Peptides for Optimal Fitness and Athletics

Neil Paulvin, DO

Thanks for having me, looking forward to it. 

Kent Holtorf, M.D.

Great. So we’re gonna focus on kinda your sports medicine aspects. But tell me how you got started in peptides. When did you discover them and what’s been your journey? 

Neil Paulvin, DO

I do a lot of—like most of my practice is either health optimization, like we mentioned, like brain, energy, and also sports. So I got introduced to, I think one of the ones we’re really going to talk about today, BPC-157 and they’re like, “This medicine can help with gut health. It can help sport injuries heal.” I was into doing things like PRP and all that stuff. I’m like, “Wait, this works just as well and there’s really no side effects to it, and it hits more than one thing!” I’m like, “This is awesome!” Then I started delving more into it. I’m like, “These things really work with almost all my patients and they’re a lot easier to do. Patients don’t have to worry about coming to the office a lot of times.” It’s just—they’re so great. I think part of the future of medicine in terms of just being able to do things much more cleanly and easier, that’s some of the things that are out there. 

Kent Holtorf, M.D.

Do you find, when you tell patients about BPC-157, it’s almost like—there’s so many studies that shows it does so many things, and when you tell them, it’s kind of like, “Hey, this must be snake oil. There’s no way something can really repair all these tissues.” 

Neil Paulvin, DO

Initially I did. I mean, then it was a combination of the fact that I’ve treated patients with it and I’ve seen the results myself. Now at the point—now I’ve literally had patients everyday coming or they’re calling me and say, “Hey, my doctor doesn’t know about BPC-157. I want to use it.” 

Kent Holtorf, M.D.

It’s amazing too, I think, is that standard medicine has never heard of this stuff. I know when I lecture to doctors, all the references, it’s like hundreds and hundreds of references, peer reviewed, and it’s like, “Oh my gosh, why haven’t I heard about this?” Do you have patients say, “Well, if it’s so great, why doesn’t my doctor know about it?” 

Neil Paulvin, DO

Again, it was the same thing, initially, yeah. They’re like, “Why is no doctor using it? Why am—you tell me about it and it worked so easy and so clean with minimal side effects.” Now that—unfortunately, I mean, that’s kind of medicine as it is. There’s some doctors who practice in one box and there’s some doctors who, kind of like what I do, you gotta play on all sides of the field to help your patients get better. So again, more and more patients now are becoming their own doctor in a good way and being advocates for their health. So they’re not surprised anymore. They find the doctor rather than them feeling bad. 

Kent Holtorf, M.D.

Yeah. I think that is good that patients are realizing that the days of just going to your doctor and saying, “Take this”, not knowing what it is are gone. They really have to understand what they’re taking and seek these different therapies out. Because, I don’t know, I just—I’m sure you may feel the same, that standard medicine is so disappointing for so many conditions. Even, you go from standard conditions and we’re talking about even sports injuries and joint issues and musculoskeletal problems. Then you get into complex problems, and I think that’s where really standard medicine just falls apart and where, if you don’t fit into a little box and have the one medicine for it, they’re done. The doctors just say, “Oh, it’s psychological.” So, what type of peptides did you use and types of patients you treat besides the sports medicine that we’ll get into? 

Neil Paulvin, DO

I mean, I use it, and I think you do—I probably now use all of them at this point, but I use—there’s 30 or 40 that are in my toolbox at this point. 

Kent Holtorf, M.D.

Wow. 

Neil Paulvin, DO

My main core, and there’s ones that are always, now that are like not true peptides, but they’re kind of cousins that we use with them. But I use a lot—again, I use [inaudible]. I have a lot of athletes who don’t only want to heal their injuries, but they want to recover quicker. So I use a lot of the peptides like Thymosin beta-4 and some of the CJC and other growth hormone ones to help them recover quicker. 5-Amino-1MQ they love. I also use it in terms of anti-aging with the brain. That’s really where I combine—that overlaps any of my patients from my athletes and executive patients who just want to be like at an 11 all the time, and then unfortunately my Lyme patient or fibromyalgia patients where they have the brain fog, or the memory issues, or autoimmune issues. It works there too, that’s what I love about them. Like I said, it hits every patient I see, pretty much I could give them 1 or 2 or 4 of them once they jump on board. 

Kent Holtorf, M.D.

Yeah. Would you say it’s really changed your practice?

Neil Paulvin, DO

Yes. I mean, totally. Initially it was maybe 5 or 10% of my practice and literally once everyone started talking about it and the word of mouth spread and I put one or two blog posts up, it’s now probably 50 to 60% of my practice as the core of why patients are seeing me. So it’s definitely exploded within the last calendar year. 

Kent Holtorf, M.D.

Yeah. Where people are getting educated on these things and they’re actually seeking you out for peptides. 

Neil Paulvin, DO

Exactly. Yeah. Between groups, Facebook groups, Reddit, word of mouth, it’s kind of become a cult thing more than it is from the doctors telling them to use it. 

Kent Holtorf, M.D.

That’s great. And have you seen any major side effects from using peptides? 

Neil Paulvin, DO

Not many. I mean, there’s one or two. The only thing I really see is in terms of some of the growth hormone peptides, I gotta couple of patients who are getting flushing with it. We just lower the dose that usually gets rid of that. Beyond that, the only other one I don’t use as frequently, except with maybe some Lyme and SIBO patients would be LL-37. That’s probably the other one where you really gotta go low and slow and make sure there aren’t any side effects to it. 

Kent Holtorf, M.D.

