minute sessions the same responses that took us 40 to 50 sessions of neurofeedback.

DrDS:

We will do them in like a week, a five day period. We’ll do two a days with them. We map them before and after and the changes are dramatic. One of the things we have added to that is we use ketamine nasal spray at the beginning of the training. So every day they come in for training, every session they come in for, they do two sprays of ketamine nasal spray and what we found is that the neuroplasticity goes through the roof with this stuff they’re learning of these new patterns is greatly accelerated. So we’re excited that we were able to kind of come up with that protocol and see the results that we are seeing.

DrMR:

Is that dose of ketamine, would that be what you would consider equivalent to a microdose?

DrDS:

It’s certainly a microdose. I mean, you’re talking about a nasal spray that’s going to get you at most, depending on the concentration you’re using, but at most 30 milligrams of ketamine. That would relate to the equivalent of about 12 to 15 milligrams of an IB or intramuscular injection, which is truly a microdose. Although some people have pretty profound effects with it, but it is an extremely low dose.

DrMR:

Just to refresh our audience, we did discuss psychedelics in a few prior podcasts, but a very loosely stated short summary, there is some psychedelic compounds, ketamine loosely being considered a psychedelic. I don’t believe it’s considered a classical psychedelic. It’s more of a newer age psychedelic, but things like mushrooms and LSD also considered psychedelics and in very low doses where they’re pretty much imperceptible to the user can, or at least the theory is, stimulate things like creativity. Sounds like you’re pairing that with this other brain technology and it’s really yielding some pretty interesting results.

DrDS:

Absolutely. Yeah.

DrMR:

You’re also using some other over the counter supplements. Are there a few there that you think are worth mentioning?

Over the Counter Supplements

DrDS:

Yeah, we do genetic testing on our clients and we usually come up with the protocols based on what we’re seeing with the genetics and the lab work, but there are some foundational ones that we’d like to use. People that are looking to enhance cognitive function, Qualia Mind is one of the best ones that we’ve found. We’ve actually found Qualia Mind by itself will create positive changes in the qEEG patterns without doing anything else. It’s one of the ones that when people are going through training, we typically have them on that. We also use that on a regular basis. We use Alpha GPC. We like to use Bacopa Monnieri and Holy Basil. Tulsi also works really well. The Tulsi really upregulates BDNF production in the brain, which is really good for learning and memory.

DrMR:

Was it Tulsa or Tulsa? I haven’t heard of this one.

DrDS:

Yeah. Tulsi Tea is what has this in it. It’s essentially Holy Basil. You can supplement with Holy Basil. It’s a really interesting compound. The Holy Basil, it goes into muscle cells and it causes the muscles to secrete FNDC5. It also upregulates growth hormone levels within the muscle cells themselves. We’ve seen really good results in athletes using the Holy Basil. That FNDC5 goes out and gets in the liver. The liver converts to a molecule called irisin and irisin goes to the brain and upregulates BDNF. What this process actually is, is that when we exercise, we also produce FNDC5 from the muscle. We’re actually getting brain results or brain benefits of exercise with a supplement.It works really well.

DrMR:

One thing I may have to add to my routine here to trial. Also maybe the Qualia. I’ve been thinking about trying the Qualia. I have a fairly long list of things I’m looking to experiment with. So there’s always this kind of a cajoling of which one’s next, but yeah, I may have to give that a trial.

DrRuscioResources:

Hi everyone. This is Dr. Ruscio. In case you need help, I wanted to quickly make you aware of what resources are available to you. If you go to drruscio.com/Resources, you will see a few links you can click through for more. Firstly, there is the clinic, which I’m immensely proud of. The fact that we deliver, cost-effective, simple, but highly efficacious, functional medicine. There’s also my book, Healthy Gut, Healthy You, which has been proven to allow those who’ve been unable to improve their health, even after seeing numerous doctors, to be able to help them finally feel better. There’s also our store where there’s a number of products like our Elemental Heal line, our probiotic line, and other gut supportive and health-supportive supplements. We now offer health coaching. So if you’ve read the book or listened to a podcast like this one, or are reading about a product and you need some help with how or when to use, or how to integrate with diet, we now offer health coaching to help you along your way. And then finally, if you are a clinician, there is our clinicians’ newsletter, the Future of Functional Medicine Review. I’m very proud to say, we’ve now had doctors who’ve read that newsletter, find challenging cases in their practices, apply what we teach in the newsletter and be able to help these patients who were otherwise considered challenging cases. Everything for these resources can be accessed through drruscio.com/Resources. Alrighty, back to the show.

