Why Your Muscle is "Toxic" | The Body Composition Blueprint

Chapter 1: Why the scale is lying about your health

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Okay, everybody, welcome back to Cell to Systems. In this episode, we're going to cover the body composition blueprint. So, we're going to talk about muscle quality as well as visceral fat and functional capacity. So VO2 max, the three kind of main things that are getting talked about right now. And as we cover this, remember we're speaking to you as a patient. That's me. And then we're also talking to providers who are out there thinking about being involved in functional longevity, cellular medicine, whatever you like to call it, and want to learn more about how to provide that at the highest level. So, as we get into this, we're going to put some things into motion and talk about stuff at a deep level.

So the first person I want to talk to today about all of this is Christie because Christie, you are truly, you know, the athlete of athletes. You're just out there making it happen all the time. You're always, you know, moving and I think you're doing it in a way that's really constructive. You don't overtrain. You just get the right amount. You do it. How do you do this in the right way to make sure that you're tracking everything and staying in the right shape and have a long-term plan?

Yeah, I mean I think you know for myself I really just go by how I feel. That's how I make my adjustments. My biggest issue is usually my sleep. I need to do more neurotherapy and I realize that. But you know for patients I think we always start with like muscle is your biggest wealth.

Chapter 2: "Muscle is Wealth": Your #1 asset for longevity

I know all of us here live that and believe in that and that you truly can't have lasting health if you don't have more muscle than fat. So I just starting simple and then my approach with patients is I in my brain I literally kind of break them up in decades—you know like your third decade, your fourth. And when I have a patient that's in their fifth decade, for me as a provider it's game on because I know if I can help catch a male or a female in their 50s and get more muscle mass on that, that will absolutely convert to their 60s, 70s, and 80s versus if I fail them if I don't recognize the muscle loss that might be occurring from a longevity perspective or that they have more visceral fat as far as disease risk.

The body fat percentage as far as metabolic and then just muscle balance. I think that's an area that I am very passionate about just being an athlete as far as the balance. I can tell by just simply how a patient walks in to me or walks down the hallway—you know, how they sit to stand. They always start in the chair, but then I will move them to the table to do a thorough exam or any procedure that might. And then another favorite one of mine is the phase angle as far as on the InBody. You know that is a very exciting tool for me. Knowing that we want that number above seven, like you know that's excellent. Not a lot of people are there but that's where we would like for them to be. You know 6 to 7 is considered like cellular health, five to six is average, but when I start seeing a patient in their fours, my radar is on as far as either looking at peptides, making sure that their hormones are optimized. And then, you know, their food and their movement and their sleep are on point.

Yeah. Sleep being so, so important and diet. Just having been getting so focused on diet recently for a specific goal that I'm trying to achieve. Which Suzanne's funny, we talked about that the other day. Suzanne, what's your thought process around what's important?

So it's interesting. It's been really curious. You know, I come from powerlifting. That's my sport or has been my sport. And my teammates are all huge guys. This guy that I train with place first nationally—I mean, internationally. He squats over 800 lb, like almost 900 lb. It's kilos, so I don't know what the math is, but anyway, it's very close to 900 lb on his last competition. And this guy was before we started working with him, he was enormous. And not just in normal—his head was big, his neck was big, his arms were everything was huge because they don't have to be balanced.

Chapter 3: Testing your "Cellular Age" with the Phase Angle

In powerlifting, all you have to do is be stable. That's what's most important. And so in thinking about these guys and a lot of the guys that we see that are like this guy, he would walk past me and he would say, "Doc, I want to have arms like you one day." And that got me thinking about like this is not about muscle mass. This is about the quality of the tissue itself, right? What is the message that the muscle or the tissue is sending when it's full of fat? When you look at it on a DEXA or whatever, you can actually see this sort of mottled appearance with lots of fat stranding in between the muscle fibers.

