You've Been Told Peptides Are Hype… Here's What Doctors Aren't Telling You

Welcome, friends. Welcome to the Precision Wellness Practice. Today I'm excited to introduce many of you to a dear friend of mine, someone I've known for many, many years, Dr. Raika Milanovic-Golbrath. Raika, I just know her as Raika, is an amazing human being, and she— it's been wonderful to see her evolve in her clinical practice, in the evolution of her message and training other practitioners. And she's getting such great results that, you know, I'm excited to ha— to share what she has to offer, uh, in the realm of peptides. I, I don't think I can go anywhere these days to any conference or even log into my, uh, Facebook account and social media and not see, uh, a conversation going on about peptides. So it's definitely in the zeitgeist. I think it's seems to be one of the biggest, uh, breakthroughs in modern medicine.. And Raika does training for other clinicians, so she's a world-leading expert on this topic, and I'm excited to have you here. So before we jump in, Raika, uh, it's great to have you here. Thanks for joining us today.

Uh, I am absolutely thrilled to share my message with your audience because you're right, I'm going to dispel— is it all hype or is it real when it comes to peptides? So I'm excited to share the truth.

Yeah, thank you. So Paint a picture for us because I know you've been on the forefront of many, many like wellness and health revolutions and you like to stay up to date with what the, what's the latest and greatest. So what excites you about peptides the most?

It's really, you know, you never wanna say there's one magic bullet, right? And I love that you're a proponent of if you just do the basic things, breathwork, diet, community, that you're— it's going to go a long way. And I agree with all that. But, you know, I've been at it 31 years in medicine, almost 15 years now in functional medicine, and I've never seen anything like it as far as having an adjunct you can add to a protocol to really afford healing. And I'll share some cases as we get into the conversation. Like, I've just never seen anything like it. So, but You also have to do it under the lens of pros versus cons and educating your patients. And there's a lot of regulatory things that have come up, and I'm hopeful, fingers crossed, Sachin Patel in July, they're taking all these peptides that were Category 2 to, you know, to Congress to say, hey, can we finally put this to rest that these are not— these peptides are safe. And if we regulate them, you're going to get people with even better outcomes and potentially, you know, none of the adverse effects if they're buying research only, which that makes me really nervous. To you, either best case scenarios, they work. Intermediate scenarios, if you buy the research peptides, that they don't work. And the worst is that you're injecting something with endotoxin into your body. So I'd be very, very cautious about obtaining them from any of the non-regulated sites.

Yeah, you got to be careful these days, right? It's the wild, wild west, uh, so to speak. So let's approach this from a beginner's mind perspective, because some people may have heard about peptides, but they may not be able to describe in in, in, uh, a few sentences what a peptide is. So give us kind of the peptide 101 definition.

So peptides, from a nerdy perspective, are just breakdown products of protein. So they're amino acids, 50 amino acids or shorter, and we make 7,000 in our body. The first one that was synthesized was insulin. So insulin's a peptide. The peptide that everyone has heard about, bad or good, are all the weight loss peptides, Mounjaro, Ozempic, which go by the trade names of tirzepatide and semaglutide. But they were actually, I'll give you a historical fact, and then the way to look at them clinically is that Pavlov, when he was studying dogs, I thought he was studying the conditioned response, but he was actually studying the digestive tracts. And he discovered the propeptide to BPC-157, which is Body Protection Compound 157, which we'll dive into in a minute. And that led and opened the way to discovering more. And now they're actually using AI to suss out millions of plant peptides to see if they can benefit humans. And one such peptide that I'm using to preserve muscle mass was derived from a fava bean, and they call it PeptiStrong. And, you know, almost everyone that walks through my doors, 2 years now we've been running in-body scans for visceral fat and skeletal muscle mass. 2 people in 2 years came in with enough muscle mass, so not sarcopenic. So even if they weren't overfat or overfat, they had low muscle mass. I'm like, that's a lot of people coming in with not enough muscle mass. And how do we preserve it? And so you can— that would be very safe. It's plant-derived and it's oral and you don't have to inject it. And so I'm really fascinated, fascinated about what the future holds. So what they are is think about medications and maybe even supplements as a phone call. So when you call someone, it is reliant on someone picking up that phone and answering. And they may or may not. I don't answer my phone. I don't know about you, Sachin Patel, but I'm rarely ever on the phone. I'm more apt to text you or send you a personal voice text. I really enjoy those. But compare those to a text. If you send someone a text, everyone is on their phones all day long. We're either posting on social or checking or we're communicating with colleagues or friends. And so it's going to exert its effects immediately or more readily. So I say think of peptides as a biologic text message. So it just really packs a punch and gets in and, and exerts that effect, um, the intended effect much, much quicker than a medication would.

Okay. So peptides can be derived, uh, are they always derived from plants? Are they synthesized? How, how are they I guess, I guess how are they manufactured would be a question.

