Craig Mullen on Root Cause Medicine and Peptides: Rational Wellness Podcast 432

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Craig Mullen discusses Root Cause Medicine with Dr. Ben Weitz.

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Podcast Highlights

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Craig Mullen is a nurse practitioner and he is the founder and medical director of Remedy Functional Health Solutions, which is located in Salisbury, Maryland and his phone is 443-342-4141.

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Podcast Transcript

Dr. Weitz:  Hey, this is Dr. Ben Weitz, host of the Rational Wellness Podcast. I talk to the leading health and nutrition experts and researchers in the field to bring you the latest in cutting edge health information. Subscribe to the Rational Wellness Podcast for weekly updates and to learn more, check out my website, drweitz.com.  Thanks for joining me, and let’s jump into the podcast.

Hello, Rational Wellness podcasters. Today we’ll be speaking with Craig Mullen about the root cause revolution, which essentially means a functional medicine approach to health. Craig Mullen is a nurse practitioner who’s the founder of Remedy Functional Health Solutions.  Craig, thank you so much for joining us today.

Craig: Hey, thank you very much Dr. Weitz for having me on the show today. I am excited to be here and thrilled to have this opportunity to talk with you this morning. 

Dr. Weitz: So where are you located? What part of the country are you in? 

Craig: I am in Salisbury, Maryland which is a little portion of the state on the eastern side of the state that is adjacent to the coast.  We’re about 30 minutes away from the Atlantic Ocean, so it’s a nice spot to be. And you know, definitely is an exciting time for the area because we’ve got an influx of people coming to the eastern shore of the past decade. We’ve got a great university here in Salisbury that you know, has excellent exercise physiology and exercise science programs, as well as a pre pre-med program.  So, great time to be here on the eastern shore of Maryland.

Dr. Weitz: I’m speaking to you from about 20 minutes from the West coast, from the Pacific Coast, so awesome. The powers of technology. So what made you decide on your career path to become a nurse practitioner versus some of the other choices could have included being a physician’s assistant, an md, or some other kind of doctor.

Craig: Sure.  So my father was an oral surgeon for about 40 years. So I was pretty well acquainted with the healthcare system. By the time I was at the point where I needed to start looking into careers felt very comfortable with you know, health and science and whatnot. Actually went to school initially for a philosophy degree.

Dr. Weitz: Me too. I got a philosophy degree from UCLA.

Craig: Nice. Yeah it’s, you know, it’s a great field to be in. It really teaches you how to read it teaches you how to, you know, formulate how to ask good questions. Exactly. Ask, you know, the important questions, skeptical. Right, right. You write a lot of papers, get exposed to a lot of Yeah.

Dr. Weitz:  I was going to get a PhD in philosophy.

Craig: Yeah. Yeah. Excellent. So, I did that and then, you know, the natural sort of inclination for a lot of people who are in philosophy is either, you know, do that, which is go on and do graduate studies in philosophy or, you know, potentially become an attorney. [00:03:00] So I started prepping for the LSAT.  And then rapidly sort of did an about face and realized that this is not what I’m looking to do for the rest of my life. No, you know, shade to attorneys or anything, you know, with regard to practicing law, but, at that point in time you know, I was, I’ve always been very interested in science.  I’ve always had a deep fascination with wellness and health. And so, there was the option to pursue what’s called aa second degree or accelerated pathway to nursing to get your registered nurse your bachelor’s of nursing science. And so, I took part in that program. And but you know, going through that whole trajectory, I knew from the most early stages of taking the classes that I wanted to have the diagnostic and prescriptive authority and privilege.

And it really is a privilege. And so, you know, very early on [00:04:00] my sites were set on. The natural next step which is for a nurse to become either a nurse practitioner or you know, pursue a couple of other different avenues such as nurse anesthesia. You can be, you know, there’s a couple other pathways, but those are the main roles that nurses who seek advanced practice roles.  You know, usually pursue nurse anesthesia or nurse practitioner. And I knew that. Being a nurse practitioner would allow me the flexibility that I wouldn’t necessarily have as a nurse anesthetist to, you know, open my own practice and you know, see patients in different. Areas of you know, the discipline, whether it’s outpatient or inpatient.  And so ultimately got my family nurse practitioner degree from George Washington University. Worked in primary care for handful of years in the urgent care and am care settings especially [00:05:00] so during COVID or during the early years of COVID. And from there I actually went back to school.  I did some more training at Drexel University. To get what’s called an acute care certification, where you can practice in the hospital in critical care settings or in medical surgical settings.

