Peptides, GLP-1s & The Gray Market: Dr. Emily Passic Sets It Straight | Ep 65

Peptide therapy is exploding in women's wellness — but most of what's being sold online is unregulated, unsterile, and quietly dangerous. Dr. Emily Passic is here to set the record straight.

In this episode, Aimee Rickabus talks with Dr. Emily Passic, board-certified naturopathic physician, certified peptide specialist, and medical director of BeautyDrip, about what peptide therapy for women actually looks like when it's done right.

Dr. Passic shares:
- What peptides actually are and why your body recognizes them
- The truth about GLP-1s, food noise, and addiction medicine
- Why the gray market is putting women in the hospital
- Her top 5 peptides and what each one is really used for
- Why HGH for anti-aging is a mistake (and what to use instead)
- How sermorelin transformed Aimee's sleep and muscle at 47
- The GLP-1 side effects most providers don't warn you about

Whether you're already on a GLP-1, considering peptide therapy, or just trying to cut through the noise on social media, this conversation will give you the science, safety, and clarity you actually need.

🔗 CONNECT WITH DR. EMILY PASSIC:
Instagram: @epassic
Website: https://www.emilypassic.com/ & https://www.peptidend.org/
BeautyDrip: https://www.beautydrip.co/
LinkedIn: linkedin.com/in/emily-passic-0391306

🔗 CONNECT WITH THE MANAGE HER:
Website: https://www.themanageher.com
Instagram: @themanageher
YouTube: @themanageher

———

The Manage Her® Podcast — hosted by Aimee Rickabus. Honest conversations on leadership, financial empowerment, motherhood, wellness, and career reinvention for ambitious women.

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Transcript

0:07

If you listen to my conversation with Tara Turner, then you've already been introduced to the world of peptides through the lens of experience, transformation, and what's possible. But today we're going deeper into the science, the safety, and what you really need to know before stepping into this space. I'm sitting down with Dr. Emily Pasik. a naturopathic doctor and peptide specialist who serves as a medical director behind BeautyDrip. She works closely with patients to create customized peptide protocols that prioritize safety, effectiveness, and long-term health outcomes, something that's often missing in today's fast-moving wellness space. She's also a premier educator for physicians on peptides, helping train doctors on how to properly use these therapies in a clinical setting. which gives her a really unique perspective on what's actually happening behind the scenes in this space. If you've been hearing about peptides, GLP-1s, or biohacking your body, you've probably already noticed that there's a lot of mixed information out there. What's safe? What actually works? What are people doing wrong? And maybe, most importantly, how do you do this in a way that actually supports your body long-terms? In this conversation, we break it all down, what peptides actually are, how they work in the body, the biggest mistakes people are making right now, red flags to watch for when sourcing or using peptides, the most popular peptides and what they're really used for, side effects versus optimized outcomes, and why peptides alone are not the full picture. We also get into how amino acids, vitamins, and foundational health all play a role in whether peptides actually work or backfire. This is a grounded, science-based discussion. conversation designed to give you clarity, confidence, and much more informed perspective. Welcome to the show, Emily Pasek. Dr. Pasek, we are so happy to have you here today. Thanks, Amy. I appreciate it. I'm glad to be here. Yeah. So let's start here. What are peptides and why are we seeing such a surge in interest right now? So I think there's a couple reasons that peptides have exploded. Peptides, you know, at a level that everybody seems to be able to understand they're a They're a string of amino acids that is not long enough to be called a protein. Peptides are treated differently in medicine than proteins. And so because these are strings of amino acids up to a certain length, they can't be called a protein. And so they are used sort of in a way that the body can understand. It's like a conversation with the body. So when you give a peptide, you're giving a signaling molecule and there's a receptor site somewhere in the body and sometimes all over the body for that particular peptide. And so if you give it a signaling molecule, the peptide sits on a receptor of a cell and then a string of things happen, like a cascade of things happen. And there's a lot of regulatory mechanisms the body has to be like checks and balances, like the next reaction won't go through if it doesn't need to. For example, I mean, I'm simplifying, but... But there's a lot of checks and balances. And so that's why it's actually kind of hard to hurt yourself with a peptide because it's just a signaling molecule versus a pharmaceutical or a drug, which is also, you know, these are, again, made in a lab just like drugs are, except they're forcing something. So peptides are not generally forcing things. They're working with our body because it's the language our body understands. That's so interesting. It really is. So how do peptides actually work in the body compared to traditional medications or supplements? Well, most of these things our body understands because for one, it's a string of amino acids and our body, it knows what that is. Just like our body knows what a carbohydrate, a protein, a fat, they know what those are versus things that are like toxins and chemicals. The body understands. It doesn't know what that is, right? So I used to explain this the way that if you've ever seen like babies or toddlers figuring out how to put those blocks inside of the holes, like this one's a triangle. It fits in the triangle hole. This is a square. It fits in the square hole. So that's kind of like macronutrients, proteins, carbs, and fats. Our body knows exactly where to put those. And so this is similar to that because it's a string of amino acids similar to a protein. It knows which hole that goes into. So it's not something foreign that the body has to try to figure out and has to processed through the liver. Like most pharmaceuticals, we process through the liver. Oftentimes we detoxify those through the liver, the kidneys, because it's essentially a toxin, although lifesaving. Again, I'm not bashing like drugs. I prescribe drugs too. Like this is, they're lifesaving, but the body can recognize it. It's just much more simple. It's so interesting. Are they working on an epigenetic level? In the body, like some of these? So many are. So many are. Yeah, I was just finishing a course on the growth hormone secretagogues. You know, that's like Cermorelin, Tesamorelin, Epimorelin, CJC. And they actually have certain genes that they activate, like tumor suppressor genes and the CERT gene, like things in the longevity world. The growth hormone peptides work on that genetic level to help those to become more available and more like function better. And there's A lot of these function on an epigenetic level. Yes. That's amazing. It's really fascinating. I love that epigenetic world. Yeah. You know, there's a lot of vitamins, you know, if you get them in the right forms, you know, they'll click right in. They're like keys into a keyhole. And so. Yeah, exactly. Right. Yeah. Right. So these are doing kind of the same thing where they're kind of like there's a key that fits into a hole. And if you get it right, it will click right in and then up and down regulate different genes. Right. Right. You essentially activate it and then you've got these downstream effects. And so that's why it's important to know which of the peptides you're using activate, which genes, if there's risks of cancer or if there's a gene you don't want to turn on, for example. So yeah, these are not benign. That is so interesting. It's absolutely fascinating. It's just one more level of understanding our biochemistry, which