Enhancing The Entrepreneur

Matthew Cook, M.D.

Well, hi everybody. And welcome to the Peptide Summit. My name is Dr. Matt Cook and I’m with my good friend, Suzanne Turner, M.D.. And she’s the founder of VMA Associates. She’s an incredible doctor I’ve known and met her at conferences and have found her to be one of the bright lights in medicine. And so because of that, we made a list of all the great doctors in the world that we wanted as a faculty and she was at the top of the list. So she’s faculty for the International Peptide Academy, and everybody loves her. And so we’re here to sit down and glean some wisdom and experience from her experience as a family medicine doctor that takes care of everything from very complex problems to the topic of our conversation today, enhancing the entrepreneur. So welcome and I’m delighted to have you, and thanks for spending some time with us.

Suzanne Turner, M.D.

Thank you Matt, it’s great to see you.

Matthew Cook, M.D.

Well, tell me about enhancing. Actually, tell me about peptides. Tell me how you got into it, how you’ve learned and just a little background experience, because I think you’re a great resource for people to learn from on this topic.

Suzanne Turner, M.D.

Sure, so it was probably five years ago. I injured myself, my own hip and had trouble getting back to I was a runner, a competitive runner and maybe it’s longer than that now. Anyway, I had trouble getting back to activity, some sort of function and was just looking for anything I could do. I’d gone through all kinds of different treatments and had really little success. So I started looking into options that were available. I happened to attend the annual meeting that A4M does and went to a peptide conference and they were talking about mechano growth factor. So I started using mechano growth factor for the injury and was able to get back to activity, which was really great. That was a big turnaround for me. And so then what is this magical stuff that’s out there and what else is there that we can learn? We’ve all got patients that are sick and we know they’re sick, but all the things that we typically use aren’t working for them. So we’re always looking for what’s the next thing we can bring to our practice to help our patients get better. Especially some of the particularly sick ones that we have that just aren’t responding to the typical things. So, sort of for my own benefit but also for them, I started going through the peptide certification course, and I did that through A4M and then I got called to be on the faculty for them, which was awesome and very exciting and fun and had a great time for several years doing that. I’m still on faculty with A4M teaching in neuropeptide certification that’s coming up. The part two is coming up the end of April.

Matthew Cook, M.D.

Yeah, I’m gonna be there with you.

Suzanne Turner, M.D.

Oh, good. Excellent, that’ll be fun. It’ll be a good one. It looks like there’s some really good talks in that one.

Matthew Cook, M.D.

Okay, good.

Suzanne Turner, M.D.

Yeah, I’m looking forward to it.

Matthew Cook, M.D.

So then, yeah, you would be kind of like me, 50% interested in this for helping people and then 50% interested in this because we like to exercise and train and do stuff. And so then, we’re bound to need a little help as we go through aging and getting older and trying to stay young. So then talk to me, maybe just tell me a little bit, how did you use that peptide to treat your hip and then how do you like to use that? Maybe we’ll just start with that one.

Suzanne Turner, M.D.

Sure, so, the best thing about peptides these are typically things that are recognized by your body that your body already makes. So, the way I use it to treat injuries is we’ll do the MGF right here in the office. And just usually at the acute, especially for an acute injury, we’ll just do it at the site of injury, either into the muscle, into the tendon, at the site of injury. And then we’ll send them home with IGF-1 LR3 to do on a daily basis for seven to 10 days after they injure themselves. Of course, we usually combine that. I probably will stack it with some BPC, TB4. I like that combo, It’s a nice, easy, because it’s in one syringe so you can combine it.

Matthew Cook, M.D.

Yeah, me too. And then what did you experience when you did that quicker healing?

Suzanne Turner, M.D.

Yes. So this was a high hamstring strain and it’s just such a terrible place because what you and I do a lot of times we spend a lot of the time during the day, either sitting or standing, but not moving. And so, that’s a really easy strain to happen. And I was a competitive runner and that’s just what happens. So I did have to give up running. It still bothers me if I run, but I can do all kinds of other sport now with no trouble.

Matthew Cook, M.D.

Okay, that’s a good one. I also would echo that idea of if there’s a problem that you have that you can’t fix, it feels psychologically fairly overwhelming. The interesting thing is, that the peptides you can inject ’em right in the area and they kind of have a local effect and a systemic effect. And so then, I’ve had so many little nagging things that bugged me for years I’m just grabbing an insulin syringe and injecting it in and you’re just injecting that subcutaneously will you go subcutaneously over that area, or will you try to go into the belly of the muscle?

Suzanne Turner, M.D.

Absolutely into the belly of the muscle or the tendon sheath if we can get it there with ultrasound guidance.

Matthew Cook, M.D.

Okay, perfect. Yeah, so then that’s super perfect. And then a lot of those hamstring tears in that area. I’ll do a sciatic nerve hydrodissection, ’cause the sciatic nerve is sort of right underneath those hamstrings.

Suzanne Turner, M.D.

Yes.

Matthew Cook, M.D.

Interesting.

Suzanne Turner, M.D.

You can do the cerebrolysin in that area, just subcutaneously and it makes a big difference.

Matthew Cook, M.D.

You know, that’s an interesting one too, because as nerves go and then they sort of arborize up to the skin. What happens is if you put something subcutaneously, I think it’s almost like a delivery mechanism and they get absorbed in those nerves and sort of track down. And so, even though I would be a relatively big proponent of treating, doing things around nerves or close to nerves, like with ultrasound, I think that as we evolve in the next kind of year or two, we’re gonna have more and more examples. And I even find it myself where we do subcutaneously something and it gets absorbed. And then that has a similar effect to a nerve hydrodissection. Tell me about cerebrolysin since you’ve brought it up.

Suzanne Turner, M.D.

Right, so that’s what I use for local injections, especially for the sciatic nerve, just because it’s so close to the surface of the skin there at the gluteal fold, it makes it really easy. I feel like it’s really getting in there and I get good results with cerebrolysin. We also use it for things like trigger point injections and the cervical thoracic if patients are having a lot of like a whiplash injury or tech neck that get they get that pain in their upper back thoracic spine. That’s a great one to use for that. Of course, we use it in much higher doses in IV for cognitive impairment or for post COVID difficulty with word finding, for thought thinking clearly that sort of thing. We use it a lot there. And also for cognitive decline in general, for age related cognitive decline, we use it there too, but for pain control, it’s great. And you can use really surprisingly big doses without really much side effect and a lot of it you can do subcute.

Matthew Cook, M.D.

Now, so then, you brought up, I think that the thing that is kind of the defining problem that I think may be what we face in our lives, which is this long COVID and it’s interesting. We’ll see a percentage of people with kind of brain fog, difficult, entrepreneurs that are just trying to make, or working people that are overall okay but struggling all the way to catastrophic, can’t get outta bed, looks like complex Lyme and Mold, but worse. How are you thinking about long COVID how do you put that together? And then, what are you finding that’s helpful?

Suzanne Turner, M.D.

