Hope for the ‘Untreatable’: How Peptides and Immune Therapy are Changing Lives

But what's happening is inside the cell, there's some damage. So the DNA repair machinery isn't working right. It starts to excrete some cytokines and some chemokines, basically these chemical messengers that are making more reactive oxygen species. And it's going down this lactate cycle rather than the pyruvate cycle, which is resulting in this depletion of NAD+, which is a big source of energy, especially for the mitochondria. So the mitochondria are getting more damaged. That cell is, is not functioning properly and it's greedy. It's like, hey, I need more NAD, I got to take my easiest pathway to do that. And so it continues down this pathway, so it gets out of kind of the phase of— yeah, it's wasting all that energy, it's wasting all that energy, and then it essentially starts to poison the cells around it.

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Hi, it's Dr. Kent Holtorf with another episode of the Peptide Summit, and today we'll be interviewing Dr. Amy Dirksen, and she'll be talking about peptide therapies for the immune-driven conditions including autism, Lyme, and that hypersensitive patient. So that the patient that everyone hates and has the hardest time treating, but, uh Dr. Amy, thank you so much for being on the summit. Uh, appreciate you taking the time and looking forward to hearing, um, you know, all your, your tricks and, uh, and then how you approach these very difficult patients. But, um, just a little bit of background, um, uh, Dr. Amy Dirksen, she's a former competitive athlete and naturopathic physician. She did hurdles for What college?

For Western Washington.

Western Washington. Very impressive. But also did studies in biochemistry and her medical postgraduate training with Dr. Klinghardt, as most people know, well-known Lyme physician, really cutting edge for over 2 years. She's one of the original doctors with him. Specializes in working with both autism, uh, you know, PANS/PANDAS patients, chronically ill. Uh, she's been involved in teaching various topics with Dr. Klinghardt since 2004. Uh, she looks much younger, so whatever she's doing is very good. She's been also speaker at Autism One, um, Academy of Comprehensive Integrative Medicine, American Academy of Restorative Medicine, um, uh, with, uh Scott Forsgren, The Forum for Integrative Medicine, I think, TFIM, and Hope to Heal Lyme Conferences. So she's just really spoken and goes to so many conferences. She's one of the first naturopathic physicians to become a fellow with the Medical Academy of Pediatric Special Needs. Wow, that's really nice. And is board certified in integrative pediatrics from the American Association of Integrative Medicine. which is typically limited to DOs and MDs. Congratulations. She's also a member of the International Peptide Society, AAEM, ACAM, you know, so environmental. She's kind of basically—

A nerd.

—been everywhere. So name it, she's done it. She's working on really those most difficult patients, the most sensitive, the toxic patients that react to everything. We're gonna get into that. Our typical patients tend to be those that have seen by multiple doctors and specialists. And I think you may agree more and more, like when we did our study 15 or 16 years ago, where we published our data, people saw on average 7.2 physicians before seeing us. Now it's like 15. Yeah. And it's everyone just goes through the, you know, basically specialists. Everyone looks at one little part and they don't get better, basically. Her greatest passion is working with PANS/PANDAS patients. And those are very tough and you have the parents and the kids, but I imagine getting them better feels so good. She feels that the more we can understand about our kids, the more we'll understand everyone's health. I totally agree with that. And my heart goes out to you and the parents of these autistic kids and just the stress that they have to go through. And even the kind of the courage to go find a doctor like yourself because they're told, oh, there's nothing you can do. And how doctors treating autism are maligned like quackery. It's like, well, here's 400 studies showing you this, you know. But anyways, I'm going on. Welcome. Thank you so much for taking the time. Um, and she's very good friends with, uh, Scott Forsgren, the Better Health Guy, uh, who's awesome. And sounds like she was instrumental in getting Scott better. Uh, so I, I think that's great. So, um, Yeah, what, uh, we kind of talked about, you know, how you got involved in this so-called integrative alternative space, but what, what, when did you find peptides and how did that happen?

Yeah, so I would go back a little bit, but back in 2014 I started working with Lotus Antigen Therapy. So a little bit about me is I have Hashimoto's, a lot of mold sensitivity, pretty sensitive kiddo, but yet I was a competitive athlete and I feel pretty hardy. And so I don't like— it's these two dichotomies, right? I'm like, okay, I'm more sensitive than I want to believe. And so, you know, I think with any of our patients, it's all about the cup is full and it's what's that tipping point that tips them over, whether it's autism or someone who's exposed to Lyme disease. Um, and so I started working with Lotos Antigen Therapy through the AEM Academy.

Okay, can you describe that?

Yeah, so low-dose antigen therapy, um, essentially the whole thought of that— and I'll get into that a little bit later too— but, um, it is all about retraining the lymphocytes to become more tolerant to the environment and to whatever you expose them to. So it's done as, uh, just a little intradermal injection, usually every 7 weeks, and as time goes on you can spread those out further apart. The nice thing is you don't have to do, like in the office, you don't have to do as much testing. You don't have to keep as many antigens there because like the food mix is 300 things mixed together. Um, the environmental mix has, you know, molds and pollens and animal dander and all that same thing, about 300 things together there. So in one little injection, you can do all the foods and all the environmental factors. You know, it hurts for like a second, but it's amazing. And for me, it was one of those things. I had a goiter for over a year. It was hard and enlarged. I kind of ignored it. You know, I didn't go to a specialist.

You're tough. You're tough. Yeah.

I'll figure this out. It's got to be weed or it's got to be heavy metals or something. But it wasn't changing and my thyroid dose was really inconsistent. And I did my first injection of that, not thinking anything, thinking, okay, this is another thing. I'm excited, but you know, I haven't seen it work and I'm kind of scared of it. My goiter got soft and it shrank within 20 minutes. It was remarkable, and it hasn't come back since then. And so I'll know— it's actually my flag a little bit if I now at this point sometimes go 3 or 4 months in between doses just because I get busy and I forget. Um, sinuses cleared up right away. It was interesting, I almost felt like I had cold air rushing through my sinuses because that's been always my area, right?

You're like, wait a minute, I can breathe now.

I was like, oh my God, that's what it feels like to get air in your sinuses. You know, I had a win.

That can make a big difference too. Do you think it's more the foods or the inhalants?

You know, it's interesting. I think it's the inhalants, but the foods for me uncovered a gluten sensitivity that I had suspected because I had seen the connection with Hashimoto's and all the literature. But it was always this, like, I wasn't sure that I was really reacting. And the whole— when you first do your— you're exposed to your antigens and there's an enzyme in your system, you can be a little more sensitive for a couple days. And I, I actually ate some gluten and it made me throw up. I thought, holy moly, right? And so it was really telling for me. And at that point, um, it's become pretty clear. I also suspect I have a little reaction to potato now over time, um, that it just wasn't so clear before. But going off that, it just, it really stabilized everything for me.

