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Key Takeaways
Most drugs in the US are prescribed off-label, meaning they’re used for things other than what they were originally approved for Stacking more and more behaviors is not the answer; No pill, potion, or injection is going to replace good behaviors but they can augment them and set you on the right path
For example, some patients build healthier lifestyles and behavior habits after losing weight with the assistance of GLP-1s Always remember the importance of maintaining positivity; it has tangible impacts on health and overall well-being – “Nothing good has ever come from negative thought.” – Craig Koniver Peptides can push and pull on various systems without intervening with hormones and potential negative feedback of endogenous production
There’s a peptide for almost everything! Injury repair, sleep, cognition, heart health, libido, etc. It’s critical to work with a physician under monitoring to source clean peptides and titrate the correct dose
The FDA regularly pulls peptides so the landscape can be tricky to navigate without help, not to mention the potential for black market contaminated peptides “If I had to pick one thing for people, engaging in NAD would be it.” – Craig Koniver Two supplements worth taking: CoQ-10 and methylated B vitamin
It’s a good idea to cycle supplements 5 days on, 2 days off (take weekends off) to improve adherence and efficacy
Introduction
Dr. Craig Koniver, M.D. (@koniverwellness), is a board-certified physician trained at Brown University and Thomas Jefferson University. He is a leading expert in performance medicine and uses cutting-edge tools such as peptides, NAD+, and hormones to enhance well-being, performance, and overall health. Check out his company, Koniver Wellness.
In this episode of the Huberman Lab podcast, Andrew Huberman and Craig Koniver discuss the therapeutic application of peptides and hormones for enhancing physical and mental health and performance.
Host: Andrew Huberman (@hubermanlab)
10:00 – Understanding Glucagon-Like Peptide-1 (GLP-1) Agonists
What is a peptide? Peptides are chains of amino acids; the body makes about 300k peptides
Peptides can push and pull on various systems without intervening with hormones and potential negative feedback of endogenous production Semaglutide like Ozempic was originally prescribed for type II diabetes then studies found patients were losing tremendous weight Most drugs in the US are prescribed off-label, meaning they’re used for things other than what they were originally approved for
GLP-1s were originally approved to help type II diabetics with glucose utilization but have since been approved specifically for weight loss Pharmaceutical companies are interested in other uses for safe drugs; research is incredibly expensive Concerns with GLP-1 use: Expenses, dependency, and behaviors won’t necessarily change – such as diet and exercise Validity of use: Some people do better by losing weight first and then become excited about cleaner eating and exercise; when something works and is safe, it’s worth discussing
If you can get people to feel better, sometimes it helps spur action Tip: Take your time dosing to avoid nausea Adipose tissue produces a lot of hormones that impact the brain and brain function
Body-wide inflammation comes down with weight loss Conventional doses of GLP-1s trigger weight loss too quickly; micro dosing is encouraged with a target of losing about 2 pounds per week – this helps reduce muscle loss as well
18:45 – Uses For Body Protection Compound 157 (BPC-157)
There is plentiful animal data supporting the use of BPC-157 but only 3 human studies Known uses for BPC-157: Potent anti-inflammatory, beneficial for exercise recovery, may upregulate growth hormone receptors, effective for gut regulation
Start with a small dose (500 micrograms per day) and increase gradually over time; cycle 5 days on, 2 days off (not taken every day to change it up to maintain potency and adherence) “I would argue, anyone who’s working out regularly, BPC is going to benefit.” – Craig Koniver Oral BPC-157 seems more limited to the gut; useful for conditions such as Crohn’s disease, leaky gut, and irritable bowel syndrome – though it seems people still benefit more from the injectable version
In general, people seem to have a better clinical response to injectable BPC-157 Intravenous stem cells have been shown to aggregate at the site of injury Injury repair: Circulation moves fast; BPC-157 shines in ligament and tendon injuries – it can be directly into tendons, and you’ll get healing within days
29:00 – Sourcing BPC-157 & Peptides
