Performance and Image Enhancing Peptides

On today's episode of The Good GP, I am joined by Dr. Ashley Bowden to discuss the emerging world of peptides. Dr. Bowden is a current Akron Registrar working on the south coast of New South Wales. His pre medicine background includes a Bachelor of Science in Sport and Exercise Science, and he is passionate about physical activity and the outdoors.

A great combination to be able to bring a strong interest in lifestyle-based interventions to the general practice consult room. Welcome to the pot, Ashley.

That I think in itself is pretty interesting. We all know about insulin, but no one's calling it a peptide, and we're not branding or marketing it as such. And there's other examples as well, including the newer GLP one analogs. And so these are peptides too. Where the big difference is that often the peptides that are being referred to on social media or in the gym or out and about are these research use only peptides. So these are new drugs, medications,

Chemicals that are being tested because they're thought to have a benefit, but they're not regulated and they're not TGA approved. In fact,

almost all of them are very far from that stage. They're very early in the research. And I think that's when people refer to peptides. Often what they're talking about are these substances which haven't been researched to the degree that we, especially as doctors, would be able to then trust that they're safe, that they do what we think they do and that we understand the side effects. and the sort of impacts they could have at different people with different conditions.

anabolic steroids or peptides, or at least we're hearing about it. And so the main thought is that this is for elite athletes. Most people think that the performance enhancing drugs space is elite athletes only. And the reality is that actually it recreational gym goers. They're probably the largest group of people using it. But there's also the occupational group. There's models and even

Hard working laborers that feel their bodies getting beaten up and think they need something to help recover better. And with that as well, there's people that are aging and sort of look for peptides or steroids or a medication for the vitality aspect. So the anti aging thing. And then sadly, there's also young adults and teenagers that are seeing social media there's this term look maxing or looks maxing where they're sort of being encouraged to use

supplements or medications or drugs to get bigger, stronger, change their look, change their skin, different things like that. So there's quite a few different areas, different groups that are being exposed to peptides. And that's when they then turn to someone and ask the question, what are these? Are they safe to use? Does it do what it says on the tin?

And initially I got asked that question in a gym, but increasingly I get asked that question in the consultation room now as well. And I think that's probably why this is so important, because I'm certainly not the only GP that's being asked about peptides or about anabolic steroids or about these different drugs that might improve their strength or their recovery or their aging or their skin.

If we take the peptides that are more associated with tissue healing, one of the most common is BPC157. And so this is a peptide found in human gastric juice. and there's a lot of enthusiasm, I say, that it's improves tendon and ligament soft tissue healing, but there's very limited human evidence. The majority of these peptides have probably not even got to phase one clinical trials. So those human trials.

But then there's a big pool of anecdotal I yeah, I don't want to use the word evidence, but because there are so many people using these, there ends up being this sort of pool of data that we can't really rely on. where people are saying, Oh, I've used it and it made my back pain go away, or I used this peptide and I was so much stronger and I was able to do so much more. And I think that's the evidence I say in quotations that

people are actually leaning on more. And especially in today's day and age where We've got search engines online that actually are just taking information from Reddit and online forums. That's the sort of evidence or information, I guess, that people are relying on more because the evidence that we would use.

that stronger clinical trials, randomized controlled trials just isn't there when it comes to these unregulated peptides. At most they're still in phase two, phase three trials and those are the ones that are actually the weight loss medications of which we've seen the newer GLP ones that have actually come and been approved by the TGA. So the other ones, the tissue healing, the vitality, the skin changes, really just don't have the evidence that we could trust.

Peptides, the ones that thought to enhance tanning, they've been shown to potentially increase moles. And so whether there's a cancer risk associated with this. And these are medications or drugs that were actually focused on trying to improve cancer risk, but until we've seen sufficient data, we don't know whether those new moles that are a potential side effect are are high risk.