And I, I think that's such a great treatment and so safe. And we, it, I don't know, you may find this too, especially of practices that you owe with other doctors, like kind of great treatment, but they kind of get away from it for a while, you know. And, uh, and it's just something to use on almost everyone. And almost everyone.

So, you know, we're all exposed to foods, we're all exposed to the environment. You can do a chemical mix. Strep is amazing, especially for kids on the spectrum. Like, whenever they get agitated or start picking at their lips until they're bleeding or like biting at themselves, the strep or Clostridia can be great. And then I've gotten into the LDI, the low-dose immunotherapy, which is more for, you know, some of the bugs. And you can look up Ty Vincent and the work that he's doing with that. So he's really gone in a great direction with that. And so, you know, that's a huge part of my entire practice. Um, I have 3 other physicians that work with me. Um, Christopher Wakely will be another speaker for this, so he's in my practice as well, and he does a ton of LDA, LDI. And so, you know what's, what's interesting with LDI, it's—

well, if doctors are like, one, people love it or say it doesn't work. I don't know if it's like how they're using it. I've been trying to figure it out, or if they have enough patience, you know.

Um, but I think it's probably how they're using it. And are they using enzyme? Are they not? What sort of education are they giving people? What are they watching for? Are they— what kind of doses? Because that's the thing, is there's a wide variety, especially when you get into—

yeah, in the Lyme organisms.

You know, there's a wide variety.

The complexity is so much more. LDA, you give it and, you know, right?

Yeah. But when you get into LDI and, you know, I've seen some wows with it. Um, some of my Lyme patients, you know, especially like the Bartonella, the burning gut kind of stuff has been great. Autologous stool, school, school, autologous stool can be really great for the chronic gut issues. And for me, so, you know, learning that, then it just hit home like what an immune component is going on with so many of these infections, um, until Until then, I was pretty heavy on antimicrobials, whether it was prescription or herbal. And so that really shifted my practice, just seeing how it played out in myself and then trying it with a few of my regular patients was like, oh my gosh, this is where you have to start. Calm down the immune system response and then see what's left.

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Yeah, and I think that's, you know, what happened with myself and then seeing with patients is that I was in the, you know, massive antibiotics. I'm not giving enough and doing, you know, 5, 7 at a time and do this bigger dose if I don't fix the immune system first. I also noticed is that like when I would do peptides or any treatment, when I was sick, I would get huge flares which looked like, you know, allergic reaction. And then, but if I wasn't, there was no problem. Right. You know, so it shows that, that the problem is the sickest patients, the ones that react negatively, you know, the ones that need it are the ones that react negatively, which, which makes it tough. Yeah. Yeah. It shows us all the immune system screwed up.

Yeah. Yeah. So we integrated that into our practice and then all of last year and kind of late 2018, I was called in like probably 25 of us from around the country were called in to work on one case in particular. So someone that could afford this, but that was very sick, a young man who, um, his symptoms were escalating to the point that he was bedbound, um, blindfolded, earmuffs, like, oh my God, in a bed. And so he called all these doctors in to start to brainstorm about that. And I was fortunate enough to end up being his managing physician. Um, but there was a group— I was co-managing him along with a neurologist who was fantastic.

And that's an oxymoron, that's usually an oxymoron. I don't mean to put— No, I know, right?

So, I mean, it was so fun. I, I was— it was like my, my nerdy dream job.

So that's nice.

Well, you said 25 physicians, so there were 25 of us, and then it was narrowed down.

Not that we were like— was that the Eric Gordon group, the I'm forgetting the name, uh, uh, whatever it was. The guy gave a donation to put all the doctors together. Was that, was that that group or the—

uh, a separate group, and I can't disclose actually because it was for a private patient. Um, oh, okay, great.

Well, that's it.

There were some great doctors involved, and the thing that was nice is so doctors from all kind of genres talking about this thing, but then it came down to there were 6 of us that were really meeting regularly to talk about this case And, you know, we had done all the things we knew, you know, you treat the infections, you look at the labs and oh my gosh, are these viruses a problem? What is it? And then one of the doctors proposed peptides and I had never heard of peptides. And he laid out a few things and what they could do and how it fit with the labs. And I got so excited. And the International Peptide Society happened to be having their conference, you know, 2 weeks later. So I got myself on a plane. I got so excited about it and how they started working in this patient who was so sensitive. You know, I mean, the thought of just doing injections and some of these things— wow, nothing was working.

I just imagine just getting 25 doctors together, usually it's a battle, you know. So, oh gosh, well, right.

And you know, you're afraid to do something like LDI because what will it— you know, it's tough, you know, you're doing a little bit of a dance. But we started the peptides and we saw some things, you know, and we discovered some other things going on with the patient, but it really helped to clarify. And just the fact that we noticed something was so exciting in a patient like him who was so immune activated, right?

Where you can't do anything and this allowed you to at least try something. It allowed us to try a lot of things. Calm down enough to—

that's awesome. We saw some changes and then, um, the other 3 doctors in my practice also got on board and I'm, I'm really spoiled. I have a group, there's 4 of us. I trust all of them, we all bring a little bit something different to the table and we meet every week. So we've gone to a bunch of conferences, but we meet every week and we get to talk about, you know, especially as we were just getting into this, you know, what were we seeing with our patients? What are we trying on a dose? What's working? What backfired on us? Like, oops, okay, this is what it looks like when you do too much. You know, I put myself, you know, I don't like to think of myself as an autoimmune patient. I put myself on 5 peptides at once as injections just to start with because I can, and, you know, flared the heck out of myself. Yeah. Oh yeah, it was kind of fun, right? Because I love that model.

You know, it's that collective brain, and, you know, and people see this, and, and, uh, you know, doctors that can extrapolate, which I have found, and you probably found this hiring doctors, so many doctors coming out, they don't understand concepts.

They memorize. They can memorize anything. Yeah, but hey, I saw this, maybe that means this is going on, you know. But meeting with the doctors, that's like an exponential brain and experience. That's, that's amazing.

And medicine's an art, and we, you know, we deal with pretty sensitive patients. So majority of our practice— so I'm up in the Seattle area, but most people fly in to see us. And so, you know, we're not a first stop. I don't have the common cold coming in. I don't have a brand new diagnosed case of autism. We have people who've been through it and they want something. And so it's fun to have that and just to have people you trust because this is not easy medicine to do. Right. And it's exciting when it works and it's, you question everything when it doesn't. So yeah.