So when we're talking about muscle hypertrophy, we're not always talking about hypertrophy of muscle. Sometimes it's infiltrated with fat. And so we call this myostasis. And this can be really toxic to the cells. So now that extra fat layer begins to communicate via cytokines with other cells. The healthier myokines which we love like irisin and BDNF that are secreted help with brain health. That helps with the neuromuscular junctions which are kind of destroyed in things like ALS etc. Those—the BDNF that's secreted by an exercising muscle—is actually going to really help with the whole rest of the body and the function of everything. Those chemicals will go out to the body and say everything's fine. This is a young healthy body. Let's keep doing all the young healthy things and producing in our sort of proteome the younger proteins.

Chapter 4: The Myostastis Trap: When muscle turns into fat

The concern is when we have that higher visceral fat then we start seeing this negative signaling and this inflammatory signaling that causes all the things. So sometimes when I see like for example a higher CRP on people I'm imagining that may be part of the situation. So thinking about not just looking at what the tissue is, the size of the muscle or the increase in amount, but also the very health. So, we look also at things like, you know, the cell membranes. Every cell are made of lipids and fats in the cell wall, cholesterol in the cell wall. We want that all to be there and healthy and not oxidized. This is a way that mitochondria function better. It's the way the cells function better when those aren't happening. And we see that with that phase angle. I'm so glad you mentioned that, Christy. That's such a great marker because you're going to see that cell wall not be as healthy as we want it to be.

And when that cell wall is not super healthy because of oxidized lipids or other metabolic inflammatory things—spike protein etc.—when we see all those things coming in we see that the cells don't function as well. So there are the receptors for our hormones, the receptors for vitamin D which is also a hormone, the receptors for moving fat in and out of mitochondria for energy production. All of those things don't work as well when the tissues aren't quite as healthy. And so, as much as we love seeing our patients put on muscle, be aware of that phase angle being so critical because it gives you really a great idea. And sometimes you may be adding a DEXA scan in addition to give you an idea of whether we're dealing with a fatty stranded meostasis situation. And then always thinking about is the tissue that we have functioning in a young or in an aging fashion.

Someone once said that to me, functional muscle, right? What is actually the function? You may lose some size along the way and think to yourself, "Oh, I'm losing muscle." No, no, you're actually—well, we got this guy down 30 lbs of fat and that was before he did his almost 900 lb squat. So he went down and yet still because he lost mostly fat, he still was able to do that competition.

Yeah. It's wild, right, Suzanne? There's this new—I don't know if you heard about it—it's called Springbak Analytics where you can send the patient to get a full body MRI and they can now measure fat infiltration in the muscle. I was trying to get them to come to COM but they were like no because they're in research and they're trying to get into the longevity space and I was like yeah you don't understand our doctors would love to have this information. You have markers or percentages of fat infiltration all over the body, all over muscle, and then they can actually look at injuries because when you have injuries in certain muscle there's more fat infiltration there or if there's more density of the muscle it looks like you have more muscle somewhere but it's really like an old injury. So really cool data that's going to be coming out around body composition even outside of InBody and DEXA scan. So really excited to see that because yeah, one of the things that we talk about a lot is people lose a ton of muscle when they're losing weight and if they come in like your patient like well-muscled and people are like oh this is anti-longevity they just lost a bunch of muscle. It's like well what was the quality of muscle that they lost right? Because sometimes they need to get rid of some of that fat infiltrated muscle and kind of rebuild it. So there's a lot of nuance to this body composition.

Chapter 5: Can you "rebuild" poor quality muscle?

He has much healthier muscle mass now than he had before. And so he's able to lift a greater amount of weight than he was because we were able—and this was all without a GLP-1. This was all with diet and changing up his activity. Yeah. And that reflects the literature because the literature tells us that strength is an even better indicator. And so what you're describing the opposite of what most people think about is like once you lose muscle mass, you lose strength. And you have this perfect example of someone setting these almost like records of squatting so much weight. I can't imagine what that's like. Can you imagine on your back what it feels like? This guy's like, "Oh my gosh, no. My lower back hurts just thinking about it."