So this is a hard one for a lot of our patients they’re coming back post COVID and saying, I kind of flew through it. Three days, it was nothing. But now I feel like I can’t find words. Now I feel like I can’t participate in meetings without stumbling over what I’m thinking without getting stopped. And so I think there’s a lot of things that are contributing to that that are maybe COVID, maybe not, but I do think it’s real. And I’m seeing a lot of patients with that. So what we’re doing to treat that is a lot of them, depending on what we find, we’re doing some research looking to see, like you said, are they coming back looking like a CIRS patient, like a Mold or Lyme patient? And so those patients, we put on a whole protocol and they’re treated in a completely unique way based on that diagnosis with their inflammation control and detoxification and all the processes there. But the ones in general, the ones who are coming just with cognitive impairment, post COVID, and these aren’t people who would fail a cognitive assessment that’s not the kind of person I’m talking about. It’s like you or me, but they’re aware that they’re not able to participate in staff meetings like they used to be able to, or to be able to quickly access information or to retain information. So for example, I have an executive who’s learning how to play the guitar, and he used to be able to remember the chords for a whole song. And now he has to keep looking back, keep looking back, keep looking back at the chords. And so this is one of his outlets for stress, and I don’t want him to lose that because we need him doing the job that he’s supposed to be doing. So for him, we’ve put him on Dihexa which I think is one of the best ones we’ve given him some cerebrolysin by IV. We also put him on ketamine, nasal spray at bedtime, some RG-3, and I’ve got him on probably a low dose of Naltrexone. He’s on a lot of things to try to get this back to because we need to do it. He’s gotta get better. We’re also using acellular growth factors in him. So he’s definitely noticing improvement.

Matthew Cook, M.D.

Tell them what the RG-3 is.

Suzanne Turner, M.D.

It’s the R isomer of ginsen number three, it’s a piece of ginsen that’s been specifically found to be beneficial in decreasing inflammation in the brain. So it’s commercially available through most compounding pharmacies.

Matthew Cook, M.D.

Yeah, I like that one too. So then, it is interesting. So my interpretation of that is basically kind of similar to what we do, which is a full court press with a variety of different modalities. There’s some little ketamine in there which will help with fight or flight and resetting sort of depression, anxiety turns off the NMDA receptor, peptides, supplements, and kind of an overall total approach. This paired with, in Dihexa’s case something that’s gonna increase brain derived neurotropic factor.

Suzanne Turner, M.D.

Right. And we’re using NAD subcu and patients are getting great response with that subcu dosing. I think it really helps. And that gives them a little bit more control because a lot of them just because of COVID in general, because of the social aspect of COVID going being out of work, coming back to work, all the changes that are happening for everyone. I think we’ve really depleted our NAD stores in general, both with the infection itself and then just life around that. So especially the ones who respond well to ketamine, I’m concerned that they are one of the reasons that they’re going down that trip that pathway, the IDO pathway is to get more production of NAD from the Kynurenine and Quinolinic acid. So what they’re telling me by their response is that they probably need some NAD so we’re giving them NAD in small doses. Most of them are two, three weeks and I don’t feel like they need anymore after that. So we’re just replacing their ability to repair, especially DNA repair, post COVID, they’re just losing, they’ve lost all their NAD. So their certs don’t work and their parts don’t work and all that.

Matthew Cook, M.D.

Okay, tell people what the certs and the parbs are.

Suzanne Turner, M.D.

They are chemicals in the body, in every cell that are involved in helping with DNA repair. So we are protecting their longevity genes and improving, instead of killing off the cell, because it’s gotten too much DNA damage. We’re allowing them to stay around and avoid apoptosis because they’re able to repair their DNA. So we’re not recycling all those cells that don’t need to be lost that are recoverable.

Matthew Cook, M.D.

What sort of dosing, when you do subcu NAD in terms of milligrams, are you giving of people?

Suzanne Turner, M.D.

It’s very individual. Most people, I start out at 50 milligrams, like little teeny dose subcu, because I wanna see how they’re gonna respond. I’ve given up to 1,200 subcu. Obviously they can’t do it all at once, ’cause it’s in a 200 per ML vial, but they’ll have to do it several times. You just have to be careful ’cause it can cause insomnia. So, if you take it too close to bed, they’ll have insomnia. And of course sleep post, whatever illness, stress, stressor you have to be aware of making sure that they’re able to sleep.

Matthew Cook, M.D.

It was kind of interesting for me NAD was like this pivotal sort of molecule that came to us also six years ago or something like early with doing those IVs. And we were doing it a lot for addiction, but basically NAD is like currency in the body that facilitates these oxidation reduction reactions that are sort of high energy ones. So then I’m just saying this to bring people up to speed. So then sometimes it’ll do detox like detoxing alcohol and stuff like that. But sometimes it turns on the sirtuin super families and kind of does DNA healing and it also sort of will turn your immune system on. And so then I love talking to people and hearing that they do exactly the same thing that I do just ’cause it’s interesting. We’ve never had a conversation about NAD. Sometimes really sick patients with CIRS or really bad Mold and Lyme. If you give them NAD, I think it drives a detox pathway and if they’re not prepared for that, then you can run into a little bit of trouble. But for people who are healthy, there’s a little bit of a histamine sort of methylation issue that happens that can cause some flushing and nausea. And so then the dose that we like is 25 to 50 milligrams. And then particularly for starting and for people that are sensitive, I find that you do that dose and they have no side effect.

Suzanne Turner, M.D.

Yes.

Matthew Cook, M.D.

Once you get used to it, we’ll go up to like 100 milligrams. But then, I like those lower dosing and I like those lower dosing. And then, there was this question we had over the years, oh, what’s gonna happen if you put all of these people on NAD, are they gonna be stuck on that? And then it was interesting ’cause when we started getting onto peptides, what happens, the combination of NAD and peptides is a super great combination, particularly like the mitochondrial peptides and sort of cognitive enhancing peptides because I find that they work by different mechanisms. And then once you balance that, just like you said, people are not so dependent on it, but sometimes it’ll take a little while and then you’ll come into balance and then it becomes one of many things that we can use to begin to modify basically our biology, but also sort of how we feel.

Suzanne Turner, M.D.

Yes, it’s been a great tool to add to everything else we’re doing. Back in the day when I was a family doctor, if someone was in counseling, we would give them an antidepressant just to get them to the point where they could actually participate in therapy and counseling. And it’s sort of that same way with NAD you’re giving this to them just so they can participate in all the other things we’re doing, so that their immune system is ripened so that their DNA is salvaged so that their stem cells have gotten back to being quiet, just so that everything is now able to function properly. So now the mitochondria can work and now we can decrease our production of reactive action species and everything begins to calm back down again.

Matthew Cook, M.D.

So then, I wasn’t gonna say this, but since you did, now I gotta say it, it’s kinda interesting. The person who is my mentor, Dr. Medier in Louisiana, who’s kinda like the OG person that I think is fundamentally and thank you, Dr. Medier. Who’s probably responsible for 95% of all the people that got interested it in NAD in the world. I mean, he has been profoundly and he knows, I remember we were like the only people doing NAD on the west coast. And then now I talk to like addiction people in LA and then everybody is doing NAD and so it’s shocking how helpful it’s been. But he told me and it was such a bold statement. He told me there’s no psychiatric condition that doesn’t respond well, he’s a psychiatrist to NAD and that seemed so crazy. And then I remember I had a patient that went through a horrible trauma that was in a fugue state. And then they came in and I said, oh, I was like, they need to do a 51,50 and go to the hospital because just kinda like what you said. They can’t even begin to participate in this conversation. And the family told me, oh, just give them NAD. And if it fails, then we’ll take ’em to the hospital. And I go, that’s the craziest thing I’ve ever heard. And, but I did it. And then we did 25 milligrams of NAD, which would be a very low dose.

Suzanne Turner, M.D.

Tiny.

Matthew Cook, M.D.

Somewhere between 25 and 50 milligrams, the person just looked at me and goes, “hello, Dr. Cook, I’m back.”

Suzanne Turner, M.D.

Aw, that’s awesome.

Matthew Cook, M.D.

And then I find that as we start to unwrap the biochemistry, sort of pairing that with peptides is something that helps a lot on the mental, emotional, spiritual. I think it helps a lot on the cognitive performance for kind of healing the entrepreneur. And then I think it also helps with these really sick people. And so then now the combination of small molecules, other molecules, peptides, and now we’re just working on dosing as we kind of play in these different communities.

Suzanne Turner, M.D.