Yeah, some are from, they're all synthesized, but yeah, some are from plants. Those are mostly the oral ones, but the injectable, yeah, they're almost all synthesized.

Okay. So tell me, like, there's a lot of hype around this topic. As you're probably well aware, and I'm, I'm just curious from your perspective as a clinician who's been using them in a variety of different ways. I know there's good and bad and ugly. We talked about the different quality levels that are available to people. How does somebody know what to take, when to take it, how to take it? It can be very overwhelming when you start exploring this area. So where did you start as a— as you were exploring peptides?

Yeah, so one of the things when we think about aging, so I break it down into categories, like what category are we trying to support within the realm, and I'll explain what those categories are. And I always have to preface it with you wanna lay the foundation. We do that in our clinic. And the second step is we look at almost everyone's genetics. So I leverage the genetics. So, and the way to think about that is that we all know someone who's used one of the weight loss peptides and hasn't lost weight. It's because they're not optimized from a foundational standpoint, whether it's diet or their microbiome or their detox pathways aren't open or, or even their hormones aren't optimal. So once that's outta the way and you've optimized, and you can do it simultaneously, like I would never deny someone Like, you think about a perimenopausal, menopausal woman. If their progesterone's low, it's low. You're not gonna bring that up, especially if they're really close to menopause, or their testosterone. I think about it, how do we increase cellular efficiency and communication? So I look at what is the presenting problem? And I like to look at 4 different categories. One is recovery and repair. And the second would be performance. You know, what helps us perform better? Third one would be our cognitive health and how do we prevent dementia besides all the diet lifestyle. And then even sexual health and wellness, because the number one thing for longevity is, that was found in a Harvard study, that bodes and correlates with longevity is relationships. So sexual health is a part of that. So I look at the different categories and the presenting problems and we start supporting. So almost everyone has, you know, digestive issues. They're all gonna come in from a diet perspective. I am like, you can clean up your, microbiome in 7 days from a diet perspective, but you're still left with the residual, and especially with someone with autoimmune. So in that instance, for recovery or repair, I'm going to reach to something that's going to heal the leaky gut. And the prime one that really has packed a punch is Body Protection Compound 157, BPC-157. You can give it orally. I tend to do it orally if there's a GI issue, or you can give it injectably if someone has an injury and will describe a case from each, or they're recovering from surgery. So let me give you a prime example. One condition that's been really hard for me as a clinician to reverse is Graves' disease. Like, the— and you got to be really careful. I had a woman come in and she was near florid, you know, hyperthyroidism. And to make matters worse, she was a doctor's wife, and I thought, oh my God, I can't have anything bad happen to this woman. And she was adamant, she didn't want to do the traditional meds. To control the symptoms, nor, you know, radioactive iodine is not a great solution, or having her thyroid out. And we utilize oral BPC on her and, and had her do the diet lifestyle stuff. And she wasn't perfect, but I'll tell you, she went from really high free T3, free T4, and very tachycardic. I did give her a beta blocker to say, hey, use this temporarily and go to the ER, like, if you get so bad. And at 6 months, all of her numbers normalized. So she became euthyroid. And in the past decade or more, well, actually almost 50 years in functional medicine, that would have been a rarity. Like, it's much harder to reverse. And she had had hyperthyroidism for several years prior. So it wasn't like she was even a new case to me. And this really packed a punch. And so, And you don't ever wanna tell people this, but very few people are 100%, all right? So this allows them to be 90% or 95%, and they're still gonna afford CURE. We also had, I had 4 cases of, you know, it seems like like attracts like. So I saw one case of eosinophilic esophagitis, which is an autoimmune disease attacking someone's esophagus. And they typically treat them with oral steroids. And of the 4, we got clinical resolution of symptoms in all of them very quickly. And, and 2, they even had documented their— the GI guys like to scope them and biopsy them. And I get it, they want to prevent Barrett's and cancer, but it's like, why not follow them clinically? So we had, you know, pathology-proven improvement in these 2 patients. And the one guy was telling me he was gluten-free, but I also treated the wife and she kind of tattled on him and said he hasn't even really been gluten-free very much. And I'm like, so I don't want to give people that excuse. But in all reality, you know, I heard another lecture talk about, you know, when you try to mitigate risk. So we treat a lot of mold, and although predominantly we're longevity and hormone optimization, 30% of our clinic is mold. And you're going to be exposed constantly, right? What if you could give them something that's going to mitigate that exposure so they're— they live as healthy as possible, but they're these people aren't gonna be able to, to avoid mold entirely. It's just, it's impossible. We're all exposed. The best you can do is to genetically turn off their reactivity to the mold and then reverse any damage that it's done, any of the oxidative stress and destruction to tissue and reverse their symptoms, et cetera.

