Rerun, Actually - What's the deal with peptides?

8:42Emily Oster:Let's talk about that. Okay. So the first thing you have to know is what a protein is. So protein is the building blocks of our bodies. And proteins are composed of little building blocks, which are called amino acid. There's about 20 that humans use in our proteins, and they're all different, but they all stick together just like Lego blocks all do, right? They have one end and the other and they kind of fit together. And you can take those 20 amino acids and combine them in any combinations that you want to make various proteins. Now, proteins can have thousands of amino acids. They can be very, very complicated.

9:22Emily Oster:Peptides are little pieces of proteins and the definitions vary, but most people say that peptides are somewhere south of 50 amino acids. So you're talking much, much smaller than a protein, but you're still using those same 20 amino acids. And just to explain why Reddit and Instagram has an explosion of all these things with these crazy names and numbers attached to them, if you want to do the math, okay, if you have 20 amino acids that you can combine into a chain of 50. The possible combinations, and I had to get out my scientific calculator for this, the number of different peptides you could create is the same roughly as the number of atoms in every star in our galaxy, okay?

10:13Emily Oster:There is a nearly infinite possibility of the number of peptides that are out there. Okay.

10:21Perry Wilson:So we've got these peptides, potentially an infinite number of them. But I think that the question is, why would having more of some peptide, I understand we have amino acids, they make peptides, they make proteins, we need those. Why would supplementing myself with some peptides have any impact at all on anything?

10:42Emily Oster:Oh, sure. Well, so peptides, you know, if you have a chain of amino acids, what's going to happen is they're going to fold into like some kind of shape based on their chemical nature. So these are not like a long stack that's just a line. Based on what the amino acids are, they kind of fold and shape into like little globby shapes, which is how your body signals to do stuff in a lot of ways. So there are receptors for different shapes on your cells and different peptides, at least purportedly, will stimulate certain receptors and those receptors tell your cells what to do. So it's almost like, you know, you can imagine a key and lock analogy or something.

11:24Emily Oster:You have these locks on your cells and you're trying to inject something that's going to form the key to open the lock. That's the theory at least. And a lot of these peptides, while based on proteins that you can ingest or that exist in your body, not all of them are. You know, some of them come from animals. Some of them are completely synthetic.

11:46Perry Wilson:And so the idea is if I had more of some of these peptides, I could encourage my cells to do more of something that I want. So I think a good example that probably anchors for people is the GLP-1s are peptides. Yeah, classic. So semaglutide, trisepatide, these like things that people are taking for weight loss, those are peptides. They are injected and then they are encouraging something that then causes you to be less hungry and have all kinds of other impacts. But it's just a peptide to try to get your body to do more of something, which it might do otherwise, but you want more of it. Exactly.

12:22Emily Oster:And just to give a sense of like the diversity of peptides, I've told you there's infinite. it. But because the shape is really what dictates the function of molecules in your body, here's some other examples. So GLP ones, you said. Aspartame, the artificial sweetener.

12:40Perry Wilson:Like in Diet Coke.

12:41Emily Oster:Yeah, I'm not sure which one is in Diet Coke. But yes, the one that people actually, a lot of wellness influencers are worried about. Aspartame is a peptide. It's two amino acids stuck together. They just happen to make a shape that stimulates the sugar receptor on your tongue. So it just like makes you think it's sweet, but it's not. It's just a peptide. Bee venom, for example, the main protein in bee venom is called melatonin, and that's a peptide. So that can be something that really hurts when you inject it, for example, right? And so one of my concerns, and actually I'd like to play you a clip, is people suggesting that peptides are really safe because of their sort of nature of being something like a protein.

13:23Emily Oster:So take a listen to this. Peptides are sequences of amino acids. And why is that important? Because your body recognizes these. It can break them down. They're called metabolites and it can get rid of the waste. When we put chemicals, synthetics and pharmaceuticals into our body, there's no natural way for our body to break them down and get rid of them. So Emily, here we have, you know, someone being like, hey, these are just amino acids. Like your body knows what to do with that. Therefore, safe. What do you think?

13:50Perry Wilson:Uh, that doesn't sound right. To me, I mean, I think the fact that something is naturally occurring in the world and is an amino acid definitely does not mean that it is safe.