Yeah, that is wild. So, Leonard, what this technology is is in research, but do you think by next year COM? Yeah, I think we created a buzz around COM. They went silent. And as soon as I got home from COM, I got an email from them: "Hey, let's revisit that talk." It's like, yes, you guys needed to be there. This is what doctors want to know. They want to know the quality of muscle. And then with injuries, there's so much implications with this thing because if you look at somebody that has like more dense muscle on one side due to an injury, some people like the left side of their body hurts because the injury happened on the right side and now they're favoring the left side. And so now when we're thinking about certain peptides that you can inject by certain locations where the injury is, now you have an MRI showing exactly where those injuries are. So I'm like we have to start having conversations with these brilliant doctors because this is going to make a big impact.

But I'll be your best crash test dummy ever. Nine orthopedic surgeries later, I'm a walking injury model. Yeah, this person that read the model for me, he saw where my symmetry was off and where I had more dense muscle. And he's like, "Did you do some type of a sport where you were leaning in one direction because I've always had really tight hips?" And I was like, "Yes, I used to snowboard a lot and I was always on my back leg, always on my right hip, and that's why my flexibility is completely off." And I think why I have certain injuries. But he had a whole report telling me about what sport I probably played just by looking at this MRI and looking at where I was favoring things. Static like not moving. It's an MRI which was incredible.

Chapter 6: New MRI Tech: Seeing fat infiltration in real-time

That's wild. That's totally next level. That is so cool. Craig, I want to bring it over to you now. You're a pretty active guy in the water. You surf. How do you approach all of these things when you think about VO2 max and visceral fat and then muscle mass? I love what Christy said—the notion of by decade. I've never thought about it that way before, but it makes such sense, right? Hey, a 50-year-old male or female and if you can have an intervention there and stop them from having these problems where 60, 70, 80 things really start to fall apart. I'm just curious how you approach this.

Yeah. So, I mean, lots of things running through my mind right now. I've learned so much just in this episode so far from you guys. But you know I am—we're all aware of the fact that as we age we lose some density of our fast twitch muscle fibers. We're much more prone to risk for injury and things of that nature. I love bringing it back to what Christy and Dr. Furry mentioned about the phase angle. It's wonderful to see these numbers being suboptimal on a measurement and then making some change whether that's optimizing fatty acids, reducing the inflammatory milieu, but then coming back on the next assessment and seeing that after somebody's hormones are balanced and any other interventions, that they've had an improvement in that phase angle which can correspond to cellular fragility and cells that are going to be less resilient to oxidative stress and even things like viral infection if we think about it.

So, definitely looking at phase angle, always trying to reinforce to patients that what we can do here in the clinic, whether it's the InBody or whether we refer you out for a DEXA scan, that's so much more important than what you're going to get at home from just standing on your bathroom scale, right? So, somebody could weigh 150 lbs and have poor muscle integrity, high visceral fat levels, and declining bone density versus somebody else who has the opposite picture weighs the same amount. And those two phenotypes are associated with very different biologic futures. So, it's not going to be about the number, it's about what is in the data that we see in those more advanced tests.

From a simplified standpoint as to what we can do just on the physical exam or in the office, you can use something like a simple sit-to-stand test. And you can really just say hey, 30 seconds, you're going to cross your arms, you're going to sit in this chair and as much as you can, as many times as you can, pop up from a seated position to a standing position. And really if it's 12 or less, you're kind of looking at somebody who's got an increased risk for frailty, they have an increased risk for mortality and cardiovascular disease.

Chapter 7: The 30-Second Test: Can you pass this longevity challenge?

You can also look at things like dynamometer results and grip strength. This was another topic at COM—so if we have a gentleman whose grip strength is lower than 30 kilograms of force, this is something that we need to pay attention to. So, simplification of things and just taking it back to the physical exam and seeing what somebody's gait looks like and the readiness to move and helping to evaluate their current health from those little assessments.

