Episode 573: Dr. Jonathan Schoeff: Peptides and the Marketing Behind Modern Longevity - Part 1

28:12They're well beyond that. And we see that in the data, right? The impact on reducing the risk of cardiovascular disease, all these things. But as a purist, as a nerd at heart, you have to look at what we call mechanisms of action. And GLP-1s do one thing and one thing only. They improve insulin sensitivity, okay? Now, how they achieve that can be through reduction in food noise, very powerful. Slowing of stomach emptying, okay? What we call delayed gastric emptying. But those agents also work preferentially on the pancreas. So they're improving insulin sensitivity. So this goes to my point. People want to say, oh my gosh, Ozempic reduces the risk of heart attack.

28:53Yeah, the data said 20 % reduction in major adverse cardiac events. But it doesn't reduce the risk of heart disease. It reverses insulin resistance. Insulin resistance is the driver between heart disease and stroke. So you can logically say, this is what I would expect to see. So you just said to me that cancer, dementia, cardiovascular, heart health, all these things, The root cause of all these things is insulin resistance. So then if you're saying that, then if you're reverse engineering this whole thing, you would say that how do we not be insulin resistant? Correct. That is true. Is then we should be, like, we should, okay, taking the tool of a GLP-1.

29:36Right. How else can we become not insulin resistant if we don't want to take that? Move to Europe? I don't know. Yeah. Right? Okay, I'll do that. So yeah, insulin resistance, understanding insulin resistance, the how, the why, the mechanistic nature of it, I think is really important because this is where all these groups come from, the carnivores, the ketos, all these things. There is no one way. But wait, then let me, I'm just going to keep on interjecting here because I've got questions. So wouldn't that make the most logical sense? If, if we, if we want, if we don't want to be insulin resistant and there is a tool like a GLP-1 or 2 or 3 with all these, you know, new ones coming up, isn't that like, doesn't that make the most sense?

30:22Why shouldn't we all be on a GLP-1 then? If that will basically create a situation where we're not going to potentially get cancer or heart attacks or whatever else. Well, I mean, I think the fundamental argument is that GLP-1s are drugs. Let's clear this up, okay? GLP-1 in situ, produced by the human body, is a peptide, short-chain amino acid. Ozempic is a drug. Yeah, they're all drugs. What makes it different? Its origins are as a peptide. But what does big pharma, the infamous big pharma, which, by the way, I'm going to give a quick PSA to the world here because you have a great following. If a doctor uses the terms big and pharma in the same sentence, you should walk out.

31:07We don't talk about big pharma. There is a pharmaceutical industry. We don't work. We're not poisoned. We're not agents of big pharma. It's just total crazy train where people go. But the important thing to understand is... Are you getting paid by Big Pharma? You weren't supposed to bring that up. I know, sorry. I only get paid a million dollars a year. Oh, here's another PSA for everybody. Just get it out in the open. Openpayments.gov. If you want to know if a doctor is being paid by anybody, Big Pharma or otherwise, you go to openpayments.gov and type in the doctor's name. It's a public database.

31:45so all the trickery of like oh you're getting paid no listen i can't be paid literally a penny not a penny that is not reported now i'm already going to go here but and yet a fitness influencer can make millions show you his new car off the peptides he's hustling you for and there's no conflict of interest there no they just they just want you to be healthy They just care so much. So a doctor, for a doctor to take money, okay, which by the way, folks, that was decades ago, decades ago, where yes, indeed, there was a time where pharmaceutical companies in my world of spine surgery, yeah, there's a lot of money being exchanged decades ago, back in the 90s, okay, the laws that had been passed to scrutinize, it is illegal for me to take money and not report it.

32:43So it's not do surgeons or physicians do it? I'm sure they do. I'm sure it happens. That's the reality of life. However, it is actually against the law. So because it's against the law now, oh my God, there's so many things here. So because it's against the law, is that why so many doctors are hustling these compound peptides because they can make money off of it and because they have the dr in front of their name people will believe them more and therefore people will subscribe and buy from their affiliate code and do all the things and they can make millions of dollars you don't have it's not just the fitness influencers my dear friend it are doctors who are doing the same shit because they want to make money i agree and And the chiropractors.

33:30Yeah. So I would say very plainly, and I see this all the time, I commented on this. Someone gave me the distinction of being the number one peptide troll on Instagram the other day. And I was like, I don't know if I've ever been number one in my life, but this is great. How is that possible? Because I don't know how the algorithm works, but the crap shows up on my feed. So if I see something that's fraudulent, I'm going to comment. So when you tell somebody that this is what BPC will do for you, the implication is that there is scientific evidence of it actually taking place in the human body, and there is not.

34:10So saying, we go back to that cell conversation, saying something like methylene blue does something in a single cell devoid of an organism is actually totally irrelevant. So when people tell me, when I hear a doctor say, it's really exciting, I look at that guy and go, you're lying through your teeth. You and I both know it's not at all exciting. Reading mechanistic data is not exciting because do you know the natural history of mechanistic data resulting in outcomes-based human evidence? Less than 10%. Less than 10 % makes it to the point because this is the standard in the pharmaceutical industry.