Yeah, it's a lot of work. And you know, one of the things that you bring up about leaky gut, it's, it's something that's so pervasive And BPC-157, from my understanding, is, is made in the gut. Yeah. And if we're not making enough, we're just not repairing enough from the day-to-day, you know, damage and what's required for us to repair. So people are kind of below that repair threshold. Mm-hmm. And particularly if, if they're trying to heal, they're coming into us and they don't have enough capacity, right? So they're not able to make enough of of their own. So they need a exogenous dose to help support their body. And it's something that just sounds like it can just come in and start repairing things so they can start feeling better and seal up that, you know, that gut lining so they're not dealing with this chronic systemic inflammation because so many people have leaky gut, they just don't know it.

Mm-hmm.

And correct. And this can serve as a, a very a valuable tool to help seal the, you know, create ba— like we have barriers for a reason. And if our skin barrier was compromised, we'd be prone to infections and issues. If, if, you know, our internal barriers are compromised, then we can't see it. And a lot of times we can't feel it where the problem actually is. We feel it more systemically. So when you can address leaky gut, you're addressing so many things at the same time, right? Because of the downstream effect of leaky gut.

Yeah, a couple caveats with it. So for people who have mast cell activation, the oral form can trigger the mast cells. So then you can consider injectable forms, which does that less. I've only had one patient come in who had issues with it, and it was actually before I started treating him, so he wasn't able to tolerate it in the beginning. And then we had worked with them for so long and pretty much everything. We did it for an injury. He had healed up, you know, he had mycotoxin illness, almost— he was disabled for a couple years leading into his time of seeing me. And then we're in the real optimization phase. And I always tell people, the first is repair and recovery, and then the second phase of our treatment is optimization, and that is lifelong. And, you know, and there's so many others you can utilize for the gut, but that would be a great start. Starting point, the oral BPC. It's very easy. It's generally considered safe. The one caveat, if you look at the literature, it says it, you know, promotes angiogenesis. But when I, I pulled an article that says it modulates angiogenesis. So where would this come into play? So if someone were, uh, developed active cancer, you'd have to stop it. You know, you'd wanna stop it right away. And, um, I use it postoperatively. So after surgery, so in case you don't want 'em to have a bleeding risk, and that's theoretic, but you start it after. I had several women come in, in their late 60s, early 70s with joint replacements. And one had a knee replacement in June and followed by one in August. And granted, we had laid the foundation for so long. And she said that was absolutely the easiest surgery recovery she ever had. And you, in, in my early days, I was only using it for 2 weeks post-op, you know, using a young gentleman who had an ACL repair. And he says, my physical therapist says I'm ahead of schedule. Like, Wow, I wonder why that is. And you don't wanna continually being, you know, repairing as well. You know, you need to break things down, build them up. And so there is a range of time for leaky gut. I'm finding 3 to 6 months is kind of that sweet spot. And then for recovery post-op or for injury, anywhere from 2 to maybe 6 weeks, kind of in there, no more than 8. And, you know, a lot of the formulations are made you're, you're looking at higher doses for recovery than you are some of these longevity formulated compounds. So some of the pharmacies are coupling are at much lower doses. So people will feel that effect gradually. And part of me says, how would I do it continually? And I don't know, I've been experimenting with that. And certainly if you cycle, so if you're careful and you cycle someone, you could do it lower doses for like a couple months on, a month off, or typically it's 3 months on, 1 month off. But, um, I like to use it very, very targeted. When it comes to repair.

Okay, so you— thank you. You know, usually when people are so passionate about something, it's, it's not because they read about it in a book or even that they're seeing transformations in their practice. It's usually something inside, it's shifted inside them, you know. So I get really worked up and excited about breathing and nervous system regulation because I had my own kind of personal journey and transformation through it. So I'm curious, did you have your own kind of peptide awakening that made you say, okay, I, I need to share this with the world? Yeah.