There’s only one anabolic steroid (deca-durabolin) that can be prescribed and used with testosterone, the rest are difficult to get ‘clean’ or black market There is a concern about loss of fertility with synthetic testosterone Have a physician help with testosterone and peptides; people get it from their trainers or ‘bros’ but this is very detrimental in the long run for sperm quality
Only put peptides into your body that you have gotten from a physician you have met with and is monitoring the dose and response Physician trust is very important in health Some companies will sell peptides labeled for ‘research purposes only’ – the potency and purity are not established and many are contaminated with inflammatory ingredients (lipopolysaccharides) In response to the black and gray market, many peptides were put on the Category 2 list (in 2023) meaning they cannot be compounded
It’s been a blow to the compounding pharmacies (compounding pharmacies are highly regulated)
43:00 – Other Peptides
BPC-157 has been removed from the market; a newer compound pentadeca arginate (PDA) is almost the same molecular structure as BPC-157 but one amino acid is changed PDA is a good physician-prescribed alternative to BPC-157; 250-500 micrograms starting dose taken Monday through Friday with weekends off (not taken every day to change it up to maintain potency and adherence) There are no known major side effects to either BPC-157 or PDA Peptides that stimulate endogenous growth hormone release:
Ipamorelin at bedtime helps push out growth hormone and directs when it’s pushed out; max dose should be 100 micrograms; ipamorelin is the most specific but the weakest
It’s important to be asleep between 10pm-2am because that’s the largest pulse of growth hormone in the 24-hour period Side effects (like flushing) can take place if taking too much Typically used in conjunction with CJC-1295 which allows growth hormone to stay in the system longer GHRP-6 binds growth hormone, prolactin, and ACTH; but can lead to cortisol spikes and hunger response
Uses: If you want to put on mass and have the discipline to eat enough protein and exercise to bulk; dose 100 micrograms Typically used in conjunction with CJC-1295 which allows growth hormone to stay in the system longer Tesamorelin (ideal dose is 2mg) and sermorelin (wide dose range from 200 micrograms+ depending on goals) work on growth hormone release
Tesamorelin works on visceral fat reduction and seems to work better on females than males Stacking peptides at bedtime: Subcutaneous fat reduction from ipamorelin, visceral fat reduction from tesamorelin, upregulation of growth hormone receptor from BPC-157
1:01:54 – Coenzyme Q10 (CoQ10) & Supplements
CoQ10 rationale: Mitochondrial health and energy; allow for more electron flow to make more ATP (energy)
Dose: Can take up to 2400mg per day; no known side effects Other uses: Has been shown to help with migraines and headaches Check out Thorne CoQ10 Homocysteine is a marker for looking at cardiovascular risk profile; an elevated homocysteine means you are at an increased risk for cardiovascular event (heart attack or stroke)
Taking sufficient methylated B vitamins lowers homocysteine Examples of methylated B vitamins: Methylated B12, folate, methylated B6, trimethyl glycine, methionine Instead of taking more caffeine if you get that afternoon slump, try taking a methylated B vitamin
1:17:13 – MK-677, Energy & Appetite Peptides, Sleep Peptides
MK-677 is similar to GHRP-6 in its ability to stimulate appetite, and cortisol; this is not what most people are looking for unless you are trying to put on muscle mass and otherwise have difficulty maintaining Hexarelin is an energy endurance peptide; use it in the morning for a nice burst of energy; a dose 100 micrograms Pinealon can improve REM sleep; works especially well in combination with glycine
There seems to be a circadian rhythm effect but much more needs to be understood Often compounded with glycine which is calming to the nervous system and helps transition from the day to settling down at night; also works on liver detoxification (particularly important in today’s world we’re exposed to heavy metals and metabolic debris)
If you can’t get injectable glycine, it is absorbed well orally – you can take up to 10g Epitalon is involved in DNA repair and has been explored in animal studies for offsetting vision loss
1:37:19 – Revisiting GLP-1 & Compounding
FDA is unlikely to pull GLP-1 because they’re making too much money Concern: GLP-1s are being compounded because there’s a shortage; this has increased their accessibility because they’re more affordable BUT there’s a chance companies are increasing production and will shut down compounding
1:39:03 – Stem Cells, Platelet Rich Plasma (PRP)
