Bonus: ‘Peptides & Anti-Aging’ featuring Dr. Heather Smith-Fernandez

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A state of high performance.

You're listening to Bulletproof radio with Dave Asprey. Today's guest knows a thing or two about hacking the human body. She's a board certified anesthesiologist and fellow trained interventional pain medicine physician. And she graduated in the first ever class of physicians trained and certified in peptide medicine. I'm talking about Dr. Heather Smith Fernandez, who's the founder of the Regenerative Institute of Medicine in Naples, Florida. And she created something called Peptology, which is a study and clinical application of peptides in living beings, both human and non human. And I consider her to be one of the go to experts on peptides because she's using them throughout her practice. Regenerative treatments, advanced aesthetics, sexual health, hormone therapy, preventive medicine, all that kind of stuff. That is motherhood and apple pie to me. So Heather, welcome to the show.

Thank you so much. Hi Dave.

You also do bioidentical hormone replacement, which is something that changed my life when I was 26. That was about 20 years ago for me because I had less, less estrogen, no less testosterone and more estrogen than my mom. When I was 26, my hormones were seriously broken.

Yes.

So I believe that that really helped to change the trajectory of my health and my life and my brain and everything else. And so that's something that already is cutting edge, but now you're all into peptides, which are super like bleeding edge. What made you go from doing things like hormones into this highly specialized but really just a couple year old area of science?

Well, I think that like you and like a lot of people who are really committed to thinking about health a different way than what we've been doing in this country for a while, really doing preventative medicine. And what you're doing is utterly revolutionary. I was kept awake at night by the patients that didn't get better from my regenerative procedures. You have two patients next to each other with the same problem, whether it was a knee or a back or a shoulder, and relatively same age, same activity level and a couple times they would have markedly different outcomes. And that just sent me down, that's what sent me down the pathway of learning about hormones. Because when I started really digging into the research, the patients that did better with every kind of regenerative procedure were patients that were hormone optimized. And once I got that, so I said, I need to learn about this. And I did that. In about 2012, I was fully certified in hormone medicine and applying that to my regenerative practice. But I was also searching for. When we target a tissue, how can we make the PRP or the cellular preparation, whatever we're putting into that tissue, how can we maximize the healing effect? And the first peptide I worked with was IGF1. And as some of your listeners and you may know, IGF1 is an active metabolite of growth hormone, and it's highly proliferac. And when it's. It can also wake up progenitor cells to get them to start helping in the healing process. And, and of course, sermorelin was one of the early peptides that when patients had their growth hormone levels more optimized, they just did better, and then they felt better. And they had all of these incidental improvements, aside from what procedure I had done to their joint or their spine. And, and it was just a love story that started right from there with me and peptides. And I went and learned from every person I could possibly learn from.

So the idea of IGF1, or insulin, like growth factor, it makes cells grow faster as well, it's kind of described. So does insulin, by the way, because insulin makes cells grow faster. That's why bodybuilders used to go slam a bunch of sugar after lifting weights to raise their insulin so they could put on more mass and get swole, despite the downside. And then sermorelin is a way of raising growth hormone without injecting the stuff. That's $1,000 a vial to inject. So you are basically modifying the growth rate of tissue so people would recover faster and doing it with these tiny little protein fragments. How do we know that they work? How do we discover all these different peptides?

Well, the first peptide that was sequenced outside the body was insulin, and it was a long time ago. And the making a peptide is actually a very, very complicated process. Being able to take a large protein from the body and find the active segment that sits in one particular receptor. Some proteins can have multiple actions at different sites. That's often how we think about hormones, is that you have one substance that has multiple different actions at different sites of the body. But being able to know which sequence needed to sit in that receptor to get the desired biological effect on the other side was years and years of research and science. And once they learned how to sequence peptides outside the body and make them stable, which was a really big leap forward in peptide medicine, then you see the research just skyrocket. Some of our Russian friends and our Croatian friends were way ahead of us with peptide research.

Oh, yeah.

And we didn't get to play with their toys until fairly recently when there was just a lot more information that was being shared. And so we're catching up really quickly though with being able to utilize peptides and study them.

You've also put together a list of sort of the top 10 things you can treat with peptides for people listening to the show. And I Already forgot your URL. What's your URL?

