December 10, 2024 • 42 mins
Peptides are becoming more and more popular, not only among biohackers, but people who just want to boost their health a notch or two. What are peptides? In short, they’re chains of amino acids that can be combined to form proteins that trigger specific beneficial cellular functions, such as reducing inflammation, improving skin health, and growing muscle. In this episode of Healthy Longevity, Dr. Comite interviews Neil Paulvin, DO, a Manhattan physician specializing in anti-aging and regenerative medicine who’s known as “Dr. Peptide” for his expertise in peptide therapy.
You’ll learn…
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How Dr. Paulvin combines personalized functional medicine, peptide and hormone therapy, and biohacking techniques to help patients improve their healthspan and perform at their best.
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Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
(00:10):
Do you feel stuck on your journey to better health?
You've improved your sleep, you've started exercising, you do it all, you run, you doresistance training, you do high intensity interval training.
You seem to be doing all the right things, but you still don't feel as good as you should.
Today's guest on Healthy Longevity believes, as I do, that you should never feel stuck inyour health journey, but you should always be moving forward.
(00:31):
And there's so much we can learn and do to help you.
And that's what we're here today to learn from Dr.
Neal Paul-Vince.
Thanks for joining me, Neal.
Thanks for having me, looking forward to it.
All right, a bit of a background, Dr.
Polvin or Neil.
Homie Florence, right, is a physician who has board certifications in family medicine,osteopathic manipulation, and anti-aging and regenerative medicine.
(00:54):
Wow, that's a lot to have accomplished.
His practice is in Manhattan and combines both traditional and alternative medicine tohelp patients live a healthy life and perform at their best.
He also works in mitochondrial health, bioidentical hormones.
Longevity medicine and the brain-gut connection.
It just about covers everything.
I'd like to start by asking you, Hattie, you came to develop this unique practice aroundage management and regenerative medicine.
(01:22):
Sure.
it started, no, it started about early 2000s.
I was just starting my career after residency.
I was in a...
kind of rural areas, I was kind of a lot of the treatments and a lot of the docs that weredown there were very, very, very old school.
And I had always like kind of pushing the edge, learning the newest things to begin with.
(01:42):
I was also a patient.
I had severe headaches.
I had seen every traditional doctor known to mankind and nothing healthy actually gave memore side effects.
I was delving into things like acupuncture and mind body medicine way before is kind of invogue now.
So that kind of set me on course.
And then I kind of hit a point where I liked family medicine, but I needed to, I likeddoing the anti-aging health prevent the
preventive health more and I started doing things like when PRP had just come out.
(02:07):
Plasma.
And AD just started kind of getting a little buzz behind it probably a decade ago now.
Peptides are still whisper a little bit and I wasn't doing them.
So I kind of went down that rabbit hole.
And if you're doing that, you have to be doing anti-aging or preventative or sports.
And that's kind of where my.
practice one too.
Cool, well you you did everything at the beginning.
(02:28):
You saw every kind of patient from a child to woman, men, aging and all of the rest.
292.
Yeah, you got a great, how many years did you do that as family doctor?
Full blast probably I think is 11, 12 years.
Good, I'm sure you learned a lot about how to be the old fashioned doctor in that kind ofsetting.
No, I didn't, liked it.
love the, I originally went into that was because you had such variety.
(02:53):
You weren't just looking at somebody's brain, you were neurologist looking at brain andnerves every day.
I love the fact that everything was different and part of the reason I love this space nowis that you're going down the rabbit, you're looking at data, you're trying to figure out
what the problem is, what the root cause is, which in an old school way, family medicine.
and it is in a lot of ways, but they don't think about it that way, especially then.
So it definitely kind of got me started on the journey.
(03:15):
What labs do you typically like or biomarkers, as we say nowadays, do you typicallyrecommend to start?
Is it individualized to a person or do you have a planned initial approach with thepatient?
It's both now.
mean, unfortunately now, there's, I mean, as you know, there's probably I could be doingtens of thousands of labs, thousands of labs if I wanted to be.
(03:37):
So I have a set initial panel of biomarkers I do on everybody who comes to see me in mostcases, unless they're a chronic illness patient, and even then there's a huge overlap.
And then I will, based on my, I have initial conversations with everybody either over thephone or in person, I will add missing pieces if they need stool testing or gut testing,
do they want DNA, do we need to do metabolite testing?
(04:00):
And then I kind of will take the pieces from there, do they need?
specific autoimmune things going on.
I kind of will start with the foundational stuff and then I've learned how to pick andchoose what I need to add on to that.
personalize it to the human being, which is great.
You're able to dig in and really understand the bits and bytes of that human being.
Do you find that nowadays patients are actually seeking more information about how toprotect their health proactively?
(04:25):
Because I've seen that change happen with COVID.
COVID, maybe the mixed blessing in COVID is that people began to understand
that protecting your health was important because if you had underlying diagnoses or otherissues you actually didn't do as well during COVID.
You actually were at much greater risk.
That was my impression.
What have you seen in the last few years?
(04:46):
No, I've definitely seen, I think we saw two pretty good trends come out of COVID.
One is that patients are being proactive.
They're being their health advocate.
They're either telling their primary care doctor, hey, I wanna get these tests done.
They're doing their tests at home and they're coming to me and wanting those tests.
And then on top of that, they now are important to them to be.
Preventative in terms of it not just being reactive like our health care system is whereokay now you have diabetes or high blood pressure now We're gonna treat you.
(05:12):
It's like let's see if we can avoid you getting those things and helping you be healthyand theory live longer Yeah, absolutely.
That's where I started like I was seeing these numbers when I would look at screens ofpatients back in the 90s even in the 80s and I Be like well, you're gonna have a heart
attack or you already have diabetes You're on your way and people didn't even know itbecause in our
(05:34):
our usual healthcare system, it's reactive, not proactive.
We don't look for disease, because it's considered a fishing expedition.
Even at Yale, old-fashioned medicine and elsewhere, it's very hard to flip that paradigm.
I think you've done it well, so I'm impressed.
And in a short period of time.
I also find it interesting that you mentioned a whole bunch of biomarkers, and we toostart with about 150 biomarkers.
(05:58):
But what I find now that I think it overwhelms people, there's like, people are nowtalking
about getting thousands of biomarkers, what are you gonna do with that data if you don'tunderstand it?
And because most, many of our colleagues don't really have a firm grasp on where to start.
So I'm actually going back to basics.
I think getting just a handful of biomarkers gives a person a great place to start interms of a basic understanding of what's going on in their metabolism, their physiology,
(06:26):
so that you can begin to turn the tide.
I agree with most, I agree with that.
in mindset, unfortunately, a practice, sometimes in a practical business sense, patientscome in wanting a certain thing.
They hear something from their favorite influencer or their favorite podcaster and theyare like, want these biomarkers.
And now they're so easily available.
(06:46):
Right.
So I tend to like, again, I talk to them.
I can kind of gauge where they are.
They somebody just wants to dip their foot in.
And then we go very you can go much smaller as needed.
Or there's somebody who speaks the language and knows mutations and.
very specific things and then yeah, you give them larger.
The patients definitely don't, a lot of times unfortunately, know what they're asking for.
(07:07):
They see again, somewhere they got a test that a patient asked me today through email, heyI want this test.
Unfortunately that test I've not used probably for seven years, but they saw it somewhereand it's recommended.
So I think education is a big part of it and then understanding what they may find, what Ithink is the other part is now with like full body MRIs or genetic testing.
(07:27):
Okay, you may find something you don't want to hear.
Are you ready for that on top of the fact that you're getting a lot of information?
You may get some life altering information.
Are you ready for that to deal with it?
Totally.
That is a huge issue and I think...
That is one of the problems I have with offering thousands.
I think it's true.
There's some people who want this whole stack.
But then we've also heard complaints from those folks saying, well, I got all this.
(07:50):
Nobody knows what to do with it.
Nobody knows what to tell me.
So there are companies that are doing that kind of thing.
It's almost like a do it yourself.
It's different in your hands.
You're an expert.
You've been training yourself.
You're kind of growing the field with your lens.
But when you don't have that background, each of us is so complicated that getting thatinformation
and then being left to like, what does it mean?
(08:12):
Where do I go with it?
Or as you pointed out, a lot of people are getting whole body MRIs, which sometimes I getif in the prior days before there was Pranuvo or Ezra, and you find a meningioma.
We've had several patients and some have gone so far as to even have surgery becausethey'll go to neurosurgeons and they'll find out, yeah, you probably should get rid of it,
(08:33):
but it hasn't been doing anything.
It's just sitting there.
It's static.
So it's scary.
The same thing with APOE4.
I found in the past, that's a common one.
Like new people will say, my God, they don't realize ApoE4 is also an indicator of highcholesterol.
And all of a sudden they look it up and all of a sudden they look and see that it'sconnected to dementia or Alzheimer's and it becomes a whole different ballgame.
(08:56):
So knowing how to sort of guide that message, I believe it's possible, but I think a lotof education, both for the public and probably for our colleagues.
You know, they need to know how to handle
that.
All right, let's dig in a little more specifically about peptides, because I know that's aparticular focus of yours and you're really good at it.
You have lot of peptides at your fingertips.
(09:17):
I'm curious about how you apply it, how patients receive it.
What do you find to be the most successful?
Maybe even mention the top three that you think are really useful, because we're havingheadaches around that field as well.