You know, I started seeing the same results my patients were. And so let's talk about the next. So you got the recovery repair. We've only touched on one, and if we have time, we can go into others. Then you get the performance. And so a key one for performance, one thing that drops with age is growth hormone. Well, in the United States, we can't give growth hormone, and nor, nor would I, I think, if it were available. 'cause you're gonna downregulate those receptors and heaven forbid you can't get ahold of it or, or whatever. I mean, you can cause, cause harm. Um, so there are peptides that actually promote the secretion of growth hormone and they increase that cell-to-cell efficiency and they have growth hormone releasing hormone and growth hormone releasing peptide. One tells the brain to make more growth hormone and one tells the when the pituitary gland makes it, tells it to release it systemically. And usually I couple them both. Some of the common names you've heard are CJC is growth hormone-releasing hormone, or, or ipomirelin is growth hormone-releasing peptide. And then another similar one to CJC is tesamorelin. And usually that combo— and I've kind of played with both— in the beginning I was using a lot of CJC 1295 is the proper name, with ipamorelin. And within a month, what my patients were telling me, and then what I experienced, was you feel a little leaner, you recover a little bit better. Um, a side benefit which my patients were telling me, and I'm like, I don't even think I have low libido, it gives you a little boost to the libido. Like, who doesn't want that? I'm like, wow, no wonder they like this. And then that one went off the market for a while, um, so I switched to tesamorelin. And tesamorelin's strengths are that it was actually— it's approved for HIV lipodystrophy. So HIV patients were putting on fat abdominally, and so it really targets that abdominal fat. More importantly though, along with two other peptides, it's really great in reducing hepatic fat. So a lot of these patients that come in under-muscled also have high visceral fat, and that is, I think, a terrible place to, to be. And if you say you've taken them through weight loss and they're still not doing it, and you know, I have all fancy markers I do. I look at a blood marker that looks at, are they at risk for fibrosis of their liver, the FIB-4 test that's just available through standard labs. And, you know, put— if they've got that high visceral fat, and, you know, for people who don't know about peptides, it can be a hard sell. Like, they don't want to inject or whatever. I'm like, you know, here are your options. Like, I'm telling you, diet, lifestyle— if that doesn't do it, you want to act because you don't want to be— 25% of people who have non-alcoholic fatty liver disease They changed the name to— it was NAFLD, now to MAZLD, metabolic-associated steatohepatic dysfunction, just to make it very difficult. Kind of how they changed the name for PCOS to something more profound. I mean, probably more accurately describing it, but more moving towards metabolic again, right?

Correct. Highlighting it. Yeah. And you know, you hear, you hear so many things now coming back to metabolic cancer being metabolic. You know, hormone imbalances, being metabolic. Um, and so it's great to have a tool to be able to help support people in that regard with peptides.

Yeah, for sure. And like 25% of those MAZLD go on to cirrhosis, so you want to be able to prevent that. You know, I had one gentleman come in and, um, his parents both died of alcoholic fatty liver, and he probably had mostly the MAZLD, but you know, he drank, so it's hard to distinguish. I don't think he was a problem drinker, but I'm like, Man, I don't know about you, but if it were me, I wouldn't drink at all based on that family history. And right, we, we reduced his visceral fat down, normalized all his numbers, and, um, they moved on from the practice. And I said, just make sure you're looking at the liver numbers at least twice a year. Like, you don't want to let that go beyond you. And if you're going to utilize alcohol, make sure you're taking all the pre and post supplements to clear it, and in moderation. So Yeah, it's really— you're right, focusing on the metabolic. And that, that's the one thing I'm speaking to in an upcoming conference is the synergy between hormones and improving someone's metabolism. And GLP-1s and 2s and soon-to-be 3s really pack a punch. And I know that both you and I run a food-based weight loss program. And I know you're a huge proponent. I use it in conjunction. So I was very conservative, I would have said. And I had a woman that we took through the weight loss program 6 times over, and she kept losing, regaining, losing, regaining. And she probably was that PCOS, which is a type person, very resistant and very difficult. And at first, she'd actually worked with another doctor down the road, um, who I actually mentored, and she sent her to me. She gained 18 pounds doing all the right things. And I thought to myself, either this is trauma, or it's stored trauma, or a whole bunch of toxins, or she's not truthful about what she eats. And she would bring in the logs, and you look through it, and you're like, Man, she can't eat any, any better than this. And we normalize everything and she's just— there's going to be that subset of patients. And the way I like to use the GLPs is even for long-term, for the— it's cardioprotective and neuroprotective. So we have a very small subset left of dementia patients. So a lot with mild cognitive changes, small subset that remains partially because it got really hard to deliver care when it was an adult child having to dole it out. Whenever there's like an adult involved that it's not their own health, it's hard because they're being in that most instances they're sandwiching. So they're very stressed out. They can't deliver care. And I always felt bad, like I'm charging these people money and they don't— they can't implement. But in one particular gentleman, he came to us with a memory score of 15 out of 30. So on the Mini Mental Status Exam, and he had seen another functional doctor for 3 years. We added some basic peptides and bumped them up to 19, and that's where they started to notice benefits. And he was definitely under-muscled, very lean body habitus, so I didn't want him to lose weight. And so we opted to— I, I added in terzepatide at just a milligram. So starting dose is 2.5, microdose is considered like a fraction of that, so half to maybe one, and watched him cautiously. He, and he came back and his memory score bumped another 2 points. And it was notable, like in his functioning. And in his case, we used a real fancy drug that's out on the market that blocks galactin. We got him higher, we got him up to 24. But that was a whole series of events. It was many, many steps to get him there. And it was really cleaning up the foundation, like what's been left to overturn. But I was really impressed with that 2-point gain. I mean, that's, You know, at 24, when he came to my office that time, he could, he went back down to his car and back up without getting lost. And his former training was as an engineer. And his wife said he was fixing things around the house all of a sudden. And so that makes him safe to be at home, safe to drive, safe to not wander, you know, all those things that go along with it. So definitely excited about the prospect.