I agree. I’ll just tell the audience, LL-37 is an antimicrobial peptide and studies show that it kills, for instance, Lyme cystic form better than the antibiotic Tinidazole. Lyme patients in general, very sensitive, they can react to supplements and things like that. I just wanted to let them know what that actually is. And that’s the nice thing. You look at the studies, they give a thousand times a dose, or a hundred times a dose, and there’s no side effect. Try that with Tylenol, try that with any medication. So the nice thing is they’re very effective and you don’t have those side effects. So, talking about BPC, so it stands for body protection compound, 157. How does that work? 

Neil Paulvin, DO

It’s kind of interesting that it’s derrived from [inaudible] body protection compound, it’s part of the [inaudible] they still aren’t really sure of. They always kind of put that in there, but they know now in terms of what it does in certain things. We know that it decreases a lot of the inflammatory chemicals in the body, the leukotrienes, the thromboxanes that cause inflammation. We know that it works on muscles, tendons, and ligaments to help heal. It helps produce collagen and helps increase growth hormone. We know that it helps to heal stomach and gut ulcers and ulcers in the cornea. So it—that’s what we know. It also works on serotonin dopamine to help with certain issues with the brain and other issues. So we know some of the mechanisms, some of the mechanisms they’re still not—it’s one of those ones where it’s still not completely felt out, but those are the things that we kind of know how it works. A lot of that applies to sports and gut health, which is where it got its start. 

Kent Holtorf, M.D.

Yeah. I think it’s interesting how they’ve really been around for a long time and it’s trying to elucidate the exact mechanisms because it’s like they have multiple mechanisms called pleiotropic where they basically have a cascade of effects, which I really think adds to the safety because you’re doing a bunch of things, modulating a bunch of different things. Like medications do one thing, turn this one thing off. And, yeah, so that’s what we find. You look at the studies, they’re so, so safe. What do you generally—sounds like you use it for a lot of things, if you can name a few things that you use it for. 

Neil Paulvin, DO

I mean, the main things I use it for are—I do a lot of gut patients. I do a lot of SIBOs, which is small intestinal bacterial overgrowth. I do a lot of like ulcerative colitis and Crohn’s, and then I do a lot of—that’s my one go to. And then sport injuries, I’ll either have them do it by doing the injections, or the creams, or the pills, or I will locally actually inject either on its own or with other substances into the joint, into their knee, or their shoulder. I’m now a little more—initially [inaudible] studies showed that may not be as necessary. I still do it to really get that local effect, especially my high end athletes who may have had a competition or we really wanted to get them back as quickly as possible. 

Kent Holtorf, M.D.

Gotcha. Yeah, that’s the nice thing. Studies show that taking it orally actually is equal potent to injection. One of the few, which makes it so much easier. You treat athletes, is it a banned substance? 

Neil Paulvin, DO

BPC, as of now, is one of the few in the peptide family that’s not banned, which—as far as I know and they always update it. So it’s not banned yet. A lot of the other ones are, in terms of the peptide anti-inflammatory ones, as far as I know. So it’s still—it’s great. Again, it’s great because it plays well with other things that we can still use as well. So it’s great for anybody from an Olympic athlete down to the weekend warrior. 

Kent Holtorf, M.D.

Yeah. I mean it’s—and that’s a big problem. It’s nice, it helps people recover, and then they want to ban it and then it gets a bad name and it kills it for so many people and they associate it with, “Oh, it must be a steroid.” And it’s the farthest—it actually protects you from the side effects of steroids and things like that. So what injuries do you typically see? What do you use it on? 

Neil Paulvin, DO

In terms of injuries, I use it on—my go to really, I love it in the shoulder. I mean, I’ve seen a lot of patients with either rotator cuff issues, small tears, partial tears of the rotator cuff, and labral tears. I’ve had some patients who now it’s been long enough where they had an MRI before we started, and now afterwards we’ve seen recovery and their traditional orthopedics are like, “What are you doing?” And they’re amazed. Then we have to explain to them and work backwards. Then also I use it either superficially on a lot of back issues, like really tough back issues, patients who can’t have surgery or don’t—obviously just really aren’t surgical candidates. I do that mixed with some other substances and it works incredibly well. The other spot that usually I’ll use it on sports-wise is like patellar tendonitis, which is in the knee. I’ll do some injections in the knee as well. That’s kind of where I’ve used—I’ve used it for everything from patel, from Achilles tendonitis, to inflammation in the trapezius, but those are kind of like the core ones that are my go tos.

Kent Holtorf, M.D.

So what do the orthopedic surgeons say after? ‘Cause they always want to do surgery. I had Lyme which really caused a lot of regeneration of connective tissue and they wanted to do hip replacements. My rotator cuff was just shredded, all the tendons. It was funny, I asked him—I went in and got the cheapest—the cheaper the group above us. I just said, “Well, what do you think of peptides, and even PRP, and STEM cell?” He goes, “The studies show they don’t work.” And I’m like, “Okay, well, I have a hundred in my bag here that show that they work.” And what do they say when they recommend surgery and the patient comes back and they don’t need surgery anymore? 

Neil Paulvin, DO

They’re pretty amazed. I mean, again, a lot of surgeons are surgery first, second, and third. So they’re a little bit surprised, initially they’re like, “Oh, this is just placebo.” 

Kent Holtorf, M.D.

But miraculously healed! Yes. 

Neil Paulvin, DO

It’s short term. But then when—they sometimes will see the change on the X rays—not on the X rays—on the CAT scans or MRIs, they’re like, “Okay!” Then they buy in, they buy in more and more. Orthos are actually—orthopedists, if you show them—again, you can prove, it’s A to B, easier. Same with the stomach things, if you can show an ulcer healing, it’s still A to B, it’s not—certain other cases are hard to prove what’s actually causing it. This is A to B, where you look at the X Ray, look at the colonoscopy, and you can kind of see, “Wow, that healed in 6 months. This stuff must work.” Which is also cool. 