It's scary what—think about it—it's almost like the most dangerous patient in your practice, Craig, right? Is the one who looks totally fine.

Chapter 8: The "Skinny Fat" Emergency: Fit on the outside, failing inside

But their muscle is quietly being just replaced by a bunch of fat from the inside out and they have no idea. This is what people need to really understand—you might look perfectly fine, but you have a problem because you have fat infiltration inside your muscle and you have no idea about that. It'll take things like MRIs and CT scan, DEXA, grip strength, gait speed to figure those things out. And where else can you go to get those things right? You got to go to very smart clinicians like you guys to get this thing done.

Yeah. Along those lines, I mean there's a lot—there are all these different agents that people are using now to, you know, cut fat, right? And there's a lot of dangerous stuff with this going on. The one thing I would say is, hey, if you're new to this and what you're hearing is something that you've never talked to your primary care doctor about, there might be a reason why. And you might be finding out right now that this is a totally different ballgame, a totally different way of looking at things. So going back to some of the stuff we talked about in the last couple episodes—and I think it's tightening up now, closing—like these windows are closing. We saw somebody voluntarily close their company just recently. But I'm curious what your thoughts are with regards to people and using agents and all of that.

Yeah. It's funny, Jock. Every time we talk, every time we meet every week, there's something new. It's absolutely crazy. But yeah, you know the black market exists right now. Everybody's using it. Things are changing. Well, it's still there because legitimate supply chain are failing, right? Regulatory forces are pushing pressure on us, pharmacies, pharmacists, physicians to do things differently to stop access or creating more difficult ways to get the good stuff. So it's very, very difficult. I mean the core message is still the same. A peptide or compound is only as good as its sterility, its purity, its potency, right? If you have to remember one thing, that's what you have to remember. When you have things like endotoxin contamination—well, if your peptide or compound is designed to enhance your muscle mass, but it's got a lot of endotoxin in it, well, it's going to trigger some type of systemic inflammation that's going to create the total opposite of what you're looking for, right?

So, you got to be very, very careful as you're navigating this. And we talk about it all the time and it's just becoming more and more clear and people are starting to actually understand those things. That same peptide sold in a research chemical site with no standard is always problematic. There's no sterility testing again. There's no endotoxin testing nor certificate of analysis. You can't actually verify it. And the analogy here is, will you go on an airplane if the captain has no license, but he can show your document that he learned to fly in the flight simulator? It's the same concept in the pharmacy where you use a peptide from a research chemical place because they tell you to trust it. You have no other way to actually trust it; you just got to trust them. And there's no accountability towards it.

So, it's just very interesting. One of the things that was so in the news I wanted to talk about is on the black market, or the research chemical side, there is a big push right now for what they call TFAs.

Chapter 9: The TFA Warning: The hidden toxins in cheap peptides

There's a lot of compounds inside steriles, sterile drugs or inside APIs. APIs is your actual raw ingredient that pharmacies are getting from the manufacturer directly. So when you get your raw ingredient that comes in, you have to make sure and ensure that the manufacturers remove certain bad products from it. Nothing is perfect. You're not getting this powder and just like perfect. There's always something in it, right? There's always traces of elements that are toxic for you. So it's the manufacturer's due diligence—I mean that's their job to ensure that they remove all those bad things from them. And what we're seeing is we start to see a lot of TFAs in there. TFAs are really bad products of pretty bad ingredient that's actually sometimes inside those products.

And what we realize is that they're not testing for TFAs. They're not testing for those products which are extremely dangerous but very often part of the ingredient. And I was doing some more research on it and I noticed that a lot of the COAs out there don't even include TFA testing which is extremely scary because it's a toxic product and over time will affect so many things like your brain, your liver, your kidneys. And to me that's just one of the other things that people need to be aware of as they're making those decisions around peptides and compounds and pharmacies and such. Certainly don't want to scare anybody, but it is pretty scary out there.

