The Power of Peptide Therapy & Functional Medicine: Craig Mullen

As be people become less metabolically efficient, they actually switch over from burning fat to sugar at a lower heart rate. Um, and so, you know, you can really get a good idea using a device like Pinoi metabolic breath analysis, you know, where people need to be exercising. American healthcare is sort of doing things in a way that may be construed as backwards or retroactive retrospective. And this point was really driven home to me once I started working in the inpatient setting. You're really covering the full gamut. Life is a journey. We're not living if we're not learning, if we're not growing. And uh that's what we're here to do. That's our mission. In this episode, Craig Mullen, who is a nurse practitioner from Maryland, who decided that the system that he was working in was broken and he wanted to change how he was treating patients and helping people to achieve peak performance in their health. In this episode, we'll dive into it all. Welcome to the show. Great to have you in. Thank you. Yeah, wonderful to be here. Welcome to the state of California. Um, all the way from lovely Maryland. Yeah. Yeah, that is um that's a trip. I tell you what, it's you know the second time I've been to California. The first time I've ever been to California to do anything other than a little bit of a backpacking excursion. First time I came out I was in Yuseite. Had a great time with that. Um but have not been out here since and that was over a decade ago. Let's take it all the way back. Well, like tell us about your childhood. So I'm going to be 38 at the end of this month. So, taking it way back. Um, childhood was, you know, kind of wild, but who's isn't? Had sort of like an interesting start to my life. Uh, it was a little bit different than your traditional start, uh, in that um, the early portion of my life was really marked by, uh, tragedy. And you know, we've talked about this a little bit before, but um when I was 16 months old on the eve of Thanksgiving, um my house burned down and uh I lost my mother and my brother and my sister in that houseire. Um my dad and I were able to make it out relatively unscathed. Um but you know, our family was fractured and we were never going to be the same as a result. um that uh you know really influenced so much of the rest of my life up up to this day. Uh my dad and I were super close growing up as a result just totally intertwined with each other and um very much codependent, you know, in some aspects and in probably a not so great way, but just had an incredibly strong relationship um with my dad growing up. And uh he unfortunately passed away this past December. Um we were, you know, doing the duo thing, father and son for up until the point that I was 6 years old and in which uh at which point he got remarried. Um so did the stepf family thing for a while. Um you know went through my dad's divorce and all through that time you know was um very much uh driven by sports you know. So I I loved uh baseball growing up. It was my main passion was just always very sort of athletically inclined. Love to love to play baseball. Uh and that really influenced a lot of my development as you know someone who was interested in sports and in mobility uh and you know overall health and just staying you know vital. uh as a kid I remember being really young and sort of like taking into consideration like you know do I have abs or do I not and you know what can I do to enhance my physicality and and things like that. So, um, you know, really had sort of a traditional life in that sense, a traditional childhood and went off to college, uh, initially in, um, North Carolina. Uh, and then I actually left North Carolina, came back to Maryland and and finished, uh, undergrad, which my, uh, initial undergrad was a philosophy degree. I thought maybe I was going to uh do something in law school or um you know, who knows what, right? Maybe maybe become a teacher or professor. Um was really influenced by some of the you know, liberal arts approaches to to various careers. Um graduated with my philosophy degree and then at that point in time decided I really have no idea what I want to do with my life. So, I took uh about a year off, moved out to Arizona and uh lived in Arizona for I'd say 13 14 months and um worked construction. Uh learned a lot and uh did a you know plenty of backpacking out in uh American Southwest. Had a great time with that. and then uh ultimately again migrated back to the east coast and at that point in time wasn't getting any younger and I decided hey you know you you want things in life you want a family you want to make money you want to forge your own way uh what are you going to do Craig to you know establish yourself as a as a young adult and um my father who's an oral surgeon uh you know gave me the idea well maybe you know think about going into healthcare or medicine or something along those lines. And you know, having been around his practice all my life, it did seem like an obvious sort of easy transition. Uh, and so I went back and did what they consider what they call a secondderee accelerated nursing program where you have an undergraduate degree, you can sort of, you know, bypass or uh just skip over a lot of the prerequisites um, you know, to get into a health related career. uh and jumped right into the nursing program. Went through that, worked as a nurse, which uh you know, as you mentioned, definitely sought after uh profession and and you know, it's hard work. It's it's honest labor. It's tough, you know, labor, but uh it's it's hugely necessary and um just as you mentioned, really sort of does set the backbone of, you know, a lot of what we do in healthcare, especially in the inpatient setting. So worked uh in critical care for a handful of years and um messed my back up, you know, pulling patients up in the bed and turning patients. But um you know, really found myself to be very fascinated by the science of it all. And um all throughout that time, I really knew that, you know, nursing or working as an RN wasn't the endgame for me. I understood very well uh at that time that I wanted to have the prescriptive and diagnostic privilege and authority. Um and so you know the next step is either go on get your nurse practitioner become a uh certified registered nurse and esthetist and do you know anesthesia by this time I'm married have uh a new child or my my beautiful baby girl was born in 2016 and uh I really wanted to be a CRNA and so I appealed to my wife you know hey why don't we think about moving uh the closest program to where we are is about 2 hours away in Baltimore. University of Maryland has the closest CRNA school. And she was like, "No, we're not moving. All of our support system is here. We got a new baby. You know, we're going to stay within our community." Um and so what I did have access to locally was a nurse practitioner school. And uh so you know that's sort of how I inevitably found myself uh in that role. Uh graduated from a family nurse practitioner program. Worked in uh urgent care and immediate care primary care setting for a few years and this is right now right about the start of COVID which is an interesting story. We can come back to that later if we want. But uh also knew that I didn't want to stay outpatient at the time. I wanted to work with sick people. I wanted to, you know, make a change and and be influential in that um area and discipline. So went back to school to get what's called uh your acute care nursing uh nurse