Yeah, it's a beautiful story, you know, to be able to give somebody their quality of life back.

Yeah.

Um, you know, something like that, when, when the body's available, the mind starts to go, it's a painful thing for people to watch, and it must be very rewarding to see people coming out of that. Um, for sure. You know, and of course it's, it's work on everyone's part, but it's worth it. So thank you for sharing that.

Yeah, you're welcome.

Uh, what are, what are some of the some, you know, mistakes that practitioners make maybe early on or if they're getting started, what are some areas that they wanna be mindful of or, or, you know, tread lightly just so they can get their feet wet or, you know, introduce these into their personal practice or into their practices.

Yeah. You, they wanna be aware of, you know, the, the regulatory compliance is a big one, right? And then we'll talk about the prescribing. So there's two different arenas for regulatory compliance. Uh, you wanna make sure all your peptides either are from 503 pharmacies, which are direct-to-it's-doctor prescription to an individual patient, or 503, which is doctor-ordered into their office in bulk. And be mindful of what's going on in the news. Also regulatory-wise is, you know, does your malpractice cover you? So, uh, you know, I switch malpractice carriers cuz if they're not gonna cover you, then you don't wanna be prescribing cuz you're, you know, it, In, in my viewpoint though, I have a different take, is that I partner with my patients, so I usually don't worry about, you know, lawsuits or things happening. But you know, you never know, right? And so you want to have that under your belt, and then you want to know pros and cons. Like I said, with BPC-157 and even the growth hormone peptides, that's even more important. Not to— you give someone growth hormone, you're going to cause cells to grow. So if someone has cancer, you don't want to give it to them, and what comes— and you want to monitor levels. So knowing the risks and benefits. And you really, from a compliance standpoint, need to be offering them diet lifestyle and say the patient was offered this, this, and this, and conjunction as an adjunct. So you need to be documenting that, that they're— that you've told them there's other options, um, that are available and let them choose. And we have them sign peptide consents. Right now we have a generic consent, but I've even thought about going to individual consents. But then, you know, when I had this discussion with colleagues, they're like, do you consent them to every single medication you prescribe? And that's not standard of care, but, you know, if you really wanted to be overkill. So knowing where to get them, knowing the pros and cons, and partnering with your patients on, you know, if you're going to use them, here are options. I do the same thing with hormones. Perimenopause, it's diet, lifestyle. Here's your herbs you can use, like Chase Vitex or Chaseberry, and here's the hormones. And when do you want to do both? What are the pros and cons of all those? And, and then, you know, partnering. Sometimes they'll ask an opinion and I'll say, well, for me, I do this, but I'm not, you know, I'm not you. I'd have to accept that risk. And then not knowing where to start. I always say, you know, my favorite thing is I was really blessed to have an excellent mentor in functional medicine. He was on a mission to train. He wanted to have 17 offices. He has 2 now. I was part of his earlier practice. And he mentored me every case every day for 3 months. And when I would hit a roadblock, I'd find a good mentor, just like when I found you for the business part. Like, that was key. And then you got trained in high-performance coaching and, and coached other doctors and practitioners as well. But finding that good mentor, because they're going to skyrocket you, and to have your questions asked— you know, I've trained under how many courses? I probably have done 4, at least 4 courses in peptides. Or 5, and not many will allow you to have that banter, case presentations. That's what I think, and that's why I always teach a case-based teaching or categories of people thinking, you know, where are they suffering the most? Do they need to recover and repair? Almost everyone does. We said leaky gut's prominent. Do they have an injury? Are they over the age of 45 and growth hormones dwindling? Do they need the support of cellular efficiency? Think about your growth hormone ones. You know, is cognition at play? Is it for prevention or is it for treatment? And we have a lot of different options. And we just said GLP-1s can be used for cognitive decline. Of course, you want to, you know, he already came to me so far gone, but we still got him benefits, which was great. But those are some of the— and not, you know, dive in, read, read, read, find a mentor, ask, and then dive in. I think until you have your first case and then, and, you know, find your tribe to be able to share those cases with and say, and keep, you know, keep attending the conferences. So there are several that I'll look to going, and, you know, now it's become a lot of it's repeat, but you always learn with a different lens. Like, you're gonna hear a different thing each time you go, right? Whenever, regardless of what you're learning, you'll hear something different each time.

Yeah, I like the idea that there's a variety of different ways to, to get started with peptides, right? And it could be as simple as the oral BPC-157, you know, all the way up to more advanced and nuanced protocols for people.

Yeah.

So we can at least start there. I guess the question I have for you is when, when people are looking, cuz there's so many companies now that are selling peptides, like how do you identify a good quality product and, and you know, who to work with?