Dr. Weitz: So your current practice, now you have your own practice and you also do some emergency or acute care.

Craig: Yes. Yep. So I still work on a part-time basis with local hospital. It’s Atlantic General Hospital. And I work with a hospitalist team there. I do like four shifts a month on average. Used to be, you know, 12 to 15. But since I’ve started my practice that this has become my real true passion and it really is.  It always has been health span optimization keeping people out of the hospital, keeping people off of. Prescription medications if we can. Really trying to [00:06:00] mitigate the risk for chronic disease. You know, not allowing it to set foot in people’s life, you know, to begin with. And if it is present, doing everything we can to halt it in its tracks and reverse that pathology so that we can help.  People live a more vital existence and add quality to their years, not just years to their life.

Dr. Weitz: And I think the need for this kind of care and the type of practice I have with functional medicine and many others do is. Ever more needed. It was just a report that the United States is doing poorer than most of the other advanced countries at reducing chronic diseases.  And in fact, hundred percent among Americans age 20 to 40, we’re seeing an increase in chronic diseases. So, we really desperately need a. Functional medicine approach that’s gonna look at diet and lifestyle and doing something about the root causes [00:07:00] of cardiovascular and these other chronic diseases, rather than just treating their symptoms when they, as they go downhill.

Craig: Right, exactly. You know, we’re just, as you were saying, we’re seeing an an increasing incidences of you know, terrible vascular events in younger people. I mean, we’re talking about myocardial infarction, heart attack as well as increased incidents of stroke among young people. So, very important that everybody start to address these issues.  Now we’re really having a. You know, it’s a struggle in America. Currently, our health system spends more money per capita compared to other industrialized, you know, first world nations. And we have one of the sickest populations despite that. 

Dr. Weitz:  So it’s about time we start preventing these chronic diseases and keeping them from getting worse rather than just treating the symptoms.  So I listened to a few of your other podcast [00:08:00] interviews and I think our approach to functional medicine analysis is fairly similar. I know you like, I like to do very detailed testing. Including a full thyroid panel, advanced lipids, hormones, nutrient status, as well as the basics. And doesn’t it drive you crazy when a patient shows up in your office and they say they went to their primary doctor and their lab showed they were in perfect health.

Craig: Yep. It really does. Yeah, because you know, patients are potentially being misguided in situations such as that. And you know, they also feel like they’re not being listened to because they feel as though something is amiss. Something is awry. They’re waking up, they don’t have the energy and the get up and go that they had in maybe their younger years or before a bad infection or a severe stressor that they experienced.  So, now they have some disruption in their life and they have brain fog, they have [00:09:00] fatigue. And they’re not sleeping well. They are having difficulty meeting the demands of their life, whether it’s kids, job you know, other things that they have going on. They’re just having more difficulty meeting those demands and, you know, it really does entail that we take a deeper look into what’s actually going on at the cellular level and looking at some of the biomechanics of, you know, how are these organs and whatnot actually functioning. Whether it’s the thyroid, which sets, you know, the metabolic rate for the body.  How are we detoxifying through the liver? You know, and how are we absorbing nutrients through the gut? And all of these things, you know, are critically important. 

Dr. Weitz:  And when these patients say they’ve had their labs done and they get the impression that every lab that would be beneficial was done what they don’t realize is that the only labs that they had run were what insurance wants to pay for.  Yes. Which essentially for [00:10:00] most patients is A CBC and a chem screen, maybe a basic lipid profile. If they get thyroid testing, it would probably just be a TSH. And so really of the thousands of potentially beneficial tests, they had five of ’em done and they think that’s all the labs that could be run.

Exactly. And

Craig: sometimes these, you know, are only being run once a year. You know, sometimes

Dr. Weitz: typically once a year. And by the way, the ranges that are looked at are what’s called the reference range, or essentially corresponds to what the average American’s levels are and. To me that is completely insane since we know the average American is metabolically unhealthy and unhealthy from any other perspectives and just looking at the range, comparing you to an average American is really doing a [00:11:00] disservice.  We need to be looking more at what we would call an optimal range.