is so cool. So from your perspective, what are people getting right about peptides right now? You know, I think the thing that they're getting right is that like as a naturopathic physician, we're always talking about root cause, like what is the root cause of the illness? And let's go there rather than the bandaid, rather than like, oh, let's put a bandaid on these symptoms and then maybe you'll feel better. But then they get off the medication and all everything rushes right back in. So we're trying to fix things at a root cause level. And that's what I love about peptides, which is why when I got into them many years ago, I was like, this is cool because it speaks to me at in my holistic nature of being a naturopathic physician, because there's a peptide called lorazetide and it seals the tight junctions of the gut. Nobody talks about this peptide. So why I bring this one up, I don't know, but it seals the tight junctions of the gut. That's its only job. It just does that one thing, right? A lot of these peptides are pleiotrophic. They do a million things, but this one, its only job is to seal the leaky gut. And most people kind of have heard about leaky gut at this point. And it also seals the junctions of the brain, the blood-brain barrier. And so that can stop this humongous cascade of immune and inflammatory events downstream. So anybody with immune stuff, we're usually looking right back to the gut and its job is to seal the tight junctions. I have herbs and I have nutrients, you know, zinc carnosine, and I can use a whole host of herbs that help that intestinal permeability. But lorazetide does it better. And there has been a ton of clinical trials. They've used this in children's hospitals with active ulcerative colitis just to seal the tight junctions. And I'm like, that's pretty much the coolest thing. And also like, I think the medical world doesn't care about gut permeability like we do as naturopaths. But I thought, oh my God, there's a peptide that can do that better than all my naturopathic tools in my toolbox. And so that's when I started realizing, same with BPC, right? In trials, it's like healing gastric ulcers and stuff that I can do. I just need sometimes like a whole dietary approach and take these five supplements. And so this is like one peptide can do all of that. It's just phenomenal. So I think what we're getting right is that we're actually doing root cause health. And I think people don't realize it, right? Like GLP-1s, like we are changing the metabolism. We're changing the landscape of everything from cholesterol to blood sugar to inflammation. And so even though people are like weight loss, it's like, but I'm looking at their labs going, oh my gosh, no, you're like, you don't have metabolic syndrome anymore, right? Like we're saving your life on a level of like complete transformation. So I love it. I love it. Yeah. I wish that they would have been around. You know, I got diagnosed with metabolic syndrome when I was 26 years old and I had to go the whole, you know, oral insulin way and diet and exercise. And I really had to bootstrap it. And it took me about four or five years of working really, really hard to get my body back on track. So it's really neat to see that there's something that now can signal the body to say, Hey, everybody, let's get in line here. And it works on your brain. which is so amazing that it actually changes that food chatter in the brain. That was the one thing I really noticed with Ditter's Appetite was, wow, instead of going like, ooh, I really want a cookie, I really want a cookie, I really want a cookie, my brain's like, hmm, you know what sounds good? A cube of cheese. Like, really nice cheese. Like, let's go get some of that Swiss Gruyere. I'm like, oh, that's so weird. I hear that a lot. I hear with JLP1s a lot of people actually crave healthy food, which is Almost across the board, I hear that. It's pretty cool. Or they, you know, of course, they don't want the alcohol. And I often find people don't crave the thing that was pushing the dopamine button in the first place. So, you know, obviously alcohol is going to push the dopamine button. For some people, it was chocolate after every meal or dessert after every meal. Or some people, it was chips. For some people, it's, you know, fried food. It's like whatever we're kind of addicted to, it tends to really blunt that craving. It's next level. I was talking to an addiction medicine specialist and he was saying, you know, I was like, well, what about GLP-1s? And he's like, oh, that's old news. We've been using those for years now in addiction, you know, in addictive medicine because it really does, it breaks that mental cycle that people have, the chatter that tells them, no, you need this, you want this, you need this, you want this, when you really, really don't. Yep. Yeah, I've been saying that for years, that they're going to use this as a primary treatment for addiction in the field of psychiatry. Soon. I mean, I started saying that probably five years ago and I have talked to some people in the industry and I think they're really, it just needs to be, you know, FDA approved for that purpose. But I do think it will be. Oh, it should be because it definitely is working. You know, there's enough that someone just needs to probably power a clinical, a big clinical trial with it. But I think that it could really change the world of addiction. And that makes me so happy because it's such a struggle for some people. Yeah, absolutely. Yeah. And what do you think are the biggest mistakes or misconceptions you're seeing with peptides right now? You know, the biggest mistakes are really just about sourcing and where people are getting them. So this is probably half of our conversation today is gray market peptides. You know, the biggest mistake is doing a peptide without it being managed by a prescriber, by a doctor, somebody who knows what they're doing. Because, you know, like I said, these are not benign. There's not a ton of really negative peptides. potential side effects or risks to the safe peptides, right? But we're kind of talking gray market. There's plenty of potentially unsafe things with gray market peptides, but okay, you don't want to waste your money. So there's a thing like if you get five peptides, you're like, I'm going to do all five of these right now. Like, I don't know. I mean, is it pushing the mTOR pathway, the AMP pathway? Like, are we trying to be anabolic or catabolic right now? Like, you kind of have to understand how the peptide works. And so when people are just like, stacking, stacking, stacking. And then I'm going to cycle it like this because I saw this TikTok. It's like, well, there's a time and a reason for all the peptides. And so you have to understand what pathways they're going down and what pathways they're pushing in order for it to really help you. Peptides are expensive. You don't really want to waste your money. And so it needs to be the right time and situation and amount and the cycling thing. So there's the whole issue with gray market, right? Like That's a no. That's a no. Like it should not be done. I think that if you can't get it from a prescriber, don't get it at all because we don't know what it is. We don't know what's in there. We don't know what's not in there. So I think that gray market is just a humongous risk. And yes, peptides are expensive, but you get what you pay for. Like it shouldn't be cheap. So if it's cheap, it's not the right thing. So it's a big question, but I think that's kind of the summary. Yeah, definitely. Yeah. Don't waste your money and do them the wrong way anyway, or just waste your money. It's better to know what you're doing and how to do it and know that you're going to get the best benefit, biggest bang for your buck really by having someone alongside you. Yeah. I tend not to start two peptides at the same time. I mean, it's. you don't know which one, especially if the peptides have similar benefits, right? Like if I bring on a growth hormone secretagogue like sermorelin and NAD, well, one of those