Kent Holtorf, M.D.

Has any of them adopted using the peptides after seeing your results? 

Neil Paulvin, DO

A few have. I’m in Manhattan, which is very, very old school. It’s a very old boy network where, unless it’s been proven for 20—there’s theories that it takes 20 years for something to come into the medical literature. That’s Manhattan. But there are some that are using it now as part of the—they’ll mix it with their PRP. I know some will put it if they do an ACL or some type of surgery. Some of the back surgeons are using it now, so it’s getting, in the last year to 18 months, it’s come into some of the repertoires, but it’s not commonly used. 

Kent Holtorf, M.D.

It’s kinda like the gastroenterologists are now discovering probiotics, you know? 

Neil Paulvin, DO

Exactly. 

Kent Holtorf, M.D.

But I found it interesting—and now I’m used to it, but I’ve been doing this for 15, 20 years—that a doctor will have a patient for 10 years, they can’t get better. You get them better. And the patient has a great relationship with the doctor and goes back and tells them, I would think the doctor was like, “This is awesome! Let me call him and find out what he did.” I found, you know, 90% time, at least where I am in Southern California, they’re mad. They’re like, “This is ridiculous. I won’t see you anymore if you don’t stop.” It’s just like, wow! It’s kind of eyeopening. 

Neil Paulvin, DO

It can happen. I mean, I haven’t had that type of response. Maybe once, I don’t get that much of a response, in terms of they’re just happy for the patient. But I could see it. I’ve seen it once or twice and it gets kind of nasty. 

Kent Holtorf, M.D.

Yeah. They’re not like, “Hey, you’re taking away all my income in my surgeries.” 

Neil Paulvin, DO

Yeah, no. Surgeons are losing their step, like between PRP, STEM cell, exosomes, all that stuff coming down the pike, they have to learn to adopt some new stuff. 

Kent Holtorf, M.D.

It is true. I’m amazed seeing like cardiovascular surgeons and neurosurgeons doing regenerative medicine, you know? Which you’re like, wow. I think that that’s incredible. They see that, “Hey, if I’m going to feel good at what I’m doing, I want to treat patients.” It’s so much safer. People think, “Oh, I’m gonna do the surgery. It’s going to be fine.” So many potential risks of side effects and recovery that no one mentioned. It’s part of the potential side effects, you know? That’s great. Do you combine the peptides with—do you use multiple peptides in a patient? 

Neil Paulvin, DO

All the time. I love to, it’s a question—I always tell—one of the first thing I tell my patients is—in a lot of cases they can dictate how fast we want to go. I can say, “Look, I can put—” I have [inaudible] patient on double digit peptides at one time. They’re used to doing the creams, and the pills, and the injections, and they have it and they don’t care. I have some patients who only want to do one or two, and that’s the first thing. You have to understand going in that it’s everyday or 5 days out of 7 days. So it’s committment. It’s not a one shot deal—no pun intended—where they do it once or twice and they’re done. But when I do do it, I mean, now it’s kind of become known as a Wolverine stack, which is for recovery, which is BPC, TB4, some people know it as TB-500, and some of the growth hormone ones, which is the CJC and Ipamorelin, or [inaudible], that works really well for healing, especially back, rotator cuff, Achilles tendonitis. If you’re dealing with the gut, then you—some of those similar ones. It will add, kind of what we talked about earlier, LL-37 may be involved in some cases. Or KPV, which is a new one that just became a derivative out there that I’m starting to fall in love with. I’m sure you guys will talk about it throughout the summit because it has so many anti-inflammatory— 

Kent Holtorf, M.D.

Are you using that oral or how are you using that? 

Neil Paulvin, DO

Which one? The KPV? 

Kent Holtorf, M.D.

Yeah. 

Neil Paulvin, DO

I was using it oral. Now, it’s harder to find than—I don’t know, whatever analogy you want to use at this point. I can’t find it, so now I’m having patients use the injectables. But the pills are supposedly coming back. So I love the pills. The pills and the cream were the most perfect thing ever. I mean, those had become one of my favorites that were out there. 

Kent Holtorf, M.D.

Yeah. Let me—what did you find with that? So, KPV is a small tripeptide fragment of alpha-melanocyte-stimulating hormone. So it’s a piece of like Melanotan II, which will—basically it’s called like the Barbie doll peptide. You get tan, you lose weight, and increased libido. It’s like, “Hey, great!” Do you use it for that? Do you use Melanotan? Just out of curiosity. Neil 

Neil Paulvin, DO

I do a little bit. I just want—I use it a little bit. I use it more for weight loss in my athletes than I do for the tan. I had one patient that asked for the tanning. I just warn them, it’s not like—you can’t always—it’s not like you can go to a 2, sometimes you may go to a 7. With a tan you can’t control it, I’ve had patients not like that. 

Kent Holtorf, M.D.

Yeah, no—and the problem is I think, and I found it myself, I used it when it kind of first came out, the dosing, I’m like, “This isn’t working!” Kept using more. I looked like a strange Jamaican guy, I got so dark. I think older people kind of— some age spots can come out and things like that. I think it’s kind of ideal for some younger people. But it’s the alpha-Melanocyte-stimulating hormone, so it increased the melanocytes but it also is very anti-inflammatory and very restorative, and that’s why you use it. The nice thing with KPV, it doesn’t have any of the tanning properties. So that’s why I think you can use it liberally. There’s so many things it’s like—I think

that you can’t believe like, “Hey, I got another tool in the toolbox and so many doctors don’t know about.” And you said you use—how many peptides are you using? 