practitioner degree. So um one of the things that sets uh nurse practitioners apart from other mid levels or you know PAs is that we sort of have to get specialized training in various different um aspects of care versus a PA which is like you get you get it all. Um, so to work inpatient or work in a in an acute care setting such as a hospital, you have to go back to school uh and do additional training, additional certification. So at that point, I went to uh Drexel, got my acute care nurse practitioner degree uh after another two and a half years of school. um did all the dactic and the clinical course work and then um basically started working impatient with the same hospital that I was working outpatient with uh previous to that. All the while knowing that um American healthc care is sort of doing things in a way that may be construed as backwards or retroactive retrospective. And this point was really driven home to me once I started working in the inpatient setting because you see all of these people who have significant burden of chronic disease, comorbid conditions and not just one or two but you know three, four, five conditions that's just like severely lifelimiting um poor quality of life a lot of times in and out of the hospital. And I said to myself, you know, this this isn't the apex of what we can be doing to help people. And um so at that time really dove into research and training for uh more functional and integrative medical approaches to uh wellness. Um namely did a lot of investigation into bio identical hormone replacement therapy. From there I was exposed to you know the nuanced um aspects of nutrition and and dietary changes and um you know lifestyle modification to really enhance mobility and exercise performance and all of that really led me down this path to peptides right so uh you know an area that you're you know very well uh aware of and it's just become rapidly the most fascinating area of my practice. this uh and my goodness, you know, it's like had I not gone down those rabbit holes, I never would have, you know, found my way to peptides. And and I'm trying to get more people to um you know, see how cool these these cell signaling agents can be and uh you know, what good they can bring to people's lives. And uh I think you know in large respects we hear it all the time but you know there a lot of peptides are going to be at the fore of medicine and where it goes in the future and in some respects they already are you know um and and have been um you know namely with things like GLP-1 therapeutics and certain growth hormone secrets that have been instrumental in you know helping um HIV patients and um peptides that were being heavily investigated for autoimmune gastrointestinal issues like celiac disease and that's just here in the states. So like when we look at what's been going on overseas, namely in Europe um during COVID and and so forth, you know, they've been doing a lot that that frankly America is sort of behind the curve um with what we could be doing in that sense. But um yeah, so that's my story. Long- winded answer to a simple question. So I apologize. I agree with you. you know, the the US healthcare system. Obviously, I've talked about it a lot for a long time. Um, when I first started my career, I was like, I don't get it. Like, you know, there's all what's going on here. Like, don't we want to do these things are going to keep people healthy? I think what's really interesting is that now we see this we're in the midst of what I feel is like this massive change in the way that people are viewing their health. You're at the forefront of it. You're doing it every single day. Uh you're seeing patients and you know the GLP1 is an easy place for us to enter this this next piece. Sure. When you see patients what what that are wanting medical weight loss. Mhm. Um how do you approach that? I tell my clients out the gate, I say, "Hey, listen. You know, these things that we do when it comes to BHRT, bio identical hormones, peptide therapies, uh any other small molecules that we may use, neutrauticals, supplements, yada yada." Um, you know, these are the sprinkles on top of the cupcake. It's the icing on top of the cake. It's these three core elements. It's exercise, nutrition, it's sleep. Um, that's 85 90% of the game right there. If you can dial those things in, you're already ahead of the curve, right? Because our population is sick, getting sicker, um, and to really hone in on those three areas of of lifestyle. Uh, and be able to say, "Hey, I'm, you know, excelling in those facets of my life, then, you know, you're already well ahead of the curve." So, I tell patients that out of the gate. you know, these are the three things. These are the core elements. Anything beyond that is just going to synergize or augment what you're already doing when you have those aspects of your life dialed in. And so, patients come to me uh you know, inquiring about GLP-1 therapeutics, something to help them burn fat um and optimize their body composition. of course there's room for all of these uh you know novel peptides and and I love to use them but it really is about setting that strong foundation and a lot of times it's you know uh it's in conjunction with the medication uh both things are happening at the same time we're trying to optimize the lifestyle but we're also seeing how we can help them out along the way with the with the GLP1s so you know GLP1s um have been around for decades now a couple of decades since uh the the first one that was introduced to the market lag glutide back in the mid 2000s as uh Saxenda and Victtosa. Vtosa had the um indication for type 2 diabetes treatment with Saxenda as the weight loss option. Um and you know a lot of people had great success with with those medications. Uh and then you know come the 201s and the advent and release of semaglutide um as a once weekly injectable really sort of changed the game up uh at that point in time and again had the indication for type 2 diabetes but then um you know also the profound um metabolic enhancements uh associated with it and then of course triepide which added the second receptor uh the GIP receptor on board which uh you it changes changes things up a little bit. Um, and it's interesting because one of the things that a lot of people don't know is that these medications were heavily studied uh in the um, you know, Alzheimer's uh, you know, area of research um, looking at how we can be more proactive about preventing the progression of dementia um, and and thwarting that disease. And that's when they started to notice oh okay well this there's you know reductions in uh hemoglobin A1C and improvements in insulin resistance uh throughout the body and improvements in cardiomatabolic health and um you know fatty liver disease and uh you know then you look at other groups of patients patients with type 2 diabetes who also have chronic kidney disease and we see preservation of the uh glomemeular filtration rate um and just you know remarkable multi-system benefits. Um and so basically you know to come back to your question when I start uh you know clients on these medications I say hey look you know we're going to have the metabolic benefit we're going to have uh the you know profound ability to to burn fat to um you know just drive and and hone in on insulin sensitivity and really make sure that we're capitalizing on that. But I'm always trying to reinforce the fact that, you know, it's those those core elements. Um, exercise, you know, you got to move, you gotta make sure that