Peptide & Hormone Therapies for Health, Performance & Longevity | Dr. Craig Koniver

1. 0:00 – 4:52

   Dr. Craig Koniver

   1. AHAndrew Huberman0:00

      (Upbeat music playing) Welcome to the Huberman Lab podcast, where we discuss science and science-based tools for everyday life. I'm Andrew Huberman, and I'm a professor of neurobiology and ophthalmology at Stanford School of Medicine. My guest today is Dr. Craig Koniver. Dr. Craig Koniver is a medical doctor who did his training at Brown University and Thomas Jefferson University. He is a world expert in what he refers to as performance medicine, which involves the use of peptides and other therapies for improving mental health, physical health, and performance. Now, many of you have perhaps heard of peptide therapies. Perhaps some of you have not. A peptide is simply a small protein, so insulin is a peptide. We have many different thousands of peptides in our brain and body, and they perform a variety of different roles. Dr. Koniver's expertise is in the use of exogenous, that is peptides that one takes, exogenous peptides for activating multiple pathways in the brain and body to augment health. Now, of course, peptides such as insulin have been used for many years now to treat things like diabetes, but today we talk about novel peptides, including GLP-1, so these are glucagon-like peptide analogues, things like Ozempic and Mounjaro, which I realize are a bit controversial. However, today we talk about the microdosing of those peptides. We talk about those peptides combined with other peptides, as well as behavioral practices to offset the muscle loss associated with them, and then we dive into some lesser-known peptides, but ones that are growing in use. For instance, BPC-157, or body protection compound 157, which is used to treat inflammation, to accelerate wound healing, and a variety of other things. Then we discuss the use of peptides specifically to increase growth hormone secretion during sleep, as well as some peptides that can actually increase rapid eye movement sleep dramatically. Today we also discuss testosterone therapies, not just for men but for women. These are growing increasingly popular, as well as things like NAD, as well as specific supplements. Dr. Koniver, as he will soon tell you, is not a huge proponent of supplements, but he does mention several that he feels are of particular use, including things like coenzyme Q10 and some of the methylated B vitamins, and he explains why he takes that stance. So today's discussion is really for anybody interested in mental health, physical health, and performance. And the reason I say that is that even if you aren't considering taking peptides or are already taking peptides, peptides and some of these other compounds I've mentioned sit somewhere between doing nothing except diet and exercise, supplements which I sort of see as the next step up the ladder in terms of augmenting your health approaches, and then, of course, there are a number of prescription drugs, including hormone therapies such as growth hormone therapies, testosterone therapies, and a number of other things that, yes, can modify those hormone pathways, they are in fact hormones, but they actually can shut down one's natural production of those hormone pathways. Peptide therapies sit somewhere between doing nothing and supplementation and those more advanced hormone therapies, and that's why peptide therapies, I believe, are growing in popularity. They can augment specific hormone pathways. They can augment specific, in fact multiple processes within the brain and body to augment health, but they don't tend to operate in that negative feedback cycle by shutting down one's own endogenous production. Now, that doesn't mean that they aren't without some safety concerns, and today we of course discuss the potential side effects and safety concerns of peptides, as well as the critical issue of sourcing clean peptides and working with a board-certified physician if one is going to pursue peptide use. So by the end of today's discussion, you will be right there on the cutting edge of what's happening and where things are going with peptides, and in keeping with that, you'll notice that during today's discussion, we talk a fair amount about what the FDA currently allows in terms of prescription peptides, what the FDA has recently removed from the market in terms of peptides, and as a very recent update, just prior to the release of this episode, I learned that three peptides, CJC-1295, ipamorelin, both of which are in the growth hormone secretagogue family, meaning they promote the release of growth hormone, as well as thymosin beta alpha, which is in the sort of anti-inflammatory and tissue repair pathway, those three are now re-allowed for prescription in the United States. So at the time of recording this episode, we discussed some of those as being recently banned by the FDA. They are now approved again for use in humans by the FDA, so there's a brief and very recent update. So just to summarize this admittedly long introduction, today you're going to learn about this incredible area of science called peptide biology and how it can augment mental health, physical health, and performance, and you're going to do so from one of the world's leading clinical experts.

2. 4:52 – 7:40

   Sponsors: Joovv & BetterHelp

   1. AHAndrew Huberman4:52

      Before we begin, I'd like to emphasize that this podcast is separate from my teaching and research roles at Stanford. It is, however, part of my desire and effort to bring zero-cost-to-consumer information about science and science-related tools to the general public. In keeping with that theme, I'd like to thank the sponsors of today's podcast. Our first sponsor is Joovv. Joovv makes medical-grade red light therapy devices. Now, if there's one thing that I have consistently emphasized on this podcast, it is the incredible impact that light can have on our biology. Now, in addition to sunlight, red light and near-infrared light sources have been shown to have positive effects on improving numerous aspects of cellular and organ health, including faster muscle recovery, improved skin health and wound healing, improvements in acne, reduced pain and inflammation, even mitochondrial function, and improving vision itself. What sets Joovv lights apart and why they're my preferred red light therapy device is that they use clinically proven wavelengths, meaning specific wavelengths of red light and near-infrared light in combination to trigger the optimal cellular adaptations. Personally, I use the Joovv Whole Body Panel about three to four times a week, and I use the Joovv Handheld Light both at home and when I travel.If you'd like to try Joovv, you can go to Joovv, spelled J-O-O-V-V, .com/huberman. Joovv is offering an exclusive discount to all Huberman Lab listeners with up to $400 off Joovv products. Again, that's Joovv, spelled J-O-O-V-V, .com/huberman to get up to $400 off. Today's episode is also brought to us by BetterHelp. BetterHelp offers professional therapy with a licensed therapist carried out entirely online. Therapy is an extremely important component to overall health. In fact, I consider doing regular therapy just as important as getting regular exercise, including cardiovascular exercise and resistance training exercise. Now, there are essentially three things that great therapy provides. First, it provides a good rapport with somebody that you can really trust and talk to about any and all issues that concern you. Second of all, great therapy provides support in the form of emotional support, but also directed guidance, the dos and the not-to-dos. And third, expert therapy can help you arrive at useful insights that you would not have arrived at otherwise, insights that allow you to do better, not just in your emotional life and your relationship life, but also the relationship to yourself and your professional life and all sorts of career goals. With BetterHelp, they make it very easy to find an expert therapist with whom you can really resonate with and provide you with these three benefits that I described. Also, because BetterHelp is carried out entirely online, it's very time efficient and easy to fit into a busy schedule, with no commuting to a therapist's office or sitting in a waiting room or looking for a parking spot. So if you'd like to try BetterHelp, go to betterhelp.com/huberman to get 10% off your first month. Again, that's betterhelp.com/huberman. And now for my discussion with Dr. Craig Koniver.

3. 7:40 – 9:37

   What is a Peptide?

   1. AHAndrew Huberman7:40

      Dr. Craig Koniver, welcome.

   2. CKCraig Koniver7:43

      Thank you, Andrew. I appreciate the invitation to be here.

   3. AHAndrew Huberman7:45

      I'm thrilled that you're here. We are gonna launch ourselves into the space that is called peptides.

   4. CKCraig Koniver7:53

      Yeah.

   5. AHAndrew Huberman7:53

      And it's a, it's an interesting space-

   6. CKCraig Koniver7:55

      For sure.

   7. AHAndrew Huberman7:56

      ... because I think, um, most people probably don't know what a peptide is.

   8. CKCraig Koniver8:00

      Right.

   9. AHAndrew Huberman8:00

      They should feel no guilt or shame about that.

   10. CKCraig Koniver8:02

       Right.

   11. AHAndrew Huberman8:02

       Well, I'm sure you'll, you'll tell us. But this area of medicine that people broadly refer to as peptides is picking up a lot of momentum, even though it's been around for a long time.

   12. CKCraig Koniver8:14

       Mm-hmm.

   13. AHAndrew Huberman8:15

       And I find it particularly interesting because, um, there are many people using peptides for very specific purposes. But most people haven't really heard of the various peptides that are out there.