14:01Emily Oster:It clearly doesn't, right? Like snake venom has peptides in it, right? There's lots of things. But I think people – one of the reasons that peptides are exploding and actually one of the regulatory reasons you can get your hands on these things even is because of this idea that like, well, they're just made of amino acids after all.

14:22Perry Wilson:Right. All right. So let's talk about whether these actually matter for anything. And I actually want to start with a place where I think the evidence is the best, which is in the space of collagen. So I hear people talk about collagen peptides, both for your face and for your joint health. So this comes up actually a lot in endurance sports. People talk about, you know, like, I need my joints to not be so elderly and creaky. And so I should take these collagen peptides in a lot of endurance sports drinks. It's a thing. And so my sense is that the evidence on this is at least reasonably good in the case of your skin.

15:03Perry Wilson:So we have some meta-analyses of trials in which, you know, using collagen peptides typically in a kind of topical way can have significant improvements in your skin hydration and elasticity. Now, okay, in that particular meta-analysis, there was a subtlety, which is that when you only looked at studies that were not sponsored by industry, the effects were not there. So capitalism. But I'm curious whether you, like, if you were interested in improving your already lovely skin elasticity, would you use a collagen peptide?

15:41Emily Oster:I mean, maybe. I don't care that much about it. But whatever. I'm a 46-year-old man. So I know that there are some differing opinions here. I mean, the interesting thing about collagen peptides is that they're basically the only peptide to exist in a regulatory landscape that makes it easy and safe to get. Because the FDA has recognized that collagen itself is safe. They call it generally recognized as safe, which means you can be a supplement company and you can put collagen in a pill and you can give it to people. Collagen peptides, all it is, is they take collagen and they digest it with an enzyme.

16:17Emily Oster:So collagen is a big protein with thousands, literally thousands of amino acids. And then they just digest it down into kind of manageable pieces, very similar, honestly, to what your digestive system does when you eat a big protein. But that said, the collagen peptides are, because they're smaller, absorb through the skin a little bit better, absorb through the GI tract a little bit better. And you're delivering in that sense, you're delivering some of these proteins, some of these constituents of the stuff that makes your skin, you know, firm and elastic directly to the site that you want them to be delivered.

16:51Emily Oster:And to me, that seems fine. You know, this is one of those things I tell people, listen, it's not terribly expensive. If you feel like trying it, try it, you know, try to be honest with yourself if you think you really look better, if you don't save your money.

17:04Perry Wilson:Yes, save your money is perhaps good advice in general, in everything we hear about on social media. So beyond collagen, I think there are actually a couple of other things where a couple of other FDA approved peptides, which treat actually somewhat unusual things. So one of them is for tanning and one is for improving female sexual desire. Did I get that right?

17:31Emily Oster:Yeah, sort of. Yeah, the one for tanning called atha melanotide, it's not FDA approved to get you tan, but it does get you tan. It's approved for a very rare condition called erythropoietic protoporphyria, which very few people have. But it does stimulate the melanin receptor, which is what makes you tan. And so people who receive this drug do get tan. And it's worth thinking about just because there is a pathway for peptides to go through the same approval process that every other drug has to go through, the same purity standards, the same testing, the same manufacturing practices. And they can do really interesting things.

18:11Emily Oster:Like it's true. The female hypoactive sexual desire disorder, which Emily, we definitely need to do a whole show about this. You need a whole show on that. It's fascinating. that's a peptide product called Vilisi which was approved to treat this condition it does apparently increase sexual desire in women it also causes nausea in 40 % of people who take it which I don't know how those two things are compatible but apparently they are well you don't know

18:40Perry Wilson:it could be the 60 % of people who are not nauseous you know it's straight

18:44Emily Oster:up fair enough you're flipping an interesting coin there and of course we should You mentioned already the GLP-1 receptors are peptides. And insulin, which is maybe saved more lives than any other injectable drug that we've ever created, is also a peptide product. So there is a pathway. But I think there's a lot of people who are trying to kind of jump that evidence gun and potentially taking on more risk than they know that they are taking on.

19:12Perry Wilson:What about the evidence on joint pain? Most of this evidence is in athletes. Some of it's in older people.