Or it's, I love, we talked about Eric Gordon. I love one of the lectures he had, everything works for somebody. And it is, it's like, and patients go online, and you can see they're just almost paralyzed, and they have some basic testimonial, this herb got this patient better, and other people say, don't do it. It's tough with all these complex patients. And then they go to their doctor, says, oh, it's quackery. And, you know, so it's tough.

All you can do is believe in what you do, practice with integrity, do your best to help people. Yeah, right.

And I think explaining to the patient— and I tell the doctors, I think first you have to convince the patient in the right spot and let them understand why you're doing this and why their doctor may say, oh, that doesn't make sense, because they don't use that model.

But what are some of your favorite treatments? See, not, not peptide-wise.

So, um, I love— so LDA, LDI, um, I like lotus naltrexone. I think it's fantastic just if you're looking at something to kind of calm things down.

Yeah, again, immune, you know. Yeah, and it's kind of like, yeah, try that. Very safe. It's safe.

You can do it as a cream, so if it's a child, you can put it on topically if you want one less pill or things you have to mix in. So that's been great. Um, I do a lot of focus on the histamine mast cell piece. So really looking at the variety. I love ketotifen. Um, I've used some chromalin, but just looking at the variety of the H1, H2 blockers and kind of seeing if you can calm things down. And also using some of the natural treatments, some of the, um, do you like the bioflavonoid, uh, fisetin?

I was looking at a, uh, study, you know, like all the mast cell guys that like Mast Cell Mastermind guys. Yeah, Afrin. Oh my God, he must do nothing else but but answer those questions. But my gosh, you know, they're kind of stuck on direct mast cell inhibition where I'm like, look upstream, you know. Yeah. And, and modulate the immune system. And once they looked at, you know, um, they all love chromalin. It doesn't absorb well, it's pretty weak. And just like, um, fisetin, or people pronounce it differently, the bioflavonoid, but much more potent, you know. Right. Um, and so it's— but mast cells are huge. But it goes along with that whole immune dysfunction. It goes with the whole immune thing.

And I think, um, everyone Everybody needs to be looking at the gut. So, so much— I mean, they know so much now about the gut-brain barrier, but 80% of our neurotransmitters come from the gut. And think of all the stuff that goes in there and the food qualities that have gone down. I've just seen the changes in stool testing over the last 15+ years. I'm seeing dysregulation of IgA levels now. I'm seeing a lot of eosinophils. I'm seeing things that I would rarely see before. You're running food allergy panels and it lights up like a Christmas tree. So you're seeing people that are just overactivated there.

Where they just have like every food, right? Every food.

You know, the solution's not taking away every food. It could be, let's start some LDA and let's try and heal that gut. And, you know, peptides can be great for that. The BPC, I'll talk about that a little bit, but that's amazing for helping to heal that up. But a lot of times, you know, we're having to do some parasite treatments or some herbal antimicrobials, something broad. Rifaximin prescription is helpful. It's not the end-all be-all, but it can be a really nice end to your treatment. And then trying to explore, like, I like the spore-based probiotics. I think they can be good. I'm not a huge probiotic fan in general just because a lot of them can be triggering. Um, but I think there's some newer products coming out that are, um, yeah.

And I think that's, you know, we're trying to say, hey, the microbiome. But when you start looking at the virome, you know, and I was looking at some studies where, um, it's basically, you get these, you know, good bacteria where they're making butyrate, which is good, right? Yeah. But if that butyrate level gets too high, it activates a bacteriophage, which is a virus that starts killing that, that basically bacteria that's making the butyrate so the butyrate level doesn't get too high. It's like a computer program. You know, it's, it's nuts. So wait until we get into the virome and everything. But yeah, gut, gut is, is huge.

But the thing that's been interesting, and I mean, I, you know, none of us have it figured out yet. But, you know, so many of my colleagues, and no bashing of them, but as a naturopath, you know, we're always taught, oh, you do some acidophilus and bifidus and you do some food stuff, and, you know, that doesn't always work. And you can give, you know, all the fancy probiotics in the world and all this other stuff, and you run a stool test and it still looks terrible. But I've got to say, either doing like oral immunoglobulins, like a product that has IgG and IgA in there, or doing something like BPC, I have seen some things really significantly change where we're repeating stool tests, but also just looking at symptoms more than anything, that things are stabilizing. People are able to eat more food. The other thing to think of is, you know, that the mental-emotional level and that neural programming. So something like DNRS, Annie Hopper's work, can be amazing. And I've had people, when they're ready to do it, it's a hard sell. You know, people want a pill more than a time commitment. At least.

Oh, that's very true. And, and that's why you talk about the gut-brain axis, but I think people forget— they understand, they, you know, talk about how the gut influences the brain, but the brain also influences the gut, right? And so that's why a lot of the studies, you give— they give all these probiotics, but as soon as you stop, it goes right back, right? Because, you know, the brain— which is kind of like why I like BPC and, you know, TB4 FRAG, where it's affecting both sides, and you can kind of get um, generally a little more long-term, uh, changes. But, uh, and stress, you know, stress is, is a killer, um, and how it affects, you know, that sympathetic nervous system and causes immune modulation and, um, all that. People kind of think, oh, you're stressed, oh, you're stressed out, well, man, oh no, it, you know, physically.

And it's tough because once you've been ill your ability to actually make cortisol and handle the stress is less and less and less. And then there's also the internal stress of the, the microbes or the toxins themselves that are stressing you, and it just really, you know, attacks.

Yeah, because everything's a vicious cycle, right? And, and I, I think if people aren't stressed, they— I think so many people have Lyme, but, you know, whatever you call Lyme could be a lot of things. But, um, if they're not stressed or have these other things, they're probably never gonna have symptoms. You know, the body just suppresses it. But as soon as you get layering of all these other things, which often, you know, I'm sure you've seen this, it's like death in the family, divorce, or some trauma sets everything off, and then all of a sudden everything just goes haywire.

Well, that's what I've seen. I've been in practice now long enough to know, like, people that we treated for Lyme before— and not to say there's, there's never a bug load, because a lot of times there is, but we've gotten them better. And then some sort of family trauma happens— a parent dies, you know, a child is sick, something, a divorce— all of a sudden all those old symptoms come back. Or what I see with my autistic children is maybe we dealt with heavy metals and all these things and they were stable when they were younger, they're coming back to me now that they're going through puberty and all the hormones, and now they're feeling different. And like a lot of those old symptoms tend to come out of the woodwork again.