   14. CKCraig Koniver8:28

       Right.

   15. AHAndrew Huberman8:29

       And if anything, we can be sure that in the years to come, peptides are going to be increasingly popular. And there's-

   16. CKCraig Koniver8:38

       Totally agree.

   17. AHAndrew Huberman8:38

       And there's of course, the incredibly popular peptide of GLP-1 agonist, um-

   18. CKCraig Koniver8:45

       For sure. Taking over.

   19. AHAndrew Huberman8:47

       So to drop into this, um, and make sure everyone's on the same page, uh, what is a peptide?

   20. CKCraig Koniver8:53

       Yeah. I mean, just from a very elementary level, peptides are just chains of amino acids. So amino acids all naturally occurring molecules. We call it a peptide if it's 40 amino acids or less, call it a protein if it's 41 amino acids or more. The body makes, I think, last I read, 300,000 peptides. So it's a massive number. Uh, we've probably therapeutically are using closer to 150 over the years, which is obviously tiny compared to that. So to your point, this is blossoming. We've been using peptides for about eight years, a long time. Um, but still very early in, in our understanding of how best to use peptides and how clinically we're gonna get the most out of them. So it's exciting.

4. 9:37 – 15:49

   GLP-1 Agonists, Semaglutide Weight Loss, Brain Health

   1. AHAndrew Huberman9:37

      Maybe just to orient ourselves, we should talk about GLP-1 first.

   2. CKCraig Koniver9:42

      Okay.

   3. AHAndrew Huberman9:42

      Um, not because it's necessarily the, uh, category of peptides that, um, I think, uh, people would want to consider for themselves, um, but because most people have probably heard of, uh, semaglutide-

   4. CKCraig Koniver9:56

      Mm-hmm.

   5. AHAndrew Huberman9:57

      ... and, um, Mounjaro and things like that.

   6. CKCraig Koniver9:59

      Sure.

   7. AHAndrew Huberman10:00

      So, um, how long ago was it that humans started injecting GLP-1 agonists in order to lose weight?

   8. CKCraig Koniver10:08

      I think the weight loss aspect has only been a couple years. I mean, it's been tremendous how it's accelerated to like literally becoming the number one prescribed in America. Uh, you know, semaglutide, Ozempic w- was approved longer than that for, for type two diabetics, helping with, you know, glucose control and, and helping with glucose utilization. Uh, and what they found, you know, as a side effect was that these people were losing weight, and then that word caught on. And you know, what's interesting, I don't think most people understand this, most of the medicines prescribed, particularly in America, are prescribed off label, meaning they've never ever been approved for what they're used. So-

   9. AHAndrew Huberman10:46

      Is that right?

   10. CKCraig Koniver10:47

       Yeah, the vast majority. Yeah. Are never approved. So as a physician, I'm allowed to prescribe any drug for any reason I want, as long as it's been approved for something, right? As long as we're safe, right? We don't wanna be cavalier about this and renegade and do all these things that are not, that are out, out of bounds. But that is the truth. So th- that's, semaglutide is a great example being used for helping people, diabetics, type two diabetics lower their blood sugar. And then it got to, well, now let's help diabetics lose weight, right? Because diabetics struggle with weight, the insulin resistance. And then it became, well, even if you're not a diabetic, could you benefit from losing weight? Well, heck yeah, right? I mean, look at the amount of obesity and people who are overweight and having trouble maintaining healthy weight. It's exorbitant in this country and certainly worldwide. So then it spread. It did eventually get, uh, FDA approval specifically for weight loss.

   11. AHAndrew Huberman11:43

       Mm-hmm.

   12. CKCraig Koniver11:43

       But, you know, at first, no, it's been just for type two diabetics to help with glucose utilization. And, you know, we've been using primarily tirzepatide, which is like semaglutide version 2.0 mostly for the past two years.

   13. AHAndrew Huberman11:58

       Mm-hmm.

   14. CKCraig Koniver11:58

       Have learned a tremendous amount, and my opinion's actually changed from working with people.

   15. AHAndrew Huberman12:04

       Yeah, what is your opinion? My understanding is that, um...... well, there's sort of two camps on this, it seems.

   16. CKCraig Koniver12:09

       Yeah.

   17. AHAndrew Huberman12:09

       At least two camps. One camp seems really bullish on this, um, they seem very excited about this drug. The other camp seems to, uh, point to the fact that one may be creating a drug dependency.

   18. CKCraig Koniver12:21

       Mm-hmm.

   19. AHAndrew Huberman12:21

       Um, that it's very expensive, um, and they point to the also potency of lifestyle factors like exercise and caloric restriction, um, eating mostly non-processed foods, et cetera, as a "better alternative". I'm not necessarily saying that.

   20. CKCraig Koniver12:37

       Sure.

   21. AHAndrew Huberman12:37

       I think they both have their place. It's re- to me, it seems very contextual, but as a clinician, I'm curious what you think.

   22. CKCraig Koniver12:43

       Yeah, I- I agree, both have their place. Um, my philosophy is I want everyone have- to have access to things that are, number one, safe, that propel them to look, feel, and perform their best. And if that means, right, if it was just about if I can exercise my way out of this, eat my way out of this, meaning lose weight-

   23. AHAndrew Huberman13:01

       Mm-hmm.

   24. CKCraig Koniver13:02

       ... change my body composition, why do we have an epidemic, you know, of so many people who struggle with that? 'Cause it's really hard, right? And we don't totally understand it. I'm not saying that... Yeah, the processed food thing's a massive problem. I mean, I know that's come to light recently with-

   25. AHAndrew Huberman13:18

       Mm-hmm.

   26. CKCraig Koniver13:19

       ... people pushing for us to take a look at food companies and the quality of our food, which is amazing. But if people aren't interested in doing better for themselves, and, you know, the- this is- may not make sense, but I think it does. The analogy I use is I like to help people win the race first, which then helps them motivate to train for the next race, right?

   27. AHAndrew Huberman13:39

       Mm-hmm.

   28. CKCraig Koniver13:39

       And this kinda goes against the grain of conventional medicine, which is, you know, if you wanna train for the race, you have to, you know, run a certain number of miles, you have to sleep a certain way, you have to eat a certain way. You have to do all the things, struggle to get there, right? And losing weight is a struggle. And- and the way I look at it, if I can help people lose weight first, literally by using something like tirzepatide, semaglutide, and I've seen this, they're now excited. I mean, I met with a client yesterday here in Los Angeles, and she literally looked at me and said, "You've changed my life." She goes, "I am a super successful woman in my company, with my family, with my kids. Everything's great, but now I love my life. My workouts are better, I look better, my clothes fit better. I am super excited about waking up every morning." Like, she is there, and that is what it's about, right? And so for people, if you can help them achieve their goal first, then they're gonna be motivated. The light bulb turns on, they're gonna be like, "Wow, I want more of this." And that's the aha moment that I love helping people with.

   29. AHAndrew Huberman14:36

       Mm-hmm.

   30. CKCraig Koniver14:36

       So at first, I was like, "Oh, we gotta be really cautious with this." Same thinking, like, I don't want people to lose too much weight, like, this is a problem. Are they gonna be dependent? I don't like the notion that you have to take something the rest of your life. (sniffs) And I'm not saying it has to be the rest of their life, but when something works, and as far as I can tell, it's very safe, I think- I think it's worth discussing. And I- I like people having those options, at least.
5. 15:49 – 18:43

   GLP-1 Microdoses, Muscle Loss; Inflammation

   1. AHAndrew Huberman15:49

      in the, um, in the case of GLP-1-

   2. CKCraig Koniver15:51

      Yeah.

   3. AHAndrew Huberman15:51

      ... um, people have criticized it saying that a fair percentage of the weight, uh, that's lost is, uh, lean body mass, muscle loss. But it seems to me that can be remedied pretty easily if people just do some resistance training.

   4. CKCraig Koniver16:05

      I- I think part of that, yeah, resistance training. The other tha- thing I would say is from what we've seen is when people are using the conventional dosages, um, they're losing weight too quickly.

   5. AHAndrew Huberman16:16

      Mm-hmm.