Craig: Exactly. Yeah. I mean, something like a reference range for insulin that has an upper threshold of, you know, 24.7 is absolutely it’s mind numbing. How you know, concerning that is you know, insulin, as you well know should be a marker that’s, you know, six or below, you know, when we’re really looking.  To optimize you know, glucose metabolism and such. And so, you know, people are walking around with you know, a lot of metabolic insufficiency and they’re contributing to these chronic inflammatory patterns.

Dr. Weitz: And your average primary care doctor is only gonna flag, first of all, insulin is usually not run right.  But even if it was, they’re only going to flag it if it’s in the red and exactly. So they’re not really looking at that. And I recently had a patient who I looked at their labs and their liver enzymes were high, but they were still in a [00:12:00] reference range. So apparently during COVID and afterwards people were drinking so much and eating so much unhealthy food that liver enzymes went up.  So, UCLA raised their reference range for a ST from 40 to 70. So now a patient with 60 is considered normal, and that’s completely insane.

Craig: Yeah, that’s incredible. I haven’t seen that yet over here, but that is wild. I’m astonished.

Dr. Weitz: So patients need to know that the reference range is comparing you to the average American.

Craig:  Exactly, and we’ve seen how over time that’s changed with regard to other things as well. You know, if you look at a hormone panel for men, you know, 30, 50 years ago you know, the upper threshold of normal was not gonna be in the mid nine hundreds, and the lower threshold was not gonna be in the three hundreds.  It was closer to, you know, a range of 500 to 1200 you know, previously. 

Dr. Weitz:  So, as we I see some labs where the reference range is. One [00:13:00] 50 on the low end and a thousand, my gosh, on high end, which is like ridiculous.

Craig: Yeah. Crazy.

Dr. Weitz: So, let’s talk about some interesting cases where you did some detailed testing and figured out that the patients were off track and I thought maybe we could start with thyroid.

Sure.

Craig: So I see a number of thyroid Hashimoto’s patients in my practice. You know, it’s one by the way,

Dr. Weitz: for those who are not familiar, what is Hashimoto’s thyroiditis?

Craig: Hashimoto’s thyroiditis is the most common cause of hypothyroidism here in the United States and in the west. It’s associated with an elevation in autoantibodies or immune proteins that are.  Activated against our own tissue and ultimately contribute to the degenerative changes of our own tissues. And in the case of Hashimoto’s that is thyroid peroxidase. And thyroid globulin [00:14:00] antibodies are the two that are primarily most seen elevated. In conjunction with one another in Hashimoto’s.  And so, it’s, you know, one of the most common things that I see in my practice, it often coincides with people that are, you know, starting to notice some changes such as brain fog. They feel you know, that their energy is poor. They’re having you know, fatigue on a daily basis. They’re not sleeping well, they’re having constipation.  They have temperature intolerance, they have skin, hair, and nail issues. Hair is falling out. They are you know, not able to, you know, perform at the gym. They’re not able to perform at the job. And they’re also starting to experience undesirable changes in some other biomarkers, like, for example, thyroid hypothyroid states will often contribute over time to.

Abnormal and undesirable changes in lipid profiles. So, I see several hypothyroid patients in my practice. You know, it’s gotten [00:15:00] to the point now where I almost expect that people, when they come to me with certain symptoms, a lot of those symptoms that I just man mentioned I almost expect to see antibodies present and you know, I, no, no longer look at the thresholds for.  Antibodies and say, Hey, this is an autoimmune situation here. If they have antibodies present, I’m already starting to look at the path towards, you know, how do we reverse this? Why is this happening? And I’m not waiting for, you know, thyroid peroxidase to rise above 30 or anything like that. I’m saying, look, antibodies are present.  There’s a reason for this and we gotta, you know. Figure this out. And you know, that involves some multimodal, multifaceted approach. But it’s one of the most rewarding things to treat in my patients. And because you see over, you know, four to six months, these initial changes happening and patients start to feel better quite rapidly once you implement certain [00:16:00] interventions.

Dr. Weitz: Yeah, and you’ve probably seen patients where they’re taking thyroid, which is usually a synthetic T four, and yet their T three is still low, and nobody knew it because nobody measured their T three.