Yeah, so that's a great question too. So you want to be able— you want to make sure they're either 503 or , and I, I, with a medical license on the line, I just simply can't use research only. And in fact, I was at a conference with a friend. She came in with an acute Achilles tendonitis, had bought some off of a research-only site and said, I don't know, it's not working. I'm like, well, here— not that you should be sharing peptides, but I said, let me give you a dose of mine. And I did. She's like, wow, that made a big difference. One dose. I'm like, well, clearly it wasn't effective. Um, you also want to make sure a couple things is there should be someone that will answer your questions. So that's a tip off if you're dealing with a rep and they're not going to connect you to someone. And I've already— there was a company that was supposed to be reputable and then I couldn't get questions answered. It was just some, someone doling them out. And so we didn't use them very long. And they want to provide certificates of analysis for every single batch. And that's why you have to also tell your patients, you know, you want to be ordering these a week before you need them. And so now we've started a system where we put tasks. If someone's on, is rotating through them, we have a task that goes in for 3 months down, order Joe Smith, you know, XYZ peptides. And they, my team checks in, hey, are you ready for your next batch? We don't want you to not have them when you need them because sometimes you'll have it, you know, a lot of these places are 3 to 5 days, but if they're batch testing, you can add another 3 to 5 days, and then you don't want anyone to be without— not that anyone will suffer greatly, but you know, I have a patient who has a true mitochondrial disorder, and what the practitioner should know, there are now 85 approved peptides by the FDA. So that's what they won't tell you, is that— and, um, the one in the fall that was approved was, um, one of the mitochondrial ones I used. It's called elamipretide. Say that quickly. Also known as SS31. And so I had a young woman who came in and she had everything you can imagine— mold, this true mitochondrial disorder that manifested as cyclical vomiting and got migraines from it. And her only wish was to be able to stand at her wedding. And we granted her wish to have full energy and be able to dance and not be fatigued. And it's like a beautiful thing. It's like, so, you know, and I use it a lot because There are several mitochondrial peptides. I'd love to highlight those if you're interested in learning a little bit about those. So, you know, my, my hero's journey was 2 and a half decades of fatigue. And a lot of that, when I finally pieced it out, is I carry this very interesting genetic kind of pattern that I've observed in about 90+% of my really chronically ill. And this pattern is also associated with really rare cancers. And I never dove in because I'm like, I don't want to know, it's probably associated with cancer. And then I was gonna present at a conference. I'm like, let's look at the literature and see. But nonetheless, we're all prone to, you know, if you exercise, you'll keep up, you know, my, you'll, you're gonna make more mitochondria, but with age it declines and then exposure to toxins. And so I always think of, there's one called SS31, the elamipretide. The other beauty, not only is it very beneficial to support the mitochondria and energy production, it'll, um, I've used it like for exercise as well. Like, and it wasn't specific, Um, but it, it deals with oxidative stress and that's what damages the mitochondria, which is a beautiful thing, is that you can counteract that while you figure out which toxin is it, or is it a nutrient deficiency, or is it a genetic variation that's led to this, um, issue with, you know, the mitochondria not fit besides age, not working so well. Um, so it's a beautiful thing. That one I'll use 5 days a week and that is injectable. It is a bit pricier, but you can cycle people on or off. So if someone's just looking for performance or whatever, I'll cycle it in 4 times a year, 1 month at 4 times a year. So it's not so cost prohibitive. If it's a chronic issue, it can be ongoing. I was, we ski once a year, so not enough to really stay in shape for skiing. And I have a really bum knee. And if I get sloppy, I'll come down off the hill or downgrade to the blues because I don't wanna injure myself. And my quads were really fatiguing and I had injected some SS31 like the hour before. It took a little while to kick in and I just downgraded and did one blue run. I'm like, ah, this kind of is a bummer. Now I can't be with my husband and daughter who are up on the, on the blues and blacks. And within one run I was back up with them. Like it just, it was so incredible. So you don't wanna override anything, but you know, and I wasn't specifically looking to perform better for exercise. I had another gentleman that wanted to cycle 60 miles for his— no, 55 miles for his 55th birthday and couldn't exceed like an hour cycling, kept fatiguing. And he noticed the same thing. He's like, wow, I hit an hour and a half and it was simply amazing. But then of course, you want to caution them that you want to have the proper recovery afterwards. You don't want to be having them overdo it. But and, you know, I had a because we do have a lot of mold illness.

I—

the one woman was mold and long haul, and at 18 months we finally got everything back. So some people you fix quick, and some people it's that long journey. And when she utilized it, she went hiking for like 5 miles, and she hadn't really even been walking. So unfortunately, in her instance, it kind of— I call it throwing them under the bus. And you got to be really careful when they have long haul or mold is because If you lose them, you, it can take you twice as long to recover them. Thank— thankfully she listened to her body and we got her back much quicker. But you gotta be really, really, really careful in both instances for performance. So they can do more damage if they're overperforming because we're overriding that. Um, and then for chronic conditions is don't overdo it just cuz you feel better. Um, there's another mitochondrial peptide that say the GLP-1s aren't doing the trick. They're hormone optimized, they're losing weight. There's another one called MOTS-C, M-O-T-S-C, and MOTS-C improves insulin sensitivity. And it's actually an exercise mimetic. So think about, we've all had the people that are just so far gone. They've spent a life unwell and now you're bringing them back. So you'll use it as an, as an adjunct and not as a bandaid. That's what I always tell people. Don't, don't spend your money if you're not going to do the other things. They all, like hormones, they work better if you're optimized.