Neil Paulvin, DO

There’s probably about 30. I mean— 

Kent Holtorf, M.D.

Wow. 

Neil Paulvin, DO

And then you get the other ones like Rg3. Rg3 is not a traditional peptide, but it’s there. And [inaudible] which is kind of—not a cousin, but it’s always involved there. So there’s ones that I always mix and match, and then the nootropics are their own family of stuff. They’re always kind of thrown in too. 

Kent Holtorf, M.D.

Yeah. And the nootropics, improving brain function and things like that. So it sounds like you do a wide range of things with all the peptides. What is your favorite thing to use BPC for? BPC-157. 

Neil Paulvin, DO

I actually—I mean, I like the sports stuff, ’cause that was my first love. I was always doing some sports stuff because I initially worked in a small town and there wasn’t really a good sports medicine doctor. So I was it. But now I always—even Manhattan—I like the gut healing the best just because it’s amazing to me. I’m in Manhattan, but I have patients come to me with ulcerative colitis, Crohn’s, and SIBO, and they’ve been suffering for years. We get them on a combination regimen and in 2 or 3 months, they’re like, “Wow, I don’t have pain. I can come off my Remicade. I can live a normal life. I don’t have to be taking these 6 different medicines.” That is such a light bulb moment—not a light bulb moment—but it’s such a great feeling and such quickly produced. These people have been suffering for so long and like that, things changed for them. So that’s why I really—that’s like the doctor moment right there, where you’re like—little angels come out and start singing, more than anything else. ‘Cause I think it’s— 

Kent Holtorf, M.D.

I mean, isn’t that amazing? Because these people generally, with let’s say ulcerative colitis, all the inflammatory bowel disease, they’ve generally been to standard experts who recommend they basically go down the algorithm, chemo, and they say, “Okay, we’ve got to remove your colon.” And they come to you and they get better. Is that what you’re saying? 

Neil Paulvin, DO

They got a lot better. I mean, it’s been proven [inaudible] several patients get a colonoscopy 6 months, or a year later now, who were doing BPC even by itself and they say the ulcers are

diminished or gone. Their ulcers—the inflammation is diminished and again, like they’re coming off their meds or their meds have been diminished. So it’s been proven so many times. Kent 

Kent Holtorf, M.D.

And you just think how you just changed that person’s life. Or they could have been having to have a colostomy bag forever. 

Neil Paulvin, DO

Exactly. 

Kent Holtorf, M.D.

That’s just incredible. So let’s talk about the sports medicine. What typically is your strategy and protocol for—let’s say someone comes in with a knee or a shoulder, do you immediately go to peptides? Do you do other things first? Do you use multiple modalities? What is your kind of strategy for that? 

Neil Paulvin, DO

In most cases, all of the above. Most of the patients seeing me have already seen at least their primary and a sports medicine ortho when they’re coming to see me. So I’m kind of there to fine tune things and also look at everything. So I do a lot of—as you mentioned, I do manipulation, I do a lot of hands on things. So what I’m looking at is, the peptide as the acute is a great way to stop things short term, but also if they have poor range of motion, if they’re a pitcher or just lifting a lot, and you don’t fix the range of motion in the shoulder, the strength in the shoulder, adjust the joints, make sure things are moving the right way, then they’re gonna be back 3 months, 6 months down the road with the same issue. 

‘Cause you’re just kind of doing the same thing and just causing the same problems. So I work with—I say, “Look, the BPC or the TB500, that’s gonna kind of calm things down for you. Now we’ve gotta work on preventing this from happening again.” Which we do—I do a lot of hands on. I work with great physical therapists and just specific fitness trainers who can kind of work on everything from their range of motion to—I adjust them, make sure that the fascia is all lined up and then when we’re done with the BPC, TB500, CJC treatment, I don’t have to see—Like, “Look, if I don’t see you back again for another 2 years, that’s my goal. I don’t want you back!” So that’s the goal. If we give them the full package, they can [inaudible] not only the acute problem, we’re making sure they don’t come back in again. That’s where it’s great. That’s the way

it should be done. This is not just, “Okay, here’s your shot. We’ll just keep doing this every 3 to 6 months.” That is nonsensical to me. 

Kent Holtorf, M.D.

Gotcha. Gotcha. Do you find—I always love it when you’re treating one thing and they go, “Oh, by the way, this other thing I never mentioned went away.” You know? 

Neil Paulvin, DO

Exactly, yeah. 

Kent Holtorf, M.D.

Which is kind of interesting. How quick do the peptides generally work? 

Neil Paulvin, DO

I’ve seen it work as quickly as 10 days, a week to 10 days depending. And I have some patients who it may take up to 2 months for it to really kick in. It depends on how good they are at taking it and how severe the injury is, their immune system, all of the above. I mean, I tell patients a lot of times it may take 6 weeks to 2 months. You also gotta play with the dose. I mean, I’m a little more aggressive than most, especially with BPC. With BPC, the dose is—we haven’t really seen any side effects. I’d push it harder than what the suggested dose is sometimes, compared to some of the other ones that are out there. But I do see anywhere between like 10 days to 2 months, depending on the whole package. 

Kent Holtorf, M.D.

So when you say you use more in general, do you—how fast do you move up on the dose? And do you add different peptides? Do you increase the BPC? What is your maximum dose? Or how fast do you change doses? 