   6. CKCraig Koniver16:16

      And so what we do is we get, uh, both semaglutide, mostly tirzepatide compounded, and that allows us to use basically microdosages, and start very s- low in terms of dosage and go slowly with people. And what we found is as long as people are losing less, two pounds or less a week, they're not losing the muscle mass. We certainly encourage a- adequate protein intake, you know, resistance training, but that microdosing has been a game changer, like literally game changer because then people don't feel like, oh my... And I've seen it where we- when we started, people were losing, you know, 15 pounds in three weeks.

   7. AHAndrew Huberman16:52

      Goodness.

   8. CKCraig Koniver16:53

      Right? And then they're like excited, but then they're not 'cause then they come off of it and they just gain it right back. Or they lose a lot of weight and they lose that fat in their face and they look like skeletons. And we've seen those called Ozempic faces. We don't like the way that looks, and that fat takes a while to come back. So if we just go slowly with this and we can really dial it in and nuance it, that has had a tremendous impact. And now beyond the weight loss, you know, w- we're seeing cognitive benefits, we're seeing, you know, inflammation benefits and a lot of people with autoimmune disease who their inflammation markers are coming down and that's the only thing we can think is working.

   9. AHAndrew Huberman17:27

      Is that a direct effect of, um, Ozempic on the immune system and pathways related to inflammation? Or is it indirect through the loss of adipose tissue, body fat, which then lowers, uh, lowers inflammation?

   10. CKCraig Koniver17:42

       Great question. O- or I could say, is it the positive thoughts that come from looking yourself in the mirror and feeling good, right? Which transcends to feeling better about yourself and that feeds forward to the momentum that you put forth in the world. All of those things. I think it's all of the above. You know, I think that's gonna be hard to dissect, but it's real. I mean, I have a patient, she's 50, she has Hashimoto's thyroiditis, meaning she attacks her thyroid. She doesn't, you know, make enough thyroid hormone. So she takes thyroid hormone. Well, one of the challenges with that is they make a lot of thyroid antibodies, this antibody called thyroid peroxidase antibody. And when you have an elevated thyroid peroxidase antibody, you don't feel good, you feel inflamed, your joints hurt, you get rashes. Life is just not easy. And it's a challenge to get that number down. I mean, certainly a challenge for me. You know, we traditionally use probiotics, a lot of things to help bolster the immune system. Well, now we're starting to use the GLP-1s and we're seeing that those antibody levels come down.... and I, I don't have a great way of explaining it, but there's something going on that's very positive.

   11. AHAndrew Huberman18:41

       Mm-hmm. Very interesting.

6. 18:43 – 23:27

   BPC-157, Inflammation

   1. AHAndrew Huberman18:43

      Well, I suppose moving from, uh, most widely known, um, peptides are still fairly unknown to most people, even the concept-

   2. CKCraig Koniver18:52

      Yeah.

   3. AHAndrew Huberman18:52

      ... but that's why you're here. Uh, you're changing that right now. Um, but moving from things like GLP-1 to what I would probably call the second most popular peptide, the one that we're hearing more and more about all the time, um, and that's BPC-157-

   4. CKCraig Koniver19:09

      Yeah.

   5. AHAndrew Huberman19:09

      ... Body Protection Compound 157.

   6. CKCraig Koniver19:11

      Yeah.

   7. AHAndrew Huberman19:12

      Um, which to my understanding, there are a lot of animal data-

   8. CKCraig Koniver19:17

      Yes.

   9. AHAndrew Huberman19:17

      ... very few, if any, clinical studies on humans.

   10. CKCraig Koniver19:19

       Agreed.

   11. AHAndrew Huberman19:20

       But a lot of people now taking BPC in various forms.

   12. CKCraig Koniver19:23

       Yeah.

   13. AHAndrew Huberman19:23

       Um, what are some known uses for BPC, let's just say within your clinic?

   14. CKCraig Koniver19:30

       Sure.

   15. AHAndrew Huberman19:31

       Um, and then we'll get around to the fact that BPC has, let's hope temporarily, been taken off market-

   16. CKCraig Koniver19:37

       Yep.

   17. AHAndrew Huberman19:37

       ... um, and what some of the alternatives are. But, um, what is BPC? What instances or people have you found it useful for?

   18. CKCraig Koniver19:45

       So many. So I think with BPC, for me, kind of the most utilized peptide that we've used, so we like to use BPC a- almost with every patient. It is very anti-inflammatory, right? And so just from a very general perspective, you know, most people walking around who are adults, you know, they're stiff, they're sore as they get older, they work out. We work with le- uh, athletes of all levels. There's that element of inflammation. Maybe they have some chronic disease, diabetes, heart disease, autoimmune disease. Inflammation is paramount, we understand that. And BPC, I, you know, observe with so many patients, we're talking thousands upon thousands of patients where their inflammation comes down. So they feel better, they're not as stiff, they're not as sore, their knee doesn't hurt as much, their shoulder's improved. So we've learned, you know, that we start with a dose, you know, based upon these, like you said, animal studies, um, which is conservative, make sure it's safe, and then we've seen over time that we can get to higher and higher dosages and have even more of an impact, you know? And I think, so for people understanding using BPC, we started with a dose of like 500 micrograms a day. We got up to 5,000 micrograms a day, you know? Uh, and we'd like a protocol five days on, two days off, and that's been very helpful for a variety of things from post-viral, you know, with the pandemic, had a lot of success with BPC too. Again, you name it, h- honestly almost everyone I could think of, particularly as people are engaging more fitness related lives, they're working out more, I would argue that anyone who's working out on a regular basis, BPC is gonna benefit. It's gonna help, you know, improve the inflammatory status, but also help with recovery, and it doesn't seem to be one of these agents that's gonna be detrimental like we've, we were talking earlier, Rob and I, before this started, like, you know, they found that people who are working out hard taking antioxidants, that there seems to be a negative consequence to that because you don't allow the body to kind of repair itself. I don't think that's happening with BPC.

   19. AHAndrew Huberman21:41

       That's interesting because my understanding is also that, um, part of the specific and general adaptation of exercise is triggered by inflammation.

   20. CKCraig Koniver21:50

       Yeah.

   21. AHAndrew Huberman21:50

       This is why indeed it is true that doing ice bath or really cold water immersion, cold shower seems fine, but cold water immersion in the, you know, four to eight hours after resistance training can limit some of the hypertrophy and strength gains from resistance training because what you're inducing when you actually go into the gym-

   22. CKCraig Koniver22:08

       Yeah.

   23. AHAndrew Huberman22:08

       ... is the, that leads to the hypertrophy and strength training is an inflammation response-

   24. CKCraig Koniver22:12

       Right.

   25. AHAndrew Huberman22:12

       ... that triggers the compensation-

   26. CKCraig Koniver22:14

       Right.

   27. AHAndrew Huberman22:14

       ... or, um, or the hypercompensation. So, um, it's interesting you're saying that BPC... And by the way, I must say this because then, uh, forgive the editorial, but that is not to say that cold plunges and cold immersion is bad, it's just in the hours following resistance training specifically for hypertrophy and strength training, if those are your goals, probably best to do it outside of that window. Other times, it has some tremendous benefits. Be safe, but there. Okay. Back to the topic at hand.

   28. CKCraig Koniver22:42

       Yeah.

   29. AHAndrew Huberman22:42

       Forgive me, but-

   30. CKCraig Koniver22:42

       No. Yeah.
7. 23:27 – 28:43

   BPC-157, Injection & Oral Forms; Injury Repair

   1. AHAndrew Huberman23:27

      Got it.

   2. CKCraig Koniver23:27

      Yeah.

   3. AHAndrew Huberman23:28

      BPC-157, um, comes in many different forms-

   4. CKCraig Koniver23:31

      Mm-hmm.

   5. AHAndrew Huberman23:32

      ... or it used to when it was allow- uh, when it was FDA, uh, not disallowed, um-

   6. CKCraig Koniver23:36

      Sure.

   7. AHAndrew Huberman23:37

      ... so I could imagine how the oral forms-

   8. CKCraig Koniver23:40

      Mm-hmm.