19:19Emily Oster:Yeah, it's there. It's there. I mean, so we do have another meta-analysis. And for everyone, a meta-analysis is just a study of studies. So it's a study that aggregates data from multiple other studies that have been done to try to kind of average out the variability and things like that. There was some evidence in this meta-analysis of 15 randomized trials of collagen peptides for joint pain, 12 of which were in athletes that showed some improvement in joint pain. There was really no evidence for muscle building, which is the other thing that people sometimes suggest this being used for. again, one of the problems we have when the outcome of a trial is subjective, like pain or fatigue or even depression.

20:04Emily Oster:How your skin looks. How your skin looks is that it is very susceptible to what we call placebo effects, like the idea that you're taking something. Now, a randomized controlled trial is going to have placebo controls, but just even because you have a placebo doesn't mean people can't figure out what they're getting. Sometimes they taste a little bit different. They look a little bit different, things like that. So, you know, again, for joint pain, it's like, it's, it's relatively safe. It's not going to hurt you. It's they're non-toxic. If it helps, that's great. I mean, some, I don't even care if it's a placebo, right?

20:37Emily Oster:Like if it helps and then you feel like it helps, you feel like it helps, it helps go for it.

20:41Perry Wilson:Yeah. I mean, this is an example of a place where I think we sort of bring together like often what we're looking for when we try to argue for causality. The question of like, is it biologically plausible? I think the answer in the collagen peptide case is, yeah, it's biologically plausible that, you know, this could have some, this could make some difference. And then we're looking for, you know, do we have evidence, either randomized evidence or even observational evidence, but here it's randomized that suggests that we do see some impacts. I will say, I take away from this, like this is small.

21:14Perry Wilson:There are many other things one might do to address joint pain, like strength training and other things where collagen could be like a little helpful, but it's probably not the be all and end all. And sort of similarly, my guess is the overall variation in skin elasticity across people is much greater than the treatment effect of a collagen peptide. Like when you see someone on the internet and their skin is amazing and they tell you they took collagen, I'm telling you, it's that they have good genetics and or are using a filter, not that they are taking collagen.

21:50Emily Oster:And are really good at makeup. Like when I was looking at all the peptide stuff on Instagram and things, these videos, all I was like, oh my God, these people are just beautiful. Like that's the, that is the requirement apparently to be an influencer is to like look really good on camera, you know, which is why I'm glad this is an audio podcast. No one has to look at my unfiltered face.

22:14Perry Wilson:Everyone would love it. Okay. So let's talk about the sort of third piece of the peptide conversation, which is the idea of using injected peptides for like longevity, wound healing. And this is a much bigger space than And then narrow, like I'm taking some collagen to improve my face. It's like, you know, BPC-150. There's a thing called the Wolverine stack, basically, Perry. There's a thing called the Wolverine stack. And I guess, do we want it? Say more.

22:49Emily Oster:Well, OK. Emily, let's take it from the highest authority in the land, Joe Rogan himself. Well, that's the thing about peptides, too. The Wolverine stack, BP-157 and TB-500. I don't know if you ever get injured. If you ever get injured, get immediately on BP-157 and TB-500. I didn't hear about TB-500. What's that one? Thymosin Beta 500. Oh, yeah. In conjunction with BPC-157, it is a phenomenal stack. And it just really helps injuries. I didn't know they called it the Wolverine stack. That's what they call it, the Wolverine stack. For healing? Yeah. Because you heal incredibly well. Like, quickly.

23:23Emily Oster:I was talking to a pro football player who pulled his hamstring. He's like, dude, I shot that right into my hamstring for two weeks, and I was right back on the field. Wow. I was like, that's nuts. So first of all, Joe Rogan, Ben Affleck, Matt Damon in that clip. I mean, we are really blowing against the wind here, Emily. I mean, I don't know that we can compete.

23:43Perry Wilson:No, totally not. I mean, Matt, yeah.

23:46Emily Oster:All right. But let's, I think BPC-157, because of Joe Rogan, honestly, and the Wolverine stack is BPC-157 combined with TB-500, which is another injectable peptide. I think it's really emblematic of the space. And so, no, we are not – I have to apologize to our listeners. There are like hundreds and hundreds of marketed peptides out there. We just simply can't get to all of them and like whether they work and how they work. But I think there's some real big principles here that BPC-157 sort of teaches us. So let's start there and kind of walk through it. So BPC-157, this is a peptide that was initially isolated from human gastric juices.

24:30Emily Oster:Which is weird.

24:32Perry Wilson:Okay. But fine. But, you know, as you said, you can get peptides from anywhere. Why not from your gastric juices?