Yes. And I think I can consider the high performing athlete, the high performing cognitively performing entrepreneur and the very sick patient to all be pulling from similar resources and to all be dealing with similar disease cellular disease states. And so, I treat them very similarly. And then of course I have a few very elderly patients, and I think that severe age, 85 plus are really dealing with the same kind of cellular disease state, because we’re challenging their cells at such a high rate. We’re dealing with that high oxidative state we’re dealing with the inability to repair. We’re dealing, all of those things that apply to all those different states.

Matthew Cook, M.D.

100%. 100%. So then take me down a road, let’s say I bought in, and let’s say that I am an executive with brain fog who had COVID and I need some help and I’m struggling in meetings. So then how would you sort of put that together in terms of like how COVID has actually affected us? And then let’s talk about designing a little program around that person.

Suzanne Turner, M.D.

Sure, so if this was my patient, of course, we would get a long history. There’s usually something pre-COVID that was a participant, that maybe was present. I have a patient right now who is an executive, this is the same guitar player. He had a lot of trouble before COVID with some mood disorder that was fairly well controlled, but that had always been present. And then we get to treating, he had COVID, had a pretty significant case of it. Several weeks was ill and got over that, no problem. But then really notice that the cognitive decline occurred post that, of course, we have to take into consideration all the factors that are going on. He’s also got things going on internationally that are contributing to his business. So his stress level is greater. There are things happening personally that are contributing to his stress level. So he is not sleeping as well. So you have to attack from all those different points and making sure that he’s doing all the things, I don’t just start with peptides from the get go, but because this person was all in and ready to do whatever it took to get him back to functioning. That’s where we started. His chief complaint was brain fog and fatigue. So we started with NAD as a base post COVID. We started with NAD and then we gave him because of his brain, I started him with the LDN We just put him on, I think I started him with three milligrams straight.

Matthew Cook, M.D.

And that’s low dose Naltrexone.

Suzanne Turner, M.D.

Yes. And that was for sleep. I gave him a really small dose of progesterone too, five milligrams of oral progesterone at bedtime. And so that combo really was a good way to get him to sleep. Progesterone has some really great brain calming benefits. And, especially for inflammation, and that’s where we started was with that LDN NAD in the morning and progesterone at bedtime.

Matthew Cook, M.D.

And then now, I’m just gonna unpack this a little bit as we go. So then the low dose naltrexone sort of is a kind of an agonist/antagonist sort of, that works on receptors in the brain that kind of can regulate, I would say, would you say autoimmunity to some extent?

Suzanne Turner, M.D.

Yes, so here’s what I explain to patients, there’s a tattle tail in the cell called nuclear factor kappa b. Whenever anything bad is happening, infection, illness, trauma, cellular stress, for whatever reason that goes into the nucleus and tattle tails to the nucleus, that something terrible is happening. Oh my gosh, the sky is falling, henny penny. And then the nucleus begins generating all the things, the signals to tell everybody else around it, that it needs help. So LDN, Low Dose Naltrexone blocks that tattle tail from entering the nucleus and causing that inflammatory cascade to begin. So we don’t get a lot of the things happening to the cell. It doesn’t block it so strongly like things we know for autoimmune the pharmaceutical autoimmune things like Humira, it doesn’t block as severely as that. So it does still allow you to respond to an infection for example, but it’s going to keep that under wrap. So you’re not going to have such an extreme response. It’ll be an appropriate response.

Matthew Cook, M.D.

Okay, now, can I unpack one thing about that that is useful for people to hear, and then this is almost on the Lyme and Mold spectrum as well as long COVID. And I’ve been explaining this to people. I said, if you had COVID like six months ago, are you actively making COVID virus in your body right now?

Suzanne Turner, M.D.

No.

Matthew Cook, M.D.

No. But you had this infection and it was a bad infection and it did all this stuff, but then let’s say there’s a long COVID patient. Are they still having a response to a virus that was there, but that’s not actually living in them anymore.

Suzanne Turner, M.D.

We think so.

Matthew Cook, M.D.

We think so. And so then interestingly, what happens is a lot of times, and I see this in complex illness, that it may be that in lyme, the lyme is potentially not active, but we’re just reacting to peptides from that bacteria that are still there, a little bit like COVID, we’re still reacting to the spike protein. And so then the reaction is actually more detrimental than actually having that peptide of the Borrelia bacteria there. And so then, calming that immune and basically NF kappa b mediated reaction down then really makes people feel better because it calms down basically this exaggerated response, which is what’s causing, I would say maybe potentially a lot of the symptoms.

Suzanne Turner, M.D.

Which is one of the reasons why I like using Dihexa in these patients, especially because it is the angiotensin two receptor that gets triggered in these patients by the spike protein and frankly in a lot of disease states in high blood pressure, in high cholesterol, this is what happens in diabetes that angiotensin two receptor gets triggered. If instead we trigger that angiotensin four receptor, it does all of that anti-inflammatory triggering or cascade signaling. And so it can overcome the angiotensin two signaling. So this is the reason we like Dihexa because of it binding to the angiotensin four receptor as an agonist at that receptor. So it really helps to create that anti-inflammatory cascade, the non-inflammatory cascade. And so things get calmed down your macrophages and monocytes that are in that phase that phase one get shut off, they phase shift back to that calm janitor type macrophage.

Matthew Cook, M.D.

And that’s super important. And then also Dihexa has this cognitive enhancing, which everybody that has long COVID. Tell me about that. What’s your perspective on how that works?

Suzanne Turner, M.D.

So we know that Dihexa can raise BDNF in the brain by 10,000 times. It specifically works on oligodendrocytes the oligodendrocytes are responsible for laying down Myelin sheath in the nerve cells. Myelin sheath is that sort of slick cascade transmission pathway that the signals are transmitted back and forth to different cells or along one cell in order to send a message to the next cell. And if those have any damage to them, which of course they do in the case of cognitive decline, we can reverse that. One of the state things we know that Dihexa is specifically good for is MS. Because that is the disease state in MS is the decline or the lack of Myelin sheath that slick sheath that helps signals transmit more efficiently.

Matthew Cook, M.D.

So then, there’s this term that I felt like, people like us, we’re talking about immune dysregulation, the immune system being kind of stressed and overactive, but it was also really cellular dysregulation because the cells were really inflamed. And then interestingly, if you wanna go down this road, then the cells are inflamed kind of from a genetic level, because basically, there’s an idea that the thing outside the cell, if there’s a lot of stress, it hits the membrane of the cell. And then basically that stress starts to work its way into the nucleus. And then the nucleus goes into an inflamed state so that the cell can respond back out. Like that’s a simplified way of thinking about it. But then that would kind of be a similar pattern to what we see in like CIRS and like the major immune problems, complex Mold, complex Lyme, Lyme of Odh. And then COVID is gonna be sort of will take a percentage of people that may have those problems or other problems can be driven into a state like that. And so now, it kind of makes sense that we’re using basically the natural molecules that exist within the body, or we’re using biochemistry basically to begin to reverse these things and then basically unwind and then basically reset biology, basically on a functional sort of pathway.

Suzanne Turner, M.D.

Exactly, it’s one of the things I love about using peptides because I’m not doing anything that the body doesn’t already know. I’m not giving you any sort of signal that’s not familiar. I’m saying, hey, let’s do this thing that your body’s not doing really great right now, at least until you can get back to doing it on your own. And that’s been my experience. Patients, like you said, if I’m giving you NAD especially post COVID, if I’m giving you NAD for that, I’m gonna see over time, you don’t need it anymore. You start saying, doc, do I need to take this anymore? ‘Cause I don’t really feel any difference anymore and they get better. Yep, we take ’em off of it. They don’t need it anymore. ‘Cause they’re making their own NAD, which is what they’re supposed to be doing.

Matthew Cook, M.D.