might really benefit your sleep. But if you start them at the same time, you don't know which one benefited your sleep. And so when your sleep starts to suffer in six months, you're like, oh, which one do I bring in? Which one do I use when my sleep isn't great? If you're cycling on and off things, right? Because they both can affect your sleep positively. We don't know which one if you did them both at the same time. So I like to bring them on, do like the full dose for a month or so. And so a growth hormone secretagogue might be five days a week. NAD might be three days a week. So like do it and do it fully and understand how it feels in your body. And if you have any negative reaction, right? Because we want to know that too. But again, if you combine two at the same time, you're not going to know. So I think that if people are doing it in a smart way, they're going to do this way, which is just focus on one. And also these are not multiple peptides. We're not mixing things in a vial, right? Like if they come in a vial, they come in a vial together. Like CJC, ipamorelin can come in a vial together. Similar pH, they're working together. And maybe we'll talk about this, don't promote mixing peptides in a vial or a syringe. So we want to know what that single peptide alone does. And because if you're going to have a reaction, we want to know that too. Yeah, that makes sense. Totally makes sense. Yeah. Are there any trends that immediately signal a red flag to you as a doctor? Well, that's actually a nice segue. Yeah. All those peptides that are combined in a vial, we don't have studies on those. We don't know if they work. We don't know if they don't work. We don't know if there is something, you know, Wolverine, Clo, Glo, things where there is GHK copper in a vial with something else. I mean, there is a ton of arguing on social media right now about the pH and what's happening with a copper peptide. And I've talked at length with pharmacists and people who have been in this industry a long time. And the people that have done this a long time say, don't mix GHK copper with anything else. And that's the main thing I see in terms of trends is people mixing stuff in a bottle, giving it a fancy name. And then everyone is like, this is great, but we don't have research to say that that is safe or effective. So, you know, maybe, maybe one of those peptides is active when it comes out, but maybe, you know, two of them are, but then they've got like three peptides in one vial and there is chemical reaction that happens with peptides, which is why we don't really know. Cause there isn't research to say that it's safe or effective. So, and you're only going to find gray market places generally that are doing this combination. So A pharmacy offers those combinations. That's a red flag to me because the pharmacies that I use that I've been with for six, seven, eight years don't even make those. And they're like the good pharmacies that, you know, sterile accredited. They're not making glow, right? No. Yeah. But you guys have, I love the beauty mints, been using them, think they're awesome. And so that your compounding pharmacy makes like an oral GHKCU, which is like the copper peptide for your skin. Yeah. I'm using it to stay, keep it young. Well, and even the copper peptides in hair, you want that to be in its own thing. Like you actually don't want to combine a copper peptide with anything else, even for topical use. Same thing. Like we're talking, this is a very fragile molecule that if you combine it with other things, it may not be effective at all. And so you don't want an expensive topical peptide or oral peptide. or injectable mixing with something where then it's not useful anymore. So we use copper on its own, copper peptides on their own. I love that. I think it's so cool. Yeah. I've, I've really enjoyed my results and even feeling it in my, my hair from taking it at night in my mouth, you know, like, you know, yeah, I noticed that too. And I was taking the beauty mint for my knee cause I had a major knee surgery and I wanted it for the collagen and elastin because I needed to like, repair a very serious surgery, like an injury. So I was taking it just for the injury. And I was like, well, my hair is getting thicker. My hair has stopped shedding so heavily. I was really going through like a perimenopausal hair loss situation. And I'm not losing as much hair as I was like, I think I started about five or six weeks ago. And it's really starting to slow down now. That's awesome. I'm very grateful for that. Yep. Me too. I noticed the same thing. Yep. Yeah. It's awesome. So how big of a concern is the gray market when it comes to peptides? Well, it's a huge concern because so many people are getting them there. And the biggest issue is the sterility. Like don't inject yourself with something that's not sterile. Period. Period. like end of story. And we don't know what's in there. People are like, there have been so many news reports of people like compounding them in their basement, you know, and then it's not even what it said it was. There's places going under. I mean, there was a local place here in Kirkland that just went under one of the big brand names that you've probably heard of that I won't say, but it's like their whole, you know, distribution center was shut down. I mean, that's just, they're not, they're not accredited. They're not, FDA regulated, like our pharmacies are regulated by the FDA. It doesn't mean that the actual peptides are regulated, but the pharmacy has to follow FDA regulation. None of that is being done on the gray market. They're not sterile. Again, it's not an accredited pharmacy by the board of pharmacy. There's this whole list of things. They're not legit script certified. I mean, there's like all these boxes to check, which that has to be done. And they're doing none of it. That's one of the reasons they're so cheap. Because it's very expensive to keep up those, right? Like as a physician, I have to keep up my license. It's really expensive to keep up a license. I can't imagine how expensive it is to keep up an entire pharmacy's, you know, everything like OSHA standards and FDA, all this stuff. And so that is one of the many reasons it's much more expensive to get sterile safe peptides. Oh, yeah, definitely. My mom is a pharmacist and my mom had a pharmacy. And so I saw it. I know exactly what goes into keeping up with the standards. And it is very expensive. It's very expensive. It's a lot of work. And you have to do that stuff usually every year. But again, you get what you pay for. And so the gray market is this weird place where it's like anybody can put themselves online and have no experience. prescriber, no actual prescription, no consultation. It's the Wild West. It is, for sure. So how, in your opinion, how important is physician oversight in this space? I mean, it's 100% one of the most important. There's two things that are most important, where you get your peptides and who is managing them for you, right? People come to me all the time. I have hundreds and hundreds of patients that I've done peptides with. And They'll tell me the either results or lack of results or the side effects from what they were on before. And I was like, oh, gosh, who is managing that? Like, just curious, is it was it your primary care or your longevity doctor, your whoever, you know, there nobody was managing it, which is why either they had side effects. It didn't work. They had a full body skin rash, whatever, what after every injection it needs to be managed. And and it's this is medicine. You know, it's medicine and it's like they're meant to be prescribed. When we talk about medication and pharmaceuticals, certain things are meant to be over the counter. You could still hurt yourself with an over-the-counter medicine, but there are certain things that have to be prescribed because they can be done wrong. And peptides are in this gray area of like, you know, you can kind of somehow get it on your own. You can get it prescribed, right? It's this middle of the road. It's