It's DrHeather.net Dave.

All right, DrHeather.net Dave. You go there. She put together a bunch of stuff. We don't have any financial arrangements other than. I just want you guys to know about peptides. There's a bunch I've written about peptides on the Dave Asprey blog. But Dr. Heather here knows a lot about them and I want you guys to know. And part of this is the price I quoted. It's what I spent on epitalin is probably 50 bucks. You go to a proper compounding pharmacy, medically certified people are going to spend what, 200 bucks on a typical peptalin?

Yeah, I mean peptides sourcing is extremely important. I learned that in my practice the hard way. And so I always share with physicians. You need to really know where the peptide is coming from. I can tell you a story about what happened to one of my patients. I normally get my peptides from a very reputable manufacturer and they were out of a peptide. It's a melanitan peptide, which is a tanning peptide. But it's also.

I like that one.

Oh, it's really good. It's so helpful for autoimmune diseases, chronic inflammation, sleep, libido and it protect. I live in South Florida where, you know, you can fry an egg on my forehead if I'm not careful in the summertime in five minutes. And so it protects you from burning and protects you from sun damage. But anyway, melanitan does have a potential side effect for some people. About 15% of people will get nauseated. The nausea is usually not severe. It usually is self limited by about 15 minutes, maybe 20 minutes and then it goes away. And not everybody gets this. Well, my normal supplier was backordered and my patient was really not patient about it. They really needed the peptide.

Let me guess, it was a guy.

Well, yeah.

We'll talk about why he was desperate later.

He just wasn't here and that I couldn't get it. And so I sourced from a local compounder, a compounder that I knew, the pharmacist. They were very reputable. I'd done a lot of business with them. And the peptide arrived with their label on, looked just like it normally should look, gave it to the patient to use. And the patient experienced such severe, severe nausea, like severe nausea to the point where they almost went to the emergency room for three days.

Oh my goodness, that's severe. I've never heard of that.

Three days. He was calling me three, four times a day, every day. What is going on? I was trying to treat his nausea, but as soon as the anti nausea medicine wore off, he was back to being on his bathroom floor. It was awful. And so I immediately contacted my compounding pharmacy and sent the bottle back. And I said, please test this. There's something wrong with this peptide. Where did you get it? And they said, well, we got it from so and so. And I said, well, is that who made it? No, we don't know who makes it. And that is the common story. There's so many middlemen in the passing of peptides that the truth is there's only a couple actual manufacturers. And you don't always know where it's coming from unless you really do the research and know. And so they didn't find any overt contaminants. But there was clearly something very wrong with that peptide. And I've heard horror stories of, you know, people ordering peptides just off of the Internet and for research only peptides. And I've seen, I've seen the pictures of some of the labs out of the country that are making peptides that literally look like they should be condemned.

Something out of Breaking Bad back in Winnebago. Guys and their BVD's.

Yep, 100% like that. That you thought, oh my gosh, you would inject this into your body. So, you know, and that was a really important lesson. And that happened several years ago. And a lot of physicians just don't know that where, you know, they think that their compounders can't do full stability and quality testing on every single bottle of peptides that come to them. They, there's a, there's a certain chain that they would never. They would have to charge you six times what they charge you. The peptide is highly underpriced. Then you probably want to make sure you understand why that is.

So let's talk about Melanotan for a minute. First, we talked about Epitalin, which makes your brain work well and is a broad spectrum anti aging. Oh, we never talked about epitalin. I spent about 50 bucks, maybe 70 bucks on it or something. But the protocol that I learned for anti aging that goes back to 2003, the first research. I think you inject once a day for 10 days, every six months. But I've also used it more frequently than that. How often do you recommend using epitalin?

Every day.

Really? Without stop?

Without stop. Just not what kind of a dose. Just small doses. So just 10 units, really small doses can be used every day. I like to cycle almost every peptide. I don't just for cost. In real estate, I'm not a very big person and my real estate gets sore. So I like to just let the injection sites heal.

By real estate, we mean ass.

Well, yeah. And belly. Any place where their skin. Right.

So the places you inject are the back of the arm, your butt. And I hate doing the belly because it always hurts. I don't do it on my belly. But you can. Those are really the only spots, right?