Apparently the FDA just rejected the appeal for BPC 157.
and that is an issue.
(09:38):
don't know if you know some of the doctors involved in it.
Dr.
Edwin Lee went to the FDA with the group and it was impossible to give their side of thestory.
There were too many heavyweights on the other side.
So even though there's tons of data in most of these peptides.
Yeah, fortunately, yeah.
It's to be determined.
We'll see what happens.
mean, BBC is probably the one, BBC 150 is a peptide that everybody knows.
(10:02):
It has so many benefits.
Why I love peptides in general is
I love things, especially like you said, there's so many things out there.
We want things that check the most boxes.
So, BPC can help with gut health, can help with inflammation, it helps with buildingmuscle, it can help with brain health, it's good for your skin.
So, all that in one injection or pill, that's a win-win for everybody.
And now we're still doing this legal dance, which is really unfortunate.
(10:25):
Again, so in a vacuum, let's say for now, the best three four peptides are, at that peopleare using it the most benefit from it.
Definitely BPC 157.
Probably my second, or thymulin, which is great for boosting immune system.
use either short Thymulin is different than the thymocene alpha one.
They're two different.
They are different.
They're cousins.
thymocene 11 or TH11.
(10:47):
Is that thymulin or is that a whole other peptide?
Thymulin depends on where you're getting it from now.
There's different variations depending on where you're getting it from.
Thymulin is a different, I don't remember the exact amount of metamucid, thymulin off theof my head anymore.
But we use them, somewhat interchangeably, unfortunately, because of what's going on.
Thymus and Alpha 1 is better, it a lot of data, it is FDA approved, which kind makes thiswhole issue more confusing, but that's another story for another day.
(11:15):
The Thymalin 11 is, I think, going to even be better than the Alpha 1.
So that's something to look forward to.
What we've heard is, it's true, we'll see.
Yes, exactly.
But I think it has potential, yes, I agree.
Other peptides I really love, and one that we know is available, is something called theRosatide, which is really great for healing the gut lung.
because people don't know gut lining is actually really paper thin almost and it's reallygood for healing gut issues.
(11:42):
there another name for that?
AT-1001 is what it's kind of studied under.
We see incredible benefits when we combine it with your BPC and or butyrate for patientswho have anything from
Crohn's are also of colitis and that's colon gas neurons used to hate me because I givethem that combination paid my patients that combination before their colonoscopies and
(12:05):
then the doctor would do the repeat and they're like what are you doing?
That doesn't work and then they see their results and like okay, whatever Paul van Songyou do just But that and we're also using it now potentially for brain health because
there's a thin blood brain barrier same kind of as the gut lining So that may have somefuture potential like for dementia
The theory, again, it's in the early stage of being studied for things like that.
(12:29):
That research, unfortunately, is way down the line, I think, at this point.
But it has very little downside or no downside.
I haven't found any downside with BPC 157.
The only downside...
seen it?
The only thing we see is patients who have problems with histamine or mast cell issues,they cannot sometimes deal with the normal dosing.
You have to really either build them up or add something in, like a ketotipin or Allegrato it.
(12:53):
But yeah, overall, otherwise, it's one of the most benign peptides out there.
The other one is look at something called amyloxinox, which I've been turned on from otherlongevity docs out there in terms of it works great for mast cell histamine patients.
It's good for weight loss.
It actually has been shown to decrease inflammation all over.
There are some studies regarding brain chemistry.
So we now know that maybe an add-on for patients with Parkinson's or Alzheimer's.
(13:17):
And again, it's something that has very minimal side effects.
How do you take that?
How is that supplied?
It's a pill.
It's usually people that take it two or three times a day.
So that's an And how long a time do you have to wait for it to see effects?
It depends what you're taking it for.
If you're taking it more on the allergy side, almost instantaneously.
(13:38):
If you're doing it more for an anti-inflammatory or brain component, I've seen it in fourto six weeks.
And like the way I explain a lot of this stuff, kind of how you have to fill the bucketfast.
It's leaking.
So people who are really bad at takes, they'll notice it quicker.
People who just need a little bit of a boost will notice it will take longer for it toreally notice that difference.
So those are kind of the ones I like.
What's great about peptides, besides the fact that they check all the different boxes fora lot of people, is you can get a cream, a shot, a pill, a nose spray.
(14:04):
So depending on what you can or can't tolerate, you can in most cases do a peptide, just aquestion of making sure you're getting quality product.
Got it, yeah.
Well, that's fascinating, and I'm sure our listeners will enjoy exploring it and go try tofind it.
Exactly, That is one of the issues.
And so how did you develop this expertise and how do you share that expertise,particularly let's stick with peptides for the moment with your patients?
(14:31):
How do you demystify or simplify?
I try to, I'm the king of cheesy analogies and metaphors.
My patients are used to it at this point, but I try to break it down, again, most of mypatients, very simple, like I said, it's...
I'd break it down, there's six buckets.
There's six buckets of different types of peptides, muscle inflammation, brain, gut, thevanity, skin hair, weight loss, mitochondrial ones.
(14:57):
And then you kind of have the bucket of misfit toys, the ones that just don't really fitinto any category.
And then you have to go through how to take them.
You kind of got to go step by step.
And what's amazing now, that five or 10 years ago when I started, you'd be like, have youever injected yourself?
Patient would be like, what?
Now, sure, I do it all the time.
It's like men doing testosterone, women with fertility and other things inject themselvesbecome kind of the norm.
(15:19):
So it's not as daunting as it used to be, which takes a lot of the tough teaching out ofthe equation at this point.
Yeah, so most of your patients are in person as opposed to telemed in order to get themstarted, particularly when it's injections or do you do that even through a telemed?
Right now my practice is probably 60, 40 telemedicine.
(15:39):
went down the rabbit hole, I think I have 21 licenses in different states, we just shipthem all over.
Both the patients, that peptides are virtual, they just wanna say, like you said, there'sso much noise out there, they wanna know, okay, this is what I should be taking, this is
how I wanna structure my program, and then they're on their way.
So they just need the kind of little bit of insight.
you follow them then regularly in terms of any kind of outcomes or what outcomes would youfollow for different types of patients?
(16:06):
Obviously, it depends what we're doing.
I mean, a lot of cases we do follow them in some way, shape or form, depending on whatwe're using it for.
Obviously, if it's muscle skeletal, it's usually going to be biggest test is theirperformance in the gym or on the field.
My patients who went, couldn't lift anything at the gym and then six weeks later becausethey have like a rotator cuff injury or a knee issue.
we're back going closer to the personal record.
(16:27):
And then if we need to, we'll do it extra MRI.
But again, to me, the proof is in the pudding a lot of cases there.
I mentioned my gut stories already.
So a lot of times we're following up with a very specific.
It's sometimes it's interwoven into what else we're doing.
Great.
Good to know.
Yeah, it's tricky, though, because the rules have somewhat changed.
But then you have to be careful because you are a physician.
(16:48):
You want to do the right thing.
You above all do no harm.
And so it's a bit of a juggling act, I think.
So it's not easy.
Congratulations on getting it right.
Yes, it's tough.
once you know how to dance, it's not that hard.
yeah, learning is hard, part.
Have you had some experience with GHK copper in some of the peptides that literally
(17:11):
change your skin from the inside out and have a Botox like effect, but also a great impacton collagen.
Have you had experience with that peptide?
It's become very amazingly popular from all ends, from the doctor and in the social mediaend.
And I mean, there's a lot of benefits that we started using it more as a general medicine,probably five, seven years ago.
(17:31):
And we use it lot for brain health and for tendon health.
It's kind of a nice add on for tendon injuries.
And then the skin component blew up more than anything else.
I think the benefits are amazing.
like it definitely builds collagen, decreases inflammation.
It's great now there's combos.
You can mix it either with BPC like I mentioned, or they've now mixed in with the othertype of skincare products that out.
(17:55):
There's some that have retinolic acid in there, some have hyaluronic acid in there.
So they're definitely taking advantage of it, both on the professional side, like frompharmacies and the consumer brands are doing it as well.
So it's something that will be here forever and I think some patients should be using.
I agree.
How do you actually apply it?
Have you used it both as creams and do you also use it as injectables with BPC or orally?
(18:19):
No, most, 95 % of patients, well, it depends what they're using it for.
If they only want face, then yeah, they'll do the facial creams that are out there andlose these, again, they're almost all combos now at this point.
But I don't know that BPC would be absorbed that great.
through creams, you have experience with doing that.
know oral There's little data behind it.
A patient have said it because we know from what's happened when we used to use it forjoints, when we only had injections and creams, that there is some absorption, it doesn't
(18:47):
go incredibly deep, it's not gonna go as deep as an injection would.
But again, people don't want their face injected, so you gotta kind of find a happy groundin the middle there.
It's not perfect.
But yeah, so the injection is probably the worst in peptide injection out there.
It burns horribly.
So most patients don't use it systemically anymore.
(19:08):
I don't think I've ever used it systemically, particularly the copper.
I've had to use a copay who want, for a variety of reasons, this is the only one thathelps their skin systemically.
They have to do it as an injection.
You can't just put cream all over your body.
You spend time and too much money doing it.
How long did you see it took if you do the injection as opposed to the cream?
(19:31):
Good question.
It took a while.
I mean, it was like two or three months.
It's not sustainable.
It's not something that.
it's daily.