Yeah, I, I totally agree. And what, what Uh, and I was thinking what kind of testing you like to do. And, you know, we like to do a lot of tests, and I've noticed that, you know, especially in the immune sense, like the Lyme patients, the chronic fatigue syndrome, and the autistic kids, their lab work looks very, very similar. You know, it's, it's like, damn, okay, there's like a very similar underlying issue going on here, right?

Yeah. So the autistic the autistic child or the PANS/PANDAS kid or the post-Lyme syndrome patient or your chronic fatigue fibromyalgia patients, they're all pretty similar. So a lot of the labs look good, like pretty darn normal, but if you really look at it, you're seeing a lot of similarities there. I think a simple thing to look at with the CBC is the MEB. So you add up the monocytes, eosinophils, basophils. If it's over 10, and especially if it's over 15, you know, the immune system is overactive and screaming at you. But everything's normal. Everything's normal. A lot of things can be normal, but man, give me someone's chem panel and CBC and you can learn quite a bit from that.

Yeah, it's just, yeah, looking a little deeper. And, and, but wait a minute, your CBC and your chem panel, your cholesterol— oh, your cholesterol is a little high, that's your problem. Like, right, yeah.

But the thing that's tough with a lot of this too is, you know, you may have a lot of elevated viral antibodies, which are also normal because it just means you were exposed before. But what, what is normal and what, what, when does that tell you that that's actually something they're still dealing with that has to be treated or killed versus it's a healthy immune response? And that's where, you know, kind of the, the art of medicine comes in.

Yeah, it's like, you know, uh, and I don't, you know, with Epstein-Barr or Leishmaniasis or HHV-6, they have like 0 to 10 as normal. Everyone's abnormal.

But like, normal, or, or there's degrees of that, you know? Yeah.

How, how high are they? You're like, normal? Are they? Yeah. But it's strange how, how— or with hormones, like, some of the levels are like estrogen, 0 to something.

Yeah, I know, right? So, so you're like, okay, I'm 0.1, but the normal range goes up to 60, so I'm normal, you know?

Yeah. Oh, you're normal.

Yeah, I know, no, it's crazy. Um, I do find like an organic acid test, so a urine organic acid test is really telling. It gives you a lot of information about glutathione, your urea cycle and ammonia pathways, all your B vitamins, gut health, so yeast bacterial markers, serotonin, dopamine. Um, really helpful just in a single, you know, morning urine sample. I also do a lot of stool testing. I do find it gives me quite a bit of information.

Well, which, which stool test do you like, by the way?

I like the GI-MAP, but I also like the Genova GI Effects. Um, I find they, like, they have their strengths and weaknesses. Yeah. Um, and what do you like, assuming—

I mean, you probably see the same thing. Well, it depends. Some people have been to every doctor, they have tons and tons of labs, but a lot have the same labs over and over and over. Um, with, let's say, you have the typical person that, okay, what test— they can't afford every test.

Um, but what do you kind of not insist on but really encourage? What do you think are some of your key tests?

Yeah, so especially if it's an adult and drawing blood is not traumatic, there's a lot we can get, um, that would be covered by insurance if they have insurance. So, you know, your CBC, your chem, a homocysteine, a histamine level. Um, you can look at some hormones, you can look at a TGF-beta 1, which will give you an idea, is there a mold exposure or is there some sort of acute inflammatory response happening? You can run your viral titers, you can look at some vitamin status. So in red blood cell zinc, a red blood cell magnesium, those are so helpful because that's looking at what's inside the red blood cell. Average lifespan of that is 3 to 4 months. So that's giving you a nice average. That's not just, you know, a supplement that they're taking. And a lot of times those two minerals are really low and really impact a lot of other things. A methylmalonic acid is really helpful to know that intracellular B12 level. You know, if you run a serum B12, everyone's going to be high if they've ever taken a B12 supplement. Um, but the methylmalonic acid could tell you a lot. Trying to think what else we put in there. Put all kinds of stuff. Um, I do quantitative immunoglobulin, so IgG, IgA, IgM, IgE, to know if there's some sort of distortion, right? Because some people are low and some people are sky high, and the way that you're going to approach treatments for those patients is going to be a little different.

Yeah, and that's what, you know, I think our average panel for a sick patient, you know, it's like 35, like Quest test, you know. Of course, the, uh, phlebotomist at the, at the draw station— we used to draw in our office, but people would think it was us. But, uh, they go crazy. And I remember I went in to get my blood drawn, like, oh, this is that doctor that orders all these tubes.

Yeah.

And I'm like, hey, I heard he's awesome. I've heard he's really good looking too. Yeah. But, uh, but it's, it, it's, uh, it's funny. And they screw up some of the tests you really want, like natural killer cell function, human growth factor beta, C4a, they tend to screw it up. But, um, yeah, and then I think they're even better, like, now that, like, you know, Quest, they're doing the immunoblot instead of the Western blot, uh, picking up a lot more. But they'll tend to be nor— like, you know, negative, but they got a band that is only in 0.1% of normal people. Like, hello.

And so that's the thing is you have to learn how to really read those labs. It's actually something that the doctors that I work with and I have been wanting to go back to Bastyr to teach graduating students of how do you navigate all these labs. What can you learn from it? I've presented in other lectures, and one thing that I'm going to upload after this is just a PowerPoint on some of this stuff, and I can also put those in there too.

Awesome. So you offer that for everyone?

Yeah, and I plan on recording it too, so if you're a visual person, you'll have the slides.

That's great because it is, it's like that within this range, you know, and, and I think you get such a good picture when, when this is high, but they can all be normal, but you're like, one glance, you're like, hello, you're screwed up, you know, you can see that it's messed up.

So the other thing is, you know, I do autonomic response testing, so I trained with Dr. Klinghardt, and that's a skill that he's developed, and I've taught for him, gosh, for a long time now. And so it's, it's another, it's a second opinion, you know. What is the body having to say? How do you navigate through all this stuff when someone is sitting in front of you and everything's normal, uh, but they still feel really horrible, you know? What's the priority? Where do you start? It can be a great way to know, especially if someone's really sensitive, what can they tolerate. So it helps us. The other thing is we also look at environment. So if there's suspected mold exposure, especially, you know, we'll do a detailed intake. And I think taking a patient history is the number one. Oh yeah, there's so much there. Learn from the mistakes of the past, learn from what helped them in the past, what made them worse. There's so many clues there. And, you know, don't assume someone else has already figured that all out. You know, they've come to you, you need to look at it with another fresh set of eyes. Yeah, yeah.