34:48You see something, it's interesting. You put it in a cell. Oh, something interesting happens. Now we're going to put it in an animal. Oh, something interesting happens. Now we're going to put it in a human. Oops, it causes cancer. Or oops, it doesn't actually do anything at all. So, okay, this is... Does that resonate? Yes, it makes sense. It does. Because that's the absurdity of the world we're living in. You're telling me you're excited. And so it's one thing for the general public, with all due respect, to be excited. Because I get it. you're reading something and you're like, oh, this sounds really cool.

35:19Or someone told me, oh my gosh, it regenerates tissue. That's really cool. I don't disagree. But as a physician, as a scientist, it's fraudulent to then tell another human, right? Because you're an authority on human health. I'm using that authority, just what you alluded to. I'm not one to point fingers at intentions or motivations. That's beyond what I can do. But the surface observation is that a doctor who is a trusted resource in human health care is making claims about a bioactive substance in humans, knowing full well that it does not exist. It's not even a leap of faith. It's just crazy training.

36:03Yeah, this is blowing my mind because BPC-157 is all over the place. And And everybody I know is taking it. Everybody. And millions have been miraculously healed. Did you know that? Yeah. Well, is it placebo? Is it like psychosomatic? Are people thinking they're being healed by it? Are they getting healed by something else? And they think it's PPC? Is it? It's hard to say. I mean, I can't say definitively. So here's my thing. You don't take it? I don't. When I had my neck surgery, I did. But why? You just finished saying that it's not necessary. There's no evidence around it. Correct. But? But there is anecdotal evidence, which has value, which has merit, and there is preclinical evidence.

36:47So here's the difference, okay? Okay. I'm not anti-peptide. I'm pro-evidence. Really key distinction, okay? I've read all the data. If I'm talking to a client, they come to me and they say, Doc, you know, I twisted my knee and my buddy's been on BBC. It saved his life. Should I be on that? I say plainly, listen, here's the situation with BPC. Here's what we know to be true. There's mechanistic data, single cell data that suggests that BPC has healing properties. Okay. We've observed that in many, many, many studies. And we also have lab rats that have demonstrated some element of connective tissue healing.

37:29Okay. At least 30 separate articles or papers written about it. What we don't have is any, zero, any human evidence. So here's where the gap exists. Like at a very basic level, who the hell knows this? I'm not even going to get into the gray market stuff, but who the hell knows if I inject BPC into my thigh, who knows how long it survives? First step one for a pharmaceutical company to build a drug is something called pharmacokinetics. You actually evaluate it in the order. Does it make it into the bloodstream? Does it survive in the bloodstream? Does it actually deliver to the intended treatments?

38:06Those are all things leading up to the ultimate question, which is, does it alter outcomes in a human organism? So you see how far removed we are from hard facts. So I can't look at you and say, Jennifer, you need to take BPC to heal your need. But wait, okay. Okay. But you don't say you need to, but would you put me on it just because it might work if i decide i wanted to go on it why did you go on it for your neck if you had all the information you know all the research you've done why did you do it because it might help because of the might didn't help hard to say because i don't ever use bpc as a as a standalone treatment okay because we have or stem cells or Well, so in that space, we have decades, maybe centuries of data surrounding growth hormone and its reparative or restorative effects.

39:05That's clear. That's very linear. And that's in humans. Big, big difference. Okay. So I will pretty much uniformly recommend a growth hormone secretagogue, which has been well studied in humans, in addition to the BPC. I mean, truth be told, I personally, as a practicing physician, I don't trust BPC enough to use it as a standalone. In my practice, I mean, over a thousand clients over time, my data is split down the middle. 50-50, okay? 50 % have a, you get to the thing too, subjective response. That's a story, which is very valuable. Placebo effect, possibly. Don't discount the placebo effect.

39:55I don't as a physician, right? There are plenty of people that you don't have a diagnosis for. They have symptoms that for them are significant, severe, debilitating. and if I have something that they take and doesn't harm them and they get better subjectively, that's not the worst thing in the world. That's just reality. Does that make sense? Yeah, that makes sense to me. So there's a balance and people, again, everybody wants to box, specifically box me in. I try to maintain a high level of transparency around what we do and don't know regarding peptides. What I can't do, I can't say, Jennifer, this BPC, so it increases new blood vessel formation through upregulation of VEGF, vascular endothelial growth factor.

40:42And that translates to improved tissue healing and repair. If you heard me say that, how would you interpret that? That it works. In you? Yeah. But you're a human. Yes. So I do have that data. Well, last time I checked. Yeah, well, I mean, you can always, it's what you identify. But the level of data that we have to make those statements I just made are in lab rats. Right. So if I don't qualify that, do you see the difference? Yes. If I don't qualify, Jennifer, this is what we saw in lab rats. Now, I need to tell you plainly that the translation of data, positive data seen in animal models to human outcomes, it translates very poorly.