They were doing it daily injections daily, at least five days a week.
And again, this is probably more right before Covid.
Now there's just so many other things out there.
It's it's way down the list of systemic anymore.
But this is kind of, again, before lot of the other stuff came out.
(19:53):
I would say, but And you had any trouble getting your hands on peptides and making surethat you're working the fligid and the compounding harnesses, because that's always an
issue for a lot of folks.
Most, no.
I mean, the ones that are really, really impossible to get right now is something calledMozi, which is a lot of people's favorite for lot of different reasons.
That one is almost impossible to get.
(20:14):
Beyond that, and another one I actually love for my infectious pace, LL37, but those aretwo that are really, really hard to get.
Other ones, there's other formulations that are available from Rebidwell Pharmacies.
What is that, LF37?
LL37 is a cathocline, I can't pronounce it, a cathocline that's an antimicrobial peptidethat they find in the gut and throughout the body.
(20:37):
We started using initially mostly for SIBOs, bacterial overgrowth patients, ulcerativecolitis.
And then people who have low immunities, we found a lot of benefit to it.
But even back then it wasn't a popular one.
And now it was on the band list and is possible almost to find in the US.
SS-31, is that another one you've tried, used?
(20:57):
I love SS-31.
I mean, it's incredible antioxidant.
It has great data behind it.
It's being studied more and more.
There's a company trying to patent it.
which makes it good and bad.
it's an incredible data for heart health.
10 tonight is using for Alzheimer's and Parkinson's.
It's something that you don't need to use continuously.
You can do it for a month or two, maybe once or twice a year, which is really great.
(21:19):
only downside is the price.
For people who are price conscious, it's gonna probably be a couple thousand dollarspotentially.
I let people know that ahead of time, but.
Couple of thousandth of the whole course or like a month?
Even for a month, a lot of times it's gonna be close to over a thousand dollars.
And how mostly is it applied?
It's an injection.
that's one of the things where you talk to five long-dairy doctors who know what they'retalking about, you're gonna get five different how they dose it.
(21:46):
We all see the benefits.
It really just comes down to personal preference and the preference.
favorite?
I mean, I patients do it two or three times a week.
And again, I'll progress to high dose for the patient I knew who can tolerate it, patientI were more sensitive or this is their first time with peptides, I'll start them at a
lower dose and build them up.
But I mean, think it's something you're gonna hear about more and more because it is beingstudied in the mainstream medicine as well.
(22:07):
What dose do you generally start wishing and work on?
What's considered your low end and high end?
I mean, I'll do usually either depending on what the...
What you would call it.
What the strength on the bottle is, every company makes a little bit different.
And I'll do like 50 units three times a week, which is, now my brain is, those depend,like I said, on which brand I'm using.
(22:29):
But there people who do 100 now, units three times a week, and we're seeing bettereffects.
It's just.
you're pushing the envelope a little bit.
Yeah.
And then a month or two and then you hold off for a while.
We'll hold off.
We'll do again.
We do markers depending on what we're using it for.
The ones that I'll tend to push with are my brain patients.
I mean, like all anti-neurocognitive.
I'll push What do you look at before and after to get a baseline in future and change?
(22:53):
Now, again, this is like I said, there's so many more tests out there now, even the lastthree months.
I mean, I love getting a neuroquant, which is a
Biome-based MRIs has other data to it.
I call it now the brain tests that are out there that you can now do mostly in New York,but other states you can do more of things like GFAP, IL-6, amyloid and tau proteins that
(23:14):
we can measure.
And you see changes metabolically with it?
I've seen some cases I've seen data, definitely inflammation has gone down.
The MRIs look better potentially in six to 12 months.
We've seen less.
Sometimes the amyloid has gone down.
This is in conjunction with other things.
And with that type of patient, as you know, it's multifactorial.
(23:37):
It could be toxins.
could be a hundred different things.
it's not just the peptide, but I mean, now we have enough tools in our toolbox, both ofthe testing side and now I think in the treatment side that you can mesh them together.
Again, this is one of those things where you definitely need a doctor kind of translatingwhat's viable and what's kind of ridiculous at this point, because there's so much, think,
(23:58):
People say, I can cure Alzheimer's and that kind of burns me a little bit because that'sreally not been proven yet at all.
And that's just okay, just ignore that.
But I listened to a podcast last night on that topic and just about plasmagines,plas-ma-gines, plas-ma-gines.
And it was fascinating.
but I couldn't really tell from the data.
They'll look like there was a lot of data and it looks promising.
(24:20):
I love the, I've been saying, but I love it.
I think there's huge potential, but we're still not at the finish line with any of thatstuff yet.
I don't think we could promise.
I get asked a fair amount, can you cure it?
my response is, you never know.
I can't say we can, but what we can do is make inroads and hopefully stop progression andmaybe gain some ground back.
Exactly.
I find testosterone to be amazing for memory.
(24:42):
I never even dreamed of that, but years
ago I had patients because I mainly did telemedicine for many years, like two, threedecades now, way before COVID.
My family finally understood what I was doing once COVID struck because they're alldermatologists or facial plastic surgeons and they're like, how could you do telemedicine?
I'm like, yes, don't, just wait.
And then COVID happened.
(25:04):
and I would explain to people how change could happen, but it takes a long time becausethe field wasn't really as mature as it's getting lately.
And speaking of doses,
in regimen, let's turn to rapamycin.
I know there's a lot of debate out there now.
Some people are actually saying, no, no, no, don't use it, or only use it in an elderly orolder patient over 70.
(25:24):
And then the types of protocols you use.
What's been your personal experience with that?
That is something that literally changes now every month with me now because not onlywe're waiting with all these new meds, we're waiting on date like you said, we're still
waiting.
The good stuff has come out in terms of fertility.
The Columbia studies are showing promise in terms of improving fertility, egg production,minimal side effects.
(25:48):
That's great.
And that's gained huge bandwidth so far, I love because fertility is...
I don't understand why you don't have more advances there.
What's the protocol they use?
know, the dosing?
think it's five.
Five a week?
Yeah, I think so.
95 % is five milligrams a week, which is great.
And I think that, but now we're, again, plateau.
So kind of back to the question would be, I normally would start patients at three or sixmilligrams, again, depending who I'm dealing with.
(26:13):
I will send it to patient who says, well, I can't take too much of anything.
It affects me.
You might start at three and somebody who is more resistant and say, throws it at throw itat me.
Five or six.
And also depends again, if I'm treating somebody again, there are some small stages likeAlzheimer's and neurodegenerative issues.
This is a lot of small stays for a lot of different niches at this point, but nothinggroundbreaking at this point.
(26:37):
So that's where I'll start six.
And I tend to.
will increase checking lab markers as much as you can.
Which lab markers are you measuring yourself?
I'm CBC, NCASE, a lot of the white blood cell markers.
I will check troughs and peaks, but I've talked to, every doc has a different answer aboutwhat you're gonna see or not see with it, so I don't know what to do with that.
(26:58):
If I'm treating a specific condition, I look at that marker.
But that's what I do now, and I still cycle patients every three to four months.
I will have them take a break.
I will not have them do it in perpetuity.
That's how I view it.
Other docs will have them just do it continuously and continue up to like 13 milligrams.
But the flip, what's also flipped a little bit is that was the first thing that got allthe publicity in terms of anti-aging longevity.
(27:21):
Now we're seeing every week there's a new study on the GLP-1s.
There's now every week, every couple of weeks a new study on SGLT2.
Medicines are all diabetic medication, but we're seeing all the benefits from them andthere's more data there.
So now is that, do we do kind of flip-flop to that more and then kind of keep rapamycinmore in our back pocket for more specifically, which is where I'm going with it now?
(27:42):
Do you ever see any immune issues with rapamycin in patients?
Because I use a fair amount.
I've been using SGLP1s for 20, since they first became available in 2005.
where you had to take an injection, was Bieta.
You took it before meal each time within a 15 minute window.
And then it progressed to daily with like Victosa and then it progressed to weekly.
(28:04):
So that's uncomfortable.
I'd have been using SGLT2s for...
since the beginning as well, because there was a lot of fear about it.
In fact, if you might remember, you might recall that it was supposed to be harmful to thekidneys and heart.
And same thing as Crestor back in the day with statins.
When I first came to New York, a lot of cardiologists were all still using Lipitor untilthe Jupiter trial came out.
(28:25):
And I remember getting calls from these cardiologists saying, how did you know that?
And I said, well, it's in the data.
So I started using Crestor quite early.
So yeah, I think those may actually have more potentials than anti-aging longevity.
and then we gotta wait for the full Rapmison data to come out.
thing with any of these types of medicines, we wait for studies, studies are expensive todo, they have the money to do the studies right now.
(28:49):
Rapmison, unfortunately a lot of our colleagues are waiting for, they can't even getfunding to do a lot of the studies that they need to do, and that just keeps it.
it puts it behind a little bit, which is unfortunate.
And even the studies are quite limiting, because if you even look at evidence-basedmedicine, you're looking at a whole bunch of people who have to be in these studies
treated exactly the same way, yet they're all different.
So one of the problems, you can get data, which is a great place to start.
(29:12):
Data is great.
But when it regresses to the mean or you just get average, then you're treating people andyou may be treating the wrong person.
You may not.
be applying it as a risk benefit at the level of that individual, that N of one.
That's one of the areas that I have trouble with, having been part of a lot of studies.