And I think, you know, after the history is that I like to do a lot of tests, then I pretty much know what it's going to look like, but I feel like to show the patient, right, that look, because everyone else said you're normal, but you know, people go, what if you don't find anything? Well, it doesn't happen yet, but, um, yeah, where you can paint a picture, you know, and then decide together what's, you know, what direction to go.

Yeah, and it's also how you present it too. So get excited with someone when you find some abnormals rather than, oh no, you know, it's all about how you frame it. So great, we found some things here, we have some explanations for why you're feeling so bad. This we can work on, this easy.

Yeah, I say, I got good news, I got bad news. The— right, like, the bad news is you're hypercoagulable. Good news is you're hypercoagulable, you know?

Right, good news is we can treat that. Yeah. The other thing is you have to make sure— I mean, it's not a lab, but do ask your patient if they're pooping every day. It is not uncommon that, gosh, I was working with a family last month and I asked about their daughter and they're like, oh, she's the best pooper in the family, she goes every 3 days, and I thought, oh my goodness, like, we've got a lot to do. And so it's not uncommon, you know, a lot of that sort of bowel laxity and the lack of peristalsis happening because you're stuck in that fight-or-flight mode. Yeah, these illnesses that you're dealing with and you're not in that nice parasympathetic mode.

Yeah, and, and it is. I've never seen so many people happy when you tell them they have Lyme. You know, it's like, thank God, you know, because they're just— they want some diagnosis, something to work on, you know.

But the other thing I would say too, because I know this is going out to other doctors, is even if you don't know Lyme, if someone comes to you saying they're a Lyme patient, it doesn't mean you can't help them. It's just, you know, the Lyme organisms, Lyme and all the co-infections, are very inflammatory, so they may need someone to help kind of know the things to treat that, but you still know the foundation and how can you work on drainage and detox support and how can you deal with immune modulation and all these things. That's what's going to help them tolerate those treatments.

Absolutely. Because it doesn't mean we— you know, we used to be, okay, you got this, let's just go after it. Now, like, they're like, why aren't you giving me antibiotics? No, we're, we're not. We're gonna do these other things first. What? And, you know, to get from, I think, A to B, we get there much faster by not doing that first. By not doing that. Absolutely.

You know, if it's an acute, you know, exposure, of course you're gonna jump to antibiotics. Yeah, yeah. It's not— it's not our first thing out of the gate. So I'm glad to hear that you're in the same camp.

Yeah, I mean, if it's acute, very aggressive with it, right? And they say, well, that's overkill. I said, if it was me, because I know how horrible the freaking illness is, I wouldn't wish it on my worst enemy, that if I can prevent that— but once you have it, there's better ways of going about it to get to that final.

But some people need to reduce that load, and that's where—

yeah, and then they have their place. Everything has its place, right? Yeah. And, um, let's see, what, what are your favorite peptides? What, what do you—

oh my gosh, we're gonna jump down there. All right, so favorite peptides, I'm gonna scroll down. Sorry, I have notes in front of me, it's been a long day. So favorite peptides, uh, thymosin alpha 1, love it. Um, TB4 and the TB4 fragment, uh, of the other species.

So thymosin alpha 1 You know, it's a big, you know, Th1 booster, boosts natural killer cell function. It's approved in 30 countries for everything from cancer to auto— to infections. Approved as an orphan drug in the U.S., also for melanoma. But yeah, it's one of the immune—

the thymic peptides, all similar but a little different.

Yeah. Yeah, so I can talk a little. I have some notes here if you want on the thymosin alpha 1. So, you know, usually it's an injection, it's a subcutaneous injection, tiny little needle. Um, really no documented side effects or negative side effects with the thymosin alpha 1. And I would say it's probably your first go-to in your chronic patients, or the patient who shows up and is saying, oh, I don't tolerate anything, I can't do that supplement because of that ingredient, I can't eat this food, I can't do anything for more than a couple days. Thymosin Alpha 1 can be fantastic. And I would also say that it's one of the only treatments where more sometimes is better in that patient. You know, usually that's the patient that we want to be really careful with. But I actually find if right out the gate, you actually go up relatively high dose, so even up to half a cc per injection every day for a total of 2 weeks before you back off, you know, see if you can get things to calm down. And that may be something that you revisit later in treatments too, whenever they're flared. You can go back to that high daily dose there for a couple of weeks and it can be really helpful.

Yeah.

And I think with that comment is because things with the immune system are kind of a teeter-totter. So if you raise that Th1, you're lowering that Th2 inflammation. Yeah. And but as if you ask a chef how to bake a cake, you're going to get, you know, ask 5 chefs, you get 6 different answers. I mean, in general, I mean, there's so many ways to do anything. Like, well, we'll usually use BPC, what they said first, kind of calm it down, then, then add the thymosins. But there's no right or wrong, it's, yeah, it's whatever works.

Yeah, so the thymosin alpha-1, the other thing I would say is this has been great in the PANS/PANDAS patients when they're flaring. Um, you know, you're not going to inject for the very first time in the middle of a raging flare, but it is something when they're more calm. I am a huge believer of talking to my patients even if they can't communicate that well. To explain, hey, we're going to do this, this shot with you, and here's why. You know, this is why I want to do this. This is why I think it's going to help you and why don't we don't have a better option. And like, hey, I'm going to teach mom right now how to do the shot. She's going to do it on me. Do you want to?

Oh, it's so tiny too. I say it even though it's big.

It's so tiny and it really doesn't hurt. A lot of kids are actually preferring to have it in their upper arm just to do a little pinch. It's subcutaneous, so you can just do a little pinch there.

Belly, the bottom, actually. Have you tried thymulin? I have not. Yeah, so I would—

and some of your patients use where we would use the thymus enough one, tri-thymulin. It's, uh, much more, uh, immunosuppressant, lowering inflammation. Okay. And, uh, I'll shoot you some studies on it for—

yeah, is it a prescription or is it—

yeah, it's the same thing. It's, uh, injectable. Um, We're working for ways to get it orally, but yeah, but yeah, I would, I would try it out and see what you think.

Yeah. And I just switched compounding pharmacies and the new pharmacy I'm working with has it as a nasal spray that I'm about to try for myself.

So I have your experience. So it's, it's interesting with, you know, people are throwing this stuff sublingually and nasally. Um, some are outliers, um, uh, but we've spent a lot of money like with, with some of the big pharma CRMs, which— and they actually have these programs that will tell you, can this absorb? And a lot of the ones that people are using, you know, sublingually— oh, sublingually it's going to work— it's like 0%, you know. Um, right. And you even look at, you know, like the GLP-1s from big pharma Actually, they got absorption up to 1%. That's the big breakthrough. So a lot of these things are very tough to get to absorb. Yeah. And, uh, but look for clinical outcomes.