What you just said, Frank, is so important for people. I mean, we've known this in the supplement industry. For those who've been in the fitness community for all these years, lifting and all that stuff, the supplements have been full of like bad stuff. It's been fraught with that. I mean, I think that's one of the things—sorry, just have to call it out—it's your company, but New BioAge or Progress Pharmacy where you guys are doing everything at the highest level. You're really calling out the industry and saying, "Hey, you have to hold yourself to the highest level." And a lot of people don't want to do that. We've seen it; people get away with this for the longest time and it's really detrimental to people. And now is the time for that to change—now more than ever in my opinion. I mean, I can only imagine how much garbage I've taken over the years and especially, Suzanne, going back to you, Dr. Furry in the powerlifting community, right? You can just imagine—I watched Bigger, Faster, Stronger again over the weekend. So good. I mean, you know, I mean, you just think about those guys and you know, it's a sad story in many ways.

But you know, that notion of, hey, they're just trying to put on—and you see these guys in the gym. It's crazy. I mean, they are just trying to get—one guy kind of strutted down the way the other day and was like, "Get out of my way or I'm going to run you over." Not to say all powerlifters are like that, but the point was like, no, they wouldn't be running. I mean they're just massive, massive guys. And it's wild to think, but I think, Frank, you just bring up such a great point and people really need to know this. You've talked about it in the COAs. You've talked about it in all of the stuff before. It's we just have to keep drilling that into people's head that really the stuff that you put into your body, whether you take it orally, you inject it, whatever it might be, however—topically—it needs to be the highest quality and it's just so, so important.

Leonard, I want to come back to you because once again there are some—when somebody comes in, they've got that toxic visceral fat and they're trying to figure out okay well what do I do, you have some products that are designed to supplement and help address that. But I think it's important to kind of talk about what do people do, what's the right approach when somebody's in that kind of situation.

Yeah, I think it's really important that you work with a provider because it's very personalized. When people come in, we've been talking about body composition. They can come in like what I call four different phenotypes, right? It could be, you know, like skinny fat like Frank was talking about earlier. But that gets mismanaged all the time. People come into a doctor's office, they say, "You have a normal BMI." They put them on the scale, they move that little weight thing to the side, and it's like, "Oh, you're doing great." And actually they can be in some of the most danger because they have low muscle and high fat. And that's one phenotype. There's a recommendation when it comes to nutrition, a form of exercise, what type of compounds we potentially want to use for that person.

And then there's the obese muscular, which is a little bit more of what Dr. Furry's been talking about—those patients that are muscular, they have high fat and they have high muscle. And so you might have a different strategy there compared to someone that's like more frail where it's low subcutaneous tissue and low muscle. So, it really depends on where you start and I think it's important that you work with somebody because how you exercise, your calories, the amount of protein you take, what compounds you use is going to be different depending on where you are.

And the one thing that you actually, Jock, I think you mentioned at the beginning of the podcast was that whatever you start initially with—like that initial protocol that you're using to initiate weight loss—is probably not the same one that you're going to have 3 to 6 months down the line because especially if you're working with one of these doctors, things change and they change quickly. So the prescription changes, the exercise prescription changes, the nutrition might change, the compounds you use might change, right? If we see somebody is in one of those scenarios where they lost a lot of muscle and they lost a lot of fat, but we're not upset about it. They're now metabolically more flexible. They lost a lot of dangerous fat tissue, but now we might want to pivot and start thinking about, okay, what are the things we're going to do to help this person regain that quality muscle?

And so I do think it's important. There's a lot of different supplements and peptides you can use, but I think you need help guiding you. I mean, I need help as well, too. I pay for a trainer just because that's their expertise, and I tell them what goal that I have right now and the injuries that I have right now, and they help guide me through what type of exercises I need to be doing, what type of stretches I need to be doing. And that completely changes for me from time to time depending on what my goal is. It might be performance. It might be body composition. And so I think it's important that you reach out for help and that you work with somebody that can guide you through that.