It's very true.
It's another dance that you have to learn where you feel comfortable.
Exactly, and where that person fits, you know.
(29:34):
I completely agree.
So there are a lot of other topics we can touch on, but that was a great discussion aboutrapamycin.
And you've been on it yourself?
Is that been the case?
I do burst.
I've been repulsed.
I found for me, cognition improved.
I have unfortunately I call myself like a muscular path I have horrible joints justbecause I abused myself as a kid not like the basketball and running and stuff and I my
(29:55):
inflammation levels went down I know Matt Kaberline has said the same thing and a coupleother people said the same thing where it's kind of a magic potion for lack of a better
word And other people don't feel that at all.
So for me, I like it I do pulse it's not something that I'd want to be doing in securitylike six a week for I do six weeks and then I'll stop it and now every six or twelve weeks
I'll restart it.
That makes sense.
No, I think we have the benefit of watching our own body because
(30:16):
when I introduce something new, unless it requires a prostate, I will test it before Iactually start using it to see how I understand it from the inside out.
Like I did it with every GLP-1, most of which I couldn't tolerate, and I had a very hardtime, even at very low doses.
It just didn't agree with my gut and the way I felt on it.
But I got to understand it from the inside out, as you're saying, just like you're doing.
(30:37):
And it helps.
It helps you explain to patients what they're going to feel, what the side effects may ormay not be.
And to understand the spectrum of how these drugs interfere.
So there's a few other things that I think you talk about too.
I don't know if you, have a few more minutes.
It'd be great to hear your thoughts on red light therapy, methylene blue, hyperbaricoxygen, something we've been looking at, plasmapheresis, which we're initiating here
actually now.
(30:57):
That kind of, those areas.
All those things have great, are great.
I think they have huge potential.
think now we're learning how to use them.
They're not just kind of a cool buzzword.
I mean, the one that has me most excited and the one you mentioned you're starting heresoon is Plasma Freesus.
Because again kind of goes back to the same thing we have mentioned is it has data behindit both for medical issues and attention now for aging And we know why it works and how to
(31:21):
integrate into a practice So I think that we're starting we started to see both initiallyfor like autoimmune issues And now we're starting to see it for long COVID and now
patients are using it to decrease inflammation and lower their biological age That'sanother kind of debate what how great biological age is but I think it's something that is
me something you're gonna hear more and more about
because it just has so many benefits to it.
(31:42):
The right now is the cost per patient, unfortunately.
But it was also great with plasma freezers.
It plays well in the sandbox without some of other things that you mentioned, depending onwhat's coming to use in you.
know the day before the day after, a lot of people are doing methylene blue because of itsbenefits.
Methylene blue, and you may love calling it pool cleaner, which is not how we use it.
There's a lot of data because the antimicrobial, antiviral, antioxidant, it decreasesinflammation.
(32:04):
It's actually, people are using it for their skin now.
So it's something you could do as an oral and IV.
Again, a lot of doctors are incorporating that with it.
And then also hyperbolic.
I mean that again that's something that's come we knew about for a while and now it'sgonna say is coming out of Israel and just general practice and data that's come out on
Alzheimer's and other brain health and autoimmune issues now like two weeks ago a PTSD andit was bipolar ish improvement with hyperbaric that to me is a home run for patients.
(32:28):
Yeah, it's it's not a medicine It's something you can find almost any town now It's notsomething you need to travel to New York, LA or Miami to do though It's hard sometimes to
get appointments and to do it at the right level because Aviv clinic is the
in Israel I think you were alluding to.
They opened up in Miami and Boston.
cool.
mean, it's a great program.
It's 12 weeks for nothing, which is good and bad.
(32:50):
But they brought it to the forefront.
I mean, great to get information.
Alzheimer's and also mean pro athletes travel.
It was every pro sports team that has one in their facility And I think it has so muchpotential and I love things that like I said check a lot of boxes and also play well in
the sandbox Well, thank you.
Do you ever bearing your patients for the hyperbaric?
I do all the time.
I do it my patients who do it again You have your own treatment.
(33:13):
No, I'm I would I decided two years ago I'm gonna refer out.
I'm not having everything in one spot.
Like you do it just
I don't have all of that.
But you have a lot of stuff here.
But yeah, it's just not how I want to practice.
love referring to the people who do it well and have the staff who do it great.
And especially being in Manhattan, it's biohackers paradise here.
again, I refer to lot of my patients to it for it.
(33:34):
And again, in conjunction with some other things that we've discussed, they're a healthoptimization patient, we know how I give them a stack, which is a combination of things
that work together really well.
If they're neurocognitive patient, still is going to work.
And you do this, this, and this with this IV.
And here you go.
It's fun.
Yeah, have you tried hormones like?
Oxytocin or any of the other combinations for ps2d or PTSD or any of the other ones yourchoice by Depression things I've done it kind of what's one way for in the distance being
(34:04):
I've treated my patients for other things that's improved that that's one of the oneniches I don't delve into there's a lot of great integrative or preventive psychiatrists
around in this place That's something to tell me I said wise right that I I'll do it inconjunction with other things but I don't delve into it myself as much because
That's one thing I just think if you're doing that you need to be doing it every day Yeah,there's great potential with things not I hate SSRIs for most patients long term I love
(34:27):
the fact things like that are emerging available.
Yeah, see big changes with that with inflammation Are you looking at like high sensitivitycardiac CRP?
Are you looking at fibrinogen?
Are you looking at?
Are there any favorites that you have in terms of saying, yes, this patient's inflammatorystatus has markedly increased or decreased and their GI tract is much better.
(34:49):
They don't have IBS symptoms anymore.
Their Crohn's is improved.
But now where is it now we can kind of narrow down where it is My favorite two or threeare I've got a CRP is still great no matter what I love Cal protecting which looks at the
gut more specifically because we know the guts connected to almost everything okay in
(35:12):
that you have in terms of saying, yes, this patient's inflammatory status has markedlyincreased or decreased and their GI tract is much better.
They don't have IBS symptoms anymore.
I love inflammation markers because you can almost do it for every area of the body now,which is great.
not only it's not, OK, you're inflamed, but now where is it?
(35:34):
Now we can kind of narrow down where it is.
My favorite two or three are CRP is still great no matter what.
I love Calprotectin, which looks at the gut more specifically because we know the gut'sconnected to almost everything.
So unless you fix the gut, and you can do it traditionally, it's not something that's likesome holistic test.
And my other favorite one now, the heart inflammatory,
(35:54):
that are a little more specific, LPPLA2 or oxidized LDL that are more specific to theheart.
I know, okay, those are high and they also have high cholesterol.
I need to be very proactive with this patient.
And not only do we have to treat the cholesterol in the plaque, we gotta treat theinflammation on top of all the other things that we know are related to heart disease like
mitochondrial and everything else.
(36:15):
You can do a whole hour on that by itself.
So I think we now have the data and the tools again to look at inflammation.
It's been a buzz line for years.
Inflammation is the cause of lot of illness out I it all boils down to the immune systemand inflammation.
Exactly.
if you get your arms around that.
But figuring out the path and the journey, I think, is complex for each of us.
(36:35):
All right.
I think we're ready to wrap, but I always like to ask visitors in the podcast, if a friendasked you, like, what's the one thing you would say that I could do to markedly optimize
my health and get longevity, what would be your top approach of anything?
You mentioned.
Let just hit on.
mean, think maximizing your sleep is by to me is by far the simplest thing you can do in alot of cases.
(36:58):
You don't have to leave your apartment or house to do it.
And we just know not only how you see, but maintain your circadian rhythm, how importantthat is now.
think that's the number one thing that you can do.
And it's in theory, it's easy to do because it's free and it's in your home.
Right.
Except if your home also has some little rug rats around and kids and that can be harder,but you have to get them under control as well.
(37:19):
There's a lot of ways now you can work around it.
I have a one year old right now and who loved hopping in bed with mommy and daddy, but wework around it.
All right.
Well, this was fun.
Here are the five takeaways that I think you'll find really useful.
First, the trends out of the COVID-19 pandemic.
were really important.
They include the fact that we want to make sure that you can be your own health advocate.
(37:40):
That's one of the roles I have here and one of the things I want to share.
Also, be aware that you want to be proactive, not reactive, and find a clinician that canhelp you do that.
The second was continue exploring on your own journey to optimizing health.
And if you find yourself in a rut, look for ways to break out of it.
There are tests you can do, there are clinicians you can see.
Make it a more personalized, proactive approach to optimizing your own health.
(38:03):
Three.
Peptides, a big popular topic now due to all the research that's showing how safe they areand their efficacy is amazing for a wild range of disorders and for longevity itself.
The potential is huge.
Neil shared that his top three promising peptides include BPC 157.
(38:24):
This is one that helps your gut and your brain, your joint pain, your arthritis,inflammation and inflammatory.
gut disease.
The second was thymalin, a peptide that inhibits pro-inflammatory changes and processesand cytokines and improves your immune system, which is really critical.
(38:45):
The third is lorazetide for healing the gut lining and in combination with other peptidesfor Crohn's disease and colitis.
Other cutting edge to wrap it up, proactive treatments with great potential and are in usetoday.
is red light therapy, hyperbaric oxygen therapy, methylene blue, which is IV, or you couldtake it in other ways, and plasma exchange therapy or plasmapheresis.
(39:12):
I'm Dr.