   9. AHAndrew Huberman23:40

      ... would allow for a just general, um, anti-inflammatory response.

   10. CKCraig Koniver23:45

       Mm-hmm.

   11. AHAndrew Huberman23:45

       It's a gut peptide-

   12. CKCraig Koniver23:46

       Mm-hmm.

   13. AHAndrew Huberman23:46

       ... so we don't have to worry about it being destroyed by the gut. Most peptides that go into the gut are broken down and so on-

   14. CKCraig Koniver23:51

       Correct.

   15. AHAndrew Huberman23:52

       ... but this peptide, when it's naturally occurring, occurs in the gut-

   16. CKCraig Koniver23:56

       That's right.

   17. AHAndrew Huberman23:56

       ... so it survives in the gut.

   18. CKCraig Koniver23:57

       Right.

   19. AHAndrew Huberman23:57

       So if somebody is taking BPC-157 orally through a capsule or tablet form-

   20. CKCraig Koniver24:02

       Right.

   21. AHAndrew Huberman24:03

       ... um, my guess is that has a general anti-inflammation response.

   22. CKCraig Koniver24:08

       I think it can. What we've observed is more limited to the gut, so people with any sort of, you know, gastrointestinal issue, whether that's inflammatory bowel disease like Crohn's or ulcerative colitis, you know, irritable bowel, you name it, leaky gut, I think oral BPC is more effective there. Mm-hmm.

   23. AHAndrew Huberman24:23

       Has it been shown to be effective for those conditions or have you observed that clinically?

   24. CKCraig Koniver24:27

       I'v- I've certainly-

   25. AHAndrew Huberman24:28

       Okay.

   26. CKCraig Koniver24:28

       ... observed that clinically. But interestingly, I've observed a better clinical response when people inject it.... even for gastrointestinal-related things. So, I think injecting, and then, so people injecting sub-q, which is right under the skin. We use the tiniest of needles, like an insulin needle, 30 or 31 gauge. We're talking super small.

   27. AHAndrew Huberman24:45

       Mm-hmm.

   28. CKCraig Koniver24:46

       Um, and so, I know a lot of people are like, "I'm never injecting one of these."

   29. AHAndrew Huberman24:48

       Yeah. This is less painful than a, um, than a Texas mosquito bite.

   30. CKCraig Koniver24:51

       (laughs) There you go.
8. 28:43 – 34:48

   Sourcing, Anabolic Steroids, Testosterone

   1. AHAndrew Huberman28:43

      is definitely, uh, shorthand for BPC-157, that is, is certainly in widespread use. I have been concerned, just personally-

   2. CKCraig Koniver28:52

      Yeah.

   3. AHAndrew Huberman28:52

      ... about, um, gray market sources-

   4. CKCraig Koniver28:55

      Yep.

   5. AHAndrew Huberman28:55

      ... that, um, contain contaminants and the fact that, um, many people are obtaining BPC-157 not from a physician, not from a compounded pharmacy-

   6. CKCraig Koniver29:04

      Right.

   7. AHAndrew Huberman29:04

      ... but just kind of on, quote-unquote, "On the internet."

   8. CKCraig Koniver29:07

      Sure.

   9. AHAndrew Huberman29:07

      Uh, you're a physician. Um, I'm guessing that until the recent ban by the FDA, you were able to prescribe clean BPC as it were.

   10. CKCraig Koniver29:17

       Yeah, there was-

   11. AHAndrew Huberman29:17

       Um, what's the story with BPC now? And maybe we could talk about gray market-

   12. CKCraig Koniver29:21

       Sure.

   13. AHAndrew Huberman29:21

       ... versus, um-

   14. CKCraig Koniver29:22

       I think it's a great question.

   15. AHAndrew Huberman29:23

       ... you know, versus prescribed and made at a compounding pharmacy versus a pharmaceutical company, uh, pharmaceutical. So, um-

   16. CKCraig Koniver29:31

       Yeah.

   17. AHAndrew Huberman29:31

       ... and then, of course, there's black market, but let's just leave that out. Um-

   18. CKCraig Koniver29:34

       Sure.

   19. AHAndrew Huberman29:34

       ... you know, there are people that are gonna tell it, you know, tell you, "Hey, this is BPC," and sell it to you. That's obviously bad and dangerous, so.

   20. CKCraig Koniver29:40

       Well, we see that with the anabolic steroids, right?

   21. AHAndrew Huberman29:42

       Right.

   22. CKCraig Koniver29:42

       Like, so anabolic steroids are on the black market. You can't really... I mean, there's one anabolic steroid which is nandrolone, which is Deca, which can be officially prescribed. We use it. You can combine it with testosterone all in the up and up, totally above table. The rest, things like Trenbolone, others, you, you can't get them from a physician. In fact, you, very hard to get them from a reputable website in the United States.

   23. AHAndrew Huberman30:05

       So, as long as we're, we're here, my understanding is Deca, Durabolin, and, uh, testosterone cypionate are, can be prescribed, or testosterone enanthate, things like that-

   24. CKCraig Koniver30:13

       Different esters.

   25. AHAndrew Huberman30:14

       ... by, by physicians. That's-

   26. CKCraig Koniver30:14

       Correct.

   27. AHAndrew Huberman30:15

       That's because it's been FDA approved for the treatment of various things. Hypocretinial syndromes-

   28. CKCraig Koniver30:19

       Correct.

   29. AHAndrew Huberman30:20

       ... uh, testosterone replacement therapy in both men and women-

   30. CKCraig Koniver30:22

       Correct.
9. 34:48 – 38:20

   Black & Gray Market, Compounding Pharmacies, Purity

   1. AHAndrew Huberman34:48

      what brought us onto the, uh, conversation about testosterone was this black market issue.

   2. CKCraig Koniver34:52

      Yeah.

   3. AHAndrew Huberman34:52

      There's also what I would call this, um, dark, dark gray market issue, which is that there are a number of companies that will sell all sorts of things, but peptides in particular-

   4. CKCraig Koniver35:02

      Sure.

   5. AHAndrew Huberman35:02

      ... and listed on their website, it'll say, "Not for human or animal consumption-"

   6. CKCraig Koniver35:06

      Correct.

   7. AHAndrew Huberman35:06

      "... for research purposes only."

   8. CKCraig Koniver35:08

      Right.

   9. AHAndrew Huberman35:08

      And one of the major issues is that the, um, potency and cleanliness, so to speak-

   10. CKCraig Koniver35:15

       Mm-hmm.

   11. AHAndrew Huberman35:15

       ... of, uh, purity-

   12. CKCraig Koniver35:16

       Yes.

   13. AHAndrew Huberman35:17

       ... of those, um, compounds is not established-

   14. CKCraig Koniver35:20

       Right.

   15. AHAndrew Huberman35:20

       Um, and many of them have LPS, lipopolysaccharide in them, which is inflammatory. And earlier, before we started recording, you mentioned, um, that you have s- heard of or interacted with, not your patients, but people who have come to you saying that they had, l- like, really serious, l- life-threatening, um-

   16. CKCraig Koniver35:37

       For sure.

   17. AHAndrew Huberman35:38

       ... consequences for using these black market certainly, but, um, dark gray market-

   18. CKCraig Koniver35:42

       Yes.

   19. AHAndrew Huberman35:43

       ... uh, peptides.

   20. CKCraig Koniver35:44

       Yeah. And so to, to tell the stor- story further is back in October of 2023, the FDA, uh, put many peptides, BPC, and we can name them out, on what's called a category two list, meaning they are no longer allowed to be compounded, right? Now, that, that excludes then research companies who are not under the purview of the FDA. But these compounding pharmacies, it's been a huge blow, because they've been told they cannot use these agents.

   21. AHAndrew Huberman36:10

       And the compounding pharmacies-

   22. CKCraig Koniver36:11

       Yeah.

   23. AHAndrew Huberman36:12

       ... are distinct from these other, um, black and dark gray, um, sources, um, in that they actually can establish purity, they are designed to be injected into humans.