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43:21what about another one tb500 tb500 is even worse way worse in wolverine and yeah the wolverine wouldn't you like to be wolverine i like i like that yes you kind of look like wolverine what are you doing i don't have i don't have the thingies okay but you look really fit what do you you're on you're definitely on something oh have to be i'm on hard work and consistency That's what I want too. That's what I use. Hard work. Everybody, oh man, that's a whole nother. We're going to get, so don't even start there. So, but let's do TB500. Let's do TB500. Because this is really important. The TB500, and I also want you to talk about the Wolverine stuff.

43:58Wolverine, right, right, right. So what I love is that people are literally going back and forth on social media about combining two peptides in a single delivery model, like the Wolverine. So TB500, BPC157. And they're talking about, well, can they survive together? Can they basically cohabitate and all this stuff? Who gives a rip if they don't even work, period? Right. Like you're talking about layers. See, this is what happens. This is the influence, right? Is we're bypassing these huge steps in the process. Yeah. And we're talking about, should they be paired together? I'm more concerned, do they do anything?

44:34Okay? Yeah. And obviously, as a physician, first do no harm. So the safety piece always has to come first. That's why we, in phase one and phase two clinical trials, those are about safety. Phase three is about efficacy. Okay. So you spend years making sure it's safe in a human being. We haven't done any of that for a peptide. Well, but your body produces it. Well, yeah, it produces GLP-1 too. So we don't need safety data. And then let's go down the vaccine route. I'm not going there. So here's really important. We got to stress about TB-500. This is borders on criminal because TB500, by definition, is a fragment.

45:13It's a short-chain fragment of something called thymosin beta-4, TB4, okay? The thymosin family, thymosin alpha, thymosin beta, these are peptides that were extracted from the thymus, which is a gland that secretes various bioactive substances in a human. And TA1, thymocin alpha 1, thymocin beta 4, have been studied in humans. Not to the extent of, say, like a drug, but they actually have indications in FDA approval for use, which means they've been studied enough to say they're safe and they actually work. Okay? So thymocin beta 4, we have great studies on. Never even heard of it, by the way.

45:59Oh, exactly. But you've heard of TB500. Yeah. So the game is, okay, so we have this larger molecule that's proven to have biologic effect, positive biologic effect in humans. So we got to credit it there. If we just chop off what seems to be the most active part of that molecule, now we're back in the Petri dish, okay? And look what it does in a Petri dish. Oh, wow, it's active. It renders similar effects. Therefore, okay, now we're here and we're going to make a big leap here. You ready? Therefore, TB500 and TB4 are the same thing. Does that make sense to you? Would you sign off on that yourself?

46:41No. Because that's what's being presented. People talk about TB500, but what they're referencing are studies. They're referencing scientific evidence in humans of TB4, thymus and beta-4. So it's a complete clown show. And one of the kings of this whole narrative is this chiropractor. I don't have any issue with well-qualified chiropractors. What's his name? Trevor Bachmeier. I mean, this guy is just totally unhinged. He literally lost his license as a chiropractor and resurfaced as, you know, we were talking about how a lot of criminals, felons like to resurface as longevity experts. You know why?

47:21Because there's no regulation. Correct. I know. So that's what they can do. So, right. So I take a lot of heat, understandably so. I mean, I get it. I don't have any qualms with that. If you can't defend or provide rationale, supporting evidence, data to what you do clinically, yeah, I would call that, I mean, some would call it malpractice. But yeah, that's the beauty of the wellness experts and enthusiasts and longevity experts, right? You can literally be picking your nose one day and the next day you're an expert just because you said so. Just because you said so. Oh, and then mix in a little bit of chat GPT.

47:58Oh. You got your certificate now, right? But the tragedy is, you know, people, what's a longevity expert? I get that all the time. I'll give you my definition. Tell me, what do you think a longevity? What is your definition of a longevity expert? So a longevity expert, first, it's a foundational educational background. So could you be a PhD in human something and become a longevity expert? Yes. I mean, you know, David Sinclair is an example, right? He's a PhD, lab at Harvard, very well known for his resveratrol work, right? Which was a total fraud, by the way. Total fraud. Correct. So. Exactly.

48:39but but well we don't want to talk a really big time fraud we can talk about the human biologist apparently now when you get a bachelor's degree in biology you are a biologist typically in academic circles we reserve a title like biologist for a higher level degree like a master's at least Minimum masters. Minimum. Exactly. Right. Like I myself, it's on my wall. I have a bachelor's of science in human biology. I'm not a biologist, nor would I ever reference myself as a biologist. But again, the rules. Also, it's like me. I have a bachelor's in psychology. I'm not a psychologist. So you're a psychologist.