Neil Paulvin, DO

It depends. I mean, usually it’s going to be about 2 or 3 weeks. I’ll bet—I mean, again, it also depends. I had people who had a race in a week and a half and in that case I’ll up it really quick. I’ll say, “Look, take this for a day or two, or three days, if it’s not working, double.” I’ll go to a 1000 milligrams on the BPC. I’ll even go a little higher than that, depending if you can find somebody to compound it that way for you. But I do really short bursts. So that’s what I tend to do. Somebody who’s in—my 75 year old osteoarthritis patient, I usually wait a month, a month to 6 weeks. It depends who you’re dealing with, but I’ve done it as quickly as a week to 10 days. I’ve switched—I’ve raised the dose because I needed to do it and it just wasn’t working. I mean, if it doesn’t work, I might as well go up with it. There’s no point in me just sitting there and the patient waits. For certain, again, more for my younger athletic patients than anything else. 

Kent Holtorf, M.D.

Yeah. I mean, I like that. I’m very ADD too. I’m like, “I don’t want to wait!” The nice thing is I think the side effects are so low you can change the dose very, very quickly. What percent of patients would you say—a patient will come in and say, “Okay, I have a basically a torn rotator cuff.” And they said, “I need surgery.” What’s the chance that this is gonna help? 

Neil Paulvin, DO

I would honestly—I tell patients 70, 80%. I have seen almost nobody that doesn’t get help, especially if go up to the—I call it the Wolverine pack, and are doing something else with it. I’ve had maybe 1 or 2 patients that didn’t get pain improvement and also potentially improvement on the MRI. It may have been just too far gone or they have some other issue where the pain is just continuing. But I tell patients 70 to 80% that they’re going to get some improvement, if not more. 

Kent Holtorf, M.D.

Wow. That’s like almost—it’s really unheard of and in medicine. 70, 80%. I mean, you look at studies on medications, they get approved when they have a 4% improvement over placebo. It’s crazy. These are often people who said they need surgery and you’re doing 70, 80%, no one guarantees anything, but that’s what you’re seeing. 

Neil Paulvin, DO

Yeah, definitely. 

Kent Holtorf, M.D.

Yeah. Well, what’s the patient’s response usually? 

Neil Paulvin, DO

They’re my new best friend! They’re your best advertising. So—no, I mean, they love you. They’re like, “I’m an athlete. I’m a runner. My knees hurt me already at my age, I’m gonna keep running.” If they have a bad shoulder, they’re gonna keep going to the gym. They love the fact that they can go back to their life. They can go back to their passion, which keeps them going. They love—that’s what makes it even better. It’s like, they’re a runner, or they want to go to CrossFit, or they want to do whatever. They can get back. That’s what makes it even sweeter when they feel better really quickly because they’ll never forget you. It’s not like you just treated their sore throat or something, this is their passion, their livelihood, their fun. 

Kent Holtorf, M.D.

Yeah. So, really it’s like, especially with these athletes, not being able to do that, it’s like they’re passion. They Live for it. You’re able to allow them to do that again. I imagine you get some good Christmas gifts. 

Neil Paulvin, DO

I get some good Christmas gifts, yeah. Between the Christmas gifts, the referrals, it’s nice to be on their good side. I’m not gonna argue that at all. 

Kent Holtorf, M.D.

That’s nice. I think it kind of makes it worth it, right? You know? 

Neil Paulvin, DO

Yeah, it’s definitely worth it. 

Kent Holtorf, M.D.

That’s wonderful. I just love to hear that. You mentioned the gut. Tell me what your thought is, how the gut plays a role, and BPC plays a role in the gut with other systems in the body. 

Neil Paulvin, DO

Okay. That’s a long question. I’ll try to summarize that there. 

Kent Holtorf, M.D.

Yeah. A lot of info in that one. 

Neil Paulvin, DO

Yeah, exactly. I mean, the main thing is, it’s become a pretty common slogan at this point. You gut is 70% of the immune system. So if anybody—if you can work on healing the gut with BPC or whatever, combined with whatever your regimen is, that’s going to help. But if there’s any type of autoimmune issue, we know about the gut brain connection, that’s going to help in terms of—it’s going to help any person, athlete or chronic Lyme patient, it’s going to help them with focus, or brain fog, or energy, or all the above. So healing the gut is gonna help that. It helps with your neurotransmitters, so it’s going to help their mood. And we know if patients up their mood, their pain may diminish, they’re going to be more healthy to begin with. 

Just by fixing the gut—I mean, we know there’s everything else in terms of where the hormones are produced, the metabolism, and if they gut is injured, they’re going to gain weight, which causes inflammation and other issues. So the gut is pretty much—the gut and the brain and the heart are kind of the cores to all medicine, traditional and alternative regenerative medicine. We kind of knew that going in. It’s just becoming more and more proven, when you fix one thing, like I said, when you fix their gut, you’re fixing a lot of other stuff too for them. Making life a lot easier. 

Kent Holtorf, M.D.

Right. Right. It’s amazing, the studies that are coming out on that. Now, let’s say I come in and I twisted my knee, do you talk to them about their gut, or—? Do they look at you like, “Doc, I came from my knee. What are you talking about my gut for?” 

Neil Paulvin, DO

I do, I mention it. Again, that’s where you have to kind of gauge your patient a little bit too. I mean, I have patients who come in with 10 pages of literature and they know all this stuff. They’re on Reddit and they know what they want. Then I can have a conversation with them. I have other patients who are like, they’re very serious. They’re like, “No, I just want to fix my knee. I don’t—” Some of them, they may not totally buy into everything else. Then you kinda just drop it in here and there, especially if, “Hey, so you feel bloated?” Or, “Hey, are you having any type of abdominal symptoms?” That may be related, you’ve gotta kind of be more subtle about it because otherwise they’re just gonna think that you’re just making stuff up. But I definitely try to get it in there most of the time. Medicine is an art too. They always say that and you’ve gotta learn—every patient is not the same— 

Kent Holtorf, M.D.