Performance Optimization

DrMR:

I do want to ask you a few kind of random questions since you seem to be kind of on the forefront of human performance optimization. Hyperbaric oxygen. Is this something that you have any experience with?

DrDS:

I don’t have much personal experience with it. I have a lot of clients that have done them. You know, there’s a big push right now in the longevity front because of the one article that was produced. What most people don’t realize is that article was sensationalized by the journalists, not the authors. So a lot of people were criticizing the authors for some of the statements made in there, but they didn’t actually make those statements. They suggested that there are possibilities, but then the press went and talked about how it’s lengthening telomeres and changing epigenetic age. It just wasn’t truly the case. Now, hyperbaric oxygen, I think has some pretty substantial benefits that can occur from it. We’ve got a client that’s flying down to Florida to stay for six weeks and he’s going to do five day / week hyperbaric sessions over that period of time. We’re hitting him up with various peptides to study what kind of results he gets in the trial.

DrMR:

Interesting. Interesting. While we’re in this realm of really outside of the box therapeutics, is there anything else that either in the clinic or you personally have experimented with and found to be fairly helpful?

DrDS:

I love to trial things. There are a lot of people that are very critical. I don’t like to call it biohacking because it’s got such a negative connotation anymore. We refer to it as the “N of 1” people, the ones that are out there that look at things from a scientific sense-making standpoint and say, Hey, this looks reasonable to try. Then they set up parameters to test it. Taking something haphazardly is the worst thing you can do. I mean, even a supplement, you don’t want to go on a supplement without something you’re going to measure to know that you’re getting the result that you’re getting. It’s so easy to get placebo effects from things and assume that these results are related to that.

DrDS:

So we always help our clients set up parameters to test and to verify that they’re actually getting what they’re trying to get. Especially in the longevity and age rejuvenation world, I mean, if we sit back and wait for the longitudinal studies to come in, we’re going to be dead. So, you know, people that are really looking to trial things and take some of the chances with stuff. You can look at it from a sense-making standpoint and say, it really doesn’t have an unreasonable risk. Those are the people that are gonna come up with the results. They’re the ones that are going to be the first adopters that will be able to help establish some of this because research the way it is right now, it’s just too slow. Especially when it comes to age rejuvenation, longevity, I mean, it is super slow because you have to wait for the time period. Most people aren’t willing to do that. They’re looking for something that can be done now.

DrMR:

Yeah. I mean, I often say that we want to be evidence-based, but not evidence limited. Where we don’t have the evidence we have to use the best evidence that we do have to make informed decisions. It looks like you have a suite of various biomarkers that you’re using. I’m assuming you’re also just combining that with some more subjective, “how’s your energy”, “how is your mile time” and looking for little indicators that would tell you that you’re kind of getting a little bit more performance. Perhaps that performance correlates with longevity. I’m assuming it doesn’t always correlate with longevity, but there’s probably some association. Then it begs a question of, well, are we trying to optimize you to live to 98 or live to 88, but have a hundred years of experience in that 88 years?

DrDS:

The whole idea behind age rejuvenation is a bit misunderstood. Aging is not a disease. Like a lot of people are promoting right now. Aging is a constellation of many processes in the body and you’re not going to have some magic pill that’s going to reverse this. So you’ve got to take a full systems-based approach when you do it. People were sitting back and thinking something’s going to come along, but if they’re not taking care of the foundational pieces, their sleep, their exercise, their nutrition, it doesn’t matter. None of this stuff’s going to do anything for you when you’re not doing the foundational pieces of it. So it’s very critical to get those pieces in play before you start playing with the really enhancement type categories of things.

Episode Wrap-Up

DrMR:

I think it’s areally important note for us to close on. If people wanted to learn more about you, your work, where would you like to point them?