   24. CKCraig Koniver36:22

       And they have a totally different standard, right? So they, and I think it's confusing for people when they hear compounding pharmacy, they thought fringe. They're not fringe. They're FDA regulated, they're Board of Pharmacy regulated in every state. They are monitored, they are inspected all the time. I've worked with compounding pharmacies my whole career, which is going on tw- you know, close to 25 years now. Just like anything, there's some amazing compounding pharmacies and there's some not so amazing compounding pharmacies which cut corners. The ones we work with don't cut any corners, and I know that 'cause they're inspected o-... all the time, right? And it's a big deal to them and they wanna do it right with purity, with processing and making sure that anything they make, especially a sterile compound, which is gonna be anything injected, you know, eye drops, things you inject in yourself, whether it's IV, subQ or intramuscular, they're st- co- considered sterile. Um, they have to then be tested by an outside lab to make sure purity, make sure that there's no endotoxins, things like that. It's, it's highly regulated and it's a big deal for them and it's a big deal for the physicians who, you know, prescribe with them. Which I appreciate, because w- the advantage of a compounding pharmacy is we can tweak the dosage. We don't have to use a standard set dosage. We can combine things synergistically to get, you know, one plus one doesn't equal two now, it equals four.

   25. AHAndrew Huberman37:34

       Mm-hmm.

   26. CKCraig Koniver37:35

       And that, to me, is a huge advantage. Just like we were talking about with the GLP-1, semaglutide and tirzepatide, we get those compounded so that... You know, we have a, a... The compounding pharmacy we're using now, we're making a unique combination of tirzepatide and sermorelin, right? Which will address some of this muscle loss that people are getting. So we can combine that.

   27. AHAndrew Huberman37:54

       So sermorelin to stim- to stimulate growth hormone release, offset some of the muscle loss from-

   28. CKCraig Koniver37:58

       Exactly.

   29. AHAndrew Huberman37:58

       ... tirza- tirzepatide?

   30. CKCraig Koniver38:00

       Yeah.
10. 38:20 – 39:51

    Sponsor: AG1

    1. CKCraig Koniver38:20

    2. AHAndrew Huberman38:20

       I'd like to take a quick break and acknowledge our sponsor, AG1. AG1 is a vitamin mineral probiotic drink that also includes prebiotics and adaptogens. AG1 is designed to cover all of your foundational nutritional needs, and it tastes great. Now, I've been drinking AG1 since 2012, and I started doing that at a time when my budget for supplements was really limited. In fact, I only had enough money back then to purchase one supplement, and I'm so glad that I made that supplement AG1. The reason for that is even though I strive to eat most of my foods from Whole Foods and minimally processed foods, it's very difficult for me to get enough fruits, vegetables, vitamins and minerals, micronutrients and adaptogens from food alone. And I need to do that in order to ensure that I have enough energy throughout the day, I sleep well at night, and keep my immune system strong. But when I take AG1 daily, I find that all aspects of my health, my physical health, my mental health and my performance, both cognitive and physical, are better. I know that because I've had lapses when I didn't take AG1, and I certainly felt the difference. I also noticed, and this makes perfect sense given the relationship between the gut microbiome and the brain, that when I regularly take AG1, which for me means a serving in the morning or mid-morning and again later in the afternoon or evening, that I have more mental clarity and more mental energy. If you'd like to try AG1, you can go to drinkag1.com/huberman to claim a special offer. Right now they're giving away five free travel packs and a year supply of vitamin D3 K2. Again, that's drinkag1.com/huberman to claim that special offer. So

11. 39:51 – 43:00

    Partnering with a Physician, LPS

    1. AHAndrew Huberman39:51

       is it fair to say that if one is interested in exploring the use of peptides for what you refer to as performance medicine-

    2. CKCraig Koniver39:57

       Yep.

    3. AHAndrew Huberman39:57

       ... um, mental, physical health and performance-

    4. CKCraig Koniver40:00

       Yes.

    5. AHAndrew Huberman40:00

       ... um, falls underneath that, to essentially only put peptides into their body, uh, maybe even on their body surface-

    6. CKCraig Koniver40:11

       Sure.

    7. AHAndrew Huberman40:11

       ... that they're obtaining from a physician who's obtained the peptides from a compounding pharmacy?

    8. CKCraig Koniver40:15

       Yeah, a- and who's developing a relationship. So we, for any peptide that we use, we meet with the patient. We make sure they're a good fit. We make sure that there's no contraindications. We also can recommend and specifically dial it up or down, whatever it is, come up with, "This is what we think you should use based upon your life experience, the medicines you're taking or not taking, the conditions you're treating or not treating," right? I think that's really important. Again, I'm biased being a physician. My whole goal is to get to know patients. That's why I'm here, is to kind of walk that walk and help people in that regard. And, you know, if someone's out there on the internet doing it themselves, they're, they're walking in, you know, kind of, you know, on their own.

    9. AHAndrew Huberman40:55

       Mm-hmm.

    10. CKCraig Koniver40:55

        And so, you know, not to make it like everything bad is gonna happen, but when you're, when you have the help of someone who has experience, that goes a long way, I think particularly with something like this.

    11. AHAndrew Huberman41:04

        Yeah, I agree. And, um, and it worries me very much that people are buying PPC from, um, gray mar- dark gray market-

    12. CKCraig Koniver41:11

        (laughs)

    13. AHAndrew Huberman41:11

        ... or, uh, uh, black market sources.

    14. CKCraig Koniver41:14

        Yeah.

    15. AHAndrew Huberman41:14

        I mean, anything that says on it, "Not for animal or human use. For research purposes only," y- you can pretty much guarantee the endotoxin, the lipopolysaccharide at least has not been removed. And that could be really problematic, especially since my understanding is that it can be cumulative over time. It's not that one injection causes somebody to go into anaphylactic shock, it's that some of this LPS can build up a, an inflammatory response-

    16. CKCraig Koniver41:37

        Sure.

    17. AHAndrew Huberman41:37

        ... over time, and then you don't know where the tipping point is. And then somebody can have a really terrible reaction.

    18. CKCraig Koniver41:42

        Well, and then taking it a step further, n- n- you know, getting away from just peptides, but any... I remember this was, I don't know, 15 years ago, someone was taking advice from a very famous doctor on TV about taking an oral compound to lose weight. And they called me up and they said, "Ugh, I'm having terrible headaches, terrible headaches for days." They came in, their blood pressure was through the roof, you know, like I don't remember the specific numbers, but let's just say 220 over 140, and normally it's 120 over 80. "Well, did you take anything different?" "Yeah, this doctor recommended I take this weight loss compound," right? So the problem is people have access to all this information, but if they're not under the guidance of a doctor to help clean up the mess and we cleaning up the mess, and not that there's always mess, but this is what we enjoy doing. You know, as, as a physician, like, we've seen the darkest of dark, you know, we're able to help people when things don't go perfectly planned. And, uh, I think that's a big deal, you know, particularly when there's lots of these tools and they're exciting tools and they're great tools. And, um, fortunate for me, I've been in this space longer than most, that I've just, you know, built up a large repertoire of experience, of observing people and working with people and seeing, we gotta tweak this, we gotta nuance this. Or sometimes we don't ever wanna use this again.

    19. AHAndrew Huberman42:56

        Mm-hmm.

    20. CKCraig Koniver42:57

        You know, this is not for most people.

    21. AHAndrew Huberman42:59

        So,

12. 43:00 – 46:35

    BPC-157, Pentadeca Arginate (PDA); Side Effects & Doses

    1. AHAndrew Huberman43:00

       given that BPC-157 has been effectively removed from the, um, legitimate market-

    2. CKCraig Koniver43:06

       Yep.

    3. AHAndrew Huberman43:07

       ... uh, what are people's alternatives? Again, uh, working with the, the, uh, caveat that, um, people should work with a physician-

    4. CKCraig Koniver43:16

       Yeah.

    5. AHAndrew Huberman43:16

       ... um, where can physicians get something similar enough to BPC-157?

    6. CKCraig Koniver43:20

       So, there's a new compound, newer, a peptide called, uh, the... shortened for PDA, Penta-DCA arginate. It's basically the same molecular structure as BPC, except they've swapped out an acetate for arginate.