you're incorporating resistance training, um, preserving lean composition in the body. Um, not only because muscle is, you know, the main metabolically active tissue and and sort of like an endocrine tissue in it in its own right. Um but you know without muscle there's there's less you know impetus for our bones to remain strong and so exercise mobility and then uh nutrition you know which comes down to everything from um making sure that we're getting the right um you know hitting our macros. We're we're taking in the protein to make sure that we we have the ability to build and preserve muscle. um but also making sure that we're avoiding the pitfalls, you know, the processed foods, the um additives and and preservatives that we know are contributing to everything from, as you mentioned, um ADHD type symptoms and you know, migraine disorders and changes in the diversity of our microbiome um and changes in the way that our brain and our pancreas, uh you know, work in conjunction with each other to signal the release of insulin. in in response to something that that's sweet but not, you know, real. It's artificial. Um, and so working with the patients on the exercise, the nutrition, and then again, how are we sleeping, you know, cuz sleep is so important. Um, it's the anabolic phase of, you know, our day where we're going through the repair mechanisms and our cells are able to clean and restore. Um, and if we're not able to do that, then we're ultimately going to become less efficient, um, as as organisms, you know, and so, um, you know, it's it's the type of thing that nowadays, you know, people are having a harder and harder time sleeping all the time because of the the world that we're living in. You know, constant distraction, uh, addiction, dopamine addiction from blue light exposure. Uh, and it's just a stressful world now. People want an escape and a lot of times it's too easy to have that escape be your phone at bedtime or TV at bedtime, you know? Yeah. A huge Yeah, it's a big It's been a big problem for me for years and I like, you know, got to a point in time I was really disciplining myself to like I'm going to have it around. I'm just going to listen. Yep. I'm curious what what are some of the things that you're seeing on the sleep side that are like that are kind of lighting it up? Well, you know, I think it's challenging number one. I mean, there are days when I struggle and uh you know, I try to do everything right and um you know, get the kids to bed at a decent time, turn off the TV, turn off the distractions and so forth, and still have a tough time. And uh you know, I'll lay my head down on the pillow and it's like, you know, why can't I get my thoughts to calm down? Why, you know, am I not tired? And um you know again I think it comes down to some of the stressors that we face in our day-to-day life but I have really found some things that uh have been you know pretty integral to helping me achieve better sleep and um starts with in home temperatures 60 to 67° just you know helps the body get into a deeper state of sleep and stay asleep um you know longer without disruption. So always have that dialed in. Another thing is try to cut down on, you know, caffeine after uh 2 pm most days. Um, and limit, you know, fluid intake after maybe 700 p.m. just so that I'm not up all night, you know, using the bathroom. Um, and then speaking of which, can I ask you, I'm sorry to interrupt you, but I'm just curious, what do you feel is the optimum fluid ounce per pound of body weight? Yeah. So, usually I tell my patients, whatever you weigh in pounds, just divide it by two. And that's sort of like the minimum or the amount that you want to target. Now, everybody's a little bit different. If they're expending, you know, tons of energy and they're out in the sun and they're working hard and they're sweating a lot or they've, you know, maybe they're sick and they've got a fever and they have like, you know, insensible losses or something of that nature, you're going to need more, right? um if you're just sitting around all day um and you know there are some people who obviously have considerations for fluid management and you know whether that's uh CHF or more progressed kidney disease, liver disease um then those people really need to be more on a you know fluid restrictive side of the equation. Um but by and large for the most part um what I recommend is take your body weight in pounds divide it by two. That's sort of how many ounces of fluid to drink a day. And that encompasses everything. So, you know, it's not just water. It's if you have a, you know, coffee, tea, soup, oatmeal, you know, the food that we eat, you have to take in to account the moisture content or the the fluid content of that. And um, you know, it's sort of an imperfect science in that sense. And and the body has its own methods for uh you know the renin angotens and eldoststerone uh system has its own methods for assessing fluid balance in the body and making adjustments along the way. Um so that you know if you're behind on fluids well you're going to conserve and you're going to hold on to salt and you're going to hold on to uh you know water and the reverse is true as well. So um but yeah so that that's you know well this is kind of interesting. You know what let's do something. Sure. Let's build a generalized path to peak performance for the average person that's sort of like starting out today. Are you on any kind of like uh diet track where you're like believing in metabolic flexibility or are you a keto guy? Are you a carnivore guy, animalbased like Paul Saladino? What what's your what's your angle? I recommend Mediterranean. I think that's the most wellressearched and it's got the most evidence to support it. I see potential benefits in some of these other uh nutrition approaches that people have. Um I do, you know, I've noticed that people have had sometimes remarkable um results and outcome with things like ketogenic diet. Uh but I do caution people because, you know, you're taking in a lot of fats. sometimes, you know, they're um, you know, not well aware of maybe their, you know, genetic predisposition to um, cholesterol synthesis and cholesterol management and things of that nature. And so you you kind of got to be careful and maybe do a little bit more of a, you know, biomarker investigation in that sense if somebody's going to be doing that. But by and large, Mediterranean diet, I think, is the way to go. So, you know, focusing on the lean protein, whether it's, you know, salmon, poultry, turkey, um, you know, vegetarian uh, sources for protein, lentils, um, utilizing things like chickpeas and and so forth and which are, you know, rich in in amino acids and, uh, namely some of the, um, amino acids that are absolutely critical for lean mass uh, acrual. Chickpeas uh have are are rich in in leucine ve um isolucine veene uh so your BCA your BCAAs and you know which are not the end all be all you need you know the full yeah the full so recommending that dialing that in uh and then I also you know am heavy on sort of baseline laboratory workup you know to see where people are at a lot of people have um impaired nutrient absorption whether that's due due to genetic uh predisposition. You've heard of things like MTHFR and MTRR and things of that nature where uh you know there is an inability to properly absorb B vitamins which are necessary for neurologic function which are necessary for hormone synthesis and and you know metabolism and breakdown of certain substances in the body. So uh as well