Pretty much. I mean, you can do them anywhere. You have some skin with a little fat underneath it, but those are the places that are easiest to reach if you're injecting yourself. So I think that cycling is necessary for a lot of peptides, but even peptides where we don't necessarily need to cycle, I think it's always good to let your body have a break.

Now, melanotan, sort of the opposite end of this you mentioned, it's one that's good for tanning. It has some other interesting effects you want to talk about other than avoiding sunburns and getting nice dark skin. What is the role of msh, melanocyte stimulating hormone, which is also known as melanotan.

Well, it works in the melanocorton system of the brain, and there's four different main melanocortin hormones and they are extremely important in the inflammatory response. So when you're managing, especially with an autoimmune situation where the inflammation is to your own tissues and it's unregulated and it obviously becomes a real problem when you can quiet that part of the system. It's very effective at that. And it does promote more deep sleep. It also has a.

When taken in the morning though.

Right.

Or do you find you can.

I think that there are two groups of people. There are those that will take it in the morning and they do better. And there are those that take it at night and they have to experiment. Really. Yeah. Especially for those people that get a little bit nauseated from melanotans. It's not a good. Yeah. When they try to take it in the morning. Now, that nausea really isn't severe. It shouldn't be severe and it's self limiting. It doesn't last very long. It can be prophylaxed with several things. If it does cause nausea, CBD or full spectrum cannabis is extremely effective at blunting the nausea from ever happening.

All right, so Pinealin's not on your radar. How about thymosin, is that one that you use?

Oh yes, I love thymosin.

Tell me about thymosin.

Thymosin alpha 1 and thymosin beta 4 are both. I use them a lot in my practice. I use them a lot on myself as well. The thymosin alpha is, it's incredibly effective at when you start, if you going to start to get sick, doesn't matter, you know, cold and flu season. And if you start to have any symptoms at all, you can do a fairly large bolus dose of thymus and alpha and, and your immune system is so propped up that you don't even get sick. It's all over from the first onset of symptoms. It's also exceptional for inflammation, for autoimmune. All the autoimmune conditions, especially autoimmune inflammatory arthropathy, which I have and I had, I should say it's something that's extremely managed. I don't think anybody with autoimmune disease should wear that label as if, oh, you've got autoimmune disease, you know, good luck. It's not like that anymore. We understand so much better how to modulate the immune system to not have symptoms. And thymos and alpha is extremely effective at that and it's very safe in high doses. It has a short half life. So if you're aggressively treating, you need to treat multiple times during the day. But in combination with The Thymus and Beta 4, you really, it just tackles inflammation. It's really, really good.

So you inject Alpha 1 and Beta 4 at the same time.

I inject a lot of peptides at the same time. I'm kind of a combination peptide freak.

Peptide pincushion, me too actually.

But they work. So when you know how to combine peptides in your system, not in a syringe, but in your system, then you're getting this synergy that is really incredible. And you can get that for your patients. We are not just tackling one thing now.

Peptides combine fine in a syringe though. They're just small little protein fragments. They're not likely to stick to each other and form new compounds when you're injecting them.

They're not likely to, but unless they've done the testing on stability now for my own self this is controversy. It comes up all the time. I get asked this constantly to save yourself from if I'm using seven peptides do I have to inject myself seven different places two to three times a day? Anybody would get tired of that. And I've Talked to different PharmD's about this. I've talked to one who works with a peptide manufacturer that said if you're combining in a syringe and injecting in your body, your chances of having some cross reaction happen where something becomes unstable is very very low. And yet there are other respectable folks in the peptide world that say you really can change the bonding, you can change things if they haven't been tested for stability to be combined together in a bottle, you shouldn't be combining them in a syringe. So there's two schools of thought. I tell my patients, you know, if it hasn't been tested combined in a bottle yet together, then you may not be getting the effect you want in the syringe. But most people are combining them in a syringe.

Here's why you combine them in a syringe. It's two things. One, it hurts less and two, syringes are plastic waste and it's just not okay. Imagine if we had 7 billion people using 6, 6 needles a day, it would not scale.

No, I don't disagree with you and I think that it's a good platform to ask for more stability testing so that we can combine peptides and feel very comfortable that your investment is safe.

What are the peptides am I missing here? We've got thymosin, we got PT141, we got Epitalin, we got melanotan.