I'm gonna try it with myself first and kiddos that are kind of tired of doing injections.

And, and there's some that don't— like the AOD, well, it's pretty long, but it absorbs. Um, we just, uh, tested— did testing on some, uh, tetrapeptides, some 4 amino acids, and got no absorption with just kind of, uh, standard stuff. So people just putting these things sublingual, uh, it's just wasting your money. But yeah, but so data is tough, it's not cheap. We're doing the test, so it's taking a little while and and, uh, it costs a lot, but, uh, uh, some of these things are tough to absorb. But anyways, that's a whole nother time.

Thymosin alpha 1 is good. It helps with, uh, senescence. I'll just put that in.

Yeah, yeah, let's talk about that because I think that's an important topic.

Yeah, I'm gonna go to my notes because it's a tough topic. So I'm trying to simplify it because I've been to many conferences talking about this and it sort of makes your head spin. And my background was in biology.

Like, why do I want to kill the cells? Yeah, I know.

So I'm gonna simplify it in a way that makes— I don't think I'm oversimplifying it too much, but just that makes sense, uh, because I've always wondered like, why is it that someone could get exposed to Lyme disease or a moldy environment and you've treated the infection, you've got them out of that space, but yet they continue to be stuck in this sort of depleted state, right? The stamina is not there, they're still so tired, they're still not sleeping. Struggling to put on weight and some of those things and having so much mitochondrial deficiency going on. It's like there's not enough gas to run the car. And the senescence piece really makes sense for me. I'm going to throw my glasses on so I can see this. Okay. So cell senescence, essentially there is, it's a cell response to DNA damage. So, which is typically oxidative stress. It could be infection. It could be a chemical exposure. It could just be normal aging. So if that, in the right environment, sometimes these cells can go into a senescent state. So basically the cell has lost its ability to divide and it's stuck in this state of arrest. And the problem with that is it has abnormal cell growth. There's a lack of that apoptosis. So the body can't clean it up and kill off that toxic cell.

So just, just define apoptosis. Yeah.

Just like that. Pre-programmed cell death. So it's not able to— so what you have is you have a damaged cell that's stuck. So it's not dividing, it's not proliferating, and that's how our body is protecting us from, like, that we're not making tumors with every little exposure that we have. But what's happening is inside the cell there's some damage, so the DNA repair machinery isn't working right. It starts to excrete some cytokines and some chemokines, basically these chemical messengers that are making more reactive oxygen species, and it's going down this lactate cycle rather than the pyruvate cycle, which is resulting in this depletion of NAD+, which is a big source of energy, especially for the mitochondria. So the mitochondria are getting more damaged. That cell is, is not functioning properly, and it's greedy. It's like, hey, I need more NAD+. I got to take my easiest pathway to do that. And so it continues down this pathway so it gets out of kind of the phase of—

yeah, it's wasting all that energy.

It's wasting all that energy, and then it essentially starts to poison the cells around it. So even in the absence of the infection, once that's been treated, or the absence of the mold exposure or the chemical exposure, you have these toxic cells that are now over time poisoning the rest of them and making the cells around them now more damaged, creating mitochondrial dysfunction. So you're depleting all the NAD, which is a lot— why a lot of our patients need the NAD and why they're so dependent on adenosyl B12 and B12 shots and all this methylation support. But yet you do the methylation support and it completely tanks them. And so it explains to me how these kind of secondary mitochondrial issues are coming up. And that's really the big thing. Once someone's been sick and they're sort of on their road to recovery, They're, they're stuck, right? They want to exercise, but they're too tired to do it, or it makes them feel worse. And so you really have to start at the ground level. And that's where the senescence was kind of the cause of that. And one thing that's nice is like TB4 and TA1 are really good at— the TA1 will kind of remove this camouflage from those cells so the body can start to clean that up. But both of those can help to repair those senescent cells. Other things that can help with that would be fasting. So that's why intermittent fasting is actually such a great thing. If you can have someone fast for 14 to 16 hours of every day, really helps to reduce that senescence, reduces aging, you know, helps you feel better. Exercise is one thing that can reduce that. Not always a possibility for our sick patients, but for the rest of us, you know, exercise is fantastic. One reason why ozone works so well is it actually activates NAD inside those cells. So the NAD that it's needing so much to function is actually getting activated by that, which is why that therapy is working so well.

Yeah, it is. It's like they got to either—

cells got to heal or die. You got to get them out of there. And do you use some of the mitochondrial booster peptides?

Yeah, I've used a little bit. I haven't played with that as much as I want to yet. And I've got to say, probably that I'm ready to play more. It's tough. Um, some of the other doctors in my practice have used that, and other doctors I've worked with have, have used that. I find a lot of times people are depleted, so I use a lot of acetyl-L-carnitine, CoQ10, other antioxidants, NAD.

Um, yeah, all those again, back to basics, you know.

Right. Yeah. And I find that they need that, um, sometimes first or in addition to. A lot of times I'm I'm still dealing with people who are pretty flared, so I'm trying to calm that down first. But yeah, I'm excited to try that. You know, my first peptide conference, probably the wisest words that came out of that were, get to know a few peptides really well before you expand the peptides that you use. Because, you know, peptides are, are a big deal. They're expensive. So that's going to be one thing that you have to justify to yourself and to your patient. Yeah, but they're reparative. So I always think of these as, these are actually healing. So if you do 3 months of a peptide, it's not like you come off it and you haven't had any gains that you're going to continue on. You know, I could do 3 months of curcumin, and nothing against curcumin, but as soon as I go off curcumin or ibuprofen, I'm back to the same inflammatory state I was in before. I just put a little Band-Aid on it. But the peptides are healing and reparative. Yeah, it's like the studies on Epitalion.

You know, basically they did it, you know, one time a year, once or twice a year, and they got great, you know, results in longevity, reduction in cardiovascular disease, mortality, morbidity, um, all these things. So it really affects the genes that perpetuate. Yeah. Um, should we maybe talk about TB4?

Let's talk about TB4. Yeah, you know a lot more about TB4 than I do, but I, I love TB4. I actually love the integrated peptides TB4 Frag Plus, um, has been pretty awesome for a lot of my patients. Um, it seems to be also really good with people who don't tolerate things gut-wise. Um, that one's been really helpful. And also for people where I either don't trust them to do injections on their own at home, like I don't know that they're going to do that in enough of a sterile environment, or it's just too much for them to kind of think of, or it's too scary.