as abnormal folate metabolism. Now this contributes to disruption in DNA synthesis and repair. Uh which is why it contributes downstream in women who um you know have miscarriage. Uh we see you know significant burden of that in in women who have MTHFR. Um and not only that but then what happens you may be aware is that they uh have abnormal elevations in um a marker called homocyine which is um you know a metabolite of amino acid metabolism uh but it's very pro-inflammatory and it's very pro-inflammatory to the vascular endothelium and so we see in patients who have um homoyine elevation that they're more prone to heart attack and stroke looking at things like that um you know doing a comprehensive analysis of their nutrition um you know B12, magnesium, B6, vitamin D um and inflammatory markers. So in all my patients I I look at their homoyine levels. I'm looking at uh C reactive protein levels to get a gauge on you know whether there is any sort of you know lowgrade or highgrade systemic inflammation. Um it's a very non-specific marker, but you know it does tell you if it's persistently elevated in somebody that you got to look deeper. Um and then uh you know certainly blood counts and liver and kidney function, but also um you know the the real meat of it is when we start to look at people's hormones and um you know sex hormones which uh play a vital role in our well-being. So um in women who are in their mid30s, half of women over the age of 35 tend to uh have a decline in progesterone, they're progesterone deficient, which leads to a functional estrogen dominant state where they start to have, you know, mood lability and disruption of sleep. Anxiety creeps into the fold. Um and they're having breast tenderness or or changes in in the uh texture and consistency of their breast tissue. um and you know maybe some heavier periods, bloating, cramping, premenstrual dysphoria. You know, I see this in so many of the women that I treat. Um and it is, you know, the type of thing that if left unchecked or unregulated really becomes intrusive in their lives and all of a sudden they're, you know, having relationship issues. They're having trouble at work. They're not motivated. kids are tiring them out, you know, and uh they're desperate for a change. Guys, too, guys, you know, they get to that stage and they're just like, "Oh my gosh, I'm so tired. I can't do anything. Can't lift. Can't work out. Start putting on body fat." Gets worse. It becomes like you start spiraling out. Sure. Right. That's it's like, you know, it's like right when you think that everything should be going well, that's when you got to really pick up that weight again and start pumping it and and cranking it as hard as you possibly can. You got it. You got it. That's um you know and that goes back to the metabolic flexibility thing too. It's like you know tricking the body and and tricking the metabolism in a way to enable us to be more efficient at switching over from things like you know glucose uh metabolism as an energy source to how are we you know oxidizing fats and utilizing um fatty acids and ketones for our energy source. And um it's the type of thing that I'm always telling my clients, hey, listen, you know, maybe incorporate a little bit of intermittent fasting a few days a week and then in the morning when you wake up, go for a highintensity interval training exercise. You know, 3 to four days a week, maybe try that. And then in that setting when you're in a fasted state in the morning, your body's looking for some other source of fuel, you know, and so you know that that's the time where it's going to say, "Hey, I'm going to I'm going to figure out this other way that and a more efficient way, you know, uh utilizing fatty acids and ketones as an energy source is actually a more efficient uh less reactive oxygen species generating pathway uh for us to, you know, develop and and utilize energy. Um, so yeah, trying to trying to drive that home home with my clients and yeah, guys, um, are are definitely, you know, having a tough time right now. I mean, I see uh, gentlemen coming into my clinic who are in their 20s. You'd think that they'd be in the peak of their metabolic performance and fitness level and um, you know, gentlemen with total testosterone levels in their mid20s of around 300. And it's like what's happening here? And um what do you think that is? Do you think that's plastic exposure? What what is it? Yeah. The plastic. Yep. Certainly. Yep. Uh it's it's microplastics, it's nanoplastics, it's um you know, vitamin D insufficiency or deficiency. Whoa. Yep. Whether there's you know changes in in cortisol uh and and you know, some aarent adrenal function uh contributing to that as well. And then also the the heavy reliance and overutilization of alcohol uh is is a real problem, you know. So, um, anything that's going to influence the health of the liver, um, in a negative way is going to contribute to more, um, you know, production of estradile, uh, which, you know, can really counter, um, testosterone, namely in the way that increased estradiol levels are going to increase SHBG or sex hormone binding globia. And when you have increased SHBG that binds up testosterone, there's less free testosterone, you know, for for men to have bioavailable um and and utilize and reap the benefits of. Alcohol even in moderation has been associated with increased incidence of uh gastrointestinal cancers um and you know liver disease and other metabolic diseases. Uh, and you know, I I tell patients in my hospitalist role, cuz we see alcohol, you know, that has gone well to beyond the point where it's moderate use. Um, and it's one of the worst ways to leave this world in in my opinion, if not the worst. Yeah. I mean, gosh, you get like go into total toxicity. Yeah. Holy smokes. Yeah. And not only not only, you know, is the risk for cerosis and things like portal hypertension, which can increase the risk for gastrointestinal bleeding and certain cancers, they just end up so bloated and um and seephilopathic with elevated ammonia levels and and such. And it's just it's a terrible terrible way to go. And um so you know I'm not averse to you know a glass of wine or a cocktail here and there maybe a beer but um you know the daily use is just something that I always caution people against and traditionally I tell patients avoid it entirely if you can. So okay so we got the nutrition piece and now we're moving into the exercise side of things. Sure. You just talked about fasted um highintensity interval training. What about just steady state cardio? Yeah. Um, how do you how do you like that as well? I think it's good. I think it's especially good if you're doing uh some component of metabolic breath analysis where you're you know able to identify somebody's zone 2 target. That's the state at which basically uh you know you're maximizing um your efficiency in terms of burning fat as your primary energy source. uh as be people become less metabolically efficient, they actually switch over from burning fat to sugar at a lower heart rate. Um and so you know you can really get a good idea using a device like Pinoi metabolic breath analysis at you know where people need to be exercising uh what steady state heart rate they should be locked in uh to maximize their fat burning potential. Um and then of course again you know tricking the body. So shifting between you know cardio to endurance train and other forms of endurance training to resistance training um mobility exercise even if it's just body weight uh plyometrics