like mixed between a medication and a supplement. It's like exactly what it is. Yeah. It's kind of like a supplement that you inject sometimes, you know? Sometimes they're oral and sometimes they're topical. Yes. It's a weird space. I mean, luckily we're getting there. Like we are getting so much closer, especially with these category two peptides that are just getting moved. And we're getting there. They just, you know, we need some years and we need a lot of trials and results and very clear indications for these. And I think things are going to be changing in the next couple of years, but it's a slow process. We're getting there. Yeah. Medicine moves pretty slow around here. And that's why people are just chomping at the bit. They're like, Hey, we got to get this stuff. Like they know it's going to take like 10 years to get FDA approval, but that's the way it is. And so I think as long as it's prescribed and managed by somebody who knows what they're doing, they're very safe. I've never had a bad outcome, eight, nine years of this. I've never had a bad outcome. I've never had a patient go to the hospital. I've never had a bowel obstruction. I've never had pancreatitis, any of the things, none. Amazing. That's good news. So tell me, what are some of the most commonly used peptides right now? Like in your arsenal, what are your like top five? I think it's, of course, GLP-1s, more terzapatide than semaglutide these days, of course, because semaglutide does come with nausea. Typically, terzapatide does not come with nausea. Those are the biggest. NAD is not a peptide. It's a molecule, but we classify it in the peptide space because it's like you use an insulin syringe, it's injected, you know, it's kind of, it's in the realm, but it's not a peptide. But I would say NAD is probably the next most common. Cermorelin is the growth hormone secretagogue that we use. That is probably the next most common. A lot of people are using CJC ipomorelin. So those are pretty common. I would say modest C is gaining traction as a mitochondrial peptide. It's also an exercise memetic and so like exercise and fasting. So it mimics exercise and fasting when people are like, that's cool. But I'm like, it's cool because it's doing mitochondrial work, which is also like, that's what we want to repair mitochondria. So Of course, BPC. BPC is famous, right? Because it does so many things. So for anybody who's never heard of BPC, what does it stand for? BPC-157, body protective complex or body protective compound. It is anti-inflammatory. It's healing. The other thing I love about it is that it sensitizes your growth hormone receptors. And so it makes your own growth hormone or your peptide growth hormone work better because the receptors are now more active. But it just heals things so well. You can use it in injection. I have it in a wound healing cream. I have it in, I have BPC eye drops. I have it in every form because I love it. I always make sure I have the capsules available just in case I ever need them, like a backup. I love BPC. It's phenomenal, you know, for wounds using, you know, injection version. You don't have to do it in intraarticular or near the wound site, but post-surgical, I mean, it heals things so fast. And what I saw in the clinic when I was doing it with kids, we would give it to kids for, you know, ankle sprains and all kinds of injuries. I'm not kidding you. They're better over the weekend when I'm like, oh, this is going to take weeks for this sprained ankle to heal. And it was days. I was amazed. That is amazing. That is so cool. Especially for my boys who all play baseball. Yeah. Yeah. As like, as moms, we're always managing, you know, our whole house full of people. So, you know, if you've got kids that are playing sports, this is one that we should be looking into, you know, do we need to have this in our medicine cabinet? Yes. It's so safe, right? You can't hurt yourself with BPC. And it's also really great for GI inflammation. I've seen cases of like kind of chronic gastritis and, um, reflux or just GI irritation. And I'm talking like 10, 15 years, people have had the same kind of GI issues completely go away with BPC. It's like, it really just answers the question that something was inflamed or something needed to be healed or both. This is so simple. I mean, your body makes a version of its own BPC. So that's why it's so amazing. That one is, and I do feel like that one has had been extensively studied and proven to be very, very safe, right? Very safe. Yep. That's awesome. So could you break down a few categories like fat loss, muscle building, recovery, skin peptides? Yeah. Yep. So I would say fat loss, we're going just GLP-1, somaglutide. Liraglutide. Nobody really uses Liraglutide. It's a daily. It's an injection version. It's a daily. But it was out before semaglutide. So I used... That's the one I started with, you know, maybe nine years ago prescribing Liraglutide, but it was a daily GLP-1. There is a... I think Saxenda is the name of the medication version of it that's FDA approved. Anyway, nobody really uses that because it's daily. And I would say for weight loss, you know, I would... There's nothing that really compares to the GLP-1s. There are some people that will see weight loss with the growth hormone secretagogues, but if I had to put those in one category, it would be muscle building. So I would say, yeah, those are GLP-1s for weight loss. Muscle building, I would go with all the growth hormone secretagogues. So sermorelin, tesamorelin, hexorelin, CJC, and evamorelin. There is five, and it's a completed category because they're all slightly different. there's the GHRHs and GHRPs. So those are growth hormone releasing hormone and growth hormone releasing peptide. They're a little bit different, but that's going to be your muscle building category. You know, those are phenomenal, but there are people that actually will lose weight because they're simply building more lean muscle mass, right? That transition, it's not going to do appetite suppression. It's just about when you have more lean mass and you have better control of your metabolic health, which they do, then you can lose weight. It's just not, it doesn't work on the same way GLP-1s work. It's not going to, you know, reduce your appetite. In fact, some of the growth hormone secretagogues can actually increase your appetite. And so that's why it's important to know and work with somebody who understands this. which ones increase your appetite and which ones don't. So I love the growth hormone secretagogues. They're probably one of my most favorite categories aside from GLP-1s because they do so many things in the longevity space in terms of presenting your body with something that it already does, it already needs. And when you lose growth hormone, you are more susceptible to the chronic diseases of aging, neurodegenerative disease, of course, cancer. And because they do work on the p53 suppressor gene, we're talking about tumor suppression, heart disease, and even bone loss, right? Like there's a risk of dying from osteoporosis and osteoporotic fractures after a certain age. And so when you build more bone, like you do with a growth hormone secretagogue, you're really reducing your risk of osteoporosis. So the things that kill us in aging, we can work to reduce those with growth hormone secretagogues and bioidentical hormones. And so You know, that's why I love them. They take a little bit longer, I would say, to work because when you're trying to build muscle, you can't do that overnight. You can suppress your appetite overnight with a GLP-1, but growth hormone is more of, I would say, more of a long-term treatment. That's awesome. Yeah, and I would say Mod SC is sort of in that category because if we're talking an exercise and fasting mimetic, it works both. It's kind of like I would put it in between the GLP-1s and the growth hormone secretagogues because it's going to help metabolically. because it's helping your mitochondria to function better from a fasting and an exercise perspective. So MAD-SC is kind