Well I think near and dear to your heart also and what you really I thought in Superhuman you did such a great job of explaining really technical things to non technical people. When it comes to mitochondria and cellular energy we have some really exciting peptides. One of them isn't even out yet. It's supposed to be available in March. But it is a mitochondrial peptide. Whoa. Yes it is SS31. SS, SS31 and it helps to dysregulate the production of mitochondrial free radical production so the mitochondrial derived reactive oxygen species and is therefore being looked at as a global anti aging molecule and it's going to make its debut in March. But there's been a lot of buzz about this peptide especially in combination with the 5Amino 1 MQ which is another one of my favorites 5Amino 1 MQ is, it's a capsule, which is kind of nice to take a break from injecting. And its real target is it's a nicotinamide N methyltransferase inhibitor. And so it. Not to get too technical on it, but you're improving your autophagy, especially muscle cells that are no longer serving you. I love the term zombie cells. If you have zombie cells, they're not serving you anymore. When the 5amino 1 mq not only improves cellular energy, but it's also flipping that switch to either take a cell that is sickly and get it back to a normal functioning cell or allow the autophagy to happen. But interestingly about this peptide is when you take it, you feel really good. You notice less body pain, more focus, more energy.

Wow.

Your own physical capability is better.

You can vitamin A1MQ1 capsule in the morning.

Well, the studies were really done with three capsules a day. And because like Monday morning, noon and evening, I usually recommend people start with one because it can increase hunger. That has not happened to me. But there are quite a few people that notice that they do feel a little more peckish or a little more hungry than they normally do. I practice intermittent fasting and I think that keeps my craving really. That's just not something that I've had a problem with since I've been practicing intermittent fasting. But that's been reported as a possible side effect. But everybody that uses this peptide and it's, it's really designed to treat. It's going to sound kind of silly, but diet induced obesity, so there's not so many forms of obesity, but that's how they kind of state it. So it's a great little peptide, very low to no side effects other than some people reporting increased hunger. And it's palpable. It's kind of nice. You know, one of the things that's nice about Melanitan is you really see it working. It's very obvious that it's doing something in your body. And not everybody is as sensitive to feeling the changes of these things, at least not right away. Everybody will notice after using peptides for a certain period of time, but when there's a. There's a somatic symptom, there's. There's a noticeable difference in how you feel, how you think, how you sleep. That's a pretty powerful reinforcement. And 5amino 1 mq is one of those. It's a very exciting peptide that has so many applications.

That is one that I have not experimented with. I've heard about it, but you've encouraged me to go find some and give it a shot. And I'll definitely be doing the SS31 as soon as that comes out because the mitochondrial peptides are very exciting. Anything that makes mitochondria work better is a good deal.

It's exciting. Please tell me how it goes for you when you use these peptides. We love to know. I will.

All right, Heather, it's been fantastic having you on the show to talk about peptides and kind of what they do and how you got there from hormones. And I'm very, very convinced after five years of using them that they're a very powerful part of anti aging medicine and I wish that we would just get more of them approved and and out there faster. And your work training doctors is important for that.

So thank you, thank you. It's been such a pleasure and thank you so much and thank you for having me on to talk about peptides, which I just is a huge passion of mine. So it's been wonderful.

A Human Upgrade Formerly Bulletproof Radio was created and is hosted by Dave Asprey. The information contained in this podcast is provided for informational purposes only and is not intended for the purposes of diagnosis in treating, curing, or preventing any disease. Before using any products referenced on the podcast, consult with your healthcare provider carefully read all labels and heed all directions and cautions that accompany the products. Information found or received through the podcast should not be used in place of a consultation or advice from a healthcare provider. If you suspect you have a medical problem or should you have any healthcare questions, please promptly call or see your healthcare provider. This podcast, including Dave Asprey and the producers, disclaim responsibility for any possible adverse effects from from the use of information contained herein. Opinions of guests are their own and this podcast does not endorse or accept responsibility for statements made by guests. This podcast does not make any representations or warranties about guest qualifications or credibility. This podcast may contain paid endorsements and advertisements for products or services. Individuals on this podcast may have a direct or indirect financial interest in products or services referred to herein. This podcast is owned by Bulletproof Media.

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