isometrics all of those things can be really useful and I think that there's room for all of them. Well, it's interesting, right? That's kind of like a that's a sort of a moderation. Um, you know, I find my training to be heavily dominated by um, you know, time in the gym and lifting cuz that's what I love to do. That's what I I mean, I always that's kind of been my thing for good muscle tone. Well, for you know, for the longest time, right? So, it's like that's kind of what I've been into. But now, as I as I look at it, I go, okay, you know, I have a pelon. I ride the pelon. I like to walk. I live in a place where I can walk and get a lot of reps in and you know, hey, the other day I walked for like two hours, got 11,000 steps in. And it was, you know, variable up and down hills and all over the place. And so you're getting more than the 11,000 steps. Sure. Uh burning a lot of calories. You know, we used to go into the gym, man. Like seriously, it wasn't that long ago and do 2hour Wow. a heavyduty workouts where you're really coming but you know I found that that would just fry my CNS. So central nervous system can be taxed by all like you mentioned cortisol. I mean stress really you know like hey you don't we don't get the right amount of sleep or we're super stressed out from whatever is happening in our environment. Uh that can come in a variety of formats. Eating the wrong food, eating too much food. uh all of these things add up. So when we start getting to this place where it's like it's all getting straight lined out, I like this notion of the training uh where you're doing lots of different things. Yeah. And and you have to also really tailor it to the individual. I mean, you know, some people just don't enjoy going to the gym. like I'm I'm one of those people that uh you know it's like a total chore for me to get myself into the car, drive 15 minutes across town to get to the gym. So like I try to as much as possible um optimize my exercise time and whatnot at home incorporate as as much of of that as I can into my home life, whether that's kettle bells or, you know, some free weights. Um, I even, you know, will go outside and just I've got some stairs leading up to my front door. We'll go outside and just do like box jumps, you know, up to the top of my stairs. Um, and so you really have to meet people where they are when it comes to prescribing or recommending exercise. And then the other thing is that the the whole other element of um exercise is not even what somebody's physically capable of. It's what their motivation and mindset will allow them to do. I mean a huge issue I think one of the major obstacles that people have is um just you know consistency and you know building habits. So people that are really resistant to the notion of exercise or incorporating movement into their life, maybe they just don't know how. Maybe they have, you know, poor ability or difficulty with building routine. And so that's one of the things that I really like to do in my practice. I see it as a puzzle. I see it as a challenge. It's like somebody comes in and they're like, "I hate to exercise, Craig." Or, "I just don't know how or I'm spending all my time helping everybody else in my family. I I leave no time for myself. Well, it's like I see that as an opportune time to intervene and figure out how can I help this person build a little consistency, even if it's just the most minute baby steps to begin with, you know, and and 15 minutes in the morning doing going through some squats or lunges or um you know, what have you. And then ultimately over weeks, over months, building upon that and helping them really build a foundation of consistency, routine, uh that's going to propel them into the future and whatever they want to do from a, you know, physical standpoint. It's so great that you actually like look at it that way. One thing I've keyed into recently, I just would love to get your take on this is minimum effective dose. Yep. So that's absolutely true. you know, whether it's um whether it's GLP1s and uh people, you know, staying at the lowest effective dose and leaving more room for if they need to titrate up their dose later or you know, just staying at a lower dose because they're having less side effects. You know, uh it's a consideration with with all sorts of other therapeutics and um you know, for example, I myself have a degree of chronic pain. I have uh Tourette's syndrome. I've had it ever since I was a kid. I have some motor ticks associated with it. uh namely in the head and and neck, you know, shoulder region. That's so funny. I never noticed. I know. Yeah. It's like when I get locked in, when I focus, it tends to get better. When I'm stressed, it really comes out. But, you know, over the years, um it's contributed to some component of like cervical donia or, you know, abnormal uh you know, muscle tension, hyperenicity in in my cervical region and in my upper thoracic spine. and inevitably a little bit of um you know degenerative disc disease and and osteoarthritis. And um so there's been a couple things that I've really found to be very uh helpful in combating and countering some of the discomfort that I feel from that on a daily basis. Number one, foam rolling uh you know and other mobility and exercise uh training like you know yoga and pilates and things of that nature. uh just availing myself of the opportunity to stretch, you know, and um decompression uh treatments with with foam roll uh are great. Number two, um you know, limiting sugars, limiting processed foods, um you know, that that's absolutely instrumental and and I can't, you know, harp on that enough. Plays back into the inflammation thing. Yeah. Exactly. Exactly. And then uh something that has really been gaining a lot of notoriety um recently over the past couple of years is the uh increasing um utilization of something uh called Nrexone uh at low doses uh which is um you know it's been used at 50 milligram a day doses for people who have issues with opioid use disorder um and alcohol use disorder as well. We're finding more and more and the research is supporting that uh utilization of lowd dose nrexone which is technically in the realm of like 1.5 to around four to five milligrams a day uh has this effect of sort of blunting chronic pain or the awareness and sensation of it and um it's interesting the way in which it which it achieves that benefit. What's the mechanism? How does it all work? the how does the low lowd dose nitrex work? Yeah. So um it blocks mu and delta receptors and uh opioid receptors in the brain um for a period of the few hours and there's a subsequent increase in our indogenous release of endorphins and eneins. You know we think of them as like our feel-good chemicals. Um and not only that but it's uh also been shown to reduce some of the bad players in terms of inflammation in the body. So we think about like interlucan one beta and tumor necrosis factor alpha interlucan 6 we see that these are you know downregulated to an extent. Um, now these are necessary molecules, necessary cytoines in certain situations, but if they're chronically elevated, you know, they're going to co cause issues. And uh, so being able to blunt the release of those molecules can um really do a great deal in in in mitigating and helping to ameliate chronic inflammation uh, in individuals. And that's one of the things that we see with lowd dose nrexone. And it also speaks to its utility in the treatment of certain autoimmune conditions, whether that's multiple sclerosis or Hashimoto's hypothyroidism. Um, you