of like a cherry on top with, you know, GLP-1s and growth hormone, if that makes sense. Awesome. I would classify BPC in there with muscle building, because like I said, it sensitizes the growth hormone receptor. So I'm not giving BPC as like a bulking peptide, but I throw it in with a growth hormone peptide because it sensitizes the receptor. right? So you're dumping more growth hormone from your pituitary and where it's receiving that or the receptor on the tissues is more active. So that's where I would put BPC. Healing peptides is going to be BPC, TB4, and probably KPV. Thymus and beta-4 is one of my favorites. I'm not a TB500 kind of a person because I've been in the peptide game long enough to know that we used to call that TB4 frag. That's a fragment of TB4. So thymus and beta-4 is a I mean, healing wounds to the max. And it often is combined with BPC. This is one of those ones that does come in. I'm talking sterile accredited pharmacies do use BPC and TB4 together in a vial. It works amazing. I mean, I must have recovered twice as fast as I should have for my knee surgery because of those peptides. Are we able to get that through Beauty Drip or do you have a pharmacy that we can use? Should be soon. Give us two weeks. Yay. Two to three weeks. So BPC and TB4 are going to be your healing peptides. Those work better than just about anything. However, this is why I said like these are pleiotrophic. They have so, they do so many things. The growth hormone secretagogues are very, very healing. So if someone's injured, I'm going to bring on something like Sermorellin and to heal an injury. It's not going to heal as well as thymosin beta-4, right, or BPC, but it will actually help with chondrocyte stimulation to build more collagen in your joints, to heal, to be anti-inflammatory, and heal bone. I mean, so the growth hormone peptides also jump into the healing category. If you don't have access, for example, to BPC or TB4, but you have a growth hormone peptide, that does incredible healing. I use it for traumatic brain injuries, post-concussive syndrome, even somebody who's had just a lot of concussions because they were a former athlete or competitive or professional athlete, I'm going to use growth hormone for that. And then skin peptides, we're talking usually GHK copper, although NAD really can help with skin as well. You know, everyone's a little bit different in how NAD helps. And honestly, like NAD is a little bit in all these categories. We need NAD to survive and have energy. And if you're pumping out more ATP, that's the whole purpose of nad and it's going to go wherever your body needs the energy so if you need it in your brain it's going there more if you need it in your heart it's going there more it's like so nad really covers like i don't know what it's going to do for you until you take it like i can say what it's probably going to do but some people say nad really helps their skin right because if you're if you're getting more atp you need that on the like the level of like hair skin and nails and so i think that was all your category so they get all the chemicals yes you did good job Good job. And with the NAD, I've only done it, I've done it with, I have a doctor and my gosh, she had us doing IV NAD therapy like years and years ago. I want to say like six years ago. But now if you're like doing it sub-Q, is that something you do like every day or how, what is that like? Yeah, we do it three times a week. So NAD IVs, when I think they're good is for like an acute big thing. And so if people were using them for COVID, acute cold and flu where they're really, really sick and you want to like get over the hump really fast, I think that's a great time for IV and AD. I personally don't think it's great to do those huge doses all the time. I think that that's too much. I think that's very, very much super physiologic. And where we're working is this very safe space. We're not trying to go super physiologic with any of these peptides, right? We don't even go super physiologic with B12 because it's not going to help you. If your body doesn't need it, you don't need it, right? You're wasting your money. And then you're pushing pathways past their point of comfort. And we don't know what happens after that, right? We're pushing NAD down the CD38 pathway. That's not good. You want it to recycle or make more or split up, go down the longevity pathway. I don't want to push something that could have a negative effect with this huge thing, right? NAD already is a big molecule. It can't fit through. It's like it's breaking up into its individual components and coming back in the cell so that it has the cofactors to come back together once it's crossed into the cell and to make more ATP. I think we need to be really careful about with NAD. So we're doing a smaller dose. It does still really work and you can feel it. The reason, part of the reason you know it works is if you've had NAD IVs, which you have, you know, you can feel like you're having a heart attack and you're going to throw up. Yes. Yes. I actually really was about to throw up this one time and I'm like, oh my God, like actually in the middle of the clinic, I am going to, yeah. And they had to give me the Zofran to calm it down. Yeah. That's exactly what happened. So you get a micro version of that with SubQ. And so we start with 10 units, which is the kind of the starting small dose. And then we have people increase each week by 10 units, max unit 50. And the way that I think about it is, okay, we're repleting a depletion of NAD. And you use up your NAD, I would say primarily alcohol use. And I'm not like saying last week's alcohol use. It's like, what have you done to your body the last 20 years with alcohol? Because you have to you have to put it back in when you've used it up and you were either not making enough because we make less as we age. We also use up more as we age because you need NAD to repair cellular processes from damage from like chronic infections and inflammation and chronic stress and lack of sleep, hormonal deficiencies. So your body's using up more and more NAD. So as you start to replenish that deficiency, you give yourself this sub-Q NAD and you start to feel things like your heart is going to race a little bit. You might feel kind of lightheaded. You might feel a little bit of anxiety. You might even feel a little bit of nausea, but it's micro compared, but it is the same kind of things that you would feel in that IV, right? But it's a micro version where you're like, oh, I think I'm going to like sit down instead of walk around the house really fast because you get a little lightheaded. I think at that point, you're actually... repleting the cells. Like, for example, I feel those kind of fluttery feelings at about 15 units, 10 units. There are people who don't feel that until 50 units. And I think they were very deficient and they finally started to replete their deficient stores at 50 units. It's like, well, then they need 50 units, at least for now. Right. And some people can replete the stores and then they can go back down, I think, to And a more appropriate dose, maybe 40 units is good for them, maybe 30 units. I mean, we don't really know, but this is why we work with each person individually on their dosing so that they have the right dose. Like you want enough for it to be effective, but not so much that you're feeling like you're going to pass out and throw up. Absolutely. Yeah. Nobody wants to feel like that, especially at home where they don't have any Zofran or anything like that. Right. And it's eating. It's usually lasts for five or 10 minutes, but that's kind of how I think of NAD. And so for some people, again, this is like the, it fixes their, their chronic insomnia. And for some people, this gives them all the energy in the world. I mean, for some people it's about mental health. It's like a creative process or it's less, you know, depression or anxiety. So I don't know where they're deficient in their body. Again, we are most of our mitochondrial lead dense organs. Like we have our