Stem cell is a problematic term; if you are taking a cell from the patient and returning it within 4 hours, that is allowed under FDA guidelines As long as stem cells are taken from your own and then given back to you, they should be safe Again, make sure you are going to a legitimate clinic with physicians you trust
1:41:18 – Thymosin Alpha-1, Peptides For Brain Health
Thymosin alpha-1 (no longer FDA approved) was used for immune modulation for overactive immune system Cerebrolysin has been used for decades post-stroke and brain injury to help with brain fog and cognition; collectively increases BDNF
Problem: It can induce some depression symptoms for 1-2 days after initial use; most people climb out of it Methylene Blue was the first pharmaceutical approved in the US; it’s gained steam in the last 5 years as a potent ‘oxygenator,’ anti-viral, helps clear the system, and is a cognitive stimulant
Absorbed well orally, and temporarily (24 hours) turns your tongue blue; if it doesn’t, that’s indicative your mitochondria aren’t working well Dose: 10mg in the morning, taken about 3x per week
1:50:20 – NAD, NMN, NR
Anecdotally, NAD infusion helped some (like Huberman) recover from COVID within 48 hrs and test negative after a strong positive days before NAD (750mg IV loading dose; not absorbed well orally) works almost inexplicably to help go from a sick state to a well state very quickly; loading dose with 1x per month maintenance dose
Anecdotally, there seems to be something in the mitochondrial effect that’s not well understood Infusions are costly ($500-1000) and can be uncomfortable to the point people take anti-nausea medication simultaneously “If I had to pick one thing for people, engaging in NAD would be it.” – Craig Koniver If you can’t afford the infusions, injections are next best; if you can’t afford either, NMN is the next most promising NMN helps hair and nails grow fast; it is studied for other uses, but data is murky NR can reduce inflammation but data is sparse; less costly than NAD and NMN but doesn’t seem as effective
2:07:53 – PT-141, Vyleesi
PT-141 bolsters immune response and bolsters libido; the problem is therapeutic window is narrow and it can cause nausea, also causes an orange tanning look Vyleesi stimulates libido in women and men
2:10:57 – FDA Intentions, Pharmaceutical Companies
Unfortunately, when the government is involved, it overreachs
There is an element of protecting people but there are ways to protect people without entirely removing drugs from the market as we see with peptides Pharmaceutical companies make tremendous profits; it’s in their interest not to have lower-cost options (from compounding pharmacies) available
Pharmaceutical companies are greedy AND want to help people – both are true “When we’re talking about healthcare and we’re talking about people’s health, we’re not even close to talking about the truth for most things. We’re not talking about why people get a chronic disease, we’re not talking about how our food is really overprocessed...you have to be your own best advocate.” – Craig Koniver
“We’re deemed healthy by the pills we take.” – Craig Koniver Seek out people with experience to help guide your truest health journey
2:20:17 – Positivity, Mindset & Health
Medicine is great for life and death situations but medicine won’t help you lead your best life “Nothing good has ever come from negative thought.” – Craig Koniver
Life doesn’t have to be peaches and cream but when you lean to more positivity, you get more positivity in return Your positivity can never be taken from you “The mindset of positivity can override everything. Literally.” – Craig Koniver
Articles
Challenges to physician–patient communication about medication use: a window into the skeptical patient’s world (Patient Prefer Adherence) Transport of Biologically Active Ultrashort Peptides Using POT and LAT Carriers (International Journal of Molecular Sciences) Dynamic Imaging of Allogeneic Mesenchymal Stem Cells Trafficking to Myocardial Infarction (Circulation) Mesenchymal Stem Cells Home to Sites of Injury and Inflammation (Advances in Wound Care)
Books
Memory: A contribution to experimental psychology
Other Resources
Stanford Metabolic Psychiatry Unproven stem cell ‘therapy’ blinds three patients at Florida clinic
Huberman Lab Episodes Mentioned
Benefits & Risks of Peptide Therapeutics for Physical & Mental Health (Podcast Notes here!) Dr. Peter Attia: Supplements for Longevity & Their Efficacy (Podcast Notes here!) Dr. Zachary Knight: The Science of Hunger & Medications to Combat Obesity (Podcast Notes here!)
People Mentioned
Chris Palmer: Professor of Psychiatry, Harvard Medical School Brian Johnson: Blueprint company founder Charles Brenner: Professor, Department of Diabetes & Cancer Metabolism, City of Hope
Huberman Lab : health, life, longevity, peptides Notes By Maryann
More Notes on these topics