know, I'm I'm seeing pretty substantial results in in patients who have those conditions. uh whether it's just a reduction in symptoms subjectively or you know if we're looking at thyroid antibodies 6 months down the road I'm seeing in some patients up to a 50% reduction in thyroid peroxidase antibbody or thyrolyoglobulin antibbody which um you know fancy words to say these are immune proteins that are generated uh by the body in an inappropriate fashion end up attacking our own you know tissues um which is the nature of autoimmunity and so you know they're reporting subjective improvements and how they feel from day-to-day and then their biomarkers are also showing improvement and uh so I like lowd dose nrexone I you know myself have been on it um now for probably four months and you know feel some benefit associated with it I think it's a really good therapeutic that is not being utilized as much as it should in uh the world of chronic pain. Cool. Nutrition, we covered that. We covered some, you know, flexibility and training and figuring out kind of what works for you. So, then we're into the testing side of things and taking a look at and you can hear you hear lots of people that are like, all man, you know, do the Mark Heyman 500 biomarker test. Sure. Uh, and then you hear the people that are like, oh no, don't do like, well, I can't make any sense of all that stuff. Um, where do you fall in that? I mean, probably mid-range. I think that there are indispensable labs that everybody should have assessed. Um, what are they? CBC, you know, make sure that we're, you know, not anemic, that our, you know, we have adequate hemoglobin and hematocrit and red cells. Make sure that our white cells are within a normal parameter and that we have, you know, an appropriate amount of platelets. Now looking always at red cell ind indices we're talking about like MCV uh MCH MCHC these give an indication uh about a couple of different things whether we have you know some component of chronic inflammation whether we have certain nutritional deficiencies um so you know there's a lot that we can glean from that um looking at metabolic function liver function kidney function these are an electrolyte balance these are indispensable multiple labs that everybody needs thyroid, right? So, um you know, making sure that the organ that's really setting our metabolic rate is appropriately functioning and there's a lot of issues that people are having nowadays with thyroid. Um so, you know, I like to do a little bit of a deeper dive with thyroid. If you go to your PCP, a lot of times you get Yeah. just the bare minimum T TSH and T4, but you know, looking at free T4, free T3, reverse T3, and then thyroid antibodies, that's that's the workup right there. Um, that should should be included. Um, but you know, hey, beyond that, lipids, right? Um, and I I think that we're doing sort of the bare minimum again of uh lipid analysis. So if you, you know, are just looking at a lipid panel as one would order again through insurance or what have you, uh, it's really not giving you the whole picture. Um, and so checking something like a lipo profile, NMR lipo profile, um, you know, gives a much more robust indication of true cardiovascular risk. And that's because, you know, you hear of LDLs as being your bad cholesterol, right? Uh but LDLs come in different sizes and they can be large, fluffy or not. Yeah, they can be fluffy and buoyant um and very you know bouncy in the endothelium the uh lining of the of the vessel. They can be very small and dense and potentially destructive more prone to contributing to aogen aogenesis and plaque buildup in the arteries. So and that's where the real danger exists. Exactly. Yeah. And so we can um you know look at those. We can see the size. We can see the particle number. Do you think statins let me ask you something where do you think statins play a role? I think there's evidence to support the fact that statins will uh through their ability to um inhibit that enzyme HMG uh co-enzyme reductase uh or COA reductase that is the um you know basically the rate limiting enzyme for cholesterol production uh cholesterol synthesis in the body and so through inhibiting them you know you are blunting your body's own synthesis and namely in the liver production of cholesterol. And there's evidence to support that, you know, statins also will help with plaque stabilization in people that have risk for or have had cardiovascular disease or stroke, um, things of that nature. So, uh, I agree that the science is there to support their utilization in some situations. I think we give them out by and large like they're candy and I think that their potential to cause issues in patients or or in people uh is way understated and I think that um you know cholesterol is an absolutely critical um you know compound in our body. It's necessary for brain health. It's necessary for the health of our uh cell membranes. It's necessary for uh steroidogenesis and hormonal synthesis in the body. and uh just you know critical. So by blunting cholesterol too low, you know, we're really doing a disservice to patients, but you know, I I'm in this interesting part of my career where I'm still working in the hospital. And it's like you're not hitting the core measures unless everybody who comes in with an MI, everybody who comes in with a TIA or a CVA, a stroke, you know that it's like they're going on a stat. And not only are they going on a statin, but they're going on highintensity lipur or crestor. Um and there's two sides of the coin. There's there's good uh associated with them. there's a lot of potential down in sides and you know statin induced myopathies and leg pain and weakness is is very real and um you know it's uh it's the type of thing that uh you know there's a lot of other potential therapies out there that can do a great job of of lipid lowering um if if somebody has high risk uh for cardiovascular cerebrovascular disease. Um, and I just think that, you know, this is another area where things like GLP-1s and and hormone optimization are really doing a great deal of good in helping to improve people's lipid profiles. It's interesting. You know, I was talking to a friend and he was like, "Yeah, going to go start back on reatide um because A1C was up." Mhm. Uh, limits are up. This is a optimizer, right? This is your guy that's at another peak level. Peak level. Okay. So, we've got the test. Now, we're into like talking about peptides. So, GLP1's phenomenal. Like, sure, there's some there's also some downsides to those and you got to be careful. Sure. Beyond that, what's a top peptide that you feel no one's really talking about or one that you just really like? Yeah. I think um thyosin beta 4 we've talked about its utilization alongside something like BPC157 for acute injury uh repair um reduction in in uh you know inflammation and pain but you know a lot of the things that you know it it it doesn't garner enough attention for um is its you know ability to help with things like stem cell migration to areas where you know tissues have been damaged in the past uh or acutely And um it's been investigated uh for traumatic brain injury and healing postCBA. Um it was used pretty profoundly in in some experimental therapies in China during the COVID pandemic. Uh so you know there's just a lot of different aspects to thymus and beta 4 and its you know partner uh thymus and alpha 1 as peptides that are really uh potent modulators of inflammatory response um and regulators of the immune system. uh and I I