49:23Yes. Oh, I didn't know that. I'm a clinical psychologist. Oh, cool. You didn't know that? No, I didn't know that. So, yeah. So the goalposts are kind of constantly moving. Yes. I digress. But really, long short of it with TB500 is we're talking about all these mechanisms and actions in the human body that are totally irrelevant. People are referencing, literally quoting research from a parent molecule. Okay, so the Wolverine stack. What is it? Why are people taking it? And that's obviously also a total scam. So I want to be careful here because I really try to adhere to science, evidence. I mean, I'm a physician.

50:07This is where, to me, the docfluencer role, which can be powerful, can be, there are some really cool people out there that I learn a ton from. Who do you like? And then, oh, I knew you said, Mary Claire, Dr. Mary Claire, obviously from a women's health perspective. I see the women's health movement that's evolved from social media is like probably the greatest thing to come out of social media, at least right now in medicine. But I could list off. There's one woman. I have to look it up. But one woman I follow, she's an obesity medicine specialist. And she gets it. The cool thing about social media is that it does force you to communicate much better because you're trying to deliver a nuanced message in 30, 45 seconds.

50:55That's really hard to do. Right. It's a challenge. And then what I love about social media is that I see it as an element of accountability because despite all the quacks that are out there, there are some really smart people. so i don't get to say i'm a physician and then just spout off on some i at least i don't believe that's that you have it's like it's like basically like a you it's like a it's like the wild west you're gonna have people who are good you're gonna people who are bad but you have to be super discerning that's the whole thing right you have to know there's so much noise right and it's over information now it's too much information which is why people are confused which is now getting back to the Wolverine stack.

51:35Tell me what you think. So BPC-TB, TB-500, like I said, that is the biggest hoax that we have. There is absolutely no human evidence. And all the rationale or thought around why this is a synergistic combination, okay, is completely irrational. It's unsupported. Now, if you were going to make something, and so why not TB-4, thymosin beta 4 very expensive difficult to make so no one's so the hustlers are like hey i'm going to just make a just a little i'm just gonna sneak this in here and so i literally see these these online peptide companies and stuff that will say tb4 when they're talking about tb500 doesn't work that way like biology doesn't work that way so at some point in time we got to call a spade a spade That's fraudulent.

52:26You're literally describing a molecule that's been studied, chopping a little chunk off of it and calling it the same, which that's just grossly inaccurate. If a pharmaceutical company did that, Wall Street would be a massive fallout, massive class action, right? So we have a certain standard that we hold pharmaceutical companies to, but we'll let the wellness guys just make these leaps of faith and, you know, it's so cool. Does that, exactly. So does that mean then TB4 is really effective? Yes, for what it's effective for. So if people who have money, if they have money, can't they get access to TB4?

53:07Right now, I would say not really outside of, again, FDA approved uses. So right now, you know, what happened with the compounding pharmacies, which is a whole nother, everybody wants the conspiracy. Everybody wants to know the money trail. How about we look at the money trail right now where fitness influencers, people who literally have no comprehension of basic science are making millions. They are profiting millions by taking off their shirt and saying, my stack did this. The stacks thing makes my head want to pop off Because conveniently, nine times out of 10, their stacks include one to two substances with well-known, well-documented effects, and then a slew of other things that are activating this pathway and moving the needle here.

54:02When you're on retatrutide, okay, and you're seeing radical body composition change real time, well, we know that's what retatrutide does. We have literally tens of thousands of human subjects that we've already proven that it works. So now why do you need to add in MOTC, 1-amino-5, this whole slew of your stack, and then try to justify it with these bizarre mechanistic pathways? Again, understanding this, that a mechanistic pathway that exists in a single cell does not mean it exists in a human. Moreover, it does not mean at all in any way, shape, or form that it's synergistic with another pathway.

54:41The idea in these guys that say peptide sciences, the theory that breaks down from the word go is that, well, if I activate this pathway and I activate this pathway, that they're synergistic. That's pure hypothesis, not even supported hypothesis. Okay, but redditruti is a hot thing right now. Yeah, totally. And I thought— It's going to change the world. Right, but I thought it was only—well, I heard, last time I checked, it was only in rats. It's not proven in humans. No, no, no. No, in the conscious. No, I don't know the exact timeline for FDA approval, but the phase three clinical trials. So, no, retitrutides at the end of the, it's coming up to the finish line.

55:25It's gone through phase one, two, and three clinical trials. It is the most well-studied, and this is a whole other story that the world has never seen, where an actual drug, a pharmaceutical drug called retitrutide, is maybe being produced in substandard areas, the gray market. Yeah. They're all compounded, the ones that I've heard of. Yeah, and I believe, truthfully, I believe some of it's retitrutide and some of it's not, okay? I mean, but retitrutide itself, that molecule, that synthesized molecule, that drug, has the most compelling, overwhelmingly compelling science to support its use in humans.