Um, yeah, it's, it's a lot. I know you've, um, been working at this for quite some time, and, and you've even started educating practitioners about peptides. Can you tell us more about that?

Yeah, so I founded Peptide Practice Mastery. It launched just after the first of the year. It is case-based learning, so I do have foundational modules. So we have a foundational modules, and I include in a peptide dosing chart, patient consents, um, kind of how to evaluate a pharmacy, a doctor getting started guide, a patient getting started guide, you know, for everything from how to travel with peptides to, um, you know, just how to mix them. Most of the ones I'm ordering lately don't have to be mixed, but you wanna be able to give that to them. How to dispose of needles, cuz believe it or not, in the United States, it varies by state to state. And in the state of Illinois, you just need a container that you can seal. So a laundry detergent container, and you gotta mark it sharps and you can throw it out in your trash, which is like crazy to think you can do that. But, um, so we give 'em all that information and then, um, we do, it used to be weekly and then, you know, I listened to what the practitioners wanted. So the key things were they wanted dosing and they wanted how to get started themselves, how to get their, how to have their patients get started, which pharmacies to use. So I've sourced out all the pharmacies and some of them don't let you come on board unless you have that introduction because they're just as cautious, you know, they're scrutinized and looked at and really heavily. And then we do twice monthly, we do Q&As, mostly they're case-based. So if the practitioners, you know, we encourage all the practitioners, I'm like, you don't have to have a patient that's actually on peptides, bring me a case that you want to consider for peptides and let's have us think. And the beauty of it is we had all— we had from PAs to NPs to MDs, and there were a couple MDs that have trained as long as I have who are really good at the chronic illness. And so I was really just humbled by that, like, what are you doing taking my course now? But they've enjoyed it and I've enjoyed the feedback I've gotten. And now it's really just improving upon everything. That we're— that I do that twice a month. And then we have a community forum too, so they can ask questions in between meetings, which I think is crucial. And sometimes I'm getting stuff that has nothing to do with peptides. So I have, I have a foundational lecture in the portal for functional medicine because that came up over and over again. And so I actually have reviewed that a couple of times just so that everyone is brought up to speed. And they know what to be doing.

So where is a good place for people to get started if they wanted to learn more?

Oh, about peptides? You can drop— I'll provide a link to it. It's just peptidepracticemastery.com and that they can review what's included there, sign up there. It's open enrollment now and we do have a discount code for people who are referred from friends like you. It's FRIENDS250. To take $250 off. Um, yeah, and then we also did a bonus class on how to create a peptide program. And so the most common question we get is, how do I price my program? And the thing I didn't learn for many years, even after being in mentorships, was you want to have a gross profit margin. So you don't— you can't scale if you're not making profit off your, um, programs. And, um, And that was kind of fun to work everyone through. Like we went through everything from niche to avatar to, you know, some names for the programs to how to build it out. And yeah, yeah. So I'm going to keep— I want to keep adding to that. We may end up— my next phase will be to launch not only the clinical but the more of the business side too. So people can choose, do they want just clinical? Do they want the business too? Maybe they want both and they can pick and choose.

Yeah, I know, I know that's, uh, something that you're very passionate about, helping people grow professionally and, and also, uh, clinically as well. So that's wonderful to see you doing that. And we'll be sure to drop the link so people can, can learn more information. This is a, this is a topic you, you've done extensive training on. In fact, you, you were just sharing with me that you did a, a whole like masterclass series on this topic. So there's so many places that we could go with it. I just want to see if there's anything else that you wanted to share that perhaps we didn't cover, or a question that I didn't ask. Maybe what is a question that practitioners should be asking? Um, I just want to make sure we leave some space for you because, uh, there's things that I don't even know that I don't know.