Yeah. So true. And there are so many resources available within the right provider groups. Like for instance, Veronica, your clinic—Christy is a coach and nutritionist, dietitian, right? And she's phenomenal. So, she's able to help people really achieve the right goals around the very things that Leonard's just discussing. How does that fit into your clinic?

I meet the patient where they're at. You have some patients that walk in and they're clueless about food. Kind of my analogy that I use a lot because people will remember it is: if it's not picked, pulled, or killed, we probably shouldn't be eating it, right? And so I say that because, one, they get a kind of a chuckle, but they will remember that. And you know, I think so much of our food source is just tainted. It's crap. And sadly, unless you're just growing your own food, it's really hard to get quality food. And so it's having our nutritionist—and she actually has her masters in dietetics—having someone that can help her walk through that. And then, you know, we also do a food allergy testing because sometimes, for instance, they might be eating a meat, beef, that is inflammatory to them and they just don't know it. So we use that test quite a bit, probably as our next test that we layer up if needed after just the basic kind of InBody that Dr. Furry was referring to.

And then I think the other thing is then also having a health coach involved so that they can help assess like what are truly their day-to-day barriers to health. My health coach—she will literally go follow them their day and like try to understand—is it a stress issue that they're dealing with? Is it a time management? Is it poor time management on their part? Or is it also just lack of preparation? You know, some people, I mean, you can't—you have to prep, right? You have to have a plan to have a successful week. Not to say you have to have all your meals prepped. I mean, that's great, but there has to be a plan in place to have success. And then we move to that next layer of actually getting them with a true coach, like a trainer—someone that's really looking at their functional movement, their strength, mobility, and, you know, their ability to get off the floor. Sadly, I'm kind of dealing with this with my mom right now. She's had a couple of complications from eye surgeries and she's having a hard time literally going from sit to stand. But it's something that we will work on for improvement.

Dr. Furry, a quick question for you with regards to all of this. When you think as we've listened to everybody today, when you think about the key takeaway here, what comes to mind? Is there anything that's like buzzing in your head right now?

Chapter 10: How minerals and hydration stop the "Stress Cascade"

It's the health of the cell. It's realizing that just because that appears a certain way, we need to be looking a little bit deeper. Just because you have enormous muscle mass may not be that that muscle mass is giving us what we want. You know, one of the things that's really important, the other piece that's really important looking at the bioimpedance analysis is looking at their intracellular water content, making sure that they're well enough hydrated intracellularly so that all their systems function well and so that we're turning down that sympathetic drive because a dehydrated cell is going to trigger a high sympathetic response. So that's also going to trigger all kinds of cascade of inflammation in the body and that's where we run into lots of problems. So making sure that you're doing things like osmolytes, like minerals, where you're getting intracellular hydration—and we can monitor that progress over time with these testing modalities that we have in our clinics.

That's super cool. Craig, anything that you want to add to it before we go?

Yes, just want to pivot back to what Frank was saying, which is on the topic of the research compounds and so forth. I find it fascinating that these companies, they're becoming more sort of like discreet or sneaky in the way that they approach clinics, you know, and the language that they use to sort of say, "Hey, this is what we offer. We can help you increase your margins. These compounds are proven safe, they're very effective. We'll give you all the COAs and whatnot." It's just getting sneakier and sneakier. And for practices at the practitioner level, we have to maintain that integrity. You know, we're not here at the end of the day for us. We're not doing this for us. We're doing this for the patients, right? We enjoy the science behind this. We enjoy seeing people thrive. But at the end of the day, it's always about the health and the safety of the patient. And so as practices cave to these research peptide companies and they start utilizing those compounds in their practices, we just got to maintain a strong line against that and make sure that we keep the integrity high. So, my message is to all of the clinics out there: don't falter, right? Just continue to work with reputable compounding pharmacies—Progress Pharmacy, other pharmacies across the country—and make sure that we're doing right by the patient.