56:05We're already, we're probably, I don't know, I'm going to guess within a year or two, it's going to be FDA approved. It's going to be widespread use through pharmaceutical channels. So if someone's buying it compounded right now, but they're still getting great results, is it, what do you say? What do I say? Do you believe in that one? Do I believe in redditrutide? Like the effects? Oh, it literally is a life-saving drug. The idea, by the way, that Big Pharma wants to keep everybody sick. People keep themselves sick, okay? When you gorge yourself on soda and donuts and you sit on a couch and play video games, you're keeping yourself sick.

56:50I hate to be aware of bad news. Big Pharma has introduced more therapeutics, even in the last decade, that are targeted therapeutics to actually reverse disease conditions. But big pharma is just out there to make money. Sure they are. They're publicly traded. That's not a secret. But so are the wellness influencers hustling peptides. They're there to make money. You see any of them handing stuff away for free? No. They're not like just use my code and get a free shipment or whatever. Yeah. So no, Reddit True Tide, the GLP class. And again, this is where it's tricky because at a very technical level, the GLP class is born out of or built off of a peptide framework.

57:31Okay. Calling GLPs peptides, I think is a pretty loose, it's a mechanism to alter the narrative because what people are doing is they're taking these wholly unstudied in humans, BPC, TB500, GHK copper, epitalin. I mean, the list goes on and on and on. Wholly unstudied in humans. Okay. And then they throw in a GLP, which is studied into the ground. Decades, decades. The first GLP was brought to market in 2005. Decades of data, proven effective. And then they're like, well, see, look how well peptides work. Let's parcel this out. We have FDA-approved drugs based on a peptide framework. Right. Then we have the influencer Hustle peptides with zero human evidence.

58:22Not the same camps. Okay, but how about... You don't get to lump them together, right? You don't get to lump... But why people are compounding trisepatide and ozempic, and it's a fraction of the price. It's really not, by the way. If you look at... Here's my belief about... You want to do the GLP conversation? I mean, we don't have to get too far into it. I mean, GLPs are... Before we get to GLP, I have one more question about peptides. It's MOTC I want to know about, and I also want to know about GHK copper. Right. So MOTC is, again, I think mechanistically— Why do people take it? So it's a mitochondrial optimizer.

59:04I said earlier, right? It's very clear. The relationship—so you're a densest repository of mitochondria, so energy production, current skeletal muscles. So think of mitochondrial health as synonymous with muscle health. synonymous with metabolic health. That is the trifecta. No other single parameter that you could trend, and this we can get into longevity metrics, has a more direct positive influence on metabolic health than muscle. And I'll unpack that for you, right? But more muscle, technically I would say more functional muscle, so strength over size, is the single greatest predictor of long-term health and survivability.

59:45Okay. But realize that's bolstered through its effects on human metabolism. By the way, VO2 max has nothing to do with insulin resistance. Sorry, sorry to break it to you folks. So we're saying the leading cause of death in the United States today is insulin resistance in the form of type two diabetes. The single most potent agent we have to directly reverse insulin resistance. Okay. We can get into the weeds of remission versus reversal diabetes is muscle, period. Everything else flows from that. Does that track? Yeah, of course. It makes sense. So when it comes to... You keep asking me that.

1:00:23No, no, no. Well, because this is the thing that I wrestle with is you can be knowledgeable and you're not an effective communicator and you might as well not be knowledgeable. Right. If it doesn't land... It's landing. If it doesn't land or resonate... And honestly, my platform, my position is very simple. I actually went into medicine. I became a doctor to help people. Crazy. I know it's crazy. Yeah. I didn't do it to get rich. I didn't do it to work for big pharma or anything, right? You're from Ohio. I mean, you're just like a... Simple, truly, simple country surgeon. Like, that's my origin.

1:01:02It is not anything fancy or elaborate. And I really believed becoming a doctor, I could help people. And so when you look at what's going on in the United States today, which is a broad landscape of insanity, but when you look at the health crisis in the United States today, the obesity epidemic, we need to get back to the root cause, the actual root cause. If I can change, it's Occam's razor, simplest explanation to equate to the larger good. If I can change one parameter and it exponentially reduces your risk of death, I would go after that. I wouldn't actually spend a lot of time chasing a bunch of other stuff.

1:01:48And we can talk about how that relates in actual clinical practice. But the truth of the matter is, if you're building healthy, lean muscle as a priority, you are indeed extending your lifespan and healthspan. If I look at someone who is insulin resistant, we get a fasting insulin on you, and we then proceed to do nothing, don't change your diet, don't change anything about what you do day to day, and we strategically build more muscle. Your fasting insulin will come down. It has to, by definition. Now, where does a GLP fit in? It's a tool. So I can talk to you about how those tools relate. But ultimately, I see a GLP as a mechanism to enhance muscle.

1:02:29But don't get there yet. I want to know about MOTC. You said the mitochondrial one. MOTC. You're right. MOTC. And then GH. Don't forget about the copper one. Well, GHK is easy. I'll just put it to you this way. There's no evidence for systemic use. Okay, because I keep on seeing girls. Topical is a workhorse. No, they're getting injections. And they're like, I'm like, why did your skin look so good? and they're like, oh, I take, yeah. So will I look 10 years younger? No, you will if you put topical. So I love GHK copper as a topical application for any invasive procedure of the skin. You violate the epidermis.