heart and our brain. So it's, The heart and the brain are what are getting a lot of that NAD, but that's also where those symptoms come from, right? Like the lightheadedness and the heart racing. This is, again, going back to why I have people do one peptide at a time. We get to know how NAD works in your body. We do kind of know at a certain age we need it. We just don't know how much. That's fascinating. And then we talked a little bit about bioidentical hormones. Are you also doing those as well? Or would somebody have to go to a different prescriber for that? Yeah, I'm not doing them through BD drip. No, I just I just am in Washington for Washington patients. But I think here's my stance is that the best outcomes generally are peptides combined with bioidentical hormones. If we're talking about a certain age group of Yeah, I mean, I'm talking about the 40s, 50s, like us girls, like, yes, Yes. That's going to be the best combination. And the reason is because if someone comes to me and they say, okay, I'm 48 years old, I don't sleep, give me some NAD. And I don't want to set them up for failure, right? We want success. And I say, I can give you NAD for, and hope that it helps your sleep. But realistically, you probably need some progesterone. So I'm not going to lie to them and say, it's the answer for everything. It's a cure-all. It's like, well, your progesterone started to decline. Like, 10 years ago. So maybe you should do that too. And I have that conversation with all my patients that we don't want to miss these other factors. And that's why we talk about sleep. We talk about diet and exercise with every patient because I don't want them to think that peptides will replace those foundational pieces of a healthy life, right? You have to have it all. And so So bioidentical hormones are a huge part of that conversation. And while we don't do them, I do say you should see your provider and somebody that does these because that's going to be the best outcome. That's amazing. And then one of the things I loved what you guys do at Beauty Drip, it's not just Terzapatide. You guys are compounding this and adding. Go ahead and tell the girls what you guys put in there. Right. So we're also using B12 and glycine. And I think most of the world understands the benefits of B12 and energy and the common deficiencies. And, you know, one of the reasons that B12 is deficient in so many people is because it has to be activated. I think there's seven different places, if I remember correctly, for medical school. B12 has to be acted upon by certain enzymes in the stomach and, you know, the duodenum, the small intestine, large intestine. If one of those things has inflammation and it's not working, that enzymatic reaction, poof, your B12 goes away. And that's why people have like B-shot happy hour on, you know, Fridays at a certain clinic or whatever. Why people are just walking around getting like B-shots, you know, at the health food store is because your gut has to be completely healthy to absorb the B12 from your diet. And so most people have a little bit of gut inflammation or chronic gut infections, and their gut isn't healthy. Or they have constipation, which is like, what, 80% of the world? I mean, it's like everybody has constipation. And then your gut is not functioning optimally. So B12 is a really, really common, you know, inefficient, like it's deficient, but not deficient enough that people have symptoms, but it's not. optimal. And I would say that's why B12 is so helpful and also why it's in a lot of the formulas. And so ours is in our semaglutide and terzepatide. And then also glycine, because glycine helps with honestly so many things, so many hundreds of reactions in the body. It's kind of the way I think about magnesium, hundreds of reactions. And so you really need glycine if you want your muscles to function optimally. And putting glycine with something that could be potentially waste muscle if you lose too much weight, if you're not strength training, if you're not carrying around that extra 60 pounds, if you don't want to lose as much muscle, you should take glycine. And so glycine is actually in these compounded peptides. That's amazing. You know, I never even, glycine was not on my radar until I started talking to you guys. And then I started doing research on glycine and it blew my mind. I sleep better. I feel like it's also helping my hair. I feel like that might be one of the other reasons why you guys put it in there because the triseptide can cause hair loss because you kind of aren't eating as much and you can get some of those side effects with it. So just brilliant to put those together. Yeah. I honestly think that glycine, one of the reasons it's so amazing too, if you were to take it orally, it tastes like sugar. It does. I have some. It's so good. You can just put it in your mouth. It's like a little powder that tastes like sugar. Yes. My recipe for iced tea, it's not iced tea at all. It's glycine, creatine. So one scoop of creatine, one scoop of glycine and fulvic acid. And then I add just a little bit of stevia to it. It literally tastes like iced tea and it's so good like post-workout. That's awesome. I'm surprised you even need the stevia with the glycine because glycine I feel like is so sweet. It is sweet. But just a little. Okay. I think I'm just conditioned for it. Actually. I think I've been using it since I got diagnosed with metabolic syndrome when I was 26. So 21 years of using Stevia, I'm just, it's my sweetener, you know? Yeah. That makes sense. Yep. Yeah. It's a long time. So what are the most common side effects people experience? So let's talk about GLP ones and side effects. So the most common side effects are if you're using some of the glutide is going to be nausea. Of course, that's the big one. It's part of the reason you people don't like semaglutide as much these days is that the nausea can go away. In my experience, that's going to take six months or so before that can subside. Some people, maybe three months. I've seen maybe 5% of my patients on semaglutide didn't even get nauseous. 95% got nauseous. And then we have to bring in Zofran and it's like, now you're adding a medication just to get over it. It's not the worst thing in the world, but it is not very fun. So I'd say the most common with semaglutide is going to be nausea. And then the other side effects are common to both. It's interseptide and semaglutide. So constipation and constipation for me, it's actually very dangerous. And so the problem is that, like I said, like 80% of people or something, they're going into this journey already constipated. And then they're taking something that generally slows their gastric motility. It slows their, you know, the emptying from their stomach. And then people haven't actually learned to eat less. Like they have to forcefully eat less when they start. So now they're kind of shoving food in and it's like a compactor and it's going down slower. I just had a patient I worked with and I, if I hadn't been messaging with her several times a day for two weeks, she probably would have gotten to the emergency room with a bowel obstruction or a complete blockage because she was so constipated. I mean, we got to the point of like stool softeners, laxatives and multiple enemas. And she's finally going for colon hydrotherapy. But if I hadn't walked her through that, she would have been in the hospital. So I was glad she reached out to me. But this is something that I see is very dangerous because if you're not taking the right amount of magnesium citrate and the right amount of fiber, you're at risk for blockages. And that is something I wish more people could understand. So when they come to beauty drip, I have a series of videos that all the patients get. And there's like a six minute video on constipation. It's like, here's what to do. You have to drink a lot of water. You know, you really have to take note of like, how many bowel movements a day you're having. And if you're having them every third day, like you need to reach out to your provider. That's