Yeah, for some people it's a big step, or, uh, I don't want to bash doctors, but training a doctor to how to give a shot sometimes can be— but, uh, yeah, I mean, people think it's a much bigger deal to do a shot, you know, they don't realize it's so tiny, but it's so tiny, it's so easy, especially the biggest men usually freak out the most. But yeah, it's, it's, I think, very complementary to BPC, you know, that the, the TB4 and TB4, uh, frag will heal the tight junctions. Um, and it's similar to thymosin alpha 1, but maybe more rejuvenating, uh, factors.

And right, it can help with bone growth, so that's really good, like in CCI patients. Or, um, I have some patients with Ehlers-Danlos. Um, TB4 can be really helpful there.

I've seen a big— I don't know if— I don't know if we should get into, into that, but yeah, that's such an interesting condition. And, and I really think a lot of the people have the genetics of it, but because they all have Lyme, right? You know, right. And then I think the immune dysfunction and infections actually epigenetically activate those genes. That's my sense. Yeah.

So then all those, you know, you have the genes and then they're— how are they phenotypically expressed? And that's all based on environment and exposures, for sure. Yeah.

And, and so it's, it's like they are just, uh, you know, a mess. And they get, you know, cerebral spinal leaks. And, uh, and yeah, I think it all is the, the epigenetics of it. Like, like I was thinking, like, why would those people be so prone to getting Lyme? You know, are they all hikers, you know, or something? You know, but yeah, it's, it's interesting stuff. And, and I think you probably find this, and the more you dig, the more you realize you don't know. And it just— you go down the rabbit hole. All of a sudden, you know, I'm reading studies and it's— the sun's coming up and I'm like, oh my God, I got to be in the office in an hour. So yeah, you probably go through the same.

I saw you emailed me at 3:30 last night. So—

oh, did I? Yeah. Yeah, that was early. Yeah, it's when usually I can catch people because they're getting up and I'm going to bed.

But so yeah, the TB4, you know, works really nicely along with the TA1, or you can use them in tandem, you know. T4, you should— so the way that it's always been taught to me and what I've seen is that you should take a break from that, where the TA1 you can stay on long term, but T4 you should cycle.

Yeah, and I think there's, there's no great studies on that, and I think just out of abundance of caution, uh, you might as well cycle it, you know. Um, and thymosin alpha 1 has more studies. It's, you know, been FDA approved in that. Um, but yeah, most stuff, uh, patients tend to cycle themselves anyways. Like, they'll go off of it, go back on it. But yeah, yeah.

And you'll find if you, you're doing this yourself, like, I noticed with TA1, I loved it, loved it, loved it, and then I was like, meh, I don't— I wasn't— it was funny, after about 3 months, I just, I had to take a break. I did. I don't know why. It wasn't that I was doing anything bad, and it worked a lot better when I went back on it.

So yeah. Or also, like, supplements, you know, I can give you 1,000 supplements that are great, and I take a ton. If you were to scan down, there's like a whole desk is full of supplements. But it's just like, I realized, let me just do my core ones, and it's like 50. And, you know, you just get tired of it, you know. So, uh, it's— it— yeah, it's tough. Which I like peptides because they're— they work in such small amounts.

They work in small amounts. Yeah, yeah. So I've seen the TB4 can be a little more triggering than the TA1. So in a really reactive patient, I go TA1 TB4.

Have you found that with the full-length TB4?

So I found that with the full-length TB4 more so than with the frag.

Yeah, so the full-length TB4, there's a domain, there's multiple domains on TB4. Yeah. And so the frag that, uh, we have out, uh, does not have the domain that stimulates mast cells.

Oh, interesting. So that makes sense. Yeah.

So TB4 Overall, it's going to be good for mast cells because the immune modulation, but there are some people go, oh my God, I just totally flared because as it has—

we had to ease them, ease them into it.

Yeah, that's too much.

That makes sense because I was using the TB4 frag more where, um, one of the other doctors in my practice was using the injectable TB4 and she was having to be really careful with dosing and I was just jumping into twice a day dosing and having some—

yeah, yeah, so it eliminates that and It also— that frag won't grow hair. There's a different frag that grows hair. So, um, although you look at the TB4 frag, lots of studies on it, it has the same, uh, immune modulatory, anti-fibrotic, uh, you know, anti-inflammatory effects as the full length, but eliminates some of those negatives. Yeah.

Okay, so if you want the hair growth help with it, you have to use the full TB4.

No, no, there's separate frag because the problem is the TB4 or your 43 amino acid, it's not going to get in.

Okay, so the TB frag that— yeah, still help with the hair.

We, uh, a separate different frag we will then, uh, well, should be available in 2 months.

Okay, I'm excited.

Yeah, and then, uh, do you like Cerebrolisin? Did you use Cerebrolisin?

I did use Cerebrolisin.

So yeah, so that I, I love. I do it myself. I mean, I had in general, because I had Lyme, I know since I was born, like the worst memory of anyone I have ever met, unless it's a medical study, unless, unless I can make connections, you know. Or if I go to dinner with someone that I don't care too much about and someone asks me about, I'm like, I never went there, it's a little scary. But if it's medical, I can cite all this and that, you know, and have those connections. But The problem is, yeah, you can't get TB, uh, strebolycin injectable anymore, right? But it is bioavailable orally. So, um, the capsule, uh, one capsule equal about 2 cc's. Okay. Um, so that should, should have been out a month ago, but with COVID uh, I think 2 weeks.

Well, I'm excited about that. So a lot of the kiddos were doing really great with this.

Yeah, for the autistic kids. Oh my gosh, it was great. And yeah, we have one autistic kid that I'm just so excited about because the mom gave a video of him playing basketball before he came in, which was him standing there and the basketball just went by him. And he came in, we had to see him before office hours, you know, because it's F-bombs going and we couldn't touch him. I had to be— now he comes in, he's actually sarcastic. Joking, says, can I have a hug? He does his own injections. Um, wow. It's— he— it's— oh, he's playing basketball, he's doing gymnastics.

Uh, just total— I mean, those are the things that are amazing. Yeah. And kids that aren't talking, and then the next visit they come in, they're like, hey, Dr. Amy, and they're reading off everything that they can see. And the parents like, can you get them to be quiet? Yeah, can you get them to be quiet? I'm sorry, we can't turn it off once we've turned it on.

That is so— it is. And I just get— you could not get near him, and he's like, can I have a hug? Wow. You know, it's just like, damn, you know.

That's the thing. And you'll get these little glimpses even in the really reactive kids, or even in your, you know, any of your chronically ill adults. There'll be these little windows where they feel normal and they act normal. I mean, for lack of a better word. And that's always a sign to me that, you know, there's not permanent damage, that we have A real goal that we can work for to get there and stay there.