    7. AHAndrew Huberman43:34

       One amino acid-

    8. CKCraig Koniver43:35

       Correct.

    9. AHAndrew Huberman43:35

       ... substitution.

    10. CKCraig Koniver43:36

        One amino acid substitution. Um, and so we're using that and having really good results. Um, I... certainly, it's early in the game of using PDA, but it seems very close to BPC in the clinical responses we're getting from our patients who are reporting back decrease in inflammation, all these wonderful things that we used to see with BPC. So, and I- and I think, uh, I surmise that this is going... how it's gonna be with all of these peptides, right? Because, again, peptides are just chains of amino acids, you know, certainly a lot of people smarter than me trying to figure out how do we then create other types of amino acid combinations, you know, i.e. peptides, that do d- similar actions to BPC, to thymosin alpha, to ipamorelin, to TB 500, on and on and on. So I'm hopeful in that regard.

    11. AHAndrew Huberman44:23

        Mm-hmm.

    12. CKCraig Koniver44:24

        Um, and I- and I also... you know, some of my patients work at the very highest level of the US government. They are well aware of this and who have assured me they're going to look at this, that this is serious, you know, because they're- they've been using peptides and they're concerned that, oh, my goodness, the FDA came in and changed the game. Very... it's been a huge setback for all of us.

    13. AHAndrew Huberman44:44

        I definitely want to circle back as to what the motivation was by the FDA for doing that, um-

    14. CKCraig Koniver44:50

        Yeah. I mean-

    15. AHAndrew Huberman44:50

        ... at, at some point.

    16. CKCraig Koniver44:51

        Yeah.

    17. AHAndrew Huberman44:51

        I think, um, in the meantime, however, I think, um, there's a lot of interest in BPC-157, a lot of use of BPC-105-57. The sources of BPC-157 are now drying up.

    18. CKCraig Koniver45:03

        Yep.

    19. AHAndrew Huberman45:03

        And that's why I'm personally concerned that people are gonna start going to the dark gray market and black market. I'm excited about the, uh, Penta-DCA arginate.

    20. CKCraig Koniver45:13

        Yes.

    21. AHAndrew Huberman45:13

        Um, so let's put that on people's, um, ear map, um-

    22. CKCraig Koniver45:16

        Yeah.

    23. AHAndrew Huberman45:17

        ... brain map. Penta-DCA arginate may be a, a good, uh, physician-prescribed substitution for-

    24. CKCraig Koniver45:23

        Yeah.

    25. AHAndrew Huberman45:23

        ... people that can benefit from BPC-157.

    26. CKCraig Koniver45:24

        A- and a good starting dose of, to make it really clear for people and helpful, 250 micrograms to 500 micrograms. We're using 500 micrograms injected daily. Again, we like Monday through Friday, take the weekends off. That's a good dosing schedule.

    27. AHAndrew Huberman45:36

        Mm-hmm.

    28. CKCraig Koniver45:37

        We'll, we'll see how that goes. We probably can use larger dosages. That's conservative.

    29. AHAndrew Huberman45:41

        Mm-hmm.

    30. CKCraig Koniver45:42

        Um, but that's a good starting point for people.
13. 46:35 – 54:17

    Ipamorelin, GHRP-6, Sleep, Appetite; Tool: Sleep & Growth Hormone

    1. AHAndrew Huberman46:35

       even though earlier we were talking a little bit about, um, some hormone replacement therapies-

    2. CKCraig Koniver46:40

       Yeah.

    3. AHAndrew Huberman46:41

       ... um, before that, off microphone, um, you mentioned that you prefer peptides to direct hormone manipulations in most cases. So I think, um, while peptides can be hormones, there are things like, uh-

    4. CKCraig Koniver46:53

       Sure.

    5. AHAndrew Huberman46:53

       ... um, uh, oxytocin is sometimes called a peptide hormone.

    6. CKCraig Koniver46:57

       Sure.

    7. AHAndrew Huberman46:57

       Um-

    8. CKCraig Koniver46:58

       Insulin.

    9. AHAndrew Huberman46:58

       ... in general, when people think about hormone therapies-

    10. CKCraig Koniver47:00

        Yeah.

    11. AHAndrew Huberman47:00

        ... they're thinking testosterone, estrogen, pregnenolone, uh, you know, thyroid-

    12. CKCraig Koniver47:05

        Thyroid.

    13. AHAndrew Huberman47:05

        ... et cetera. It, it sounds to me like much of your practice is built up around the, the notion that there are things that one can use, peptides, to kind of, um, push and pull on these various systems-

    14. CKCraig Koniver47:17

        Mm-hmm.

    15. AHAndrew Huberman47:17

        ... without getting into them directly. My understanding is the advantage of that is you don't get the negative feedback. You don't gain the-

    16. CKCraig Koniver47:22

        I agree.

    17. AHAndrew Huberman47:22

        ... shutting down of natural production.

    18. CKCraig Koniver47:24

        Yeah. You know, and testosterone's a great example. Um, because, like we were saying, I don't ever want to manipulate hormones. You know, growth hormone's another example. I don't ever want to manipulate that. Meaning, you know, providing it to people more than they would get in nature. This is why I actually don't... a little bit off topic, like when people use testosterone pellets or any sort of pellet therapy, because you're exposing people to a concentration of hormones we would never, ever see in nature. I would prefer people inject it, where you're gonna get some variation in dose on a day-to-day basis, which, we're humans, so we do get some day-to-day variation, or topically or under the tongue or something. Um, peptides, same thing. I don't want to manipulate the hormones, right? I want to just stick within kind of the, the highways or the lanes, swim lanes for how they should operate and, and then take advantage of that. And that's been a safe way to do it, as opposed to... and I've seen it, you know, talking about another peptide, which is ipamorelin, a growth hormone-releasing peptide. Uh, ipamorelin, you inject under the skin, travels up to the pituitary, the posterior pituitary in the brain, which is responsible for putting out growth hormone. That growth hormone then leaves the pituitary, enters the bloodstream, travels to the liver, where we make insulin-like growth factor one, which then enters the circulation as very anabolic, meaning growth, healing, mending. You know, as we get older, we make less growth hormone. As we get older, we wear down, obviously, we get, you know, degenerative conditions. Part of that, uh, I don't know what part, for everyone it's a little bit different, is because of our hormonal decline.

    19. AHAndrew Huberman48:53

        Mm-hmm.

    20. CKCraig Koniver48:53

        And so when you can give something like ipamorelin, and we can talk about others, you're actually helping not only push out a little bit of growth hormone for people, but you're directing when you push it out, right? We, we think that's why it's important for people to be asleep by 10:00 PM, between 10:00 PM and 2:00 AM, because we think that's the big, largest pulse of growth hormone during the 24-hour period.

    21. AHAndrew Huberman49:12

        Is that right? Uh, so, I've, um, long wondered whether or not the, um...... the tale I was told when I was growing up, which is that every hour before midnight is worth two hours of sleep post-midnight. Um...

    22. CKCraig Koniver49:23

        Does that ring true?

    23. AHAndrew Huberman49:23

        That feels true to me.

    24. CKCraig Koniver49:24

        Yeah, yeah.

    25. AHAndrew Huberman49:24

        Um, then again, feels true is, is often misleading, but feels true to me. Um, but it makes perfect sense if the, the largest pulse in growth hormone is occurring in the, in the couple of hours before midnight.

    26. CKCraig Koniver49:35

        Yeah. I mean, that's, that's how I learned it.

    27. AHAndrew Huberman49:37

        Mm-hmm.

    28. CKCraig Koniver49:37

        Um, I agree with you, it feels true to me as well.

    29. AHAndrew Huberman49:39

        Mm-hmm.

    30. CKCraig Koniver49:40

        Um, but taking advantage then of, you know, injecting something like ipamorelin at bedtime, then you're gonna, you know, within a few minutes... And with ipamorelin, it's interesting, 'cause people will get a little flushing, tingling at times.
14. 54:17 – 58:45

    Tesamorelin, Sermorelin, CJC-1295; Stacking Peptides

    1. AHAndrew Huberman54:17

       tool. What are some of the other growth hormone secretagogues? And I should just brief ... I'll, I'll take the liberty of defining it. These are peptides that stimulate the release of your own endogenous growth hormone.