That’s exactly right. And then with all of these things, I would say philosophically, we’re probably gonna be similar with a few exceptions of generally doing things and then rotating off and doing and rotating off. And then in the rotation then sort of feeling like, oh, okay, how do I feel? How are things going? And then that kind of relates to your psychology of how you’re feeling but then basically for me, what I feel like as I end up with so much control over it, that it makes me feel calm.

Suzanne Turner, M.D.

Yes.

Matthew Cook, M.D.

It’s like a psychology enhancer.

Suzanne Turner, M.D.

It’s interesting to treat. I have a woman who owns a cosmetics line and it’s interesting to treat these people for a while, with a combination of peptides. If you can afford it, you can have the world of peptides and so treating her with this combination, she’s finally figuring out what her body rhythms are and says, oh, I know it’s time for me to stop my Tesamorelin oh, I know it’s time for me to go back on my Dihexa oh, I feel like I need some, she can tell when her body’s got, because she’s been doing it now for a couple of years with me. So it’s interesting to watch them also develop their own intelligence and intuition about it because their body will tell them when they’re done or when they need the next thing.

Matthew Cook, M.D.

Well, and then that’s why it’s like a good one. This is actually kind of a good one that I was telling somebody. Every doctor that does something will do too much of their own thing. And so then you realize, aesthetic people all do way too much aesthetic injections on themselves. And so you see like, oh my God, the hormone people do too many hormones on themselves. And so it’s just interesting and you see it when you walk around when we walk around at the antiaging meetings, but then the amazing thing about peptides to really understand how to do it as a doctor, you have to live the lifestyle. In doing that, then initially, and I see there’s this period when you’re doing sort of a lot, and then you kind of come into this home, like we’re really in this fairly homeostatic balance of feeling it. And then cycling on and off and sort of trying things. And it’s kind of fairly nuanced and not too aggressive, but I feel it’s incredibly helpful and to do it. In terms of anything that I’ve ever done this is sort of the most enjoyable because I’m actually talking to a lot of people. And like now I do a lot of 10 minute conversations. I just tell people, oh, I’ll talk to you for like, to people that I like, I’ll talk to you for 10 minutes, because then you kind of figure out, and then we talk for five minute. And so then we talk and figure out what to do. And then now they have a great intervention that they do and I talk to ’em again. And so, I don’t know. Now then, you mentioned growth hormone secretagogues Tesamorelin, that one. How have long COVID patients responded to that? And then how do you put that together in terms of the architecture of a peptide plan?

Suzanne Turner, M.D.

I’ve been a little anxious to use it in my long COVID patients. I think, I would rather use something that I can get rid of quickly if I need to, you know, it lasts 18-24 hours, something like that. And so I’d rather have something that worse case scenario, because a lot of these patients with long COVID are multi chemical sensitive. So I hate to give them something that has such a long half-life. So I usually will start with one of the shorter acting ones, Ipa, probably Ipa alone and I like Ipa alone for this.

Matthew Cook, M.D.

Ipamorelin.

Suzanne Turner, M.D.

Yes, because a lot of these patients will have intestinal distress. They’ll have some sort of they just have messed up microbiome and it doesn’t work. Constipation is a big report post illness. And so the Ipamorelin really helps with that because of improving intestinal motility, as well as improving the cells ability to function. We know that one of the things that happens with these cells is they are no longer the affected cells that are affected by even stress. They are no longer able to maintain that hypoxic lumen that’s necessary for the life of the good bugs that are supposed to be there, that we like, like akkermansia and others. And so those bugs really prefer to be in a hypoxic state or environment. And we allow the growth because now the oxygen is not being used by the stressed out intestinal epithelial cells. Now we allow the growth of other bacteria and the dysbiosis to occur because the cells aren’t functioning optimally. So not only does the Ipamorelin improve motility just purely by its straight up action, but also it improves the ability of the cells, the intestinal epithelial cells to go through beta oxidation. So they’re now using that oxygen and stealing it from the bugs in the lumen. So now we begin, it’s almost like this, I think of an engine that’s just starting to go back and now we get it going again and now the engine is working because the intestinal epithelial cells are using all that oxygen from the blood supply. So there’s none to go to the lumen. Now there’s a hypoxic environment. All those obligate aerobes die off and many of the facultative anaerobes die off. And now we have the bugs we want there instead of the original dysbiosis that occurs because of the illness. That’s another place where we use Zonulin because we use Larazotide because the infections, as well as the stress itself, of whatever’s happening will raise that Zonulin. So Zonulin is a chemical that disrupts the barriers between your epithelial cells and so the epithelium, the lining on the inside, pretty much from the nose, the tip of the nose, down to the anus, all of those cells have these gates sort of gates between them. Our daughter lives in new neighborhood and they have their houses right side by side by side, and they each have a little gate in between. So I use that example when I’m talking to patients about this, that Zonulin is produced in response to the infection or inflammation that’s going on, or even dysbiosis itself and stress will cause that, they will raise Zonulin, which then breaks down that gate in between. And you can imagine if your gates are broken down, the things that can get in and out that aren’t supposed to. So we’ll use Larazotide as part of this treatment protocol to try to restore that function. And so many things are affected by dysbiosis, your bile acids, which are very involved in brain function, post illness, post stressor. So I see this as one of the factors that we put in the line of treatment.

Matthew Cook, M.D.

Tell us about Larazotide in terms of how it works.

Suzanne Turner, M.D.

It blocks Zonulin. So we know that the things like in celiac disease, that gluten will raise Zonulin as well, but stress will do it. Cortisol, stress will do it, and infections or illness will do it.

Matthew Cook, M.D.

I’ve been taking the Larazotide also for the last six months. 

Suzanne Turner, M.D.

How much do you take?

Matthew Cook, M.D.

I think it’s 200 milligrams. How much are you taking?

Suzanne Turner, M.D.

Five.

Matthew Cook, M.D.

500?

Suzanne Turner, M.D.

Yes.

Matthew Cook, M.D.

And so then I’m taking it in combination with BPC orally, and I think it’s kind of wonderful. I think it’s definitely a benefit, but then if you think about like what Dr. Turner is just saying many of those long COVID people that we were talking about, the reason that they’re long COVID is that they had some leaky gut and it was going on and they had probably high Zonulin because of that. And so then they had basically inflammation that was in their gut that was leaking out. And then part of that was maybe what they’re eating, but then as you hear, part of that is the microbiome, what bacteria are in their gut. And so then that’s an interesting one that potentially a lot of what’s going on is, is that we ended up allowing bacteria that like oxygen, instead of the ones that don’t like oxygen, ’cause we tend to be more healthy in our gut if we have more of the bacteria that don’t have any oxygen. and I’ve actually bought into this to the extent that I really don’t really recommend people do rectal ozone anymore because I think that that is introducing oxygen and helping to grow the oxygen loving bacteria. And so then that’s just a little interesting data point, but then figuring out how to fix people. It’s in our contract as functional medicine doctors that we have to dedicate 20% of every conversation to the gut.

Suzanne Turner, M.D.

Yes you do. I mean, I remember the naturopath saying that to me years ago and I just poo-pood it and they were right.

Matthew Cook, M.D.

You poo-pood it.

Suzanne Turner, M.D.

Yeah, years ago. Back when I was a regular family doctor, I remember them saying it’s all about the gut and I thought they were crazy and they were not.

Matthew Cook, M.D.

