A Shoulder Surgeon's Six Rules for Responsible Peptide Use (BPC-157 · CJC-1295 · Ipamorelin)

I'm Dr. Patrick Denard. I'm a shoulder specialist with over 15 years of experience treating people with shoulder conditions. I want to talk about my rules for responsible use of peptides. Now, peptides have a lot of potential in shoulder surgery and across all over the body in terms of orthopedics in general. And the biology of peptides is real, but the problem here is the approach is often wrong. And there's a lot of interest in things like BPC-157, which increases vascular proliferation or angiogenesis, things such as the growth hormone pathways such as epimarelin and CJC-1295. And this ecosystem is really the wild, wild west. There's a lot going on and there's a really little monitoring occurs. So there's a major gap between the biology and what probably are some real effects, but also some real contraindications, and then also sourcing without oversight and lack of clinical follow-up. And there's really a dearth of clinical studies. Now I study the biology seriously, and what follows are what consider the 6 rules that I have formed for responsible peptide use. First of all, you want to monitor your labs. Second, you want to know the source. Third, you want to match the protocol to the healing phase. This is important to understand what's actually occurring from a healing standpoint, so then you can use peptides appropriately. I think it's very important to optimize a substrate. Getting post-operative imaging, I think, provides value both for the patient and for the greater good. And then also importantly, screen for contraindications. So let's dive into each of these topics. Now, you can't optimize what you're not measuring. So I think it's really important to monitor labs. This involves monitoring before, during, and after consideration of peptide use if you're using it for healing, especially a situation like rotator cuff or shoulder replacement. In particular, if using a growth hormone pathway, I think it's important to look at IGF-1 level— levels, which is basically the byproduct that can be monitored as a result of using such compounds. Along with this, it may be valuable to look at fasting glucose levels and then finally check this again. And there's also some pre-screening that I'll go into at the very end because there's some potential risks, especially with the growth hormone pathways, that can be present with the use of such peptides. My second rule is know the source. Now, compounds that are coming from online sources are categorically different than those that are coming from licensed compounding pharmacies or sources where there is purity testing. That is critical, okay? You will find a lot of sources for peptides, but knowing the quality is very important. What I advise to people is that they obtain these from compounding pharmacies and they look for certificate analysis And if they are getting it from an online source, they ensure there's purity testing. Any responsible provider of peptides will provide certificate of analysis testing, which can ensure you as a consumer that what is in there is actually what is reported to be in there. And I would look for 98 to 99% purity. 99% and better is certainly ideal. The third rule for this is that timing is the protocol. Okay. Compounds without phase match timing are really just noise. You need to match the protocol to the biology. Now, if you think about this from the tendon aspect, you go through inflammatory, proliferative, and remodeling phases. Inflammatory phase is the first 0 to 7 days where you get all the cytokines and activity that's going to take place. You have then proliferation where there is vascular formation, etc. This may be a phase in particular, for instance, where BPC-157 has some value. And then later you go into the remodeling phase. Now, if you understand these phases, you would understand that remodeling isn't necessarily a place for BPC-157 because that is stimulating more vascular peripheral whereas you may want to lay the foundations early for inflammation, proliferation, and then remodeling by using a growth hormone compound that perhaps increases IGF-1 levels and continue throughout. Now, at the same time, this is a limited phase. So in my mind, it does not make sense to use these compounds just continuously throughout. You want to use them in a critical window where you can impact your potential for healing, but you don't want to use them indefinitely. And also, which goes along with that, is that there may be some risk to having elevated IGF-1 levels for a long period of time, such as by using growth hormone compounds, because those can potentially fall into the same pathways that get down cancer pathways. And that's something to definitely be avoided, which I also think gets into screening, which I will talk about later. Now, when you think about this, peptides are the construction crew, but nutrition is the building materials. Now, you— so you need both. In other words, if you're going to try to approach healing and maximize your healing potential, yes, you want to have the signals, but you also want to have the fuel for body. So I think anybody who's seriously thinking about peptides should be taking high levels of protein. That typically means doubling their amount of protein on a daily basis, considering things like vitamin D, which play a role in bone and tendon health. We know, for instance, that those people who are vitamin D deficient have 3 times the retear rate after a rotator cuff repair. And then also collagen, vitamin C— both of these have been shown to improve tendon. Vitamin C in particular has been shown to improve rotator cuff tendon healing, because essentially it plays a role in collagen formation. So when you think about this, you have the signal, which is the peptide, that is the direction of what things are going to go. But you need the substrate and that's nutrition. So you need the fuel and then you need a direction for which that will go. Now, if you have put those together, that's where you can potentially get your best result or output. And that's really what we are looking for. My rule number 5 is post-operative imaging. It's just the right thing to do for yourself and for every patient who comes after you. There is a lack of clinical studies on peptides. In orthopedics in general, and especially in the shoulder world. I think it's a responsible thing for anybody to do this who's considering the use of peptides to get imaging, because that helps everyone learn from this and find out if we really have situations where it helps, or find situations where maybe less is needed or more is needed, etc. And if we all do this, it's all going to get better and benefit everyone. Also, I think it's beneficial to just know if your rotator cuff healed. The reality is that about 25 to 30% of rotator cuff tears do not heal after repair. So getting that imaging, I think, is very, very valuable for the individual. That's something that I really encourage my patients to do if they're doing peptides, to get imaging so that they can really get feedback on this. And that may also relate to perhaps another scenario, like for instance, they choose to have another orthopedic procedure and they want to know, did this protocol work for me? My 6th rule is screen for contraindications first. Now, I mentioned this earlier, but especially when you get in the growth hormone pathway, there is the potential theoretical risk that because IGF-1 levels are raised, that is in pathways that are related to cancer. You don't want to stimulate cells to growth if you have bad cells around. Simply put, there's some different ways you can do this. You can do this with basic labs. You can also do things like do some cancer screening labs. You can even consider something like a Galleri test that provides a cancer screening. Now, the likelihood of this is very low in a younger individual, but especially as we get older, sometimes there are things that we are not aware of. And the last thing somebody want to do is try to get healing healing and unfortunately promote the growth of something in an inappropriate manner. This also gets back to why I think it's important to use these compounds or peptides for a short judicious period of time that is optimized to particular windows around healing. So that's it, really simple. 6 rules. None of these are complicated. I think these are all non-negotiable. Montier Labs, match the protocol to the biology. Know the source. Optimize the substrate, that is critical. Get post-operative imaging and screen for contraindications first. I advise that people do that with physician oversight. Thank you for listening. If you're preparing for shoulder surgery, I'm happy to help you through that process, review any MRIs as necessary.