Yeah, for sure. Well, you know, practitioners should be asking, you know, and I think they should be asking, you know, I was reluctant. I put off training for a year because they yanked these peptides off the market right after the pandemic. I waited a year too long, to be honest. That was to the detriment of my patients. So A, don't wait. B, become well-versed. Find a mentor you resonate with, whether it's me or somebody else, you know. If I may share, you know, I spoke at a recent conference and one of the attendees— and I did a book signing immediately immediately following, one of the attendees came up and said, I learned more in 40 minutes than I did in a whole certification program. And I'm like, wow, that's— but I really think that I like the case-based learning. I feel like, how many times have we all gone to conferences, you're like, now what do I do with this Monday morning? I remember even with IFM back in the day, I spent 40 hours— not 40 hours, say 8 hours dissecting a 1-hour lecture to create a handout to teach my colleagues at this clinic where we all taught each other things. On how to do a workup for hypertension. I'm like, that's a long time to really— maybe with AI we'll get a little quicker. But yeah, is don't wait. Find someone reputable that you can learn from. You know, there's a lot of people that, you know, I've not taken courses before, like I didn't like their teaching style or whatever. I've resonated more with one mentor than the other, you know, for mold. I really resonated with Dr. Neil Nathan. So that's who I did my training with. And there's several prominent ones out there. Yeah, those are kind of big things. The other way from a business standpoint, you know, that will set you aside. And you think about, you know, with peptides. So for hormones, we typically will see patients a couple times a year. With peptides, you really want to be seeing them quarterly because you cycle them quarterly too. So then it's that opportunity. And I'll tell you, I have a businessman who, thankfully, I've been working with him for 4 years, and I didn't know he had some memory decline going on. He didn't tell me, but his markers didn't lie. So there's some advanced markers for memory loss. The p-Tau 217 was mildly elevated, and even his galectin-3, which correlates with heart disease and neurodegenerative disease, all mildly elevated. And we just— I said, all right, well, let's— we need to reverse this now. And so we added in the appropriate measures from a functional standpoint, added in some peptides. And 2 months later, he comes back in and he says, Doc, I don't want to tell you this, but I couldn't remember the 6-digit verification codes they used to text me. I used to have to write it down. To then input it into my computer. I'm like, man, you better, you better tell me next time. And he keeps saying like, and he's actually on top of it. I think I'm ready for my next set of peptides or whatever. And so it's just that opportunity to really, you know, he wants— he's a business owner that went from owning 3 businesses down to 1. Now he's 74 years of age and he's going to work. That's his passion to some degree, the remainder of his life. That's what's going to keep him youthful. He's got his hobbies. That he partakes in, and he's equally passionate about his family. So it's not all about work, but he wants to, you know, be there for his, his loved ones. So I'd say don't wait, you're missing out on that. It's like functional medicine, you know. I was in medicine for 16 years before I trained. I didn't know it existed, you know. If you knew the outcomes you could get and the lives you could change, you know, it's, it's like a win-win all around. So the impact you'll make, and then Hopefully, you know, the key thing— I was just doing this AI course and it asks 25 questions to upgrade your memory. It's all the great things you should be able to answer, like, you know, how risk-adverse or tolerant, what are, you know, what's, what are your one-year goals. And really, for me, and it just came up with this, and it said that I was in the business of leadership. Oh, can you imagine? I was blown away. Here I thought I was building a clinic and training practitioners. But I just— yeah, it was just— I was just blown away with this AI. And I think that that'll help some of the complexities with peptides is just, I think, the ordering and staying on top of who needs what. And I think you'll be able to dial that right in. And so that's one thing I'll probably add. I know with Chats, you can share your chatbots with other people. With Claude, you cannot, only if they're in your work. Work environment. But I thought, wow, that would be really, really great to be able to, to impart that. Um, but yeah, I, yeah, I hope, hope that answered that question.

Yeah, thank you. Um, aside from the course, where else can people follow you? Where can they learn more about your work?

So all of my social media is @drrajka, so it's just D-R-R-A-J-K-A for Facebook, Instagram, LinkedIn. I dialed that in for all three of those. Also for YouTube, I took a little pause, but yeah, I've been pretty regular last year on YouTube, almost a weekly video. And now I'm kind of testing the waters. And I think with AI, we'll be able to dial it in as to what are people seeking. And yeah, never, never stop learning and leverage the AI. And hopefully I'll be able to share all this knowledge more, more readily. That's what I'm hoping to do is have a, have my clone within the community so that they're getting like real-time answers that I can then—

well, there's, there's no cloning you, Raika. There's no cloning you. It'll be your clone. Your AI clone will be a very distant second to you, to the real you.

Oh, I'm so flattered, especially coming from you. Yeah, yeah.

Well, I love, I love seeing the evolution. I love that you're always paying it forward, sharing your knowledge, uh, so generously and freely. If you're watching this and you're interested in learning more about peptides, we'll, we'll drop a link to where you can go and repeat that coupon code again, Raika, if you would.

Sure. FRIENDS, all capital letters. So F-R-I-E-N-D-S 250, 2-5-0. All right.

Yeah. So FRIENDS 250 and you'll, you'll save some extra cash off the, off of the course. And, but more importantly, you'll learn some life-changing information from one of the best teachers. So thank you again, Raika. Thank you for being here. Thank you for sharing your precision practice with us and educating us on peptides today. It was very insightful and informative.

Yeah. Thank you, Sachin. So grateful to you to allow me to share.

My pleasure. Have a wonderful day. Bye.