One of my best friends in the world is an amazing doctor Shannon Brian, shout out to Shannon Brian. And she was in town visiting me. This was a long time ago and so she needed CME. And so then she said, Hey, I’m gonna be in town and I have vacation and I had vacation. And so she said, hey, let’s go to a rheumatology board review course because there was just like a board review course and if you’re like us I would go to a board review course of a different specialty every week if I could, because it’s just like, you get the deep download. And this was probably 10 years ago. And so then we spent the week just going through rheumatology cases and I knew that we were onto something because we went there and then every single lecture was a lecture about the microbiome, but these are people with problems in their wrists, but the inflammation in the gut was causing that wrist. And these are just straight up hardcore, like, UCSF professors giving the lectures. And then she kept looking at me and she was like, oh, the microbiome, oh, the microbiome. That becomes what I tell people is the gut is something that we are going to project manage for the next 10 years.

Suzanne Turner, M.D.

Yes.

Matthew Cook, M.D.

It’s interesting. What are your top three things for gut health if I gave you that one?

Suzanne Turner, M.D.

Whew, okay. So the research on butyrate is outstanding, but I haven’t found it to be that impressive in clinical practice taken orally. The only time I’ve found it to be helpful is using it rectally which is hard to convince a lot of people to do, unless they’re very symptomatic.

Matthew Cook, M.D.

How much do you give ’em?

Suzanne Turner, M.D.

500.

Matthew Cook, M.D.

500?

Suzanne Turner, M.D.

Milligrams.

Matthew Cook, M.D.

How many?

Suzanne Turner, M.D.

My compounder hates making it.

Matthew Cook, M.D.

Yes, did you hear that I put out on a thread somewhere about how we use the rectal ozone catheters to do that?

Suzanne Turner, M.D.

Oh, no.

Matthew Cook, M.D.

I have a good way to do that because I think they compound it for us at pure, I think, as a liquid. And so then they have these little catheters that are rectal ozone catheters that are very small and very easy to slip into the rectum and thread up about two or three inches. And then you can take a syringe like a 20 or 30 CC syringe, and then you can draw up, fill that up. And then the nice thing is, is 10, 20, 30 CCs. Then you screw that on to the rectal ozone catheter and there’s millions of places, you can buy those online. And there are some that are very soft and then there’s some that are more firm and the firm ones are kind of nice because if you push with your finger and then it’ll slide in and the soft ones also are nice, ’cause they’re softer, both just see which one you like. And then interestingly, and then it’s very nice because it’s very measured because you can inject 10 CCs. Now, then what you have to do is you have to squeeze your anus. Then when you pull it out and hold it in. And then what I have people do is lie down. But for people with real inflamed sigmoid colon, and real inflamed colons in general, I have found that to be, I like the Probutyrate pills and then I’ve been taking two or three of those also along with the Larazotide for the last six or eight months.

Suzanne Turner, M.D.

Did you ever try Tributyrin?

Matthew Cook, M.D.

No.

Suzanne Turner, M.D.

There’s lots of great research.

Matthew Cook, M.D.

Where do you get that at?

Suzanne Turner, M.D.

Who makes it? I get it on… Who makes it? I think Designs For Health makes it.

Matthew Cook, M.D.

Okay.

Suzanne Turner, M.D.

Tributyrin. There’s a lot of research on it.

Matthew Cook, M.D.

So then, and tell me about that as opposed to regular Butyrate.

Suzanne Turner, M.D.

So it’s an Ester backbone with three Butyrate, fatty acid chains attached to it.

Matthew Cook, M.D.

Okay.

Suzanne Turner, M.D.

As opposed to being sodium butyrate or calcium magnesium Butyrate. It’s actually an Ester backbone with three…

Matthew Cook, M.D.

Orally?

Suzanne Turner, M.D.

Yes.

Matthew Cook, M.D.

Okay, so Butyrate number one, for gut health, number two?

Suzanne Turner, M.D.

I love a really good fiber. So probably MegaPre by microbiome labs. That’s probably my favorite right now. And then my third favorite is one of the many IgG products that are out there. So Intergam is the branded product, the pharmaceutical grade product. I forget we’re not doing CME so I can say names of things. The microbiome labs makes MegaPre IgG 2,000 mega IgG 2,000. New Medica makes immuno PRP, something like that.

Matthew Cook, M.D.

These are basically all the same things that are made by the same people that it’s like an antibody, that are bovine antibodies.

Suzanne Turner, M.D.

Serum, bovine serum.

Matthew Cook, M.D.

Exactly. SBI protect is the other one. And so then, imagine if you made an antibody to COVID, these are antibodies and they bind onto gram negative rods and inflammation and toxicity in the gut. And they really down regulate the amount of inflammation that those cells are seeing.

Suzanne Turner, M.D.

Just allows ’em to recover.

Matthew Cook, M.D.

And so then what I do is, this is a hot tip. Somebody gave me a coffee cup, but then we put Larry Hamilton’s coconut creamer and then we put a couple scoops of the immunoglobin powder in

Suzanne Turner, M.D.

Oh.

Matthew Cook, M.D.

And then we’ll put a little bit of brain octane oil in also. And so we blend that up and it kind of tastes like a smoothie. It’s like an amazing coffee, but then every day I take the immunoglobins and I found that to be super amazing.

Suzanne Turner, M.D.

Yeah, that’s great.

Matthew Cook, M.D.

And then I do it and then I would not do it if I didn’t do it, but this is part of my thing. And then I do it every day. So it’s kind of amazing.

Suzanne Turner, M.D.

Right, I’m a fan of that. I would say Larazotide’s my next one, but it’s a unique patient. It’s not gonna be an everyday patient that’s gonna need that.

Matthew Cook, M.D.

Do you find BPC 157 either systemically or orally is very helpful for gut health?

Suzanne Turner, M.D.

Yes. I primarily use it for trauma, for injury. I just haven’t had as much need. I use it in my CIRS patients for inflammation in general. It’s one of the few they can actually tolerate so often we’ll do BPC.

Matthew Cook, M.D.

So then, it’s kind of interesting because basically I would somewhat agree with you. It’s kind of like everybody would love to talk about BPC for orally and I would like it, and I’m currently, taking a product that has BPC and the Larazotide but then I’ll cycle on and off of those things. And also systemically, I think it will have some benefits. And then interestingly, I did a BPC through an insulin pump. And when I did that, I was like, and it’s kind of interesting because these peptides sort of have a short half life, I did it for like a weekend. And I was like, my gut has never felt this good in my entire life. It just felt like great. So it’s interesting that it definitely has an effect, but I do think that in terms of fixing dysbiosis and leaky gut and inflammation, those other things are potentially more important and that illustrates the importance of a diversity of strategies. It’s never just peptides. It’s kind of interesting.

Suzanne Turner, M.D.

Right and they’ve gotta meditate. They’ve gotta do all the things, they’ve gotta sleep at night. So whatever the things are that are gonna be helpful, these are helpful in the interim, if they’re not able to, for whatever reason, they’re not able to, they got young kids and they have an elderly mom and they gotta take care of both of ’em. So they can’t get out of their stressful situation. This is a good bandaid, but it’s not gonna fix the problem if the stressor persists, if the stressor is still there. So like you or me with jobs that we have running companies and running around the country teaching and all the things that we’re doing, those things are gonna go on. So those are sort of ongoing treatments. What do you use as a marker for when you’re going to stop or rotate off your BPC?

Matthew Cook, M.D.

For me, that would be a good one. That would just be like a feel of how I feel. And then basically, if my gut feels so perfect that I haven’t taken that product in like a week, ’cause it just feels perfect. And then I was sitting there going God, I can’t even believe how good it is. And so then I will stop doing anything. And then what I’m doing is then I’ll have that little conversation on that topic. God, it still feels perfect, still feels perfect. And so then, then if that problem sort of goes away, then it’s almost like I’ll cycle off of it a little bit. And then, if you said we have a joke around home with Barb of like, we’re looking for BPC miracle because if she cuts herself or burns herself in the kitchen or something like that. It’s so helpful for burns and cuts.

Suzanne Turner, M.D.

Oh my gosh.