    2. CKCraig Koniver54:27

       Correct.

    3. AHAndrew Huberman54:27

       This is not taking growth hormone.

    4. CKCraig Koniver54:29

       Right.

    5. AHAndrew Huberman54:29

       Yeah.

    6. CKCraig Koniver54:30

       Yeah. Um, two other main ones that we use, one would be tesamorelin.

    7. AHAndrew Huberman54:34

       Mm-hmm.

    8. CKCraig Koniver54:35

       Uh, which is s- similar into semorelin in that it also is going to work on the growth hormone-releasing hormone aspect, a little bit higher up in the, you know, chain of how these hormones are released. So, both semorelin and tesamorelin, um, you, you don't necessarily need to add anything else to it. Classically, with ipamorelin, hexarelin GHRP-6, we would add this other compound, CJC-1295-

    9. AHAndrew Huberman55:00

       Mm-hmm.

    10. CKCraig Koniver55:00

        ... which is gonna work on the GHRH, which allows the peptide and then the growth hormone to stay in your system a little bit longer.

    11. AHAndrew Huberman55:06

        The growth hormone-releasing hormone, so-

    12. CKCraig Koniver55:08

        Correct.

    13. AHAndrew Huberman55:09

        Yeah. But, we can almost set aside CJC now, because CJC-1295-

    14. CKCraig Koniver55:13

        That's on the same list as BPC.

    15. AHAndrew Huberman55:13

        The FDA just came in and, uh-

    16. CKCraig Koniver55:15

        It's now on.

    17. AHAndrew Huberman55:15

        ... one a- let's just say one acronym took out another.

    18. CKCraig Koniver55:17

        There you go.

    19. AHAndrew Huberman55:18

        The FDA took out CJC. Okay.

    20. CKCraig Koniver55:20

        (laughs) That's right. And BPC, yes.

    21. AHAndrew Huberman55:21

        And BPC.

    22. CKCraig Koniver55:22

        Yeah.

    23. AHAndrew Huberman55:22

        Um, people are probably getting a little dizzy with these acronyms. But I think we're, uh, we're, uh, doing a good job of guiding-

    24. CKCraig Koniver55:27

        Yeah.

    25. AHAndrew Huberman55:27

        ... people, uh, uh, along. So, sermorelin, um, and tesamorelin-

    26. CKCraig Koniver55:33

        Yeah.

    27. AHAndrew Huberman55:33

        ... are similar enough.

    28. CKCraig Koniver55:34

        Similar in that regard.

    29. AHAndrew Huberman55:35

        Yeah, okay.

    30. CKCraig Koniver55:35

        Tesamorelin, again, talking about flavors, tesamorelin works on visceral fat reduction, so fat around the organs.
15. 58:45 – 1:01:54

    Sponsor: Function & Eight Sleep

    1. AHAndrew Huberman58:45

       I'd like to take a quick break and thank one of our sponsors, Function. I recently became a Function member after searching for the most comprehensive approach to lab testing. While I've long been a fan of blood testing, I really wanted to find a more in-depth program for analyzing blood, urine, and saliva to get a full picture of my heart health, my hormone status, my immune system regulation, my metabolic function, my vitamin and mineral status, and other critical areas of my overall health and vitality. Function not only provides testing of over 100 biomarkers key to physical and mental health, but it also analyzes these results and provides insights from top doctors on your results. For example, in one of my first tests with Function, I learned that I had too high levels of mercury in my blood. This was totally surprising to me. I had no idea prior to taking the test. Function not only helped me detect this, but offered medical doctor informed insights on how to best reduce those mercury levels, which included limiting my tuna consumption, because I had been eating a lot of tuna, while also making an effort to eat more leafy greens and supplementing with NAC, N-acetylcysteine, both of which can support glutathione production and detoxification and worked to reduce my mercury levels. Comprehensive lab testing like this is so important for health, and while I've been doing it for years, I've always found it to be overly complicated and expensive. I've been so impressed by Function, both at the level of ease of use, that is getting the tests done, as well as how comprehensive and how actionable the tests are, that I recently joined their advisory board, and I'm thrilled that they're sponsoring the podcast. If you'd like to try Function, go to functionhealth.com/huberman. Function currently has a wait list of over 250,000 people, but they're offering early access to Huberman Lab listeners. Again, that's functionhealth.com/huberman to get early access to Function. Today's episode is also brought to us by Eight Sleep. Eight Sleep makes smart mattress covers with cooling, heating, and sleep tracking capacity. Now, I've spoken many times before on this podcast about the critical need for us to get adequate amounts of quality sleep each night. That's truly the foundation of all mental health, physical health, and performance. And one of the best ways to ensure that you get a great night's sleep is to control the temperature of your sleeping environment, and that's because in order to fall and stay deeply asleep, your body temperature actually has to drop by about one to three degrees. And in order to wake up feeling refreshed and energized, your body temperature actually has to increase about one to three degrees. Eight Sleep makes it incredibly easy to control the temperature of your sleeping environment by allowing you to control the temperature of your mattress cover at the beginning, middle, and end of the night. I've been sleeping on an Eight Sleep mattress cover for nearly four years now, and it has completely transformed and improved the quality of my sleep. Eight Sleep has now launched their newest generation of the Pod Cover, the Pod 4 Ultra. The Pod 4 Ultra has improved cooling and heating capacity, higher fidelity sleep tracking technology, and even has snoring detection that will automatically lift your head a few degrees to improve your airflow and stop your snoring. If you'd like to try an Eight Sleep mattress cover, go to eightsleep.com/huberman to save up to $350 off their Pod 4 Ultra. Eight Sleep currently ships in the USA, Canada, UK, select countries in the EU, and Australia. Again, that's eightsleep.com/huberman.Before

16. 1:01:54 – 1:05:16

    Coenzyme Q10 (CoQ10), Mitochondrial Health

    1. AHAndrew Huberman1:01:54

       we started recording, uh, you mentioned that you're actually not a huge fan of taking massive amounts of supplements.

    2. CKCraig Koniver1:02:00

       Mm-mm.

    3. AHAndrew Huberman1:02:00

       That you are a big fan of taking CoQ10.

    4. CKCraig Koniver1:02:03

       Yes.

    5. AHAndrew Huberman1:02:03

       Coenzyme Q10.

    6. CKCraig Koniver1:02:04

       Yeah.

    7. AHAndrew Huberman1:02:04

       200 milligrams per day in the morning.

    8. CKCraig Koniver1:02:06

       Mm-hmm.

    9. AHAndrew Huberman1:02:07

       I also take CoQ10. Um, I think (laughs) I started taking it for, uh, quote-unquote, "general mitochondrial health."

    10. CKCraig Koniver1:02:13

        Yeah.

    11. AHAndrew Huberman1:02:13

        I don't know that I thought very carefully about exactly what I was trying to accomplish with it.

    12. CKCraig Koniver1:02:17

        Yeah.

    13. AHAndrew Huberman1:02:17

        Um, but what, what is the rationale of taking CoQ10?