Florence Comete.
I'm really excited that you've joined me to listen to our podcast and to continue on yourjourney to healthy longevity.
See you soon.
Do you feel stuck on your journey to better health?
You've improved your sleep, you've started exercising, you do it all, you run, you doresistance training, you do high intensity interval training.
You seem to be doing all the right things, but you still don't feel as good as you should.
Today's guest on Healthy Longevity believes, as I do, that you should never feel stuck inyour health journey, but you should always be moving forward.
(00:31):
And there's so much we can learn and do to help you.
And that's what we're here today to learn from Dr.
Neal Paul-Vince.
Thanks for joining me, Neal.
Thanks for having me, looking forward to it.
All right, a bit of a background, Dr.
Polvin or Neil.
Homie Florence, right, is a physician who has board certifications in family medicine,osteopathic manipulation, and anti-aging and regenerative medicine.
(00:54):
Wow, that's a lot to have accomplished.
His practice is in Manhattan and combines both traditional and alternative medicine tohelp patients live a healthy life and perform at their best.
He also works in mitochondrial health, bioidentical hormones.
Longevity medicine and the brain-gut connection.
It just about covers everything.
I'd like to start by asking you, Hattie, you came to develop this unique practice aroundage management and regenerative medicine.
(01:22):
Sure.
it started, no, it started about early 2000s.
I was just starting my career after residency.
I was in a...
kind of rural areas, I was kind of a lot of the treatments and a lot of the docs that weredown there were very, very, very old school.
And I had always like kind of pushing the edge, learning the newest things to begin with.
(01:42):
I was also a patient.
I had severe headaches.
I had seen every traditional doctor known to mankind and nothing healthy actually gave memore side effects.
I was delving into things like acupuncture and mind body medicine way before is kind of invogue now.
So that kind of set me on course.
And then I kind of hit a point where I liked family medicine, but I needed to, I likeddoing the anti-aging health prevent the
preventive health more and I started doing things like when PRP had just come out.
(02:07):
Plasma.
And AD just started kind of getting a little buzz behind it probably a decade ago now.
Peptides are still whisper a little bit and I wasn't doing them.
So I kind of went down that rabbit hole.
And if you're doing that, you have to be doing anti-aging or preventative or sports.
And that's kind of where my.
practice one too.
Cool, well you you did everything at the beginning.
(02:28):
You saw every kind of patient from a child to woman, men, aging and all of the rest.
292.
Yeah, you got a great, how many years did you do that as family doctor?
Full blast probably I think is 11, 12 years.
Good, I'm sure you learned a lot about how to be the old fashioned doctor in that kind ofsetting.
No, I didn't, liked it.
love the, I originally went into that was because you had such variety.
(02:53):
You weren't just looking at somebody's brain, you were neurologist looking at brain andnerves every day.
I love the fact that everything was different and part of the reason I love this space nowis that you're going down the rabbit, you're looking at data, you're trying to figure out
what the problem is, what the root cause is, which in an old school way, family medicine.
and it is in a lot of ways, but they don't think about it that way, especially then.
So it definitely kind of got me started on the journey.
(03:15):
What labs do you typically like or biomarkers, as we say nowadays, do you typicallyrecommend to start?
Is it individualized to a person or do you have a planned initial approach with thepatient?
It's both now.
mean, unfortunately now, there's, I mean, as you know, there's probably I could be doingtens of thousands of labs, thousands of labs if I wanted to be.
(03:37):
So I have a set initial panel of biomarkers I do on everybody who comes to see me in mostcases, unless they're a chronic illness patient, and even then there's a huge overlap.
And then I will, based on my, I have initial conversations with everybody either over thephone or in person, I will add missing pieces if they need stool testing or gut testing,
do they want DNA, do we need to do metabolite testing?
(04:00):
And then I kind of will take the pieces from there, do they need?
specific autoimmune things going on.
I kind of will start with the foundational stuff and then I've learned how to pick andchoose what I need to add on to that.
personalize it to the human being, which is great.
You're able to dig in and really understand the bits and bytes of that human being.
Do you find that nowadays patients are actually seeking more information about how toprotect their health proactively?
(04:25):
Because I've seen that change happen with COVID.
COVID, maybe the mixed blessing in COVID is that people began to understand
that protecting your health was important because if you had underlying diagnoses or otherissues you actually didn't do as well during COVID.
You actually were at much greater risk.
That was my impression.
What have you seen in the last few years?
(04:46):
No, I've definitely seen, I think we saw two pretty good trends come out of COVID.
One is that patients are being proactive.
They're being their health advocate.
They're either telling their primary care doctor, hey, I wanna get these tests done.
They're doing their tests at home and they're coming to me and wanting those tests.
And then on top of that, they now are important to them to be.
Preventative in terms of it not just being reactive like our health care system is whereokay now you have diabetes or high blood pressure now We're gonna treat you.
(05:12):
It's like let's see if we can avoid you getting those things and helping you be healthyand theory live longer Yeah, absolutely.
That's where I started like I was seeing these numbers when I would look at screens ofpatients back in the 90s even in the 80s and I Be like well, you're gonna have a heart
attack or you already have diabetes You're on your way and people didn't even know itbecause in our
(05:34):
our usual healthcare system, it's reactive, not proactive.
We don't look for disease, because it's considered a fishing expedition.
Even at Yale, old-fashioned medicine and elsewhere, it's very hard to flip that paradigm.
I think you've done it well, so I'm impressed.
And in a short period of time.
I also find it interesting that you mentioned a whole bunch of biomarkers, and we toostart with about 150 biomarkers.
(05:58):
But what I find now that I think it overwhelms people, there's like, people are nowtalking
about getting thousands of biomarkers, what are you gonna do with that data if you don'tunderstand it?
And because most, many of our colleagues don't really have a firm grasp on where to start.
So I'm actually going back to basics.
I think getting just a handful of biomarkers gives a person a great place to start interms of a basic understanding of what's going on in their metabolism, their physiology,
(06:26):
so that you can begin to turn the tide.
I agree with most, I agree with that.
in mindset, unfortunately, a practice, sometimes in a practical business sense, patientscome in wanting a certain thing.
They hear something from their favorite influencer or their favorite podcaster and theyare like, want these biomarkers.
And now they're so easily available.
(06:46):
Right.
So I tend to like, again, I talk to them.
I can kind of gauge where they are.
They somebody just wants to dip their foot in.
And then we go very you can go much smaller as needed.
Or there's somebody who speaks the language and knows mutations and.
very specific things and then yeah, you give them larger.
The patients definitely don't, a lot of times unfortunately, know what they're asking for.
(07:07):
They see again, somewhere they got a test that a patient asked me today through email, heyI want this test.
Unfortunately that test I've not used probably for seven years, but they saw it somewhereand it's recommended.
So I think education is a big part of it and then understanding what they may find, what Ithink is the other part is now with like full body MRIs or genetic testing.
(07:27):
Okay, you may find something you don't want to hear.
Are you ready for that on top of the fact that you're getting a lot of information?
You may get some life altering information.
Are you ready for that to deal with it?
Totally.
That is a huge issue and I think...
That is one of the problems I have with offering thousands.
I think it's true.
There's some people who want this whole stack.
But then we've also heard complaints from those folks saying, well, I got all this.
(07:50):
Nobody knows what to do with it.
Nobody knows what to tell me.
So there are companies that are doing that kind of thing.
It's almost like a do it yourself.
It's different in your hands.
You're an expert.
You've been training yourself.
You're kind of growing the field with your lens.
But when you don't have that background, each of us is so complicated that getting thatinformation
and then being left to like, what does it mean?
(08:12):
Where do I go with it?
Or as you pointed out, a lot of people are getting whole body MRIs, which sometimes I getif in the prior days before there was Pranuvo or Ezra, and you find a meningioma.
We've had several patients and some have gone so far as to even have surgery becausethey'll go to neurosurgeons and they'll find out, yeah, you probably should get rid of it,
(08:33):
but it hasn't been doing anything.
It's just sitting there.
It's static.
So it's scary.
The same thing with APOE4.
I found in the past, that's a common one.
Like new people will say, my God, they don't realize ApoE4 is also an indicator of highcholesterol.
And all of a sudden they look it up and all of a sudden they look and see that it'sconnected to dementia or Alzheimer's and it becomes a whole different ballgame.
(08:56):
So knowing how to sort of guide that message, I believe it's possible, but I think a lotof education, both for the public and probably for our colleagues.
You know, they need to know how to handle
that.
All right, let's dig in a little more specifically about peptides, because I know that's aparticular focus of yours and you're really good at it.
You have lot of peptides at your fingertips.
(09:17):
I'm curious about how you apply it, how patients receive it.
What do you find to be the most successful?
Maybe even mention the top three that you think are really useful, because we're havingheadaches around that field as well.
Apparently the FDA just rejected the appeal for BPC 157.
and that is an issue.
(09:38):
don't know if you know some of the doctors involved in it.
Dr.
Edwin Lee went to the FDA with the group and it was impossible to give their side of thestory.
There were too many heavyweights on the other side.
So even though there's tons of data in most of these peptides.
Yeah, fortunately, yeah.
It's to be determined.
We'll see what happens.
mean, BBC is probably the one, BBC 150 is a peptide that everybody knows.
(10:02):
It has so many benefits.
Why I love peptides in general is
I love things, especially like you said, there's so many things out there.