Matthew Cook, M.D.

And little muscle injuries. And so then I’ve sort of mostly evolved into like what you said, my little emergency pain thing that I have that I’m cycling on and off of.

Suzanne Turner, M.D.

Yes, it’s in my regimen. So I do power lifting as a sport. And so I use it after, I use it post-workout, definitely.

Matthew Cook, M.D.

How much?

Suzanne Turner, M.D.

Ooh, probably 20 units of… how much is it, a 2,000 micro ML.

Matthew Cook, M.D.

Okay. So then 50 units of that dose would be 1,000 milligrams. And so then half of that would be 500. So like 400 micrograms.

Suzanne Turner, M.D.

Yep.

Matthew Cook, M.D.

And so then that would be a good one. I’ll always use 400 to like 1,000 micrograms, but then we’ll use high dose often for major problems.

Suzanne Turner, M.D.

Yeah.

Matthew Cook, M.D.

And so whether in…

Suzanne Turner, M.D.

In concussion.

Matthew Cook, M.D.

Concussion or major if I’m doing nerve hydrodissection in an area that’s super inflamed. So then this is a great little idea in thinking about dosing. If I’m dosing for subcutaneous dosing, for a systemic effect, I’m looking for a nice little bump and then raise an effect and having some systemic/local effect, but I’m thinking of low dose, but then if there’s an area that’s really inflamed and you go into that area, what I find is you can go to very high dosing. And then if there’s a nerve that’s really profoundly inflamed, then I do a nerve hydrodissection, I’ll use high dosing. And then framing that and then thinking about that and kind of building our clinical experience of what people can take in what area it has been kind of probably the thing that I’m most interested in.

Suzanne Turner, M.D.

How about interarticular? Have you done anything with that yet?

Matthew Cook, M.D.

Yeah. And so then, I would be a fan of that. And then that one is another one where blood supply is also not potentially that great. And so then you can go to quite high dose intraarticular and so then I would be a big fan of intraarticular. Yeah, or more like two milli two to five to potentially even more milligrams. And then, I think that it tends to the classic idea for joints it has been to do was traditionally Thymosin Beta-4 and BPC together. And then, I initially was hearing about it, and then doing a lot of thymosin Beta-4 in a two to one ratio. And then, the other thing that you can do with the fragments of Thymosin Beta-4 that I think are, potentially first of all, they’re much more potent because they’re just a smaller act of fragments. And then I find they work way better than Thymosin Beta-4 and that is partially because of dosage, but partially because they’re small. And so there’s also an immunologic reaction to them. And then I’ll combine those with BPC. And I would be a huge fan, A B, I think that with joints, we’re gonna have a conversation. It’s kinda like the gut. So then, if you look at five years from now, what I think a lot of people are gonna be doing is cycling through hyaluronic acid, cycling through other combinations, cycling through peptides, cycling through PRP or PRP plus other things. And so then now, or growth factors or placellamatrix. And so then with that in mind, then you begin to realize, oh, that’s a fairly robust approach to taking care of joints. And realistically, I think that that’s the most important thing that you can do for anti-aging because if your joints are good and you can achieve that power lifting biomechanics. You have to have good biomechanics to be a power lifter. If you don’t, then you can’t do it. That also sounded so badass. When you said I do power lifting as a sport. I also do power lifting also for comedy.

Suzanne Turner, M.D.

I have a really good trainer.

Matthew Cook, M.D.

I do power lifting for your comic amusement, but I would like to take a lesson from you so that I can say I do power lifting as a sport.

Suzanne Turner, M.D.

It’s a lot of fun. We haven’t started using it, but that article came out about using, did you see it about using liraglutide interarticularly?

Matthew Cook, M.D.

Oh yeah. Explain what liraglutide does.

Suzanne Turner, M.D.

So it’s a GLP-1 agonist. GLP-1 is a protein that’s found, a peptide that’s normally found in your body that helps your cells to choose to burn fat as a substrate instead of burning sugar. It has lots and lots of other benefits in addition to that. So that’s a very simple, simple way to think about it. But you could imagine if your chondrocytes were better able to function much like your intestinal epithelial cells, we talked about a minute ago, that theoretically it would be a really helpful thing if your chondrocytes were able to work by beta oxidation, burning fat instead of burning sugar. So they were working more efficiently and producing fewer reactive oxygen species or inflammatory chemicals inside the joint.

Matthew Cook, M.D.

Yeah, I wouldn’t have predicted that one. Although, the GLP sort of category is an amazing category, ’cause it’s pretty helpful for weight loss, pretty helpful for controlling blood sugar. I was talking to John Francois and he says, you know, basically all you need to do, he’s good at kind of summing things down. And he says, all you need to do is control inflammation and blood sugar.

Suzanne Turner, M.D.

He’s right.

Matthew Cook, M.D.

Are you using those and then what’s been your experience on that in terms of your practice?

Suzanne Turner, M.D.

Yes, we use it a lot. The weight loss stories are amazing. 100 pounds, 200 pounds, really. Especially when patients are also doing it, it’s just like Dihexa, it’s just like the others. If you are also doing the things that you need to do to take care of yourself, then they’re super effective. So exercise and diet alone, you might lose whatever you’re gonna lose, but you add to exercise and diet that GLP-1. And now the weight loss is amazing. And you’re able to maintain that weight loss. We’re using it in patients with ApoE-4 gene mutations, which is a predisposition to dementia. This category of peptide was originally studied in patients with Parkinson’s and other neurodegeneration like dementia, Alzheimer’s disease. And so I’m using it in those patients at a super low dose. I have ’em just use 25 micrograms, little teeny dose, milligrams sorry, little teeny dose. No, it is micrograms.

Matthew Cook, M.D.

Of liraglutide?

Suzanne Turner, M.D.

Yes. Sorry, I’m getting it mixed up. I use semiglutide so much now I forget the dosing for liraglutide, so let me say.

Matthew Cook, M.D.

So you’re primarily using semiglutide?

Suzanne Turner, M.D.

Almost exclusively. It’s just so easy at once a week.

Matthew Cook, M.D.

Okay.

Suzanne Turner, M.D.

And the research is impressive that it’s more effective than the Liraglutide is.

Matthew Cook, M.D.

Yeah. How much nausea and other stuff do you see with that?

Suzanne Turner, M.D.

Almost 100% if you get too high of a dose.

Matthew Cook, M.D.

Right. And so then that’s a thing to manage, but I would agree. And then that is if you can, and maybe we buried the lead, you know what I mean? This is the weight loss, because if you fix that, then that would potentially drive a lot of longevity.

Suzanne Turner, M.D.

So many things, so many things, it lowers cholesterol. I mean, there’s research to back that up, but I have patients who’ve dropped their cholesterol amazingly. Now again, you have to be careful. You don’t wanna go too low on a patient’s cholesterol. And especially the ones who are taking the Liraglutide plus testosterone, you might see their cholesterol drop really low. And then you run into problems with depleting plasmalogens and that’s another story for another day, but I titrate that dose to effect. And I have ’em started from the the very beginning. Tell me what your goal weight is. If your goal weight is whatever, 150, then we’re gonna get you to 150 and then we’re gonna drop your dose back down. So you don’t have to feel nauseated for it to be effective for weight loss. A lot of people will lose weight even without the nausea, it should cause loss even without the nausea. One of the side effects that I think is less common, but is something for people to know about is the possibility of insomnia so just be aware of that in your patients. It does bind to the cart receptor, it’s cocaine, amphetamine, something. I can’t remember all of it, but there’s a receptor in the brain for that. Anyway, it binds to that same receptor and can cause you to have insomnia just wakefulness, can’t sleep at night because of the Liraglutide or semiglutide. So be aware of that. It’s less common with the semiglutide than with the Liraglutide. And it typically wears off after two or three weeks of therapy. So just be aware, that’s the case, and you may need to augment their other care in the beginning if sleep is a real problem, it’s not always my first go-to.

