DON'T Inject What You Can't Verify: Compounded Peptide Safety Explained

Dr. Gabrielle Lyon (0:00)

What is the first mistake almost everyone makes? They treat, quote, peptides as one category. And this is where the gap between the internet and the published science is the widest that I've ever seen in my career. I've never seen anything like this. The casual peptide culture, which is something that we've never seen before, means hard on the phrase, absence of evidence is not absence of evidence. And this is true, but the absence of evidence also doesn't give you permission to pretend you know things you don't. People will say, GLP-1 are peptides and GLP-1s work. Therefore, peptides work. Well, that's not how evidence works. The question that we have to come back to is, what does the human data show? Why are we utilizing these peptides? And this episode is not hype and it is not a fear-mongering episode, because I don't make those. It's about a single idea that I want you to carry out of here, because it will protect you better than anything else that I can give you. Let me walk you through what those human studies showed.

Last week, a patient came to see me and she was convinced that she had finally found that one thing. Now, she wasn't naive. She was an engineer, so very methodical. She had a folder, an actual folder of studies on a peptide she'd been injecting for six months, something that she had ordered online after a man she trusted with real credentials said it had healed his shoulder.

She had done her homework and she had done a lot of homework. She had what looked to her like a mountain of evidence. Here's what I had to tell her.

That mountain of evidence, over 500 published papers on this compound, comes down to roughly 30 human beings in the study. Three small pilot trials, essentially one researcher behind most of the human data. Everything else, the other 99% was done in rats and mice, rodents. She hadn't found a mountain of human proof. She found a plausible mechanism and a proof of concept, which I think is very important. So let me say this clearly, upfront, I am not anti-peptide. Peptide medicine is one of the most exciting frontiers we have in modern medicine. Some of the most important drugs of the last century are peptides. And this episode is not hype and it is not a fear-mongering episode because I don't make those. It's about a single idea that I want you to carry out of here, because it will protect you better than anything else that I can give you. You have to separate the molecule from the marketplace. The molecule can be brilliant and the marketplace, well, that can be a little crazy with trends and noise. And we're going to hold on to these two thoughts, the molecule and the marketplace.

What is a peptide? A peptide is a short chain of amino acids, my favorite thing, typically somewhere between 2 and 50, linked by what are called peptide bonds. They sit in a unique pharmacological space, bigger and more specific than a small molecule drug, smaller and more nimble than a full protein. That structure in particular is the whole appeal. Peptides can act like a key for one lock, high target specificity and a well characterized mechanism of action, and generally lower toxicity than a blunt small molecule drug that hits everything all at once. It's that precision, the targeted aspect of these peptides.

So, what is the first mistake almost everyone makes? They treat, quote, peptides as one category. It's not one category. It's a spectrum of where a compound sits on that spectrum. And that's what tells you what you need to know about the peptide. People ask me, what do I think of peptides? Well, my answer is, which category, which peptides? It's like the equivalent of someone asking me, what do I think of protein? Well, are you asking me if I like steak or fish or pea protein or tofu? Now, at the top, you have an FDA-approved peptide drug class, and this is rigorously trialed, manufactured under pharmaceutical standards, with their benefits and risks formally characterized in humans. This is where the Inchertons live, like semaglutide, terzepotide, the GLP-1 class. These medications work. They have done and given people more hope and have transformed the obesity epidemic.

And people will say GLP-1 are peptides and GLP-1s work. Therefore, peptides work. Well, that's not how evidence works. Semaglutide is not the same thing as, say, another peptide like samorlin. Take retitrutide or RETA. Still one rung down. It's investigational, not yet improved, and I am seeing more people take it. I have never seen anything like this in 20 years of medical practice. Now, retitrutide, it's a once-weekly injectable that hits three receptors, GIP, GLP-1, and glucagon. In its phase two trial in the New England Journal of Medicine, the 12-milligram group lost an average of 24.2% of their body weight at 48 weeks.