think you know it also has these abilities alongside you know BPC with augmenting EGF or vascular endothelial growth factor to promote angioenesis and the formation of new blood vessels. So, I love thyosin beta 4. Um, you know, it's even got uh skin and soft tissue and hair benefits, you know, where so people can uh have improvements in hair, skin, nail quality with with something like Disin Beta 4. Um, and beyond that, one of the ones that I like to utilize a lot in in my clients, um, and it's simple, uh, and it's not an injection is, uh, CAX, which, um, you know, is a nasal spray that people can utilize on, uh, once or twice daily, um, regimen. And um you know this is a peptide. It's a neuropeptide that has the ability to um increase the amount of BDNF or brain drive neurotrphic factor which is associated with improvements in short-term memory uh and hippocample volume which is where you know it's basically like the seat of short-term memory formulation in the brain. Um and then you know we see as we do with so many of the other peptides that that we love better regulation of the inflammatory molecules that can either create problems or help to resolve a problem in an acute situation. So, so you must like Seal Lake then. Yeah, I do like Selena and I think that you know that has um a lot of utility in people who have anxiety disorders and you know whether it's uh whether that's contributing to sleep disruption or or panic episodes uh what have you. I I think that they can be used you know in combination with each other sill and simax. So I really love those. Um, another one that I've been utilizing with um increasing frequency is is um Tesmorlin. And I mean, I'll tell you what, Tesmlin is like Yeah. Oh, wa. It's talk about a miscell fat destroyer. Sure. That is like um it's roots in you know where it came from. Maybe you can explain more about that. But a grifta is like whoa man that's serious stuff. Absolutely. Yeah. So, igrifta was the FDA approved medication for for tessimoralin um as you know way to counter some of the HIV associated lipodistrophe uh that we see in patients who are on these ant anti-retroviral medications to treat their illness. So, lipodistrophe for those that don't know means that you know you've you put on mass amounts of uh visceral body fat in the adult cavity and Exactly. Yeah. So, yeah. Yeah, Tesla is great. It's um you know, it's phenomenal for helping to reduce visceral fat and and for um you know, people who may not be aware that's the fat tissue that we really have to be very cautious about and and be aware of in the body. It's very pro-inflammatory. It's uh hormonally disruptive. So, so we're talking about nutrition, we're talking about pep testing, talking about use of peptides. Um you like um Cmax Cell Inc. um Thyson beta fourth thyin beta fourth thyin alpha 1 from a immune standpoint BBC 157 um GHRH's and GHPs. Yeah. Yeah. So talk you know what so many people when they hear that they don't know what that means. Can you break that down? Right. So uh growth hormone of which there are you know over a hundred different types in the in the body um you know that are naturally produced uh is you know the type of thing that is associated with um generation of tissues or expansion of tissues whether it's you know uh cellular growth or uh reproduction of cells. Um and so it becomes instrumental as you know a hormone that drives growth. um which is necessary through development and you know as we age we tend to lose growth hormone. Now growth hormone peaks in our 20s it generally declines by about 14% every decade thereafter. Uh and so by the time we're in our later 40s or our 50s 60s you know we're dealing with a lot less growth hormone than we had when we were in our younger years. That being said, the machinery that's implicated or involved in producing growth hormone um does not decline in its you know ability to do so. So uh one of the things that we can do is use growth hormone secrets or peptides that mimic some of the natural substances found in our body that um enable us to release or or promote the release of growth hormone in order to achieve some of those uh more robust levels that we had in our younger years. And so when we talk about a a GHRH, we're talking about a growth hormone releasing hormone um which you know basically primes the machine so to speak and then a growth hormone releasing peptide which allows for the actual release of of growth hormone from the anterior pituitary gland. And um you know what happens growth hormone is it's not just in a steady state of uh being released throughout the day. It's released in pulses. Uh, you know, when we're younger, we get, you know, maybe eight good pulses of growth hormone throughout the day. The strongest of which being uh at night time during sleep uh which again helps with that you know anabolic repair phase um of our day. Um and then you know as again as we age we're losing the number of the frequency with which growth hormone is released and we're also losing some of the amplitude the amount of growth hormone that's released. So by utilizing uh growth hormone secreted glogs whether it's CJC uh 1295 or um surrealin with the hexarellin or uh utilizing tesmarellin and um you know that combination of GHR and GHRP allows for us to restore the frequency with which the growth hormone is is pulsed from the pituitary gland and restore the amplitude the amount uh and volume of growth hormone uh that is released and then you know basically what that does is it it drives IGF-1 which is um you know a molecule synthesized in the liver uh that really incites those those processes of of repair and growth um and you know as a result individuals have um increased muscle protein synthesis so they're able to you know put on more lean composition they have increases in lipolysis and fat burning potential um we see you know changes in the way that their body responds to insulin and that's one of the things that we have to keep an eye on because sometimes those uh can actually go the a little too far and drive some insulin resistance. So um you know we pay attention to that. And then the other benefit of working with growth hormone secrets is that they um do help with uh deeper sleep. You know so people that have some sleepreated issues uh often see that there's some improvement in their substantial improvement in their sleep. Um and for those who have taken it, you know, uh they'll they'll notice, you know, a a very present, you know, flushing sensation, maybe 5 to 10 minutes after, um utilizing something like CJC or Tesaran. Yeah. See that with CJC epimean heavy flushing. Yeah. Um I liken it to like a like a nascin flush but without the uncomfortable itching associated with it. It's like anytime you take beta alanine. Yeah. Yeah. Dude, this is terrible, right? I can't I hate that stuff. I mean, it's great for like endurance workouts, but sure. Um, but just And she'll say, "Yeah, that flushing that you get CJC 1295, not as much as Tesmearellin. Hexarellin is going to give you a pretty heavy duty cortisol response." Sure. Yeah. Probably not a great one to take at night. There are some other things you can use with it though to short yourself down and get get to sleep, right? That's actually one that I haven't prescribed or utilized, you know. Uh yeah. Yeah. So the other ones have become very, you know, challenging to uh utilize and and prescribe to to people. Now that's because of some of the recent FDA changes, um you know, and putting them on bulk substances, category 2 bulk substances list and and