That is so true. I didn’t mean to cut you off there. Yeah. I just—it’s amazing. And how many symptoms patients have. Let’s say someone comes in with—an athlete comes in with an athletic injury, how often do you end up like mentioning some things and taking over their care for everything else and becoming their physician? 

Neil Paulvin, DO

A lot of time I do now, especially with everything that’s kind of coming out. I mean, again, like I said, the tools I had 10 years ago, or even 5 years ago, compared to what’s out there now, it’s totally changed. So now a lot of times they wanna know about their hormones, they want to know about the recovery, they want to know about how their gut health, or how their brain health can get affected, or even their blood pressure, their sugar. They’re wearable now, so it’s all become integrated more with not just, “Okay, we checked, we did your test once a year. Your LDL is fine. I don’t need to see you again.” 

Medicine now has become much more comprehensive, the patient now, we’re seeing changes, the patient has now become much—at least my patients—much more proactive about their health than some of their doctors are. So most people know what they want, they—I tell them, I’m the traffic cop. I can dig as deep as you want to—like I said, it depends—and get you where you want to be very easily. Then also, again, I let the patient kind of guide me a little bit a lot of times, and it works out better because if they feel they’re the ones guiding you, they’re going to buy in a lot quicker. A lot of this is always about buying. If they’re not going to do what you tell them to do, you’re wasting your 60 minutes with them. 

Kent Holtorf, M.D.

Yeah, yeah. I think it’s really essential nowadays that the patient can active role in their care. I have some friends who see me, I refuse them, because they don’t care to know what they’re on. And I’m like, “I can’t treat you like that.” You know? I think too, the way kind of medicine has gone where everything is so compartmentalized. Okay, you mentioned all these things that someone comes in with a knee and they could have some gut issues, brain, high cholesterol, where they’d have to see a cardiologist, a gastroenterologist, orthopedist, but they go to one source who can actually look at everything and how it all relates. And it does! These are not separate systems. I think that’s so powerful and I’m glad that patients seem to be realizing that finally. 

Neil Paulvin, DO

Oh, yeah. It’s getting there, at least on the East coast here it is. It’s great. It’s so much—it makes life easier and it’s good for the patients. They need to take care of themselves for the long run. 

Kent Holtorf, M.D.

So, you’re kind of the one stop shop? 

Neil Paulvin, DO

As much as I can be, yeah. [Laughing] [Inaudible] If you get too busy, then you do what you can and then you have other people to help you out. But yeah, I do as much as I can for them. And then, as I said, I have helpers and I have other doctors in the area. That’s a good thing about Manhattan, there’s literally a doctor every block. So, “Hey, I can do all these things with you and I know so and so is really good.” I just have them help me out. 

Kent Holtorf, M.D.

That’s good. That’s the way it should be. It seems now it’s kind of like the so-called—I don’t even know what to call myself and I hear what you like—how do you describe what you do? Like the standard doctors don’t like the integrated doctors, or they call them alternative, and there’s no—”Oh, that’s quackery!” Whatever. With my story, which I told that, I would never have gone—it’s ingrained in medical school that alternative medicine means no evidence based. And it’s amazing that—I hate that term and I don’t know why. 

Integrative, functional medicine doctor, whatever, it’s so much more evidence based than standard medicine, you know? I just feel like so many doctors are kind of like just doing what they’ve been doing in residency. And, “Don’t confuse me with the facts.” But the system is made like that, I mean, they’re not bad people. The system is not going to allow them to spend more time with the patient. They don’t get paid more. They’re already busting their butt to see a patient every 8 minutes, wherever it is. So, I think things are changing and I think with all the COVID-19 and the telemedicine, I think it’s gonna really change medicine even more. What else do you use peptides for in terms of like anti-aging, or weight, or—what else do you use peptides for? So you basically kind of use them for almost anything it sounds like.

Neil Paulvin, DO

My second big one is—besides gut, is brain. I mean, that’s where I use a lot for, again, for all the patients that I brought up before. Weight loss, weight loss, I like as an add on. They’re great. I mean, a couple of the ones that I used to use right now are very hard to find. So that made me kind of pivot a little bit away from them in terms of weight. Like you said, the M2—the Melanotan II is good for weight to a certain extent. But again, that’s where you kind of use the cousins like Liraglutide, which is a prescription medication. I use it a lot, it helped with weight loss for my athletes. I use it a lot for—what’s the other ones I use it for—and I use it a lot for autoimmune. I have a lot of autoimmune patients who come to me, like Hashimoto’s and rheumatoid arthritis, we don’t train their pain complaint, trying to keep their pain controlled. I’ll use a TA1, or thymosin alpha 1, to calm their immune system down. 

I usually will mix that with low dose naltrexone and then that really gives them a one, two punch when we’re treating their acute pain. Then we can calm things down by treating their gut with either the BPC or one of the other ones entering your immune systems to [inaudible] acute and then treating the longterm. And again, you can kind of get them off their medications. That’s kind of one of the other ones I use. The other big one now that’s gotten more and more popular of course is the ones for erectile dysfunction and sexual dysfunction that are coming down the pike too. The PT-141 and some of the ones that now—copeptin for testosterone, 

Kent Holtorf, M.D.

It’s interesting how the celebrities really can drive things and drive awareness. Do you have any cases that you can talk about? Of course, don’t say any names, but just kind of how the process went. 

Neil Paulvin, DO

Sure. I mean, the two that I can really allude to—I kind of hinted at it before, I had a patient who had—big CrossFit guy, 240, has been lifting for 20 years, 5, 6 days a week. At [inaudible] couldn’t even lift his arm up above his head, probably couldn’t carry a 2 pound bag. We put him on the Wolverine, which is the BPC, the TB500, and the CJC. 