As you were saying that, no joke, I just got a text message from a local doc in Florida, and he's like, "I just got a rep that came in my office. I can't say the name of the drug here, but it is the hottest one on the market right now for weight loss, right? It's about to get approved. Obviously, it's not FDA approved yet, but it's about to get approved. Starts with the R. Can't say it." He's saying—it's a text message—"I got a guy asking me, telling me right now he can give me 50 vials for about $50 a piece." Oh my god. So he's like, "And he's also designing my 3-month protocol and commitment. What do you think I should do?" FYI, this guy that's texting me this right now is a very well-known plastic surgeon in Palm Beach area. Okay. And I'm like, "Wow, wow." And Craig just saying this, I'm like, and I'm seeing this. He has no idea. He's out there doing surgery all the time. These guys are being sneaky. He's walking in the office. He's telling the girls up front, "Hey, you know, I can get you this for 50 bucks." Next thing you know, he doesn't know any better, right? He's like, "Oh, I can get this. Oh, no problem. Here's the money." So, yeah, this is so right. It's so true what you just said, Craig. They're making it so enticing, too. You know, we all here know that blends are generally a no-go, right? And they're putting like three, four agents into one vial—oh my god, it's just preposterous.

I actually want to ask you guys about this because the other day somebody said, "Hey, in our business, they said hey, we're ranking number one across the country for this one particular thing." Not going to mention what it is. And it's four agents. It's four different peptides all mixed into one. I'm like, "Do you really believe in that? I mean, are you going to really have that? You really want to have that in your clinic?" He's like, "Well, you know, I guess that's something I think it's out there." And I was like kind of blown away by that—that anybody would want to actually do that. Frank, what are your thoughts on that?

It's unbelievable, man. I mean, you can't even get—I don't know if I'm allowed to say this, but an NAD to be in the same drug as another peptide, you know, because we tried this many times—to get a GLP-1 mixed with another product, right? But then you have to go prove stability, right? You know, so you say, okay, let's do it. Let's find something that we can add to a GLP-1 to enhance the pathways and things like that. This is very basic compounding, but then it sounds amazing, but then you got to make it and then you got to go prove stability in a lab, right? That this thing is stable together. You're not creating a new drug—which you actually are creating a new drug. They're binding. So when you tell me that there's a people out there selling things with five or four different peptides as a stack together, then you're creating this long chain of amino acid that I don't even know it's going to bind to a receptor. So is it going to bind, it's not going to bind. First of all, that's just from that side. And then the second piece is wait, are you going to keep stability of this product you know because they all work differently—different pH right? You have to have different active ingredients. One of them is stable at this pH, the other one is stable at the other pH, so if you have one pH they're not going to be all stable at the same time. I don't want to bore you guys but this is insanity.

Yeah, that just—I was like wow. In the same line of thought, a lot of times these companies will sprout up from very prominent individuals in this industry. So recently was approached by a rep for a company that's relatively new in the past few months and the mastermind, the brains behind this operation, is somebody who owns a very prominent PRP concentrating system and owns several other biomed companies and whatnot. So you can't be fooled. And again, just—I noticed when the one research peptide company went down. Everybody of course was posting it. And I couldn't believe that some of the people that have their own research peptides like wrapped around with their brand and logo on it were then making posts saying like, "Yeah, guys, you got to get this from a credible source." It's like, you just were doing that. But I guess people, they rely on people just not checking up. And so like the same educational places that are pushing people towards these places—well, we'll just pretend like we never did it or never cared.