We want things that check the most boxes.
So, BPC can help with gut health, can help with inflammation, it helps with buildingmuscle, it can help with brain health, it's good for your skin.
So, all that in one injection or pill, that's a win-win for everybody.
And now we're still doing this legal dance, which is really unfortunate.
(10:25):
Again, so in a vacuum, let's say for now, the best three four peptides are, at that peopleare using it the most benefit from it.
Definitely BPC 157.
Probably my second, or thymulin, which is great for boosting immune system.
use either short Thymulin is different than the thymocene alpha one.
They're two different.
They are different.
They're cousins.
thymocene 11 or TH11.
(10:47):
Is that thymulin or is that a whole other peptide?
Thymulin depends on where you're getting it from now.
There's different variations depending on where you're getting it from.
Thymulin is a different, I don't remember the exact amount of metamucid, thymulin off theof my head anymore.
But we use them, somewhat interchangeably, unfortunately, because of what's going on.
Thymus and Alpha 1 is better, it a lot of data, it is FDA approved, which kind makes thiswhole issue more confusing, but that's another story for another day.
(11:15):
The Thymalin 11 is, I think, going to even be better than the Alpha 1.
So that's something to look forward to.
What we've heard is, it's true, we'll see.
Yes, exactly.
But I think it has potential, yes, I agree.
Other peptides I really love, and one that we know is available, is something called theRosatide, which is really great for healing the gut lung.
because people don't know gut lining is actually really paper thin almost and it's reallygood for healing gut issues.
(11:42):
there another name for that?
AT-1001 is what it's kind of studied under.
We see incredible benefits when we combine it with your BPC and or butyrate for patientswho have anything from
Crohn's are also of colitis and that's colon gas neurons used to hate me because I givethem that combination paid my patients that combination before their colonoscopies and
(12:05):
then the doctor would do the repeat and they're like what are you doing?
That doesn't work and then they see their results and like okay, whatever Paul van Songyou do just But that and we're also using it now potentially for brain health because
there's a thin blood brain barrier same kind of as the gut lining So that may have somefuture potential like for dementia
The theory, again, it's in the early stage of being studied for things like that.
(12:29):
That research, unfortunately, is way down the line, I think, at this point.
But it has very little downside or no downside.
I haven't found any downside with BPC 157.
The only downside...
seen it?
The only thing we see is patients who have problems with histamine or mast cell issues,they cannot sometimes deal with the normal dosing.
You have to really either build them up or add something in, like a ketotipin or Allegrato it.
(12:53):
But yeah, overall, otherwise, it's one of the most benign peptides out there.
The other one is look at something called amyloxinox, which I've been turned on from otherlongevity docs out there in terms of it works great for mast cell histamine patients.
It's good for weight loss.
It actually has been shown to decrease inflammation all over.
There are some studies regarding brain chemistry.
So we now know that maybe an add-on for patients with Parkinson's or Alzheimer's.
(13:17):
And again, it's something that has very minimal side effects.
How do you take that?
How is that supplied?
It's a pill.
It's usually people that take it two or three times a day.
So that's an And how long a time do you have to wait for it to see effects?
It depends what you're taking it for.
If you're taking it more on the allergy side, almost instantaneously.
(13:38):
If you're doing it more for an anti-inflammatory or brain component, I've seen it in fourto six weeks.
And like the way I explain a lot of this stuff, kind of how you have to fill the bucketfast.
It's leaking.
So people who are really bad at takes, they'll notice it quicker.
People who just need a little bit of a boost will notice it will take longer for it toreally notice that difference.
So those are kind of the ones I like.
What's great about peptides, besides the fact that they check all the different boxes fora lot of people, is you can get a cream, a shot, a pill, a nose spray.
(14:04):
So depending on what you can or can't tolerate, you can in most cases do a peptide, just aquestion of making sure you're getting quality product.
Got it, yeah.
Well, that's fascinating, and I'm sure our listeners will enjoy exploring it and go try tofind it.
Exactly, That is one of the issues.
And so how did you develop this expertise and how do you share that expertise,particularly let's stick with peptides for the moment with your patients?
(14:31):
How do you demystify or simplify?
I try to, I'm the king of cheesy analogies and metaphors.
My patients are used to it at this point, but I try to break it down, again, most of mypatients, very simple, like I said, it's...
I'd break it down, there's six buckets.
There's six buckets of different types of peptides, muscle inflammation, brain, gut, thevanity, skin hair, weight loss, mitochondrial ones.
(14:57):
And then you kind of have the bucket of misfit toys, the ones that just don't really fitinto any category.
And then you have to go through how to take them.
You kind of got to go step by step.
And what's amazing now, that five or 10 years ago when I started, you'd be like, have youever injected yourself?
Patient would be like, what?
Now, sure, I do it all the time.
It's like men doing testosterone, women with fertility and other things inject themselvesbecome kind of the norm.
(15:19):
So it's not as daunting as it used to be, which takes a lot of the tough teaching out ofthe equation at this point.
Yeah, so most of your patients are in person as opposed to telemed in order to get themstarted, particularly when it's injections or do you do that even through a telemed?
Right now my practice is probably 60, 40 telemedicine.
(15:39):
went down the rabbit hole, I think I have 21 licenses in different states, we just shipthem all over.
Both the patients, that peptides are virtual, they just wanna say, like you said, there'sso much noise out there, they wanna know, okay, this is what I should be taking, this is
how I wanna structure my program, and then they're on their way.
So they just need the kind of little bit of insight.
you follow them then regularly in terms of any kind of outcomes or what outcomes would youfollow for different types of patients?
(16:06):
Obviously, it depends what we're doing.
I mean, a lot of cases we do follow them in some way, shape or form, depending on whatwe're using it for.
Obviously, if it's muscle skeletal, it's usually going to be biggest test is theirperformance in the gym or on the field.
My patients who went, couldn't lift anything at the gym and then six weeks later becausethey have like a rotator cuff injury or a knee issue.
we're back going closer to the personal record.
(16:27):
And then if we need to, we'll do it extra MRI.
But again, to me, the proof is in the pudding a lot of cases there.
I mentioned my gut stories already.
So a lot of times we're following up with a very specific.
It's sometimes it's interwoven into what else we're doing.
Great.
Good to know.
Yeah, it's tricky, though, because the rules have somewhat changed.
But then you have to be careful because you are a physician.
(16:48):
You want to do the right thing.
You above all do no harm.
And so it's a bit of a juggling act, I think.
So it's not easy.
Congratulations on getting it right.
Yes, it's tough.
once you know how to dance, it's not that hard.
yeah, learning is hard, part.
Have you had some experience with GHK copper in some of the peptides that literally
(17:11):
change your skin from the inside out and have a Botox like effect, but also a great impacton collagen.
Have you had experience with that peptide?
It's become very amazingly popular from all ends, from the doctor and in the social mediaend.
And I mean, there's a lot of benefits that we started using it more as a general medicine,probably five, seven years ago.
(17:31):
And we use it lot for brain health and for tendon health.
It's kind of a nice add on for tendon injuries.
And then the skin component blew up more than anything else.
I think the benefits are amazing.
like it definitely builds collagen, decreases inflammation.
It's great now there's combos.
You can mix it either with BPC like I mentioned, or they've now mixed in with the othertype of skincare products that out.
(17:55):
There's some that have retinolic acid in there, some have hyaluronic acid in there.
So they're definitely taking advantage of it, both on the professional side, like frompharmacies and the consumer brands are doing it as well.
So it's something that will be here forever and I think some patients should be using.
I agree.
How do you actually apply it?
Have you used it both as creams and do you also use it as injectables with BPC or orally?
(18:19):
No, most, 95 % of patients, well, it depends what they're using it for.
If they only want face, then yeah, they'll do the facial creams that are out there andlose these, again, they're almost all combos now at this point.
But I don't know that BPC would be absorbed that great.
through creams, you have experience with doing that.
know oral There's little data behind it.
A patient have said it because we know from what's happened when we used to use it forjoints, when we only had injections and creams, that there is some absorption, it doesn't
(18:47):
go incredibly deep, it's not gonna go as deep as an injection would.
But again, people don't want their face injected, so you gotta kind of find a happy groundin the middle there.
It's not perfect.
But yeah, so the injection is probably the worst in peptide injection out there.
It burns horribly.
So most patients don't use it systemically anymore.
(19:08):
I don't think I've ever used it systemically, particularly the copper.
I've had to use a copay who want, for a variety of reasons, this is the only one thathelps their skin systemically.
They have to do it as an injection.
You can't just put cream all over your body.
You spend time and too much money doing it.
How long did you see it took if you do the injection as opposed to the cream?
(19:31):
Good question.
It took a while.
I mean, it was like two or three months.
It's not sustainable.
It's not something that.
it's daily.
They were doing it daily injections daily, at least five days a week.
And again, this is probably more right before Covid.
Now there's just so many other things out there.
It's it's way down the list of systemic anymore.
But this is kind of, again, before lot of the other stuff came out.
(19:53):
I would say, but And you had any trouble getting your hands on peptides and making surethat you're working the fligid and the compounding harnesses, because that's always an
issue for a lot of folks.
Most, no.
I mean, the ones that are really, really impossible to get right now is something calledMozi, which is a lot of people's favorite for lot of different reasons.
That one is almost impossible to get.