Matthew Cook, M.D.

Okay, that’s a good one. And then also, the nausea sort of wears off once you kind of get used to it too.

Suzanne Turner, M.D.

You got it, yep.

Matthew Cook, M.D.

And a lot of people will eat less too. A lot of people tell me.

Suzanne Turner, M.D.

Yes, and the nice thing about it being compounded is you can go at really low doses.

Matthew Cook, M.D.

100%. And then that would be like a theme that we could talk about forever. And then also, I actually would echo that the low dosing and then kind of finding your way up is such a better way to practice this type of stuff I think.

Suzanne Turner, M.D.

I agree.

Matthew Cook, M.D.

Than a one size fits all.

Suzanne Turner, M.D.

It’s fun too. You also have to realize that being sick for a patient, especially someone who’s a high achiever, being sick is a loss of control. And so if you give them control over the thing, for example, I get control over what the doses that I take, how much I feel, where I’m going. Then it’s one less thing I feel like is out of control. And now I’ve restored the control over my body. So my cortisol goes down.

Matthew Cook, M.D.

That’s how I feel too. So then speaking of that, then the one other thing, and then this is gonna be one thing that actually helps with sleep where let’s maybe just chat a little bit about kind of the growth hormone secretagogues. We talked a little bit about that, but, I don’t know if you found that, the CJC and Ipamorelin, if people take that at night, sometimes can be fairly helpful for sleep.

Suzanne Turner, M.D.

Super helpful.

Matthew Cook, M.D.

And then that also, for people who are on the healthy side, and so then there’s gonna be handful of different ones. So then, sometimes people can just take the Ipamorelin. Sometimes people can take CJC and Ipamorelin. We talked about Tesamorelin. How do you put that together over the arc of a year? Do you have people cycle on and off or will you have people generally stay on it all year? And then there would be some people power lifters like myself who will do it, who might do it more than once a day or would be more, just once a day, maybe that might be enough for them.

Suzanne Turner, M.D.

Right, so I’m using the CJC Ipamorelin. It depends on what goals you’re trying to achieve. So is it, am I trying to increase your fat burning, then I’m probably gonna do it fasting and I’m gonna do it well, obviously I’m gonna do it fasting. I’m thinking of Tesamorelin then I’m gonna do it up to four times a day if I can find a fasting window four times a day, then I’m gonna have them take it that often. And they’ll get that because they’re increasing their fat burning. Now you’re probably gonna see that they get increase in muscle growth. So it’s just the body composition shift. You might not see pounds on the scale change. So this is where we always use a bio impinging analysis to measure where they are or you could do the Dexa machine to get where they are, or you can use, dunk tank of course, a water dunk tank. You could do that, which is a gold standard for that. But the goal is to realize you’re probably not gonna change your pounds a lot, but what we should see is that increase in definition, increase in muscle mass, decrease in fat mass. I think my patients feel better on tesamorelin and I know that because most of them refuse to come off of it but I tell them ahead of time, look, I’m gonna put you on it for three months. You gotta come off of it, give it a month. We’ll put you on CJC in the interim, CJC and Ipa, in the interim, and then we’ll go back to it for a couple of months. They fight every time, but I think it’s a good practice to hold. And then I usually will follow their IGF-1 just to be sure it’s not going too high. And most of ’em, it doesn’t, even on Tesamorelin which is supposed to raise IGF-1 higher, it doesn’t, I don’t usually see that. I usually see ’em staying right under 200 right where they should be.

Matthew Cook, M.D.

Right, it’s so interesting in the past I remember, and you could tell all of those people I had, I remember getting those patients that were on too much growth hormone. And you could tell exactly what they looked like. They all had that same look of like pro athletes. Back in the day when that was invoked. But I think, this as a concept is so much better and I find levels are more balanced. People feel better. And then if you’re only gonna do it once a day and you can’t sleep, then we have, ’em take it at night. You know, fasting, if you’re sleeping great, you may take it in the morning. I also feel like the tesamorelin is really a miraculously wonderful sort of feel good. And so then now.

Suzanne Turner, M.D.

You have to careful about dosing though, ’cause they’ll end up with some of those growth hormone symptoms, the swelling in their hands.

Matthew Cook, M.D.

Oh, have you seen them?

Suzanne Turner, M.D.

Yeah, and the nice thing is, you just titrate it. That’s the best part about it is I’ll tell people, just like we talked about with everything else, if you’re finding that you’re having that symptom. So I let ’em know what their side effect might be and then you just titrate it down if that’s what you’re experiencing, you’re getting the benefit. You don’t have to push yourself to the swelling to get the benefit.

Matthew Cook, M.D.

That’s right, yeah. And then that one is usually a six days on, one day off. And then often that comes compounded with Ipamorelin.

Suzanne Turner, M.D.

Yes.

Matthew Cook, M.D.

So then, you get that benefit.

Suzanne Turner, M.D.

I usually have them do it separately and I’ll do the Ipa twice a day and the Tesa once a day.

Matthew Cook, M.D.

Okay. Do you ever have ’em do Tesa once a day and CJC Ipa at night?

Suzanne Turner, M.D.

No, I haven’t found anybody that needs that. and the Ipa is so inexpensive.

Matthew Cook, M.D.

That’s true. So then that’s a good one. So then we usually will do the CJC Ipa, but then I just have an algorithm of doing that. And so then you see the diversity of this and then that’s my favorite part about these podcasts is then I get to talk to people like you. And then in the diversity of how we’re doing this ourselves and how it plays out in our patient’s lives is miraculously interesting. And then it’s so much fun. We talked about many things. From an antiaging perspective, the one thing we were gonna mention was the GHK, the copper peptide. How do you think about that? I mean, a lot of people use it aesthetically, but from an overall wellness perspective, what are your ideas about that one?

Suzanne Turner, M.D.

So, Dr. Picard back in the seventies was the one who figured out if you add GHK, which is naturally produced by your body, if you add extra GHK to a cell, it produces a more youthful cadre of proteins than it would otherwise produce. Your DNA is there and it’s available for production. There are more youthful proteins that it can produce or more aged proteins it can produce the more youthful ones get wrapped up on the histones as we age and aren’t as accessible or used as often. And aging proteins are more accessible as we age. And so it appears as though the GHK actually increases production or the transcription of those more youthful proteins. So we do that just for antiaging purposes on a twice a year basis. We do the same thing for epitalon and cerebrolysin on a cycle, a couple of months, maybe a month long, twice a year. And so these are our anti-aging protocol therapies. The science with the epitalon is really very interesting, especially if you have Google translate.

Matthew Cook, M.D.

Right, exactly. You gotta read the Russian literature. What sort of dosing will you do on a yearly cycle with GHK?

Suzanne Turner, M.D.

One milligram daily for about 40 days. I like the idea of a 40 day.

Matthew Cook, M.D.

Okay, yeah. So then interestingly, I think of GHK as, and I had this whole conversation with John Francois about this the other day about GHK is kind of like a bio regulator.

Suzanne Turner, M.D.

Yes.

Matthew Cook, M.D.

And these small three amino acid peptides then would be bio regulators so KPV is not a known bio-regulator, but would be kind of bio-regulator of MSH. And so then, this one, I’ve never talked to you about this, but this would be an interesting thing to kind of think about which is, the research was really fantastic with epitalon in this high dose range. And so then we’ve been doing some, based on that, kind of micro dosing.

Suzanne Turner, M.D.

Yes.

Matthew Cook, M.D.

Micro dosing bio-regulators in general, micro dosing epitalon and then in parallel to that, GHK and then thematically, those are basically affecting what genes you print. So the transcriptome and so then as a result of that, we find that whole category fairly helpful for neurological conditions and CIRS and immune problems, but then we’re all somewhere on that spectrum.