24:39Emily Oster:Sure. But, you know, because it's being promoted for healing and everything, you kind of, I was like, oh, it must have been isolated from like healing cells or something, whatever. But, you know, hey, the gastric mucosa is a hostile environment. So maybe there's some biologic plausibility there. The data for BPC-157 is essentially entirely in mice and rats. So you injure a rat, like you sever. This is cruel a little bit, but this is how science works.

25:08Perry Wilson:All research in rats and mice is cruel. I know.

25:11Emily Oster:So trigger warning for pet rat owners. They will like sever part of a rat's Achilles tendon. And then, you know, they either inject this stuff or they inject a placebo. and then they see how fast the Achilles tendon heals. And some of those studies in mice and rats do show accelerated healing with PPC-157.

25:31Perry Wilson:Okay. I just want to pause on the question of mice and rat studies because I feel like a tremendous amount of the data that we have in the world about all kinds of different treatments come from mice and rats because mice and rats are really easy to experiment on. You can do all kinds of stuff with them, like cut their Achilles and do other things and look in their brains and kill them and do all kinds of things which may be sad but are effective for learning. And we always then have the question of how do we take the evidence from mice and rats into humans? And, you know, there I think are really good learnings, but someone said to me the other day, you know, if we were mice, we would have solved like everything because actually in mice, you know, you can really titrate and be careful.

26:17Perry Wilson:And there's a lot of things that work in mice, but then when we bring them into humans, it doesn't work or the effect size is totally different or just this doesn't port over.

26:26Emily Oster:Yeah, we're just not the same creatures. But there's even bigger issues than that, particularly when it comes to the longevity space, because mice and rats don't live as long as people. In their natural states, you know, mice might live a year or two, rats might live a little bit longer. But you know what, But in these research studies, they're not letting these mice live to a ripe old age, right? What you do is you do your little Achilles tendon thing and then you watch them for a couple weeks as they heal. And then you – the euphemism is sacrifice the mice humanely. That's the euphemism? The euphemism is sacrifice.

27:04Emily Oster:You kill the mice in as humane a way as possible and there are protocols for that. And then you can extract their organs and look at them under the microscope and do all that stuff. So even if we're like, oh, yeah, this appears to heal Achilles tendons, the larger scale questions of like what happens if you're doing this repeatedly on a weekly basis for years and years and years, like we're not even close to knowing that. And there are some concerns here. So BPC-157, thanks to the mice, we know a little bit about how it might work aside from the general magic of being a gastric juice peptide. BPC-157 appears to bind a receptor called VEGF or vascular endothelial growth factor, which promotes the growth of blood vessels into tissues.

27:49Emily Oster:And sure, that makes sense. If you're talking about healing, you want a lot of blood flow, like that's no doubt a good thing. One of the problems, actually, you probably can guess the problem, Emily. What's wrong if we promote blood vessel growth into tissues too much?

28:04Perry Wilson:I actually, I feel like this is like when my 14-year-old asked me about her biology homework. And I feel like I'm just, no, I don't know.

28:14Emily Oster:Cancer is begging for blood vessels to come into the tumors. And one of our main therapies to treat cancer is blocking VEGF because it turns off that signal that the cancer is saying like, ooh, give me blood, grow blood vessels into me. And then the cancer starves and dies. And so there is a theoretical concern that ongoing stimulation of receptors like this could lead to cancer. And we have no idea if that's true because you kill the mouse a week after you give the injection. So just something to be aware of there.

28:42Perry Wilson:When we look at this particular thing in people, I would say my read is that we don't have much evidence in any direction that this is effective in people. We don't have any randomized control trials. We just don't have anything.

28:57Emily Oster:Correct. Only anecdote, which is unfortunately the problem. Yeah.

29:02Perry Wilson:Anecdote is not data. I mean, this whole space, this Wolverine stack, all of the other stacks, the different things really has the feel of like there's an interesting potential something to explore based on the animal data, but nothing in the people data that would say this should be widely adopted based on efficacy foundation. and then we are worried about, you know, some of the potential risks to using such a treatment.

29:34Emily Oster:Absolutely right. And I think that's the prudent point. But we also have to realize that, A, there are a lot of people out there that are potentially suffering with something. And a lot of times the medical establishment that I'm a part of does a poor job of this, right? They've got joint pain. They have something, you know, yes, sure, they were told to do physical therapy. They're told to do strength training and things just aren't working. So there's a desperation there. Like this does fulfill a need that I think some people have. And then there's a whole group of people, you know, the kind of biohackers who are like, yeah, yeah, yeah.

