Summary
Andrew Huberman hosts Dr. Craig Koniver, a board-certified physician specializing in performance medicine, for a deep dive into the therapeutic use of peptides and hormones for health, performance, and longevity. They begin with GLP-1 agonists like semaglutide and tirzepatide, discussing how microdosing (limiting weight loss to under 2 lbs/week) prevents muscle loss and Ozempic face while still delivering cognitive and anti-inflammatory benefits beyond weight loss. Koniver shares his philosophy of helping patients 'win the race first' to build motivation for sustained lifestyle changes.
The conversation extensively covers BPC-157 for inflammation and tissue repair, growth hormone secretagogues (ipamorelin, tesamorelin, sermorelin, CJC-1295) for sleep quality and body composition, and peptides for cognitive function including pinealon, epitalon, cerebrolysin, and methylene blue. They discuss NAD infusions and NMN/NR supplementation for mitochondrial health, CoQ10 for cellular energy, methylated B vitamins for homocysteine management, glycine for liver detoxification, and the critical importance of sourcing peptides from reputable compounding pharmacies rather than gray market suppliers. The episode also covers testosterone therapy for both men and women, stem cell therapy, PRP, and the evolving FDA regulatory landscape around peptides.
Key Points
- GLP-1 agonists like tirzepatide are most effective when microdosed (under 2 lbs/week weight loss) to preserve muscle mass and avoid rebound
- BPC-157 is the most widely used therapeutic peptide, reducing inflammation and accelerating tissue repair; available in injection and oral forms
- Growth hormone secretagogues (ipamorelin, CJC-1295, tesamorelin) promote deep sleep and growth hormone release without shutting down natural production
- Pinealon and epitalon are peptides that can dramatically improve REM sleep quality and duration
- NAD infusions (750-1000 mg) combined with NMN or NR supplementation support mitochondrial health and cellular energy production
- Methylene blue at 10-20 mg daily supports cognitive function through mitochondrial enhancement; CoQ10 at 200-400 mg supports cellular energy
- Always source peptides from USP 800-compliant compounding pharmacies and work with a knowledgeable physician; gray market purity is unreliable
Key Moments
Cold water immersion within 4-8 hours of lifting can blunt hypertrophy gains
Cold water immersion after resistance training limits hypertrophy and strength gains by dampening the inflammation response that triggers adaptation.
"And it doesn't seem to be one of these agents that's going to be detrimental. Like we were talking earlier, Rob and I, for the starter, like, you know, they found that people are working out hard taking antioxidants, that there seems to be a negative consequence to that because you don't allow the body to kind of repair itself. I don't think that's happening with BPC. That's interesting because my understanding is also that part of the specific and general adaptation of exercise is triggered by inflammation. This is why indeed it is true that doing ice bath or really cold water immersion, cold shower seems fine, but cold water immersion in the four to eight hours after resistance training can limit some of the hypertrophy and strength gains from resistance training. Because what you're inducing when you actually go into the gym that leads to the hypertrophy and strength training is an inflammation response that triggers the compensation or the hypercompensation. So it's interesting. You're saying that BPC, by the way, I must say this because then forgive the editorial, but that is not to say that cold plunges and cold immersion is bad."
Methylated B vitamins and TMG lower homocysteine, a cardiovascular risk marker
Elevated homocysteine raises cardiovascular risk. Methylated B12, folate, and TMG lower it through liver detox pathways.
"And so if one's got an elevated homocysteine, an elevated, by some labs it's going to be greater than 7, by most labs greater than 9, means you're at an increased risk. What that is, I don't remember, but you're at an increased risk of having a cardiovascular event, which would mean a heart attack or stroke. And so we want to lower that number. And the best way to lower that number is taking ample methylated B vitamins. Methylated means you're adding a methyl group. So methyl B12, methylfolate, trimethylglycine, methionine, these are all methylation donors, which just metabolically and through your detoxification pathways in your liver is going to help you lower that homocysteine."
Glycine at 3,000-5,000 mg calms the nervous system and supports liver detox before bed
Glycine is an inhibitory neurotransmitter that calms the nervous system at high doses. It also supports phase two liver detoxification.
"It's calming to the nervous system over the years. I tend to start with that when people are having trouble settling down at night. Not that it's going to sedate people, but just transitioning from being active, 8 p.m., 9 p.m., wanting to settle down. Glycine in pretty large dosages, at least most people think they're starting with 3,000 or 5,000 milligrams orally, kind of tones down the nervous system. People relax a little bit, and then they tend to sleep better from it. And then you can dial it up. I mean, I've used very large dosages. The other advantage of glycine is it works on phase two liver detoxification, which is amino acid conjugation. So you're helping your liver work better. And in a world where we're being exposed with all these toxic things from glyphosate to heavy metals, we all need to do some sort of liver mitigation strategies. Glycine is one of the best."
PRP is FDA-compliant if your own cells are returned within 4 hours
Platelet-rich plasma uses your own blood spun down and re-injected within 4 hours, making it FDA-compliant. Results for rejuvenation have been strong.
"Right. And so the ruling is, I understand it, as long as you're taking a cell from you and you give it back within four hours, then that is allowed under the FDA guidelines. Interesting. There was this clinic in Florida a few years ago was touting stem cell therapies for macular degeneration, injected some stem cells into these patients' eyes, and they went blind really quickly, and they were not blind prior to the injections. That, to my understanding, caused a severe setback to the whole field. I'm old enough to remember when gene therapy was set back by about 10 years because a patient received gene therapy, which is now pretty common for certain diseases, and the patient died. It's unclear exactly why they died, but that delayed the field of gene therapy by at least a decade. I mean, this country is very conservative when it comes to the approval of new therapeutics. Sure. Yeah. Yeah. No, and I think like anything, there's going to be people who get too aggressive amount. I've heard of doctors injecting stem cells into people's discs and then they get discitis and infection and that can just spiral very quickly. I think you got to be reasonable in, you know, what you're trying to accomplish. I'm excited about stem cells and exosome therapy and PRP and PRF and using them as, you know, kind of biologics and because I think there's a lot to learn. I think we only know very little from what we've seen from working with our patients. It's been tremendous from a rejuvenation standpoint. I mean, we're,, it's taking from your own and then giving back your own within how the FDA outlines it, I think that's a great way to do it."