Kent Holtorf, M.D.

So let me just kind of go back. He was probably knowledgeable about all this integrative medicine stuff and he had a rotator cuff problem, poor range of motion. Okay. Did he go to the orthopedist?

Neil Paulvin, DO

Yeah, they were telling him they either wanted to do surgery on both shoulders and they told him he’d probably be out of commission potentially for 6 months or so, which he didn’t really want. He also was a big part of an exercise company, which would affect things too. So we have a mutual friend who sent him to me and within 2 months he’s like, “Wow, the pain is pretty much diminished. I’m back in the gym.” He’s not exactly where he was before, but he’s getting close. I used one with him, which we really didn’t talk about, which is GHK copper, which locally with the cream I find is a nice little add on. I found a perfect one for something like a rotator cuff that’s a nice little add on. And the other one I have that—like I said, I have a patient who had really bad ulcerative colitis, had just had her colonoscopy done with her gastroenterologist, six months later, just on BPC, had another colonoscopy. We already knew her pain was diminishing, [inaudible] “I don’t like to take my meds anymore.” They did the scope again and I think 2 were gone, 1 was like a third of the size. That’s where the gastro was like, “What in the world…?” He was mystified. 

Kent Holtorf, M.D.

Well, again, I just think we have some [inaudible] class patients and we have some—like this 8 year old girl that’s gonna basically get her colon removed and came in, kind of didn’t believe in the stuff, and totally fine now, you know? I just think how many lives you’ve changed with the peptides. And do you think—so you use them after the acute problem? Do you think they’re good for anti-aging in general? Should everyone be on these peptides? 

Neil Paulvin, DO

I think they should. I think—I mean, there’s the combination of the anti-aging protocols, things like Epitalon, and Thymulin, and MOTS-c, and [inaudible]. I’m sure you’ll be talking about them throughout the summit. They have their own protocol. Then you get into the whole senescent cell protocols with things like rapamycin, and NAD, or NMM, which are kind of getting—they’re always involved with the peptides, but they’re not actually peptides. Again, Thymosin alpha-1 comes in, and Metformin, and all those things. So I take it myself. I have my patients who—those are my clients that are on the 10, 11, 12 peptides, and a lot of them will come to me and say, “Look, I want to be on this protocol. I know that they’re expensive. I know that’s gonna be 10, 11 needles for a couple of weeks. I don’t care.” 

Kent Holtorf, M.D.

If you use 10, 11 needles, do you have them do separate shots of each peptide or do you combine them into one syringe? 

Neil Paulvin, DO

I’m still old school with that. There’s certain ones I combine. A lot of them I don’t, because I don’t know, I haven’t seen that many studies saying that you can combine certain ones. So, again, unfortunately they’re not inexpensive—some of them are not inexpensive, so I buy them most—I give them the shots. Some of them they’re doing nasal spray anyway, so they don’t care, but most of them are doing separate shots. 

Kent Holtorf, M.D.

Yeah. Yeah. Yeah, there’s not a lot of studies showing—but it’s also interesting where people say this is FDA approved and—don’t get me started with all that. But you have—there’s no double blind placebo controlled studies showing someone on a statin and 4 different meds, what does that do to their life? And really how it just destroys their mitochondria, and increases risk for diabetes, and all these things. I think it’s amazing that there are so many studies and people look to the FDA approval, which more and more I’m just so disappointed with. Even things like getting something published in a major medical journal. If it’s anything outside the realm of Big Pharma, it’s difficult. Despite that, I think things are moving so fast in the so-called integrative [inaudible]. I hate that term. Functional medicine, whatever you want to call it, space where, as you’ve mentioned, a study in [inaudible] medicine showed it takes on average 17 years for a proven new therapy to get accepted into mainstream medicine. It’s kinda jokes like, how do you hide something from an endocrinologist? Put it in their journal. It’s amazing this stuff, I think that is going on in this integrative space and how fast it’s moving to help patients, you know? 

Neil Paulvin, DO

Yeah. I mean, that’s one of the silver linings of the COVID stuff is that things that people know about are being studied for COVID and they’re coming out in other studies, things like hyperbaric and ozone, and even the peptides are being used and checked out. So I think that’s going to help push things forward because people are like—they want everything now integrated. They hear about IV vitamin C, they hear about peptides. They want to be on Thymosin alpha-1. That’s driving it even more. They’re like, “There’s nothing traditional for—that’s gonna help me really.” Right now this stuff is gonna help. Vitamin C and all this stuff has now—vitamin D has obviously come to the fore, so it’s pushing these people even more to this, which I think is one of the unfortunate silver—or forunate silver linings. 

Kent Holtorf, M.D.

Yeah. I don’t want to get too into this, it could get a little political, but it’s scary how all these basic therapies, where studies show they work and they’re so safe, I mean, looking at even vitamin D, high dose vitamin C, zinc, ozone, IVIG, Heparin, that if you put that on the internet, you get a letter from the federal trade commission saying, “You can’t say that about treating COVID”, which is nuts because we got one for basically saying, “Here’s some integrative therapies”, and with references. So I think I’m a little worried, certainly a little worried, scared about the politics of medicine and how things are being dominated and suppressed. But I think that talk is for another day. [Laughing] 

Neil Paulvin, DO

Exactly. 

Kent Holtorf, M.D.

But, yeah, I think about it all the time. Any last things you wanna say about BPC-157 or peptides in general? Or how it changed your practice? Or anything? 