not okay. And that's not okay anyways. But you don't want to make it worse, right? So constipation is a big issue. Reflux, I would say reflux is very interesting because most of the time people have reflux. They simply had reflux before they started and it just got worse. However, there's the case of eating too much. And I think oftentimes people aren't counseled to eat less. Like they should start eating less within that first shot. Like it's in your system in a couple hours, four hours, start eating less right away. Because again, if you pack it in, it's going to start refluxing, right? That's really uncomfortable. Because it's slowing everything down. Your metabolism is being slowed down by this signal. Your signal says, slow it down. Yep. Slow down boss. And then you're like, but I'm eating the same amount. And then it's kind of coming back up. And so- you don't want reflux, that's really bad for your esophagus long-term. And so I don't see reflux in my patient population quite as much. I do see constipation more, but I think reflux you need to tackle if it happens. I have certain supplements that really help with that. Sometimes it's digestive enzymes and sometimes we just need something to like coat the layer. Like We call them mucilaginous herbs. Mucilaginous is sort of like the consistency of oatmeal if you made oatmeal and let it cool down. Like marshmallow root and slip, you know, it's like DGL, which is decoacidated licorice and aloe. You know, it's all those. And so we have some supplements that will coat the lining of the esophagus and the stomach to help that. And those tend to work really well. And eating less. And eating less. Amazing. What separates a bad experience from an optimized one? in your opinion, with these kinds of peptides? It's so hard to say like what a bad, I mean, a bad experience is somebody that is frankly injured by a peptide, right? So that's what we're talking about there is kind of two things. Poor dosing and management and somebody ends up in the hospital, like worst case scenario, right? Somebody ends up in the hospital because they weren't managed appropriately or weren't managed at all because they got them on the gray market and no one said how much to take or what to do. And they had a bowel obstruction because of severe constipation. I had this once where there was a patient and I prescribed it to a person. That person's spouse did not consult with me. They just took it. They ended up in the hospital with a bowel obstruction. And so education and guidance. It's like being having a practitioner that can educate you on how to use these things appropriately is essential. And be there for you when you have questions. Like, yeah. I'm answering questions seven days a week, holidays, Sundays, Friday nights, whenever, like before I get out of bed in the morning, I'm answering questions. Those questions don't go unanswered for 12 hours. It's like you need to have somebody you can ask, you know, that is managing your health around peptides so that they can say, OK, here's what to do. And I tell all my patients, if you're constipated even for two days, please reach out to me and I'll help. That's nice. I mean, I think that's what I feel so good. Even trying the Smorlin with you guys. I love it by the way. I'm sleeping so good. And I think that's great. Yeah. It's one of the things that in the last year with, you know, my hormone changes, the thing that was affected the most was my sleep. And I am sleeping so much better. Like the five nights a week that I take it before bedtime, I sleep so good. And then those other two nights are, maybe I need to fill in with a little NAD or something so I can, you know. I love, I love this for you. I was, I was just doing my course on growth hormone secretagogues and I've really seen in my patient population, I treat a lot of firefighters interestingly, and they don't sleep for obvious reasons. And I've seen a bunch of them. I just absolutely love it for sleep. And, you know, growth hormone needs to be activated for appropriate sleep. And, And it's kind of like this loop where when you sleep, you produce more growth hormone. So there's a reason we dose it before bed because that's your biggest surge. You know, you've got these surges throughout the day and throughout the night, but your biggest surges are at night. And that's when you produce more growth hormone. So you want to give yourself that little oomph before bed because it helps with your sleep. But then it also, when you have more now, you have better sleep. And so it's so interesting where The people who were deficient and not frankly deficient, they don't need human growth hormone from an endocrinologist. We're talking like optimal health, right? And so that's what I'm finding is that just like you said with the sleep, you get to know how it worked in your body. And for me, I sleep great. I didn't need it. I've been taking growth hormone peptides for like four years. I use it for muscle optimization. Like I just want to be stronger. So that's what I use it for. And I absolutely see it work. Absolutely see it work for that. I mean, I've got that too. My muscles like came back. I really lost a lot of muscle last year. And so it was nice to be putting muscle back on and sleeping great. So I have to say two thumbs up from me on the Surmoreland. I really, really like it. And I haven't had any side effects from it at all, which is awesome. That's great. And I would say it's a low side effect profile for Surmoreland and Of all of them, of all the five that I had mentioned that are in the growth hormone secretagogue class, it is the safest. It comes with the least side effects. Like it doesn't promote hunger and you can use it in most people. So I would say that is a great peptide. I had all my muscle come back after being non-weight bearing for four months after my knee surgery, where everyone said it's going to be two years until you get your muscle back. Because it's like I completely lost all of it because I couldn't walk for four months. But It's back and I'm seven months post-op and it shouldn't have been back for two years. So that's what I did differently, right? It was growth hormone. That's amazing. And so we had this great conversation about actual growth hormone, though HGH versus these drugs that make you secrete your own growth hormone. Let's educate them because you gave me such a good education on this. Yeah. So you don't want to take actual growth hormone. This is like HGH, human growth hormone. This should only- be prescribed by an endocrinologist for frank growth hormone deficiency because you will burn out your supply and your receptors by using actual growth hormone. I think about it the same way testosterone is used. So once you take exogenous testosterone, and this is generally in men, it will affect their fertility. That's why if we give testosterone to a man, the conversation is, are you planning on having kids or any more kids? Because your supplies are going to be burned out after this. Once we give you this outside version, right? Same thing with growth hormone. If we give outside growth hormone, actual growth hormone, you're burning out your receptors. And guess what? You have to take it for life now. For life. For life. And so we don't want that. So a peptide version is a signaling molecule, going back to what we said at the very beginning, a signaling molecule that tells your pituitary to make more growth hormone and dispense more growth hormone. But it's doing what your body already does. It's just signaling this cascade so that you essentially just dump more out of your pituitary. And we're giving these tiny amounts, right? This is like a micro dose, but it's not actual growth hormone. It's a signal. And so and these are, you know, two of them have been FDA approved of the five that I mentioned. That's sermorelin and tesamorelin have been FDA approved. And the reason – so they took surmorelin off the FDA-approved sort of status recently, not because it's not safe, not because, you know, it hurts somebody. It was simply that it wasn't