30:06Emily Oster:I understand in theory that we would like to have a large randomized trial to prove that this works, but I'm not going to wait for that. Like this stuff seems great. My buddy says it's great. This guy online says it's perfectly safe. You know, LFG, like let's go and I'll sort of throw caution to the wind. And I think as much as we can say like, well, guys, I don't know, there's no hard data, it's still going to happen. And so I think anticipating that this stuff is out there, we might want to try to give people some like tools to be able to separate at least what is potentially safe from what is potentially not safe, even if we throw evidence out the window.

30:45Perry Wilson:Yeah. So I want to start with actually the just noting that the – OK. So let's kind of back up. When we think about peptides, there are some peptides that people take orally. Other than some of these collagen peptides, generally oral peptides are totally ineffective because they break down in your stomach and are not therefore absorbed. So if somebody is telling you here are some gummies with this amazing peptide, like that's just a money toilet, like you're just putting your money in a money toilet and flushing it away, correct?

31:15Emily Oster:I think broadly, yes, there are ways to make peptides more stable in the GI tract. oral peptide consumption is basically going to be safe, you know, even if you are ingesting like bee venom.

31:26Perry Wilson:Because it's not effective. It's safe because it's useless. Your stomach is eating it.

31:31Emily Oster:Correct. And so I don't worry too much about people, you know, wasting their money on things. You know, I'm a libertarian in that sense.

31:40Perry Wilson:No, I will say I worry about that because I feel like exactly to the point you had before, which is, you know, people are struggling with this. They want to get help and then online someone's telling them, oh, just take this gummy bee venom and like it's going to fix all of your of your problems. I actually think that really gets in the way of people finding solutions that might actually work for them. So I am more worried than you are about the kind of I'm buying this unapproved thing that somebody on TikTok told me about, even if it is not actually unsafe. Although I agree with you, it's worse if there's a potential safety risk.

32:13Emily Oster:Yeah, I mean, the trick here is being honest with yourself and really trying to determine whether this thing that you tried, if you're going to try it, helped you or not. Like, is your life better or not? Is it worth the expense or not? I agree with you. It probably isn't most of the time.

32:29Perry Wilson:Okay. But then there are these products that you're injecting. So most of these peptides would be delivered. To the extent they could be efficacious at all, they are delivered through an injection like a GLP-1. But these, unlike the GLP-1s, are not in an FDA-approved product category. So generally, the FDA does not approve these peptides, which are made by compounding pharmacies and are not regulated because the FDA has actually now said they are illegal to compound. That includes this BPC-157 and all of these other ones. And so if you're getting these, they are not from an FDA approved supplier.

33:10Emily Oster:I think this is such an important point. And I want to play a clip here about someone who's trying to talk about safe sourcing of peptides.

33:19Perry Wilson:So today you and I are going to have a little chit chat about where you're getting your peptides from. There are a couple of different ways that you can get your hands on peptides. One is going to your doctor and getting a pharmaceutical prescription for it. Option number two, compound pharmacy. But there are two split offs that come up when we talk about compound pharmacies. So one is going to be pharmaceutical grade, human grade, made for human beings. The other is research grade. This is the one that I am telling my clients to stay away from. There's not the same amount of oversight. We don't have third party testing.

33:49Emily Oster:So I really do think because, you know, if you're listening to this and you're like, well, I don't know, Joe Rogan says BPC-157 is good. Like, I want to get my hands on some BPC-157. It is important to know what the regulatory landscape is here. Compounding pharmacies are pharmacies that have a license to mix drugs. That's what compounding is. They can make their own concoctions under specific conditions, ideally sterile conditions, that they can then sell for injections and things like that. Compounding pharmacies are regulated at the state, not the federal level, which gives this whole crazy patchwork of what's legal across the country.

34:29Emily Oster:And because you can ship these things from state to state, it basically is like a lowest common denominator of what the compounding pharmacy can do. Many of the peptides that you'll see out there on Instagram are able to be made in compounded pharmacies, but many of the most popular ones, as you said, Emily, are not. So BPC-157, this Wolverine stack peptide out of Joe Rogan fame, was classified by the FDA as a category two substance, which is one that has significant evidence for harm. And compounding pharmacies are not allowed to synthesize or create anything that is category too, or they lose their license, that's illegal.