DrDS:

They can go to our main website, which is apeironzoh.com. People always ask me what Apeiron Zoh means. It’s Greek for limitless life.

DrMR:

Very cool. Well, Dan, thanks so much for taking the time. It’s exciting to me what you do. I’m assuming a lot of our audience also. I think we’re all looking to have as much experience as we can in every moment. That’s where I really see so much potential in these therapeutics. If we can optimize someone’s cognition, their energy, I often give the example of this hobby I have of learning piano. I find that when I’m doing everything right, and I have optimum energy, I have enough juice at the end of the day to learn a section of Beethoven, which isn’t necessarily easy. But once you get that in your brain, it’s like, that was amazing. I’m so glad that I did that.That makes me feel better about myself and has a lot of carry overs. It just seems like what you’re doing really helps people try to get as experience and joy out of life that they can. Really awesome stuff.

DrDS:

I would love to add to this, um, something that people don’t leverage that is readily available for everybody is the trackers like the Oura Ring, the Garmin watch, the bio strap. These are such valuable tools. I mean, we give the Garmin Fenix 6 to all of our clients and we monitor them on a weekly basis. We look at what’s happening with their stress. We look at what’s happening with their resting heart rate. We look at their sleep schedule, their body batteries, and we correlate that with their activities. We even put people on a, on a Firstbeat heart monitor for three days prior to their first visit so that we have 300,000 heartbeats of tracking that we can see how it relates to their activity, what their HRV does during that time with each activity. That data is the most valuable data that you can get right now because it’s instantaneous feedback.

DrDS:

My wife and I don’t don’t drink and she just happened to have some champagne on New Year’s Eve. What she saw was the next morning was that her body battery, which typically charges over 90 overnight and it’s related to resting heart rate, heart rate variability and sleep time. But her body battery got to like 30, which is unreal and she felt it and it was due to a glass of wine. That’s one of the reasons we really quit drinking any alcohol was just because the impact on our stress system was so high. Now it’s not to say don’t drink alcohol because actually that stress periodically can be healthy. Because it does, it stresses the system. So the system adapts and that adaptation is typically pretty healthy. Just when it becomes more habitual that is probably not going to benefit you very much.

DrMR:

The, what is the Garmen Fenix 6? I haven’t heard of that.

DrDS:

The Garmen Fenix 6 is more designed for athletes, but the depth of the data that you get with that is unbelievable. I mean, just what you get on the phone that it connects to, but the data you get on the dashboard online is so much more in depth. You can see all these reports. That’s what we review every 30 days with all of our clients, we go through their month of their Garmen data as part of the call. We say what was happening here? Where your stress scores went up, your HRV went down on these two days and you can usually see consistent patterns. Like I had one guy who every Saturday and Sunday, his body battery would just tank. Sure enough he was drinking on Friday nights and Saturday nights. Then he was trying to work out and he was like, I just can’t work out on the weekends. My body is exhausted. He quit the alcohol and all of a sudden he was doing great with it. Also people who overtrain, if they’re over-training, they won’t get that body battery recharged. They shouldn’t do a hard workout when that body battery is down. It teaches what we call interoception, the ability to understand the signals that the body is giving you. And to be able to read that and say, Oh, okay, this is what the signal means. You learn that over the course of time when we’re working with them. Then they don’t need to have those devices all the time.

DrMR:

The right use of some of these bio tracking devices can be pretty cathartic. I shared my experience prior on the podcast with my Oura Ring and how that was a huge eye opener for me in terms of being more attentive to specifically my time to bed. So that may be something I have to grab one of those and see what else I can learn.

DrDS:

Especially if you work out regularly. You get the chest strap to go with it and the data from the workouts is unreal. You go for a run and it’s talking about your cadence, how much head oscillation you have, you know, it’s just so much detail your, your stride length, all of that.

DrMR:

Wow. Interesting. Well, you’re making a compelling case. Cool. One more toy for me to add to my collection. Awesome. Well, Dan, thanks again, really appreciate it. Keep me in the loop on any, any new and insightful stuff you have going on in the clinic. And we’ll have you back on some time hopefully to, to expand upon it

DrDS:

For sure. It was a pleasure.

Outro:

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