whatnot. But there are still uh compoundingies out there that are, you know, going full steam ahead with their peptides production. Um and and you definitely want to go that route. You do not want to go Yeah. researchbased. Yeah. Yeah. There are a lot of people that are on that researchbased tip. There really are. And I I think it's unfortunate. And there's people who are big names in that industry who are um you know they're they're really they they've got companies they're making products but I just you know as a as a clinician number one I would never you know it's 503A compounding pharmacy all the way compliant third party tested. Exactly. Exactly. And not only that, but like, you know, for a consumer, you know, if you're somebody who's got access to the internet and a credit card and you want to go buy peptides online, you know, that's that's on you at the end of the day. If you receive something in the mail and and put it in your body, you know, at least when you're working with a clinician, um, and having recommendations and peptides prescribed to you from known, you know, reputable sources, um, again, you know, 503A compoundingies, there's, you know, a a little bit of protection and and potential recourse if you have a negative response or some sort of iatrogenic in injury, god forbid, from um, you know, taking a taking a peptide. Now, generally peptides are very safe and I I feel like I have to say that, but pretty pretty rare to get some I mean, exactly because they're signaling agents. Yeah. You know, you're not going to go off the wall like if you took a a real drug that's causing a mechanism of action that's like not going to be able to stop it. Right. Exactly. Exactly. And then the other thing, um, you know, I'm just going to throw this back in. Go back to the GHR GHP thing. So, you know, it's kind of like um in this industry in in this, you know, the world of fitness, bodybuilding, um performance optimization, uh there's people who are using actual HGH, you know, human growth hormone, which um when it's utilized, uh unfortunately, um you know, is suppressive to um you know, that axis again and uh you're you're only use utilizing one of the one of the forms of of HGH when there's you know, several So you're not giving the body the opportunity to decide, you know, which is the right growth hormone to release for which indication and then you're shutting it down. So um you know that's one of the things that you can circumvent and bypass when you use growth hormone secrets. So like a patient comes to see you. Mhm. So first thing it's like work upon tests trying to figure out you get to talk with them. What are your goals? Trying to understand where they are, meet the patient where they are. Uh love your philosophy on exercise. Um, and then nutrition. Uh, trying to get somebody, you know, I'm sure you work with people who are vegan and you work with people who are congar and all these types of things, but trying to work in all of that. Um, and then, you know, talking about testing, um, peptides and sleep. You're really covering the full gamut for someone, which is super cool because often times you're just not going to get that in the traditional model that we've been talking about. that is really what we'll call quote unquote sick care. Certainly. So, yeah, I think that um you know, hitting on all those points, I mean, I pride myself on the fact that when when clients come to see me, I I want them to feel refreshed by their encounter. You know, I want them to feel like, wow, somebody sat there and actually asked me about, you know, how am I managing stress? How am I sleeping? You know, what did I eat yesterday? What did, you know, what am I doing to move my body? um and where do I want to go with my health? And um you know that's just not the type of thing that's uh that you see or encounter much in in the traditional sick care model. And so um you know that's where it starts with me. And then you know my philosophy coming back to the peak performance uh aspect my philosophy from the time when I was a kid and on now I'm going to be 38 at the end of this month. Um, you know, it's do the next right thing. That might be paying a bill. It might be, you know, taking out the trash, raking the leaves, um, you know, reading your kid a story to bed. You know, do the next right thing because when you put the the foot down and you're on the right path, the next step becomes so much easier and uh, it builds on it. It builds. Give it an effect of a success. Exactly. Yeah. It starts there. And uh that's hard for some people. I get it. And um you know, I just I want to emphasize to to people that you know, tomorrow is a new day. There's there's always a new opportunity. And that's when you got to lock in and say, "Hey, I'm just going to do the thing that I know that I got to do to get me to the, you know, the next phase, the next level up." Um and and the more that people continue to build upon those habits and you know strive for those small successes, the more inclined they are to you know bigger projects, greater endeavors, you know having more future success down the road. And so um that's my personal philosophy. I think that's what's enabled me to go from working as a as a CNA to getting my nursing degree to going back to grad school, becoming a nurse practitioner, you know, and continuing to learn. You know, life is a journey. We're not living if we're not learning, if we're not growing. And uh that's all I can say. You know, this is what you got to do. That's what we're here to do. That's our mission. Yeah. It's all It's always about, hey, what's next? Like the brain scan stuff we were talking about. I mean, I think that's going to be fascinating. Super cool. Yeah, I'm excited to uh neurostere the uh Yeah, you know, it's it's brain wave uh brain activity, electrical activity u mapping. Um and I'm I would love to incorporate that into my practice. And I think, you know, really again sort of what you're alluding to and and uh what I was alluding to is, you know, you got to avail yourself of opportunities. Don't limit yourself. You know, don't fall victim to negative selft talk and imposttor syndrome and and things where you're ultimately setting yourself up yourself self up to fail because you think that you can't achieve. you know, it's it's about just availing yourself of opportunities, you know, diving in, taking risks, and um calculated risks and and uh you know, you got to go for it, man. You got you got to go for it. And you know what? Like there's a million reasons why not to. Uh but at the end of the day, when you go for it and you know, quiet the noise of what it everybody else is going to think or what they're going to say, who cares? Exactly. You know what? What really matters is if you got a good heart for it, you really care about what you're doing. You're not going to be perfect. Going to make mistakes, going to mess up. Uh obviously not a clinical side, but you know what I mean? It's it's important to uh to stay with it and and really uh and really hit it as hard as you possibly can. So, I'm stoked for you, man. Great. Great to have you here and um yeah, it's just been a pleasure spending time with you. Likewise, my friend. Thank you so much. Thank you. Yeah, this is awesome. Hey, thanks for joining us today. If you like what you heard or saw, please make sure to like, comment, and subscribe, and share with a friend so that they might be able to get access to this content as well. It really means a lot to us. 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