BPC-157: A Shoulder Surgeon's Honest Take

I'm a shoulder surgeon. I performed over 10,000 surgeries, and I'm going to talk to you about why so many of my patients are using one specific peptide, BPC-157. I'm going to tell you why that is, how people should consider using it, what the science says, and where the science is still lacking. I'm Dr. Patrick Denard. I'm an orthopedic surgeon who specializes in the shoulder. I've published over 300 articles and done over 10,000 shoulder surgeries. I spend my days repairing tendons and replacing shoulders. And one of the things I recognize and see frequently is with the rotator cuff, healing is not reliable. In fact, many people don't know this, but when you look at our data, somewhere between 25% and 30% of rotator cuff tears fail to heal. Why is that? Now, there's a lot of problems. There's the surgeon side, of course, but one of the big problems, and probably the bigger problem, is the biology. Now, you can attack this from a couple of ways. You can attack this from the fuel side. That's what's going into your body, thinking about nutrition, vitamin D, et cetera. You can attack this from the repair side, augmenting the tissue. But one of the exciting ways is to perhaps think about the signal. That is, how do you tell the cells what to do? Now, I want to be clear up front, this is not medical advice. I can tell you that I've tried BPC-157 for myself. I can tell you that many of my patients use BPC-157, but BPC-157 is a peptide that is not FDA cleared at this point. So there is definitely a gray area in this field, and people ultimately have to do this on their own if they're going to use peptides with rotator cuff repair or any orthopedic surgery for that matter. So what are peptides? Peptides are short-chain amino acids. So essentially they're longer than amino acids and they're not quite proteins. And they're short chains that are put together, and they're not hormones. What they do is supply a signal. They can encourage certain things to occur in your body. And there's actually medications that are peptides that are actually used on the market right now, like GLP-1s are peptides, in fact. And there's medications like Forteo. Forteo is a medication that's given to people who have osteoporosis, and that helps stimulate bone formation. That is indeed a peptide. So it's not as if it's just in this area. BPC-157 is just one of these many peptides that are in existence. And a bottom line is they work by signaling the body to do certain things or upregulate certain areas. Why are people excited about BPC-157? So BPC-157 in particular potentially has a role in a couple of things. Number one is angiogenesis. What does that mean? Angiogenesis is stimulating blood supply. Now, in the rotator cuff, that is particularly appealing because rotator cuff tears typically lack vascularity. Most rotator cuff tears are degenerative. So the idea of upregulating vascularity or neovascularization is really encouraging or exciting. Now, if you also think about rotator cuff healing, you go through a neogenesis or angiogenesis period where you need upregulation of blood supplies. That's one of the first things that happen, and I'll come back to that in terms of thinking about the phases over which you should consider using BPC-157 if you're going to do so. The second thing is that peptides can have anti-inflammatory effects. Particularly, BPC-157 is thought to have an anti-inflammatory effect, so you can get downregulation of negative inflammation that occurs after a rotator cuff repair. The third thing that BPC-157 does that's encouraging, and it may be with these mechanisms, is it, at least in a basic science level, encourages tendon-to-bone healing. And that's where it gets really exciting because, as I mentioned, rotator cuff tears often fail to heal. We know without a doubt as orthopedic surgeons, particularly if you're in the shoulder world, that we need to be doing more to get the rotator cuff to heal. We always talk about it being biology problem, and this is potentially one of those areas. Not yet proven, but potentially one of those areas. Again, you have to think about the overall fuel that the body has, and you have to think about the repair. But if we can impact the signal and upregulate activities that need to occur, there's some excitement in that area. So what does BPC actually stand for? It's actually body protective compound. It was discovered in gastric juices. And all the data essentially in BPC-157 is in the preclinical area. Investigations, for instance, going back quite a long time now, over a decade, have shown that in animal models, if you look at rotator cuff, you can potentially see improvement in tendon to bone healing. Now, the caveat here, and it works by those mechanisms I said before, but the caveat is that number one, there are no human studies at this point in time for rotator cuff. So this is theoretical. Number two, one word word of caution for BPC-157 is that many of the studies come out of one area, and as