1:03:03So that could be like a skin pen, RF microneedling, even a laser, okay? So GHK topical works. Has excellent human evidence. More than the injection. Well, the injection has zero. It's never been studied. So why is everyone taking it? Because you told me that you took it and your skin looks amazing. You left out the part that you just did a full field ablative laser, right? And high dose omegas and you do vitamin C. You want to talk about, by the way, making skin glow and heal? You do high dose vitamin C infusions, okay? But that's the part they leave out. why? Because they can't sell that stuff.

1:03:48That's not, but I can hustle you for some GHK. I can put it on my podcast and get a lot of likes. There is zero. There's no debating it. And for some reason, someone will come up maybe from this podcast and be like, no, see, here's the studies. Yeah, it's called topical. If I put it in a cream form, it's actually well-studied, most well-studied actually in aging women, 70-year-old women. It's a very effective tool. where do i get it compounding what's the best i compound it can you compound them for me sure yeah just the just a top of i make lots of concoctions really oh yeah do you use it so my i mean the workhorse is tretinoin you everyone talks about tretinoin okay okay what is that tretinoin's the oldest vitamin a vitamin a uh but this is really important yeah so for the listeners okay and for me i'm listening i know i know you have retinoids you've heard yeah oh you need retinoid no you need retinoic acid they're different retinoids are retinal-like compounds so you see those you can get uh now there's some that are otc over the counter you get at walgreens okay retinoic acid the pill form accutane you've heard of that right so the topical form tretinoin is pure retinoic acid.

1:05:10And so retinoic acid is the most potent, is the single most critical anti-aging skin health modality. Every single person should have a high quality tretinoin. It can't be, I can't make the same claims for the stuff on the counter at Target. Where do I get it? From a doctor's office. And they have to prescribe it? Yeah. And how often do you use it? So I try to have every one of my clients build up to nightly application. Tretinoic acid, or excuse me, retinoic acid, tretinoin, at the concentrations that I would recommend. So for you, I'd recommend 0.1%. Okay. If you just started at 0.1%, it will fry your face.

1:05:53Now, I would submit that probably six to eight weeks of, you know, some redness, some flakiness, some real irritation, you'll get past that initial phase and it's a glow up for life. But the way I do it in my clinical practice, because no one's jumping around to do it, is I start at 0.025 and then I progressively work up. So we start extremely light, have a great vehicle. This is, don't worry, I don't get kickbacks. We love skin better. SkinBetter, by far and away, I think is the most powerful, potent skincare line, medical-grade skincare. And so that starts at 0.025 % retinoic acid. So can I buy that?

1:06:32Yeah, from a physician's office. So you can prescribe it for me? Yeah, yeah, yeah. I think it's a really nice delivery vehicle, so it keeps your skin hydrated. You could do the experiment like on your form. I give you 0.1%. I mean, it's pretty irritating. It's pretty harsh. It's only six to eight weeks. And so like a lot of dermatology colleagues of mine are like, ah, it's only six to eight weeks. I'm like, come on, really? Your whole face is flaking off, bright reds or itchy. Not too many people sign up. But if you sequentially, if you go 0.025, 0.05, 0.1, and you work up to it, I usually with clients, it's like six to eight months.

1:07:11I'm in no hurry because ultimately when you get to that 0.1 concentration, that's the sweet spot. But I love that with topical estrogen. Oh, that works so well. Yeah, so I make my own little concoctions. It's a very potent, it's a powerful hormone for skin health and skin turnover. But can't it like seep into your bloodstream, the estrogen? No, no, no.

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1:09:28Okay, so what if I just use the topical estrogen? Does that work without the... that no tretinoin is the workhorse tretinoin literally every single person that wants to age well proactively should be on tretinoin and i would argue like all the people like oh it's it's the ghk and all that stuff and then they refer you to the link to buy they're probably doing something else i'm sorry i'm sorry that's just the truth of it now people are going to flip out and be like, oh, you're lying. I get this all the time. Well, how do you account for the millions of people that have been cured of X, Y, and Z with BPC?

1:10:07I say, that's great. If it works for you, that's great. I've used it in my clinical practice. I track every patient as part of being an expert. It requires documentation, data analysis, and interpretation, right? That's how you're an expert. In my practice, and really if you pin people down, BPC is a 50-50. And last time I checked, flipping a coin is not, if I said, we're going to do surgery on you and we'll flip a coin to see if it's going to work, would you sign up for it realistically? I had someone tell me, I said 50-50 and they're like, so you're saying it works great. No, I'm saying it's placebo effect.