    14. CKCraig Koniver1:02:21

        So if I can break it down, try to keep it simple. If we... People are familiar with the mitochondria, it's the battery of the cell, these little organelles inside each cell, um, and they're responsible for, you know, doing many things, but primarily making ATP, chemical energy. And so, how do we make energy? Well, there's three main ways the body uses it, right, or makes it. First is glycolysis. We take glucose, which is a six carbon molecule. We break it in half to make two pyruvates, right? That, when we do that, we make a little bit of ATP. That pyruvate then is converted to something called acetyl-CoA. We run that through the Krebs cycle, where we're also making ATP, but we're, then we're making these intermediate products. One of those intermediate products, and the main one, is something called NADH. That NADH is then shuttled to the mitochondrial membrane for, uh, you know... This is the magic where we make the most ATP, and there's five different hubs, or we call cytochromes, right? And this is how I think about it, 'cause I just like to simplify. Cytochrome I is where we use NAD. And, um, what the s- what the different hubs are doing is we're exchanging electrons for protons, and that's a, kind of an electrical process. We're exchanging electrons for protons, going down an assembly line to eventually turn this wheel, the ATPase wheel, to make ATP. The way I understand it is, the five different hubs, different nutrients hit them. So cytochrome one is NAD. Cytochrome two is riboflavin, vitamin B2 and succinic acid. Cytochrome three is CoQ10, vitamin K2. Cytochrome four is methylene blue, which we can talk about. And then cytochrome five are things like magnesium, vitamin A, and copper. So if you're thinking about mitochondrial health, if you include any, or better, all of those, you're gonna maximize how your mitochondria can work and make energy. It's the strongest way to do it, and it's, again, not necessarily that complicated. So when I think of CoQ10, and again, we'd use a lot of NAD, which we can talk about, where I think most people, the, the traffic congestion happens on cytochrome one, right? And so when we give people or upregulate their NAD production, it's essentially, we're allowing for more electron flow at cytochrome one, which has a downstream effect on the other cytochromes, so the traffic jam opens up, and now you can move electrons to exchange for protons and make way more ATP. And if you're... And, but that's not true for everyone. And so some people, it could be at cytochrome three with CoQ10. It could be at cytochrome two. A lot of people at cytochrome four, which is, again, cytochrome... We call it cytochrome c oxidase. This is where methylene blue binds, but that's just a simplistic view. We just... People, we run into traffic jams, right?

    15. AHAndrew Huberman1:04:52

        Mm-hmm.

    16. CKCraig Koniver1:04:52

        These electron flow gets stuck. We're just trying to open up the traffic jam.

    17. AHAndrew Huberman1:04:56

        So 200 milligrams a day of coenzyme Q10 can be, um, can facilitate some of that-

    18. CKCraig Koniver1:05:01

        For cytochrome three, for sure.

    19. AHAndrew Huberman1:05:03

        ... flow through. Yeah.

    20. CKCraig Koniver1:05:03

        S- And CoQ10 has been studied, very safe up to 2,400 milligrams a day.

    21. AHAndrew Huberman1:05:06

        Oh.

    22. CKCraig Koniver1:05:07

        No harmful... Yep.

    23. AHAndrew Huberman1:05:07

        Yeah.

    24. CKCraig Koniver1:05:08

        No harmful effects. Sometimes I'll take more. Uh, like I was telling you earlier, it's been dramatic for me with migraine headaches and, you know, basically reducing them to zero.

17. 1:05:16 – 1:14:09

    Prescriptions, Physicians & Trust

    1. CKCraig Koniver1:05:16

    2. AHAndrew Huberman1:05:16

       Uh, you know, as people are hearing this, they're probably thinking, "Okay, well, these are just, you know, this is what I call anecdata or whatever." I, I, you know, I don't have to remind people that you're a, a board-certified physician. I think that what was, w- what's still ringing in the back of my mind this entire conversation, even though I'm paying very careful attention, is that most of the drugs that are prescribed in this country are off-label.

    3. CKCraig Koniver1:05:35

       (laughs) Yeah.

    4. AHAndrew Huberman1:05:35

       I think that just, like, I, I don't think I've ever heard that stated out loud.

    5. CKCraig Koniver1:05:38

       Mm-hmm. Yeah.

    6. AHAndrew Huberman1:05:39

       It's wild.

    7. CKCraig Koniver1:05:40

       Yeah, yeah.

    8. AHAndrew Huberman1:05:41

       Right? So the idea that people would take something that wasn't, um, shown in a, uh, clinical trial to be effective for purpose A, um, that they would... But it gets ap- that it gets approved for purpose A-

    9. CKCraig Koniver1:05:52

       Yeah.

    10. AHAndrew Huberman1:05:52

        ... but then can be prescribed by doctors for purpose B, C, D, or E.

    11. CKCraig Koniver1:05:56

        Right.

    12. AHAndrew Huberman1:05:57

        I mean, you're not telling me this is commonplace. You're telling me this is the majority of-

    13. CKCraig Koniver1:06:01

        The majority.

    14. AHAndrew Huberman1:06:01

        ... prescription drugs.

    15. CKCraig Koniver1:06:02

        Uh, but it makes sense if you think about it, right? So if you took an antibiotic, right? Like if we can just... An antibiotic's gonna be very specific what it gets approved for in terms of, like, working against a specific bacteria.

    16. AHAndrew Huberman1:06:12

        Mm-hmm.

    17. CKCraig Koniver1:06:12

        But then through clinical use and just experience, you know, we learn that, oh, I can use doxycycline or a Z-Pak azithromycin or whatever it is for a variety of bacterial infections that extend well beyond just what it's approved for. Well, that makes sense.

    18. AHAndrew Huberman1:06:27

        And, and does that ever cycle back to the, uh, clinical trials or-

    19. CKCraig Koniver1:06:31

        Mm-mm.

    20. AHAndrew Huberman1:06:31

        ... or no? This just becomes physician understanding and lore. Like, "Hey, yeah, you know, I've got patients that-"

    21. CKCraig Koniver1:06:36

        Yes.

    22. AHAndrew Huberman1:06:36

        "... you know, they get on, on azithromycin and their, uh, their acne clears up." By the way, I'm not saying that, folks. I'm not a physician, but, um, but for instance.

    23. CKCraig Koniver1:06:43

        E- exactly what happened with semaglutide and Ozempic, right?

    24. AHAndrew Huberman1:06:47

        Hm.

    25. CKCraig Koniver1:06:47

        Approved for helping glucose utilization or lowering, you know, blood glucose in patients with type 2 diabetes, and they found, through use only, people were losing weight.

    26. AHAndrew Huberman1:06:57

        Mm-hmm. So-

    27. CKCraig Koniver1:06:57

        And now it's become blockbuster and it's... And we see it with, you know, things like, you know, repurposing drugs for cancer, right?

    28. AHAndrew Huberman1:07:04

        Mm-hmm.

    29. CKCraig Koniver1:07:04

        There's, there's a, there's a lot of that going on, a lot of the repurposing. So, you know, doxycycline is a very common one that's used in cancer therapies-

    30. AHAndrew Huberman1:07:12

        Mm-hmm.
18. 1:14:09 – 1:17:13

    Agency in Your Health

    1. AHAndrew Huberman1:14:09

       I've certainly, um...... been, um, e- kind of both astonished and positively amazed in the ways that the pandemic and the post-pandemic years, I- I like to think we're in the post-pandemic years.

    2. CKCraig Koniver1:14:22

       I do too.

    3. AHAndrew Huberman1:14:22

       I- I think we can safely say that-

    4. CKCraig Koniver1:14:24

       Yeah, yeah.

    5. AHAndrew Huberman1:14:24

       ... now. Um, how they've drawn people's attention to this idea that they need to take agency into their own healthcare.

    6. CKCraig Koniver1:14:31

       Yeah.

    7. AHAndrew Huberman1:14:31

       That- that no o- no one, no pill, potion, injection, et cetera, can replace good behaviors. Um, pills, potions-

    8. CKCraig Koniver1:14:38

       Correct.

    9. AHAndrew Huberman1:14:38

       ... and injections, uh, can potentially augment those good behaviors, um, and get people going down the right path, which is what we're talking about today, but that it's a- it's really a personal responsibility. I mean, n- no-

    10. CKCraig Koniver1:14:49

        For sure.

    11. AHAndrew Huberman1:14:49

        ... no one can give us a calmer mind, no one can give us a healthier body. (laughs) Um, no- no one can do that, right? You can inh- it's interesting that some of the wealthiest people in the world, um, th- the new thing isn't for people to boast about their- their yachts or their properties, it's about, uh, their health.

    12. CKCraig Koniver1:15:05

        Sure.

    13. AHAndrew Huberman1:15:05

        It's about their vitality, their longevity, because that's the thing that, uh, I suppose in some sense money can start to buy, but it doesn't require a ton of funds to take great care of one's- one's body and mind.

Episode duration: 2:29:13