effective enough to give kids with frank growth hormone deficiency because they need actual growth hormone. They were like, well, you know, this is okay, but it's not good enough to use in big pharma for actual growth hormone deficiency. But it's been studied – heavily because it's already been FDA approved. And tesamorelin too, which is used, you know, in essentially HIV patients who are cachectic and bedridden for, you know, maintaining muscle mass, building muscle. Wow. That's fantastic. Because you do see some of the anti-aging doctors prescribing the HGH for anti-aging purposes when they could be using this instead. And I'm so glad that, you know, I went this way with you rather than going the other way. Cause that was the option happening there. I don't think it's safe. And you know, you can have 10 doctors in a room with 11 different treatment plans. So like, but I don't think there's something I'm missing there with the growth hormone. I think we really, you know, you, you shouldn't be doing it. I love it. I love it. Well, I have to say, I actually really love my results and I really went in with low expectations, not really knowing exactly the result I was going to get from it. Kind of just hoping that, that I could put on a little more muscle and bring my muscle back. And what I ended up with was way better sleep and muscle and zero side effects. And I have to say, I really big, big fan of this peptide. And I do feel like it is anti-aging for me. And I love that too, because who wants to get old? Not me. Right. It's just like you're saying, it's like you have to have the right peptide for the right person at the right time of life, you know, even the right time of that year. And so that's like, You found it's the perfect one for you, right? Like it's great because we've uncovered a deficiency that we wouldn't have known was there. Yeah, I sure feel better. I have to say I really do. I didn't really realize that I had a growth hormone deficiency, but I'm 47. So of course, you know, my body is moving towards that season of life where it starts turning some of these things off. Progesterone, estrogen, human growth hormone, DHEA, you know, all of these levels need to be optimized if you're going to kind of run an anti-aging protocol and age a little more gracefully. Yeah, absolutely. You got to look at the whole picture. Yeah, for sure. So what, what makes your protocols different from what people might find elsewhere? Well, I think just that we have protocols. I think that I've like, you know, created something that is safe for one, but it's also personalized, right? So there, there are protocols, but they are with the patient in mind. It's like, Who are we talking to? What do they need right now? And maybe the dose starts at this and then it moves to this, right? So it's that we have a relationship and that protocol for that person might change over time, but the relationship is what makes the protocol effective is it's because it's individual. It's like you can't know, I think, by going to the internet or going to the gray market what you really need. unless you talk to somebody who sort of knows what they're doing. So I think that's the difference. Oh yeah. Having an actual expert who has experience with these kinds of supplements, medications, whatever they actually are, this gray market world of peptides, we don't even know exactly what to call them, but you know, it's really important. Somebody who has more knowledge and experience can really help you and guide you through this process and help you optimize your spend and Because, you know, everybody's watching their budget. Nobody wants to buy a bunch of stuff that they don't know how to use, that they're afraid to use or that they, you know, when they use it, it's going to give them maybe a bad result. And so it's nice to know that there are people like you that we can schedule with you, hop on a call that's free and then figure out what we need and then go up and be able to get a good, high quality, safe, peptide that's actually been compounded in a compounding pharmacy here in the US. You're not seeing a lot of this around like this level. We're not. And, you know, we are kind of expanding into nationwide telehealth service since I can't see every patient anymore. I'm kind of it. And we're branching out and I'm training other providers to do what I do, which is why I created the training program. program that I did so that I could make sure that all the practitioners that are working under me for us are having the same conversations, these synchronous visits, right? Synchronous meaning on video. And we had a really hard time finding a telehealth company that would do that. They said, well, everybody just has people fill out a 90 second form and then they get their GLP-1 and it's like, how do you, what? Like you fill out a form and then you just got it like without talking to anybody or what if there's a, risk involved or what if there's a family history of something that we need, you know, like. There's a lot of that right now, even with the bioidentical hormones. Totally, totally with the hormones. Like what? I mean, hormones are one of the hardest things that I manage because it's been there's so much back and forth and testing and, you know. So we had a hard time finding a company that actually would do it because most of them are not doing it. And they said over 90% of companies doing peptides are not doing this. You guys are one of the few. And so we're like, you guys are one of the very few that, but then we really knew that. Yeah, definitely. So real quick viral video style, are peptides being overhyped or underutilized? You know, I think they are being underutilized in the right way. I do not think they're being overhyped. I actually think that If we utilize them the right way, I think that if somebody thinks a GLP-1 is just for weight loss, I could tell you 10 other things that it's good for. Heck yeah. What's one thing people are doing that makes you cringe as a doctor? 100% gray market peptides. This is not only cringe, but frankly dangerous and inefficient for the body, not effective for your health. And I think this is just a big, big, big safety issue. If someone is buying peptides online without guidance, what would you say to them? I would say find a place that you can get peptides that are prescribed by a doctor who will answer your question every day if something happens to protect you and to make sure that you're getting something that is safe and is actually going to help you with your health. Can peptides actually backfire if used incorrectly? Absolutely. If you use the peptide at the wrong time, then you could be doing your body a disservice. If you use a peptide at the wrong dose, you could actually hurt yourself. And I think that if you get a peptide that is gray market or it's not sterile or it comes from not a reputable pharmacy, you can cause skin reactions or immunogenicity problems with your immune system. And I have absolutely seen this happen where you can create antibodies against something and now you have harmed yourself. Wow. Wow. Dr. Pasik, this conversation is such an important reminder that access to powerful tools requires responsible use. Peptides are not magic. They're not shortcuts. They're signals. And when you understand how to work with your body rather than override it, that's where the real transformation happens. This is about being informed, being intentional and taking ownership of your health in a way that actually supports your life long term. Thank you for bringing such a grounded, intelligent, and honest perspective to this conversation. Thank you so, so much for being on The Manager. We loved having you here. We hope to have you back, Dr. Passick. Thank you so much. You're a wealth of knowledge yourself. Thank you. And if you guys are interested in learning more about Beauty Drip, you can go to www.beautydrip.co. And learn all about what Beauty Drop offers. And get in touch with Dr. Pasik. And take a look at all of their wonderful offerings. I'll see you guys next week.