(20:14):
Beyond that, and another one I actually love for my infectious pace, LL37, but those aretwo that are really, really hard to get.
Other ones, there's other formulations that are available from Rebidwell Pharmacies.
What is that, LF37?
LL37 is a cathocline, I can't pronounce it, a cathocline that's an antimicrobial peptidethat they find in the gut and throughout the body.
(20:37):
We started using initially mostly for SIBOs, bacterial overgrowth patients, ulcerativecolitis.
And then people who have low immunities, we found a lot of benefit to it.
But even back then it wasn't a popular one.
And now it was on the band list and is possible almost to find in the US.
SS-31, is that another one you've tried, used?
(20:57):
I love SS-31.
I mean, it's incredible antioxidant.
It has great data behind it.
It's being studied more and more.
There's a company trying to patent it.
which makes it good and bad.
it's an incredible data for heart health.
10 tonight is using for Alzheimer's and Parkinson's.
It's something that you don't need to use continuously.
You can do it for a month or two, maybe once or twice a year, which is really great.
(21:19):
only downside is the price.
For people who are price conscious, it's gonna probably be a couple thousand dollarspotentially.
I let people know that ahead of time, but.
Couple of thousandth of the whole course or like a month?
Even for a month, a lot of times it's gonna be close to over a thousand dollars.
And how mostly is it applied?
It's an injection.
that's one of the things where you talk to five long-dairy doctors who know what they'retalking about, you're gonna get five different how they dose it.
(21:46):
We all see the benefits.
It really just comes down to personal preference and the preference.
favorite?
I mean, I patients do it two or three times a week.
And again, I'll progress to high dose for the patient I knew who can tolerate it, patientI were more sensitive or this is their first time with peptides, I'll start them at a
lower dose and build them up.
But I mean, think it's something you're gonna hear about more and more because it is beingstudied in the mainstream medicine as well.
(22:07):
What dose do you generally start wishing and work on?
What's considered your low end and high end?
I mean, I'll do usually either depending on what the...
What you would call it.
What the strength on the bottle is, every company makes a little bit different.
And I'll do like 50 units three times a week, which is, now my brain is, those depend,like I said, on which brand I'm using.
(22:29):
But there people who do 100 now, units three times a week, and we're seeing bettereffects.
It's just.
you're pushing the envelope a little bit.
Yeah.
And then a month or two and then you hold off for a while.
We'll hold off.
We'll do again.
We do markers depending on what we're using it for.
The ones that I'll tend to push with are my brain patients.
I mean, like all anti-neurocognitive.
I'll push What do you look at before and after to get a baseline in future and change?
(22:53):
Now, again, this is like I said, there's so many more tests out there now, even the lastthree months.
I mean, I love getting a neuroquant, which is a
Biome-based MRIs has other data to it.
I call it now the brain tests that are out there that you can now do mostly in New York,but other states you can do more of things like GFAP, IL-6, amyloid and tau proteins that
(23:14):
we can measure.
And you see changes metabolically with it?
I've seen some cases I've seen data, definitely inflammation has gone down.
The MRIs look better potentially in six to 12 months.
We've seen less.
Sometimes the amyloid has gone down.
This is in conjunction with other things.
And with that type of patient, as you know, it's multifactorial.
(23:37):
It could be toxins.
could be a hundred different things.
it's not just the peptide, but I mean, now we have enough tools in our toolbox, both ofthe testing side and now I think in the treatment side that you can mesh them together.
Again, this is one of those things where you definitely need a doctor kind of translatingwhat's viable and what's kind of ridiculous at this point, because there's so much, think,
(23:58):
People say, I can cure Alzheimer's and that kind of burns me a little bit because that'sreally not been proven yet at all.
And that's just okay, just ignore that.
But I listened to a podcast last night on that topic and just about plasmagines,plas-ma-gines, plas-ma-gines.
And it was fascinating.
but I couldn't really tell from the data.
They'll look like there was a lot of data and it looks promising.
(24:20):
I love the, I've been saying, but I love it.
I think there's huge potential, but we're still not at the finish line with any of thatstuff yet.
I don't think we could promise.
I get asked a fair amount, can you cure it?
my response is, you never know.
I can't say we can, but what we can do is make inroads and hopefully stop progression andmaybe gain some ground back.
Exactly.
I find testosterone to be amazing for memory.
(24:42):
I never even dreamed of that, but years
ago I had patients because I mainly did telemedicine for many years, like two, threedecades now, way before COVID.
My family finally understood what I was doing once COVID struck because they're alldermatologists or facial plastic surgeons and they're like, how could you do telemedicine?
I'm like, yes, don't, just wait.
And then COVID happened.
(25:04):
and I would explain to people how change could happen, but it takes a long time becausethe field wasn't really as mature as it's getting lately.
And speaking of doses,
in regimen, let's turn to rapamycin.
I know there's a lot of debate out there now.
Some people are actually saying, no, no, no, don't use it, or only use it in an elderly orolder patient over 70.
(25:24):
And then the types of protocols you use.
What's been your personal experience with that?
That is something that literally changes now every month with me now because not onlywe're waiting with all these new meds, we're waiting on date like you said, we're still
waiting.
The good stuff has come out in terms of fertility.
The Columbia studies are showing promise in terms of improving fertility, egg production,minimal side effects.
(25:48):
That's great.
And that's gained huge bandwidth so far, I love because fertility is...
I don't understand why you don't have more advances there.
What's the protocol they use?
know, the dosing?
think it's five.
Five a week?
Yeah, I think so.
95 % is five milligrams a week, which is great.
And I think that, but now we're, again, plateau.
So kind of back to the question would be, I normally would start patients at three or sixmilligrams, again, depending who I'm dealing with.
(26:13):
I will send it to patient who says, well, I can't take too much of anything.
It affects me.
You might start at three and somebody who is more resistant and say, throws it at throw itat me.
Five or six.
And also depends again, if I'm treating somebody again, there are some small stages likeAlzheimer's and neurodegenerative issues.
This is a lot of small stays for a lot of different niches at this point, but nothinggroundbreaking at this point.
(26:37):
So that's where I'll start six.
And I tend to.
will increase checking lab markers as much as you can.
Which lab markers are you measuring yourself?
I'm CBC, NCASE, a lot of the white blood cell markers.
I will check troughs and peaks, but I've talked to, every doc has a different answer aboutwhat you're gonna see or not see with it, so I don't know what to do with that.
(26:58):
If I'm treating a specific condition, I look at that marker.
But that's what I do now, and I still cycle patients every three to four months.
I will have them take a break.
I will not have them do it in perpetuity.
That's how I view it.
Other docs will have them just do it continuously and continue up to like 13 milligrams.
But the flip, what's also flipped a little bit is that was the first thing that got allthe publicity in terms of anti-aging longevity.
(27:21):
Now we're seeing every week there's a new study on the GLP-1s.
There's now every week, every couple of weeks a new study on SGLT2.
Medicines are all diabetic medication, but we're seeing all the benefits from them andthere's more data there.
So now is that, do we do kind of flip-flop to that more and then kind of keep rapamycinmore in our back pocket for more specifically, which is where I'm going with it now?
(27:42):
Do you ever see any immune issues with rapamycin in patients?
Because I use a fair amount.
I've been using SGLP1s for 20, since they first became available in 2005.
where you had to take an injection, was Bieta.
You took it before meal each time within a 15 minute window.
And then it progressed to daily with like Victosa and then it progressed to weekly.
(28:04):
So that's uncomfortable.
I'd have been using SGLT2s for...
since the beginning as well, because there was a lot of fear about it.
In fact, if you might remember, you might recall that it was supposed to be harmful to thekidneys and heart.
And same thing as Crestor back in the day with statins.
When I first came to New York, a lot of cardiologists were all still using Lipitor untilthe Jupiter trial came out.
(28:25):
And I remember getting calls from these cardiologists saying, how did you know that?
And I said, well, it's in the data.
So I started using Crestor quite early.
So yeah, I think those may actually have more potentials than anti-aging longevity.
and then we gotta wait for the full Rapmison data to come out.
thing with any of these types of medicines, we wait for studies, studies are expensive todo, they have the money to do the studies right now.
(28:49):
Rapmison, unfortunately a lot of our colleagues are waiting for, they can't even getfunding to do a lot of the studies that they need to do, and that just keeps it.
it puts it behind a little bit, which is unfortunate.
And even the studies are quite limiting, because if you even look at evidence-basedmedicine, you're looking at a whole bunch of people who have to be in these studies
treated exactly the same way, yet they're all different.
So one of the problems, you can get data, which is a great place to start.
(29:12):
Data is great.
But when it regresses to the mean or you just get average, then you're treating people andyou may be treating the wrong person.
You may not.
be applying it as a risk benefit at the level of that individual, that N of one.
That's one of the areas that I have trouble with, having been part of a lot of studies.
It's very true.
It's another dance that you have to learn where you feel comfortable.
Exactly, and where that person fits, you know.
(29:34):
I completely agree.
So there are a lot of other topics we can touch on, but that was a great discussion aboutrapamycin.
And you've been on it yourself?
Is that been the case?
I do burst.
I've been repulsed.
I found for me, cognition improved.
I have unfortunately I call myself like a muscular path I have horrible joints justbecause I abused myself as a kid not like the basketball and running and stuff and I my
(29:55):
inflammation levels went down I know Matt Kaberline has said the same thing and a coupleother people said the same thing where it's kind of a magic potion for lack of a better
word And other people don't feel that at all.