1:10:46There's a 50-50 chance. Do you know what this reminds me of? Have you ever seen Dumb and Dumber when they're like, would you go with me? One in a million. So you're saying, that's what it is. So you're saying there's a chance. Exactly. And that is the essence of the peptide hustle. So you're saying there's a chance. So you're saying there's a chance. So a 50 plus billion dollar industry, that was 2024, 50 plus billion dollars spent on peptides for the hopes. Of something. So you're saying there's a chance. Yeah. Is a chance worth$50 billion? I don't think it is. But the tragedy is people would rather take that chance than just do the basic stuff.

1:11:29Tretinoin, I mean,$20? I mean, it's dirt cheap. GHK, it's a nice theory. But again, GHK copper, tretinoin, estradiol cream, now that we're talking. And you'll see meaningful results. So wait, guess back to the tretinoin. So then would you put the 0.025 on every night yes for sure okay like what would be the routine would i wash my face then put serums how about the serum yes so usually so so the application of the tread product whether it's pure tread or it's or it's um in a carrier vehicle and then that's when you put whatever serums lotions beef tallow butter um so you think beef tallow no i'm being sarcastic.

1:12:12It's just outrageous. I mean, you stick your head in an ice bucket and then you put butter on your face. Who is coming up with this stuff? And it would be one thing if we didn't have tried and true proven, but yeah, the not so secret secret, every one of my clients, regardless of age. Now, a younger woman, for example, I would keep on 0.025 30s into their 40s unless they demonstrated more accelerated age-related change. So for every day, you'd wash their face, put that on. In the evening, evening, right? Yeah, yeah. Okay, and then you could put your serums. Yep. Or some moisturizer. I would always do a moisturizer on top of it.

1:12:55So when, how often should we use the estrogen on our face? It can be periodized, but on a daily basis. Like during the day or at night? At night. Yeah, I would do it at night. Not during the day? During the day is when I would use whatever your standard regimen is. Typically some type of moisture, some type of delivery vehicle. You know, a lot of these products have vitamin C, so on and so forth. I don't... How about hyaluronic acid? Complete clown show. Really? Topical hyaluronic acid is only matched by injected, right? Skin V? Have you heard of Skin V? No. Allergan bought Skin V. it was well over a billion dollars.

1:13:36I don't want to misspeak. SkinVe is an injectable, just like your HA fillers, that you're supposed to inject into the skin to deliver hyaluronic acid. Being in Colorado, by the way, hyaluronic acid is a workhorse in my practice. Hyaluronic acid is hydration and volume. Think of it that way. So its basic function is to pull water into the extracellular space. So you get that nice plump hydration. And in Colorado, we're bone dry. So it's huge. There is actually a technology that works so well. It's actually proven in large-scale studies, 200 plus percent increase in hyaluronic acid production, 212 to be exact, but it's a technology.

1:14:21What is it? It's called Exeon. So it's a combination of radiofrequency and ultrasound heat. Have you ever heard of Ultherapy? Yeah, I have. Think of it as kind of, it's a cousin of that. I wouldn't consider it a similar modality, but the data around hyaluronic acid production is rock solid. We use SkinV in my practice. I'm free to say all this stuff, right? People may throw fit. SkinV is a disaster. I've never once seen a good result. Hyaluronic acid is a workhorse for skin health. Again, so we use it. think of it as even like we'll use this technology it's it's anywhere from a five to eight minute treatment my female clients will come in the morning of a social event because you get this immediate production of hyaluronic acid so you get this nice kind of it's a glow up but it's a real glow up that yeah you actually glow so you get a nice little pink a little plump they go to their event, rock stars.

1:15:22But that's a technology. So then just to be clear, topical hyaluronic acid, I am not aware as a physician of any study that demonstrates efficacy for topical hyaluronic acid because hyaluronic acid exists below the cell, outside of the cell. So to cross an airtight, watertight barrier called the epidermis. Think about that. It's kind of silly. So you're right, but it sounds good. It does? Yeah, yeah. And I would stress, very importantly, hyaluronic acid, collagen, elastin, hyaluronic acid. Those are the three most critical elements of skin health. What is it called? Collagen? Collagen, elastin, right?

1:16:10Yeah. So you've got your collagen is your support structure. Elastin gives your skin that elasticity. and all these obviously decrease with age and then hyaluronic acid. So those are the three components. So every product on the market will make some reference to those. But bear in mind what is critical for collagen production. We know what happens when you don't have it. It's a vitamin, right? Vitamin C. So you said high doses of vitamin C. High dose. What does that mean? Eight to 10 grams. Of what? Vitamin C. No, of how? Intravenous, intravenous. So we should take, where do we do that? Come to my office.

1:16:50It only took me like an hour and a half to get here. So it's not that far. That's not bad. Right. I could just take a plane. I mean, I think a lot of, that's become kind of one of my, so now we veer into a little bit about what we do in the non-invasive aesthetic space, but vitamin C people forget that that is by far and away the most potent element of collagen synthesis that having optimized levels. I use it. I mean, it's been described in cancer treatments as well, but using pretty high dose is very powerful. People are going to argue this. People are going to throw fits that I'm saying this, but anytime we're doing an invasive procedure, so like an RF micrometeeling energy based procedure, we'll run a drip of high dose vitamin C.