There's certainly safety concerns, but because of the lack of evidence, it's really hard to point to one thing or another. The other thing that's often not talked about is that The way these peptides are used is often as an intramuscular or a subcutaneous injection. And so just that in itself is a risky way of giving medication, whether people are using clean needles, whether they are getting infections at the infection site.

whether they know how to inject and aren't causing damage locally. There's so many other risks to this. And on top of that, one of the biggest ones is if this is an unregulated product, how does the person that

managed to acquire it, know that what they have in front of them is the peptide they were after. We know that things could be cut with something else. Is it baby powder in front of you or is it something else? And so there's a lot of Harms that are actually not specific to the peptide itself, but to do with the broader use of them and the unregulated nature of it.

But it is our reality, I think, now. And this it's yeah, it's mind boggling and a little bit scary to think. Let's keep on going though. I wanna talk practically about how to approach this, because this is really what this episode is about.

As a GP, if we have a patient that comes in asking us about starting peptides, how do we approach that conversation?

I know everything about this. I've done all the research and my friend's been using it and it's helped them. But that's also not new. Patients have often talk to doctors about drugs that they've used, illicit drugs, illegal habits, or something that they've heard, whether it's Himalayan salt or something that they think is shown to be beneficial. And so it really falls into that space of this is a unproven, unregulated product. And

How we approach that, it can be really uncomfortable. I think a lot of people feel that they need to say, no, this is a bad idea, and tell the person in front of them, don't do it.

when in actual fact they've usually done a lot of thinking, research, spoken to plenty of people before it's come up in conversation with their doctor. And so I believe the best approach is one of being curious, no judgment, building a rapport with the patient and being inquisitive, maybe letting them teach you about it, being wary that what they

think maybe evidence, maybe less evidence or less solid evidence at least. And with that you can then start to explore what the risk might be. And as we've talked about, the risk can include how they use this drug or where they've got this drug from and whether it is actually what they think it is.

whether there's any testing that we can do to check whether it's baseline, kidney and liver function, and importantly also check in with their mental health, because that's a huge aspect of their health that will be linked to why, first of all, that they're actually seeking this drug. But also we know that some performance enhancing drugs play a huge role in mental health and can cause

aggression or deteriorating mental health. So I think it's our role as a GP to try and rein in that judgment and rein in the advice giving, especially in this unknown area. be inquisitive and then start to explore it. And maybe if we were on the same side, we can then say, Hey, look, if this was me, I think I'd feel really hesitant because we don't know enough.

I guess how can we respond and, you know, what can we do to support them in that situation?

And so there's often this idea that actually the GPs don't know what they're talking about when it comes to these new peptides and these performance enhancing drugs. And so again, being non judgmental, being curious, asking them what they can tell you about it, and then offering our medical advice, which would be, how can I keep you as healthy as possible?

Can we do some tests? Can we have some check-ins? Can I see you more regularly to make sure you're going okay? Often people will cycle peptides. And so they may use it for a certain period of time. Now, that can be because it costs a lot of money and so they can only buy a certain amount and they use it for four weeks until it's gone. Or it may be that's a recommendation, which I could digress on that as

crazy in itself that there could be a recommendation on something when we don't know doses or durations. But what you can then offer is maybe we do a before and after check-in and we do some blood tests before and after and again check in on mental health. And I think at least through that non-judgmental harm minimization approach, we can build rapport. And I've had patients who on the sort of fifth, maybe sixth visit, have said to me,

What do you think? Is this a good idea? And they really feel now invested that I'm on their side and gives you an opportunity to say, actually I I wouldn't do this. I think this is unsafe. I want to support your health, but I think this is a bad idea.

And that can be impactful at that point, not at the beginning. I think at the beginning it's a how can I support you to be as safe as possible and maybe down the line we can approach it like we would with other lifestyle behaviors and that sort of motivational interviewing, checking when they're ready and seeing when we can intervene maybe a bit later.

Thanks, Ash, for helping to enlighten us as GPs, especially for some of us who haven't had as much experience or seen this coming up as much. I think it is definitely around and that's definitely around to stay for a while. So a really helpful conversation. Appreciate your time on the good GP today.