a scientist who does a lot of research, anytime there are a high concentration of findings coming out of, say, one institution, there's some concern there. So I don't think we by any means have the verdict out in this area and can yet be conclusive that BPC-157 increases tendon healing Nonetheless, it's exciting for the reasons I said before. So how do you take BPC-157? Well, you can take it orally or you can inject subcutaneously. In terms of the effectiveness, it makes sense to me that if somebody's going to do this, that they would inject to get a more favorable uptake of BPC-157. That involves self-injection each day with essentially what's termed an insulin-like syringe, a very small needle. Having done this myself, it's actually a lot easier than you would think if you've never had that experience, and I think people are becoming more and more used to doing something like this as peptides grow in general. One of the big things is to think about though, when should I do this? And unfortunately, what I see people doing is they take BPC-157 all the time, or they take it without any sort of cutoff. If we go back to rotator cuff healing, the first 6 weeks is really where the vascular mechanism is occurring. That's really where you need the vascularity, because tendons, when you get a repair, go through an inflammatory stage then you get a remodeling stage. And you probably want to impact this early stage where you need to affect the inflammation process that's occurring and where you get upregulation of, or need for, vascularity. So what does that mean? That means the first 6 weeks. Now, I think it may make sense to begin a couple of weeks prior to a rotator cuff repair to sort of prime the body, but then continue for no more than 6 weeks after. I do not see any benefit for somebody continuing for months and months after a rotator cuff repair or using BPC-157 on a daily continual basis, as you see some people do. There are also some trade-offs. So if you stimulate angiogenesis, we don't always want that to occur in our body. We may want to do that in a healing period, but we don't want to do that on an ongoing basis because that has negative consequences. For instance, if you look at cancer, that is stimulated blood cell projection or angiogenesis, neoangiogenesis. So if somebody were to have an underlying cancer, you would by no means want to be stimulating that process to occur. So one of the things that along those lines it's important to do anytime somebody considers peptides, in my view, is to really seriously consider should you do any screening in advance. The next thing that I think is important to really consider in this is the actual quality of what you're getting. Because it's not FDA regulated, this is essentially Wild West. We have people taking all sorts of different dosages without physician guidance, again, over all sorts of periods of time, but the sources are everywhere. So what you really want to do is make sure you're getting a trusted source. I think one of the best ways to do that is make sure you can see a certificate of analysis. Now, can those be faked? Absolutely. That is certainly an issue. What I try to do is have people know exactly though where it's coming from and have a certificate of analysis at least, because there's actually been some work that's been done showing that some of these peptides actually are not containing at all what they are saying. So if somebody wants to use BPC-157, I send them to somebody who I trust that they are getting it from a proper source and they are having third-party testing done in the United States because many of these peptides, or most of them, are produced in China actually. And so we want to make sure that it's what it is, is what they say it is, and then it's third-party tested again in the United States. So this whole regulation topic is why I'm really cautious about this in general because again, this is not FDA approved. This is just how I think about it. I do think it's mechanistically something that's very appealing. I've used peptides myself. I have many patients who have used peptides, but I think this has to be done in a responsible manner, and I think people have to be thoughtful in the time frame under which they use it. I also really advise that my patients who are going to do this get healing data afterwards so we can see what the impact is and potentially improve care for others. So if you're dealing with a shoulder condition, you want to talk about emerging topics in the shoulder, I offer virtual consultations to talk about things that can impact your healing. And this is not just things like peptides. There's a lot of different ways we can approach this difficult problem because ultimately the goal is to get you back your function to live the life you want to live. But we can't just think about rotator cuff as repairing it alone. It is a complex problem with many different angles that need to be attacked by you and by your surgeon if you're going to get the best outcome possible.