And I think it's key. And I train doctors to say, OK, really work to get them some improvement. It doesn't have to be permanent. So they have hope because they've been told all these things and nothing ever happens. And people say, well, that was probably placebo. Not with these patients. Everything's a nocebo. It's like they don't expect it to work. Right. And so if you can get them feeling better, even just for a little bit, a glimpse. Okay, we made it there, you know, and usually, okay, you're probably gonna relapse a little bit, but it's never as bad, and the next time it'll be shorter, you're gonna feel better longer, and it's just— they just totally different mindset.

But also prepping that they can flare and how that can be a positive, you know. If you're doing antibiotics or you're starting LDA or LDI and you feel worse I'm sorry you feel worse, but that's awesome because we found some organisms that are triggering all these reactions in you, so we can work with that. Yeah, right. It doesn't mean I'm shit. I mean, yay. Okay, yeah, you're feeling bad.

Oh great, you know. And but I think less and less we're kind of— because we, you know, like, as you— we've learned to mitigate that, you know, feeling horrible. But it's like when I did SOT therapy, I didn't do any of this stuff to mitigate, um a flare because I want to see if it worked.

And then I'm like— and I thought it was pretty cured— and I'm like, damn, I'm getting— this is a Herx. I'm like, awesome, you know. Um, yeah, so, uh, it's, it, it's interesting. And, and, uh, I'd rather see a new treatment flare someone because you know it's doing something, right?

You know it's doing something, right? Yeah, because we have a lot of people with no reaction. Yeah, um, so, uh, I don't—

I just love speaking with you. I keep— I feel like we just keep going on and on.

I did have PPC-157, which is one of my favorites. Okay, so, you know, and Integrative Peptides offers a great capsule option that's a good price point for people.

And but let me mention, it's available many other places. I can't—

it's available many other places. Um, I have it compounded. I love the injections. As well. Um, personal issue is I had a pretty severe Achilles tendonitis, um, so bad so that I was having a hard time walking around the office. I was meant to be doing this Ragnar relay race that was 8 miles, a lot of moms depending on me, you know, and it was Ragnar as in Vikings.

What?

Ragnar as in the Vikings?

Oh, it's just that it's like a relay thing overnight. Yeah. Yeah. And so it was 2 days away. I was having a hard time even walking around and I didn't want to bail on this and took my VPC, injected my own Achilles twice a day for 2 days. Pain was gone. And yes, it flared after my, you know, across the finish line, I was ready to be off that, but pretty amazing just to see firsthand something that like Achilles tendonitis, my shoe couldn't even touch it. And it's a stubborn, you know, with plantar fasciitis, Achilles tendonitis is a bad thing.

Yeah, the other alternative, okay, do steroid injections, put in a splint, you know, right?

And I mean, there's still other things to do with it, but just to see firsthand how, how healing it could be. And like, even after starting injections, I had an old snowboarding injury of a shoulder that I, you know, couldn't lift my arm. I had done all kinds of stuff. After just doing sub-q in my abdomen for a month, I realized I went to pay a, like, a parking meter and I was like, oh my God, my shoulder doesn't even hurt. And I hadn't even— it wasn't even on my radar that it could be working for that. And so it's, you know, it finds its way to wherever the distress signals are.

And that's what we find, and people say, well, I treat it like, wait a minute, now I can do this, or I can, you know, tie my shoes, or whatever it may be.

So great for injury prevention, great for those old injuries. The other thing I'm really loving with the BPC, which, you know, I'm preaching to the choir here, but um, is for the gut repair. You know, that's been probably the biggest wow, because when I first learned about it, you know, that it was all like sports medicine sort of driven, all the lectures on that. So I was really thinking the athletic sort of piece and the sort of feeling better in your body, but— and it was sort of a side note that it could help the gut. And what I was seeing with so many people is after years of us being on this train of like, oh, you know, a couple times a year we're having to do some sort of parasite protocol or whatever, like their gut is healing up, like it really is, which is also translating into them feeling better. So I'm using it a lot now with my autistic kids. I'm using it definitely a lot with a lot of my adults and the people who were sick before and aren't like 100% well but are on their way and trying to get stronger. I find the BPC is excellent for that.

Yeah. Yep. I, I agree. Uh, it's kind of— it's basically a core for us now. Yeah, that and the TB4, TB4 Frag. Uh, and, uh, you know, it is— we do a lot of other things, and, um, it's even like, you know, we love— I love hormones, I love thyroid. Uh, you know, there are so many, so many great things, but it's— you start doing what most people get better with. You know, and is the safest. Yeah, yeah, the core. Well, awesome. You're obviously doing so many great things with some of these sickest patients, and, um, you're, uh, having to run a practice with other doctors, which— my—

good. I'm lucky I have a good team. Yeah, we were— we were talking about work in progress always, you know. Luckily, the person I'm dating is actually a management coach, and so he's helped me through some big office transitions and things, just It is tough.

I don't know, this is kind of off, off topic for the thing, but you know, where doctors want to see patients but you end up managing. And I don't know, I'm a, I'm a bad manager. I'm too nice. I'm, you know, and that's not what I want to do, and it's taking away time from seeing patients. But, um, yeah, it's like you only see so many patients, so you're branching out, you're teaching all these other doctors. And I just love the fact how you guys are collaborating together Um, that's what medicine should be.

Yeah, it's fun. It's awesome. Yeah, so you can interview Christopher Wakely. He's one of the other doctors in my office.

You interview him tomorrow, so have fun with that. Oh, great, great. Yeah, look, looking forward to— he's really nice.

Oh my gosh, he's super nice. And he is like, if you ever need research, he's your guy. Oh, I love that. He is a fantastic clinician, but oh my gosh, he's like always hitting the books and looking at the studies.

Oh, that's awesome. Yeah, that's like me. I end up spending all night to find one little piece of information that I can maybe use, you know. But that's awesome. I mean, you're just doing great work, and thank you for taking time. So glad I met you. I met so many great people doing this summit, you know. Yeah. And which even at conferences, you don't get to sit down and talk to people, you know. So, uh, so thank you. Yeah, yeah, it's a pleasure. Just the— your passion just exudes. So, so thanks so much.

All right, keep up the good work.

You too. Good night. Bye-bye. Thanks for joining us on the Peptides and Longevity Podcast. If you enjoyed today's episode, don't forget to subscribe, share, and leave a review. It helps us reach more listeners passionate about optimizing their health. For more insights, resources, resources and updates, visit our website at www.holtorfmed.com. Together, let's embrace a future of health and vitality. Until next time, stay inspired and keep thriving.