So for me, I like it I do pulse it's not something that I'd want to be doing in securitylike six a week for I do six weeks and then I'll stop it and now every six or twelve weeks
I'll restart it.
That makes sense.
No, I think we have the benefit of watching our own body because
(30:16):
when I introduce something new, unless it requires a prostate, I will test it before Iactually start using it to see how I understand it from the inside out.
Like I did it with every GLP-1, most of which I couldn't tolerate, and I had a very hardtime, even at very low doses.
It just didn't agree with my gut and the way I felt on it.
But I got to understand it from the inside out, as you're saying, just like you're doing.
(30:37):
And it helps.
It helps you explain to patients what they're going to feel, what the side effects may ormay not be.
And to understand the spectrum of how these drugs interfere.
So there's a few other things that I think you talk about too.
I don't know if you, have a few more minutes.
It'd be great to hear your thoughts on red light therapy, methylene blue, hyperbaricoxygen, something we've been looking at, plasmapheresis, which we're initiating here
actually now.
(30:57):
That kind of, those areas.
All those things have great, are great.
I think they have huge potential.
think now we're learning how to use them.
They're not just kind of a cool buzzword.
I mean, the one that has me most excited and the one you mentioned you're starting heresoon is Plasma Freesus.
Because again kind of goes back to the same thing we have mentioned is it has data behindit both for medical issues and attention now for aging And we know why it works and how to
(31:21):
integrate into a practice So I think that we're starting we started to see both initiallyfor like autoimmune issues And now we're starting to see it for long COVID and now
patients are using it to decrease inflammation and lower their biological age That'sanother kind of debate what how great biological age is but I think it's something that is
me something you're gonna hear more and more about
because it just has so many benefits to it.
(31:42):
The right now is the cost per patient, unfortunately.
But it was also great with plasma freezers.
It plays well in the sandbox without some of other things that you mentioned, depending onwhat's coming to use in you.
know the day before the day after, a lot of people are doing methylene blue because of itsbenefits.
Methylene blue, and you may love calling it pool cleaner, which is not how we use it.
There's a lot of data because the antimicrobial, antiviral, antioxidant, it decreasesinflammation.
(32:04):
It's actually, people are using it for their skin now.
So it's something you could do as an oral and IV.
Again, a lot of doctors are incorporating that with it.
And then also hyperbolic.
I mean that again that's something that's come we knew about for a while and now it'sgonna say is coming out of Israel and just general practice and data that's come out on
Alzheimer's and other brain health and autoimmune issues now like two weeks ago a PTSD andit was bipolar ish improvement with hyperbaric that to me is a home run for patients.
(32:28):
Yeah, it's it's not a medicine It's something you can find almost any town now It's notsomething you need to travel to New York, LA or Miami to do though It's hard sometimes to
get appointments and to do it at the right level because Aviv clinic is the
in Israel I think you were alluding to.
They opened up in Miami and Boston.
cool.
mean, it's a great program.
It's 12 weeks for nothing, which is good and bad.
(32:50):
But they brought it to the forefront.
I mean, great to get information.
Alzheimer's and also mean pro athletes travel.
It was every pro sports team that has one in their facility And I think it has so muchpotential and I love things that like I said check a lot of boxes and also play well in
the sandbox Well, thank you.
Do you ever bearing your patients for the hyperbaric?
I do all the time.
I do it my patients who do it again You have your own treatment.
(33:13):
No, I'm I would I decided two years ago I'm gonna refer out.
I'm not having everything in one spot.
Like you do it just
I don't have all of that.
But you have a lot of stuff here.
But yeah, it's just not how I want to practice.
love referring to the people who do it well and have the staff who do it great.
And especially being in Manhattan, it's biohackers paradise here.
again, I refer to lot of my patients to it for it.
(33:34):
And again, in conjunction with some other things that we've discussed, they're a healthoptimization patient, we know how I give them a stack, which is a combination of things
that work together really well.
If they're neurocognitive patient, still is going to work.
And you do this, this, and this with this IV.
And here you go.
It's fun.
Yeah, have you tried hormones like?
Oxytocin or any of the other combinations for ps2d or PTSD or any of the other ones yourchoice by Depression things I've done it kind of what's one way for in the distance being
(34:04):
I've treated my patients for other things that's improved that that's one of the oneniches I don't delve into there's a lot of great integrative or preventive psychiatrists
around in this place That's something to tell me I said wise right that I I'll do it inconjunction with other things but I don't delve into it myself as much because
That's one thing I just think if you're doing that you need to be doing it every day Yeah,there's great potential with things not I hate SSRIs for most patients long term I love
(34:27):
the fact things like that are emerging available.
Yeah, see big changes with that with inflammation Are you looking at like high sensitivitycardiac CRP?
Are you looking at fibrinogen?
Are you looking at?
Are there any favorites that you have in terms of saying, yes, this patient's inflammatorystatus has markedly increased or decreased and their GI tract is much better.
(34:49):
They don't have IBS symptoms anymore.
Their Crohn's is improved.
But now where is it now we can kind of narrow down where it is My favorite two or threeare I've got a CRP is still great no matter what I love Cal protecting which looks at the
gut more specifically because we know the guts connected to almost everything okay in
(35:12):
that you have in terms of saying, yes, this patient's inflammatory status has markedlyincreased or decreased and their GI tract is much better.
They don't have IBS symptoms anymore.
I love inflammation markers because you can almost do it for every area of the body now,which is great.
not only it's not, OK, you're inflamed, but now where is it?
(35:34):
Now we can kind of narrow down where it is.
My favorite two or three are CRP is still great no matter what.
I love Calprotectin, which looks at the gut more specifically because we know the gut'sconnected to almost everything.
So unless you fix the gut, and you can do it traditionally, it's not something that's likesome holistic test.
And my other favorite one now, the heart inflammatory,
(35:54):
that are a little more specific, LPPLA2 or oxidized LDL that are more specific to theheart.
I know, okay, those are high and they also have high cholesterol.
I need to be very proactive with this patient.
And not only do we have to treat the cholesterol in the plaque, we gotta treat theinflammation on top of all the other things that we know are related to heart disease like
mitochondrial and everything else.
(36:15):
You can do a whole hour on that by itself.
So I think we now have the data and the tools again to look at inflammation.
It's been a buzz line for years.
Inflammation is the cause of lot of illness out I it all boils down to the immune systemand inflammation.
Exactly.
if you get your arms around that.
But figuring out the path and the journey, I think, is complex for each of us.
(36:35):
All right.
I think we're ready to wrap, but I always like to ask visitors in the podcast, if a friendasked you, like, what's the one thing you would say that I could do to markedly optimize
my health and get longevity, what would be your top approach of anything?
You mentioned.
Let just hit on.
mean, think maximizing your sleep is by to me is by far the simplest thing you can do in alot of cases.
(36:58):
You don't have to leave your apartment or house to do it.
And we just know not only how you see, but maintain your circadian rhythm, how importantthat is now.
think that's the number one thing that you can do.
And it's in theory, it's easy to do because it's free and it's in your home.
Right.
Except if your home also has some little rug rats around and kids and that can be harder,but you have to get them under control as well.
(37:19):
There's a lot of ways now you can work around it.
I have a one year old right now and who loved hopping in bed with mommy and daddy, but wework around it.
All right.
Well, this was fun.
Here are the five takeaways that I think you'll find really useful.
First, the trends out of the COVID-19 pandemic.
were really important.
They include the fact that we want to make sure that you can be your own health advocate.
(37:40):
That's one of the roles I have here and one of the things I want to share.
Also, be aware that you want to be proactive, not reactive, and find a clinician that canhelp you do that.
The second was continue exploring on your own journey to optimizing health.
And if you find yourself in a rut, look for ways to break out of it.
There are tests you can do, there are clinicians you can see.
Make it a more personalized, proactive approach to optimizing your own health.
(38:03):
Three.
Peptides, a big popular topic now due to all the research that's showing how safe they areand their efficacy is amazing for a wild range of disorders and for longevity itself.
The potential is huge.
Neil shared that his top three promising peptides include BPC 157.
(38:24):
This is one that helps your gut and your brain, your joint pain, your arthritis,inflammation and inflammatory.
gut disease.
The second was thymalin, a peptide that inhibits pro-inflammatory changes and processesand cytokines and improves your immune system, which is really critical.
(38:45):
The third is lorazetide for healing the gut lining and in combination with other peptidesfor Crohn's disease and colitis.
Other cutting edge to wrap it up, proactive treatments with great potential and are in usetoday.
is red light therapy, hyperbaric oxygen therapy, methylene blue, which is IV, or you couldtake it in other ways, and plasma exchange therapy or plasmapheresis.
(39:12):
I'm Dr.
Florence Comete.
I'm really excited that you've joined me to listen to our podcast and to continue on yourjourney to healthy longevity.
See you soon.
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Intentionally Disturbing
Join me on this podcast as I navigate the murky waters of human behavior, current events, and personal anecdotes through in-depth interviews with incredible people—all served with a generous helping of sarcasm and satire. After years as a forensic and clinical psychologist, I offer a unique interview style and a low tolerance for bullshit, quickly steering conversations toward depth and darkness. I honor the seriousness while also appreciating wit. I’m your guide through the twisted labyrinth of the human psyche, armed with dark humor and biting wit.