35:07Emily Oster:So if you're getting BPC-157, you're actually not getting it from a compounding pharmacy. You're getting it from overseas almost certainly, and most of it comes from China. So again, BPC-157, I think, is like the poster child for this set of problems. It's marketed aggressively. I mean, Wolverine stack, that is awesome. Sounds amazing.

35:28Perry Wilson:Totally. Awesome.

35:28Emily Oster:I'm a superhero fan. That is great marketing. It's got really impressive influencers

35:33Perry Wilson:things come out of your hand like with.

35:35Emily Oster:I mean, I would do it. I would do it if you show me. You've got these impressive influencers talking about it. You have, you know, anecdotal evidence from anecdotal stories, I should say, from people saying how great it is. But it's actually like deemed unsafe. You have to source it from some external country. And we have no idea what its actual effects are. And that's sort of the space right now. It's like it's pretty much the Wild West. And when it comes to eating something, you know, I'm more experimental when it comes to injecting things into your body. Like you don't really want the wild west.

36:06Perry Wilson:Yeah. And I mean, there are all kinds of examples in the past of things that were injectable that turn out bad. I was looking at this Scientific American article from a number of years ago about stem cells where someone had like injected some stem cells to try to fix some eyelid problem. And they ended up growing tiny bones in their eyelid, which need to be removed. I'm not saying that's going to happen here.

36:28Emily Oster:That is worse than the substance.

36:30Perry Wilson:It is somewhat worse. Well, I don't, I don't, I know you may not have watched the substance. That's pretty gross. It's pretty gross. But I mean, I feel like there is a general sense that injecting yourself with things, it runs a risk of infection. And it is just a much more extreme approach to this than say eating something, which again, I don't think that makes sense in this context for almost any of these peptides.

36:56Emily Oster:Let me give you two more risks of injecting things into your body as if we don't have enough. Number one, allergy. As you may know, when we eat things, we have this whole immune system in our gut that surveils them for allergens and gives us tolerance to the things we eat. This is why, like Emily, I'm sure you've talked about, it's actually good for little kids to like get kind of dirty and put dirt in their mouths and stuff like that so that they have less allergic reactions, right? That's what our GI tract does. When we get what are called antigens, which are peptides or proteins or other things via another route, like the injection or sometimes the inhalation route, a whole different immune reaction occurs.

37:35Emily Oster:And that is an allergen forming immune reaction. It is worth noting that the first time you get stung by a bee is not when you have the anaphylactic response to a bee sting, if you're allergic to bees. It's the second time. The first time the allergy starts to get learned and woken up essentially. And then the second time you get stung, you have the anaphylactic shock. As I said, there's infinite peptides you could theoretically inject into you, and it is likely that some, at the very least, will cause severe allergies in some people. So be aware of that. Number two is what we call autoimmunity.

38:11Emily Oster:So your immune system is this amazing thing that surveils all the cells in your body and decides, is this me or is this something else? And in general, if you're healthy, it looks at your cells and says, oh yeah, this is me. I don't need to attack this. This is myself. We're okay. Autoimmunity is when the immune system starts to recognize something in your own body that is you, but it doesn't recognize it as you anymore. So it attacks it. And lupus, for example, is the prototypical autoimmune syndrome where your immune system is attacking these various cells in your body. When you inject a protein into yourself, you form antibodies to that protein.

38:49Emily Oster:That is how vaccines work. When we inject a COVID vaccine, antibodies form against the spike protein. And that works because the spike protein is not you. And so when the immune system sees the spike protein again, it can attack that. Many of these peptides are derived from human proteins. And if your immune system starts to recognize those peptides as foreign, there's a chance that they might start to attack your own proteins that contain those peptides as foreign. And that could be really bad. It could almost do the opposite of what you want these things to do, right? because you want these peptides to stimulate this system.

39:28Emily Oster:And now all of a sudden you have antibodies that are directly attacking the system. That could be an issue in the long term. That does seem like an issue in the long term.