So it is—Craig, you're right. It's hard to navigate because everybody's really busy. Everybody's working. Like you said, you have the plastic surgeon, he's doing surgery, everybody's working. They're trying to keep track of their businesses. Someone comes up and says it's an FDA registered facility, it's X, Y, and Z. We've just never faced this at this level before in medicine. In medicine, there's always been gray areas, but never just these sales reps and multi-level marketing schemes and affiliate marketing coming from every angle looking legitimate. It's like medical practices are being attacked right now. And it is at least—we have to talk about it and I think that's what changes it and that's what we're doing. And I think you have to remember the legality of this, right? The changes that happened with peptides—and certainly Leonard, you're the expert in this—did not affect whether or not they could be prescribed. They merely affected whether or not they could be compounded. And so we're still held to a standard. If I am prescribing something that is a research chemical only and the patient has a bad outcome, I am ultimately responsible for that choice. And so we have to realize you probably won't have a leg to stand on if the patient has a bad outcome—that's going to completely come back on me. And this is the trouble. And then you have to have a whole additional layer of consenting and explaining and I think for us there's so much already consenting that goes along with these chemicals that that's another level that we're not willing to go. So we have clients that come to us and we'll just say look, I can't guarantee your outcomes but I really can't guarantee your outcomes—in fact, I'm concerned about the health, the safety of your outcome if you're using something other than what I'm recommending.

Yeah. I mean, Suzanne, what do you do when you have a patient that you've got them on a protocol and then they're out on YouTube and wherever and now they're—or like Frank, you said the other day, you know, it's kind of that "trust me, bro" culture that's in the gym, right? That shows up. It's like, oh yeah, well, you get this from this guy over here. What do you do when somebody shows up and says, "Oh, I want to take this and I've gotten this." Do you discharge that patient?

Um, that's a hard question. My typical practice is not to discharge the patient. I have a lot of conversations with them and then I'm just going to keep an eye on them. I have a guy who is a "bro gym doc." That's his thing. He's actually the guy from whom I learned peptides first back in like, I don't know, 2009. He came to the office and was like, "Ah, doc, you got to get on some peps. You got to do the things." Um, so then I went and actually learned about them, which was great. But it was—he took a lot, a lot, a lot and way higher doses than anything is recommended. And he had a lot of side effects—let me put it that way. He had a lot of problems as a result. And as much as I love him, we continued to monitor things like his liver function and his kidney function and we kind of worked around them.

It's sort of like you're dealing with an alcoholic. Are you going to discharge the patient because they're an alcoholic or are you going to work around and take care of their alcoholism? And this is where you go and you say every time you see them, you make the comments, you make the notes in the chart, and if they're eventually not responding then yeah, they do get discharged from the practice. But the idea is hey, let's work with what we've got. Kind of like our patients who aren't willing to change their diet or they're not willing to change their stress factors in their life, they're not willing to cut out the caffeine in the morning, whatever the circumstances are. You know, I'm going to work with you, especially if you've been my patient a while. And now I'm going to say, "Hey, let me explain to you why this isn't working." I draw a lot of pictures in my office with patients so they get to see what I'm talking about—about the resin and the TFA that gets put on and it has to be then pulled off and if it's not actually pulled off, that's what's toxic to your liver. All that sort of thing. You've got to be the educator for these people.

That's a lot of work, I would imagine. Obviously I never have to do that, but I would imagine it's a lot of work. Well, this has been a phenomenal episode and I just want to thank all of you once again for putting the time and brain power behind it. In the next episode, we're going to talk about dysregulation of the autonomic nervous system based off of the talk that took place at COM—the presentation that Dr. Furry made. And so we're going to go into a deep dive on that. I think it's going to be super interesting to discuss that because one of the things that you said, Suzanne, was that hey, maybe if your longevity medicine isn't working, it could be this. It's certainly a topic worth digging into. Really excited about that. I want to thank all of you again. And for those of you who are new to Cell to Systems, please remember to like, share, and subscribe. Also, leave us a comment. We want to hear from you. We want to know what you're thinking about, and we want to be able to address the things that are most important to you as the show progresses. From all of us at Cell to Systems, we wish you a great week, and we'll see you on the next one.