Neil Paulvin, DO

Sure. No. I mean, I think people want—that peptides are definitely going to be part of the future of medicine. So definitely check them out. And secondly, is that BPC, if you’re concerned about anything, it should definitely be your gateway because it hits so many different parts of your health. Like we talked about, from your eyes, to your gut, to your muscles, to your joints. It’s so safe, so easy to use. We know that you can take it orally, cream, you can take it rectally. So if this is your entree into peptides, or the first time you’ve been hearing about them, this is the place to start because it’s gonna help you. You’re going to feel better. It’s like, “Ooh, this one works. So let me see what else I can do with them now.” So I think definitely check it out, learn about it, and you can learn about more peptides throughout the summit I’m sure. 

Kent Holtorf, M.D.

Yeah, it’s interesting. A doctor [inaudible] up and we were talking about BPC-157. You know it’s available as a supplement now? 

Neil Paulvin, DO

Yeah. 

Kent Holtorf, M.D.

Yeah. She came up and just said, “It makes everything else work better!” You know? Have you found that? 

Neil Paulvin, DO

Yes, I have. When I take it and my patients will tell me the same thing. It’s becoming more and more ingrained as a part of their general health. 

Kent Holtorf, M.D.

Let’s just say you’re giving advice to other doctors that are listening to this. BPC-157, you say that’s the place to start? Or how would they best get started using peptides? 

Neil Paulvin, DO

The best places is definitely now—I mean, you definitely want to take a course. There’s so many out there now. Find the good organization, A4M or AMG, that are really good at getting the

courses to get your framework of just how to use them, how to interplay them, how to interplay them with other things you may use in your practice. And then just start with a couple. It’s like juggling, you gotta start with a couple, learn how to use them, learn where they’re usable. If you try to learn 20 or 30 at a time that are the ones that are all out there—there’s literally, every week, there’s some new one out in a Reddit group or Facebook that you could say, “Oh, let me try this one.” It just doesn’t work ’cause you need to understand how to use them. It’s just like any other medicine, we need to know how it works, how to use them, what patients not to use them with. So get a good foothold, get a course, start with whatever your specialty is. Then it’ll kind of snowball from there and you’ll get patients who love you. You’ll get more patients into your practice. 

Kent Holtorf, M.D.

Let’s say from the patients side. Okay, “I’m a patient. I have problem X. I want to look into peptides. My doctor [inaudible] says, never heard of them. What do I do?” 

Neil Paulvin, DO

What do you do? I mean, this is one of the cases that where Dr. Google will work in terms of finding a doctor who does peptides. Again, also there’s a couple of organizations. I know A4M and International Peptide Society will link you with a doctor in your area. There’s also a bunch of doctors now who treat you over telemedicine within their scope to help you kind of guide you with them. Then also there’s actually some good groups that can at least give you a guide of who to go see, depending on what you’re looking to do, because it’s like anything else in medicine, there’s some people who just do the sports ones, there’s some people who just do the skin ones. They may not know anything about doing the autoimmune ones. So you want to make sure you’re getting somebody who knows—it’s in their wheelhouse. And don’t try to self dose everything, I see plenty of patients come in on the wrong dose. They’re combining 5 things. You need to take a break with some of them. The stacks are insane and this is not always a do it yourself type thing. That’s my first thing I would always say, no, don’t always do it yourself. 

Kent Holtorf, M.D.

Yeah. It’s Dr. Google and hey, there’s great information online. There’s also just misinformation, so much kind of scary stuff out there. And I tell patients, go read everything. I also hear like a lot of standard doctors are like, “Stop reading the internet!” You know? Because there’s—they don’t like the information, but, you know. What I’ll say is, read everything and come and talk to me. I’ll tell you what’s right or wrong, and defend the treatments. I just think these other doctors can’t defend their treatments because they don’t know all these things. But I think—would you say—is your favorite patient the educated patient that really knows about these things and has heard about peptides and can really question you on, “Hey, why are you giving me this? What about this? What about this?” 

Neil Paulvin, DO

My favorite patient is a [inaudible] patient who is willing to have a conversation. There’s some people who are, “I heard this on such and such—” I’m not gonna name names. “Such and such podcast. I have to take this dose for this period of time.” And you know that— 

Kent Holtorf, M.D.

Oh, yeah. 

Neil Paulvin, DO

Then they won’t yield on it, but most of my educated patients, we’ll have a conversation, like a tennis match. They say, “What do you think about this? I heard this.” And they’re very educated. They have studies, they have PubMed stuff, and that’s fine. I love that because it makes things easier. It’s not like you’re speaking to them in a foreign language, but they can’t—some patients are just adamant, “I must have this.” And then you’re like, “Okay.” Again, it’s an art where you kind of learn how to play that game too. 

Kent Holtorf, M.D.

Yeah. I think it’s totally true. If they hear it somewhere or read it, it has to be true, which isn’t true. I think too—or the doc, “My doctor is adamant that I should not do this.” And you’ll find that the less the doctor knows the more adamant—the more adament they are, the less they know. Because I found the more I learned, the more I learned. I don’t know, you know? It sounds like peptides have changed your practice and changed many of patient’s lives. That’s just a wonderful thing to hear. 

Neil Paulvin, DO

No, they’ve been great. And I said, I’m so looking forward to see what the future holds with sports and regenerative medicine. 

Kent Holtorf, M.D.

Well, great. Thank you for spending the time with us here on the peptide summit. Some great information for patients and really enjoyed it and learned a lot of new information, which I’m sure everyone will find very useful. So I thank you for that. And we really appreciate you being on. 

Neil Paulvin, DO

Thanks for having me. It was a good time. Great to talk peptides. 

Kent Holtorf, M.D.

Great. Great. Thanks so much. Bye bye. 

Neil Paulvin, DO

Have a good night.