39:35Perry Wilson:Okay, so Perry, I honestly feel like we could just list all of these peptides that exist in the world and just talk about why there's no evidence for them. You know, there's TB500, there's GHKCU. There are a million of these peptides. And if we talked about every one, in nearly all cases, what we would say was, you know, maybe there's a little bit of suggestive something in mice and there's nothing to say in people. And there are these risks of injecting yourself with random things, which you want to be careful about. So I do want to acknowledge the people who are listening, who are like, I hear you about this, but it sounds good.

40:17Perry Wilson:I'm interested in trying. And so if someone came, you know, your doctor, somebody comes to you and they're like, look, I'm really interested in trying to inject myself with a bunch of different peptides. I just feel like it's like, that's for me this week. Is there any way to ameliorate some of the concerns that you have about such activities?

40:37Emily Oster:Yeah. I mean, so, you know, you're probably not going to get them from me directly because I don't think the risk benefit calculus is there. But yeah, just to understand, let's accept the fact that people are going to do this. Like, you know, we cannot fight the tides.

40:52Perry Wilson:Ben Affleck comes to you and asks for some advice. What's the advice?

40:55Emily Oster:All right. Ben, what was up with Gigli? Did you need to do that? Like, was she pressuring you? Okay. If you're going to do it, okay. Realize that if someone tells you that they're getting some of these peptides like GPC-157 from a compounding pharmacy, they're not. It's not legal. So it's coming from outside of the US. So be a little skeptical of, you know, wherever you're getting them from. If you are getting that, and there are places that do a better job of trying to be reputable in this space. And what they do is they farm out the substance to an independent testing laboratory, which issues what's called a certificate of analysis, which basically says like, we tested the stuff in here.

41:35Emily Oster:And yes, it is what it says it is. The things you're looking for on a certificate of analysis, number one is purity. Is it actually, you know, is it clean? Is it the stuff you want? You want basically greater than 98 % purity to feel comfortable. Number two, you want testing for something called endotoxin. This is a bacterial byproduct that causes sepsis and inflammation. You do not want endotoxin in anything you inject into your body. It's also the thing that causes toxic shock syndrome. You want heavy metal testing. So a lot of these that have come from China and other countries are contaminated with lead and other heavy metals.

42:11Emily Oster:So you want the certificate of analysis to demonstrate there's no heavy metals there. You want sterility testing. So they've confirmed that it's sterile. It doesn't contain bacteria or anything. And finally, you want to check the certificate analysis, which should list the batch number and the lot number against the one on the thing you're injecting or else, right, it could just be referring to some other one that was tested years ago. And I know that sounds insane. And maybe that more than anything else is going to convince people not to use these things. But I do think if all of these pieces are in place, you may be okay.

42:45Emily Oster:I would not recommend long-term use though, because we really just don't know the effects. And I am quite concerned about allergy and autoimmunity with repeated dosing. All right, Emily, talked a lot here. What's your one thing about peptides?

43:00Perry Wilson:Don't inject something in yourself that's not FDA approved just because it worked on a rat.

43:05Emily Oster:That's a good thing.

43:07Perry Wilson:What about you?

43:09Emily Oster:I'm not ready to give up on this, but there's some serious snake oil vibes here.

43:16Perry Wilson:Wellness Actually is produced in association with iHeartMedia. Our senior producer is Tamar Abishai. Our executive producer is Jennifer Bassett. Our theme music is by Eric Deutsch. And our content is for educational purposes only.

43:30Emily Oster:If you like the show, help other people find us. Leave a rating and review on Apple Podcasts or your podcatcher of choice and help us spread the word about the show. Don't give the TikTokers all the power. And don't forget, we want to hear from you. Head over to wellnessactually.fm and leave us a question for our mailbag or suggest a topic for a future show.

43:50Perry Wilson:We'll let the influencers have the last word.

43:52Emily Oster:I've gotten a ton of questions about what a peptide even is. So let me make this stupid simple. Peptides are short chain amino acids. They're fragments of protein. They're not steroids or drugs or some fairy dust that some influencer talks about. So imagine your body is like my 911 Turbo S. Now imagine somebody handed you the upgrade file, the tuning file that gets your car to use all the stuff that it already has, but forgot was even there. That's what a peptide is. It's not forcing anything. It's saying, hey, you know all this hidden horsepower? Yeah, do that. Peptides are like voice commands for your biology.

44:26Emily Oster:They walk into the pit crew of your body and they say, all right, fire up.

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46:26Emily Oster:36-month commitment.

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