Suzanne Turner, M.D.

Yes.

Matthew Cook, M.D.

And, and so then thinking about the diversity of doing and then also all of these sick people, they react to everything, but they don’t react to these small peptides. And so then I think directionally in the next five years, I think that’s the future. And then figuring out, oh, okay. If you think of high dose epitalon being like 10 milligrams a day for 10 days, twice a year and low dose being like a milligram a day for a month. And so then doing that milligram a day for a month, or the 10 milligrams, and then doing that for two or three months or every other month, and then combining that then with other small as kind of a design element. And then, for me as a design element, to me, that’s like actually my foundation and then thinking, and then the next thing would be like the growth hormone. How are we gonna manage that and think about that. And then basically all of these other things are basically symptom managing kind of biochemical, directionally influencing, kind of.

Suzanne Turner, M.D.

Yes. Right. So your baseline is the epitalon and the GHK and the growth hormone secretagogues and then everything else you add on based on what’s happening with the patient, what they specifically need. Agreed.

Matthew Cook, M.D.

Yeah but then I would include some of the other bio-regulators too. Like for example, immune people will respond well to like Thialon and, panealon, very much so.

Suzanne Turner, M.D.

Taxorest, have you used taxorest in your COVID patients?

Matthew Cook, M.D.

I have not. I have not.

Suzanne Turner, M.D.

That’s a great one It’s amazing, it’s the pulmonary bio-regulator.

Matthew Cook, M.D.

So I just haven’t had it. And so we’re gonna talk about that. How do you dose with that?

Suzanne Turner, M.D.

It’s the oral one, so it’s just two caps daily. In the COVID folks, I’m doing twice a day, two caps twice a day while they’re sick.

Matthew Cook, M.D.

Oh, for acute COVID?

Suzanne Turner, M.D.

Yep.

Matthew Cook, M.D.

Okay, so then that’s gonna be a hot tip and so then that would be an amazing idea. That would be a very, very, very good idea.

Suzanne Turner, M.D.

Yeah, and what is it? Is it vasaluten that’s the…?

Matthew Cook, M.D.

Vasogen.

Suzanne Turner, M.D.

Vasogen, yeah.

Matthew Cook, M.D.

And so then I would have everybody on that. I just haven’t had access to the Taxorest. So then we’ll sort that out. It’s kind of interesting. I try never to talk about COVID, acute COVID, but then this category would probably be a very useful category of stuff to eventually kind of dive into, because we’re basically just thinking about how to use things to support your biology. And there’s certainly a lot of biology happening with COVID.

Suzanne Turner, M.D.

Well, and as we come out with the more recent water damage building data around actinomyces really probably being it’s actual problem and not the mold itself, these patients that are coming back with pulmonary Actinomyces, that’s where I’m finding lots of great use for Taxorest. But these are patients that are gonna be using it daily for a while. Of course, they’re using it in combination with other things. It’s not the only thing we’re doing, but this is one of the things that’s been really helpful for that water damage building CIRS patient who has the pulmonary effects and they’re getting much more comfortable and better able to function with those bio-regulators. It’s impressive.

Matthew Cook, M.D.

And so then just for people to hear. It’s interesting, I heard this and then it’s just like, all of these memories sparked up in my mind if you walk into a building where there was a flood, and then you get that almost sort of musty smell that is a smell of Actinomyces. And then often in a water damaged building there’s mold and Actinomyces, and then also probably gram negative rods. But that Actinomyces and the mold, it’s a combination, but potentially more so the Actinomyces is actually, and it can colonize our skin and you can’t see it. You can see the water damage in sheet rock, but you don’t actually see the Actinomyces, but you can wipe it down with soap. And then that basically dysregulates your immune system. And then once that happens, now you’re basically vulnerable to other issues. And then that’s basically, this is like the cliff notes of it. But then basically you’re more susceptible to COVID and more susceptible to things like tick born illnesses and viral illnesses.

Suzanne Turner, M.D.

And fish.

Matthew Cook, M.D.

And what?

Suzanne Turner, M.D.

Fish, the Ciguatera.

Matthew Cook, M.D.

Oh yeah, that’s right. You’re down in Atlanta. Tell ’em what Ciguatera is because that’s a real problem.

Suzanne Turner, M.D.

It is. So people go down to the Gulf near me to the Gulf of Mexico, to the beach. And there are lots of fish. It comes from dinoflagellate and Ciguatera is the toxin that is produced by the dinoflagellate that’s eaten by the fish. So Amberjack is a common fish grouper out of the Gulf. We love to go down and eat it Panama Joe’s and get our crusted grouper or sandwich or whatever that we’re getting but at times those are affected by Ciguatera and you can become very ill if you have a genetic susceptibility to this kind of response, you can become very ill from exposure to that toxin, that Ciguatera toxin that’s just in the fish flesh. It is not cooked out. So it doesn’t mean that your fish wasn’t cooked well number one, you have a genetic susceptibility, number two, or maybe an environmental, but probably genetic probably there’s a genetic predisposition. And then you eat this fish from the water, there’s no testing available. We can test the fish. If you could find the fish, we could test that fish for Ciguatera but there’s no test for humans. So we’re kind of guessing based on your history. I have an unfortunate woman who’s a functional medicine doctor who came to me who was very, very neurologically ill and has been unable to work for several years now because of what we presume is Ciguatera poisoning.

Matthew Cook, M.D.

And have you found anything that’s helpful for that?

Suzanne Turner, M.D.

Sure, we treat. ’em just like, whatever, all the CIRS protocols, every thing that we would do for CIRS. Her problem, and with a lot of CIRS patients is they have that multiple chemical sensitivity and you can’t use anything. You can’t use binders. There’s so much that you can’t use because they don’t tolerate it. They get worse.

Matthew Cook, M.D.

Top three things for that category for that very sensitive, sick cohort of people top three or four things you like.

Suzanne Turner, M.D.

BPC is great ’cause they almost never react to it. TA-1, they almost always will. We’ll start them with something like SPM active by Metagenics.

Matthew Cook, M.D.

This a sexy fish oil.

Suzanne Turner, M.D.

Yes. That helps to resolve the inflammation in theory. And I probably will start them on okra, powdered okra, ’cause they usually will tolerate the powdered okra.

Matthew Cook, M.D.

So then that category, and so then I think, kind of is a nice bookend to our conversation because then if we go down that road, then we’re gonna talk for six more months. But then it’s kind of interesting to think of. So here we are with a diversity of the title of our talk was enhancing the entrepreneur, but then really the way that we know how to enhance the entrepreneur is by fixing the real serious problems of our day. And those neurological problems are chemical, metal, which we didn’t talk about, but we will in the future and toxin, and then autoimmune and our body’s reaction to it. And so then basically now we’re in an evolving and exciting sort of journey of figuring out how to basically take those problems away and rebuild the body and get it basically working functionally so that we can perform and do all the things we love to do.

Suzanne Turner, M.D.

Yes, that’s right. That’s a brilliant way to think about it, that we take all the knowledge we get from those very ill patients and apply it to our patients who are not so ill, but not optimal including ourselves and see if we can get them if we can tweak and turn and just get that knob a little bit tighter.

Matthew Cook, M.D.

Perfect. Well, if you wanna learn more from Suzanne, go to A4M, to the World Academy and then come to the International Peptide Academy and we’re delighted to have you and your wealth of information and I look forward to our next conversation.

Suzanne Turner, M.D.

Thank you. It’s great to be on. I appreciate your time today.

Matthew Cook, M.D.

Okay, thanks.

Suzanne Turner, M.D.

Bye Matt.

Matthew Cook, M.D.

Bye.