1:17:37Really? And then what I'll finish off the treatment with is what we talked about is plus or minus PRP, but we use PDGF, platelet-derived growth factor that that's the best it's the only yeah okay that's the exosome people are going to crap their pants because because they we get so such great results and we actually have no research to support it and we actually are printing money no one likes to hear it but i only i'm i'm really stressed in my practice i'm only going to use the things that have clear supporting evidence Yeah, so you still believe in PRP as the best thing. What's the difference, PRP?

1:18:16What's the other one you said? So I always, in truth, I'm giving away all the secrets here. I add PDGF. PRP, platelet-rich plasma. Platelets are Amazon trucks, okay? They contain a whole slew of growth factors. Yeah, yeah, yeah. One of the highest concentration growth factors in a platelet is platelet-derived growth factors. So I just use, it's synthesized in a lab, what we call recombinant, pure PDGF, and I mix that with PRP. That way, there's always this debate around PRP and biologics, PRP, PRF, in that as we age, is the quality of our platelets less? I don't know of any scientific evidence one way or the other, but I don't take chances.

1:19:05imagine this. PDGF, recombinant PDGF is 10 ,000 times more potent than PRP. Wow. And this is for when do you use this? For what? So I will use it. My general sense of it is anytime we violate the epidermis for any type of procedure, I'm going to use it. Do people use it? Is it common? Topically. I think it's gaining more traction. But again, what Instagram is, it's just a brilliant MLM marketing system, right? It's just a giant marketing scheme. You get, you're right. I mean, you get the right person. If Kim Kardashian says, oh, I use exosomes on my face, right? Guess what's going to sell? Exosomes.

1:19:48Does that mean they do anything? No, not necessarily. So, but, but that's, that's the part about Instagram. That's crazy. Crazy. What about if I just go to, if I just get like, call my friend, um, my friend, Dr. Abe Malkin, shout out, he has a high like drip hydration or concierge md whatever and i said hey can you come and give me a vitamin c drip would that be great for my skin i think so i do it bear in mind i do it more strategically okay give me an example what should i do give me so like any if you're getting a treatment with an energy-based device so that's like a blade of laser therapy what if i'm not doing that i don't see there being there's not enough bang for your buck okay so take advantage of this is where you're always looking for synergies, right?

1:20:35I mean, efficiency is the name of the game in my practice, whether it's clinical, whether it's aesthetic, shortest distance between two points, still a straight line, least amount of resources. So if I'm going to invest in an energy-based procedure, we're doing RF microneedling. We're giving you a shot of energy. We're violating the epidermis. I'm going to put everything into your system that's going to facilitate a maximum tissue response. Okay. So input output. Okay. So that's why you say vitamin C. That's why you're saying PRP. PDGF. Yeah. So we just slam it. What do you do? All this stuff?

1:21:12Cause you look like, you look good. Yeah. I, I'm, and you're a guy. I'm a geek about it. Yeah. Yeah. I could tell you do a lot of skincare. You look very put together. No, I have a wonderful wife that tells me, like, she puts the things out in order, and I just do it. Like what? Again, this, I don't, nothing for, shout out to Skin Better. I do love their line. So I use the Sequins. Yeah, yeah. And what's the Sequins? The Sequins is, I got to think. So it's Alta Advanced. So it's a, it is a vehicle for a vitamin, basically a topical vitamin application. but it's also very hydrating and then you're not getting paid by saying this no no no yeah nope you want to know if i'm not getting paid yeah you can go check just go check yeah no it's the product line we use and then um i have to i can give you the whole the whole rundown but we do that in sequence now they do have a topical ha product that i've been using so i'm always open to things i don't want it to come out as like really dogmatic and black and white because it's not.

1:22:19I mean, medicine is nuanced for a reason. There's a reason it's the practice of medicine because there is, that's the human part of it. And that's why AI will not replace doctors because one AI is not compassionate above all else, but so on and so forth. Yeah, exactly. So, um, so do that then to do a moisturizer and then, and then topical sunscreen mineral based sunscreen so they have tinted trust me five years ago if you said would you use a tinted sunscreen what are you talking about but that's my go-to so what you need is just like i mean i'm pretty pale and so it gives you a little color but um tinted or otherwise but spf 75 sorry paul saladino uh ionizing radiation is still ionizing radiation yeah and and the the the weathered look is out yeah like especially for men in colorado for example there's been a big i see a big shift or trend now more and more men are coming in like okay i gotta do something but the thing is men and women just need to be starting much much earlier yeah start literally start on a retinoid in your 20s that's true story for me and that's the tretinoin that's tretinoin tretinoin's optimal.

1:23:38That's what I would recommend. If someone comes to me and says, what do I need to do for life? Very low dose. Again, age-related or decade-related. But tretinoin. Tretinoin's the base. That's your nighttime hydrating moisturizer, and then a quality sunscreen, mineral-based sunscreen. That's what you need.

1:24:07Thank you.