Craig: Exactly. Yep. And there’s a number of things that will contribute to low T three. I mean, there can be impaired conversion of T4 into T3 peripherally.  This is often attributable to certain nutrient deficiencies to, you know, other inflammatory insults. And so we, you know, have to really look at all those factors, take everything into account, what’s their vitamin D level? You know, are they getting you know, optimal diet exposure to things like selenium, zinc, copper you know, other factors that are gonna be involved in you know, conversion of of T4 into T3.

How’s their liver function? Liver and thyroid are very much interwoven with each other. So if there’s dysfunction in the liver, there’s oftentimes gonna be dysfunction in the [00:17:00] thyroid. Another thing that I see all the time is perimenopausal women and beyond into menopause and post who, you know, they’re obviously progesterone deficient.

Well, progesterone and thyroid also very interwoven with each other. And balancing progesterone is usually always one of or restoring progesterone really is one of the initial steps that I’ll take in women who are having significant hypothyroid issues. So interesting. Can you explain

Dr. Weitz: how progesterone affects thyroid?

Craig: Especially in the context of you know, in immune dysregulation. So, progesterone as a hormone is very immunomodulatory and it helps promote immune tolerance and will really down regulate processes in the body that contribute to immune hyperreactivity. So progesterone, you know, outside of Hashimoto’s.  It’s also been shown to be very beneficial for a number of other [00:18:00] autoimmune conditions, such as multiple sclerosis, ankylosing spondylitis rheumatoid arthritis, psoriatic arthritis. So, it’s, it has these very immunomodulatory and anti-inflammatory properties that really. You know, make it such a huge a powerhouse tool to employ and deploy in the treatment of autoimmunity.

Dr. Weitz: That’s really interesting. Do you ever use progesterone for men?

Craig: I do not often use progesterone for men, but there is, you know, it is necessary for men as well. And I have heard of practitioners who will recommend utilization of progesterone. Topically sometimes just applied, you know, along the inner thighs or to the scrotum for you know, the optimal benefit of progesterone.  It’s not something that I typically do. In my practice, I’m open to it. I’d have to read more into the science of it.

Dr. Weitz: Yeah I don’t know anybody who really [00:19:00] does it, but yet we get progesterone on the labs and I see that it’s sometimes low. I think the one context in which it is accepted to use it is in the context of traumatic brain injury.

Craig: Exactly. Yeah. And IV progesterone, right? So, that’s one of the things that I really picked up on. Dr. Lindsey Bergon was one of the ones who first introduced me to that idea. And you know, really profound. Absolutely.

Dr. Weitz: So let’s talk about looking at an advanced lipid profile. Why should most patients have an advanced lipid profile?  Why is the basic lipid profile so inadequate? And what are some of the important information we can glean from such a panel?

Craig: Yeah. So, I think, you know, it’s really important to also focus on cholesterol. What is cholesterol? What does it do in the body? Well, cholesterol is the precursor. It is the substrate from which our hormones are [00:20:00] ultimately generated and derived.  Not only that, cholesterol is a major component of. Cell membranes, right? So the delicate membranes that surround each and every one of our cells that provide some protection and support for their structure. So it’s essential as cell membranes are broken down, if we don’t have appropriate cholesterol to strengthen the cell membrane those cells are gonna be more prone to damage from oxidative stress and inflammation in the cellular environment.  And this will ultimately contribute to you know, changes in DNA structure and you know, proteins within the cell. So we, we need to have adequate cholesterol. Cholesterol is very important for overall cellular health’s critical for brain health. When we look at a lipid panel, if you go to your PCP and you get a standard lipid panel that shows total cholesterol, LDL cholesterol, HDL, triglycerides, v LDL.

You know, that’s really only part of the picture. And it’s an, [00:21:00] unfortunately, it’s a very archaic way of looking at lipids because we know that, you know, something like an LDL, for example can have various sizes and those sizes to the l sizes of the LDL correspond to. Various levels of risk.  For example, if somebody has a, what could be called a pattern, a LDL, which is a larger size lipid molecule, then this means that it skews towards being more of a buoyant beach ball esque lipid molecule that’s much less prone to contributing to atherogenesis. So the formation of plaque.  Inside the lumen of the blood vessel. So, this in comparison to somebody who has a higher count of small LDLs or their LDLs skew towards the smaller size, these are much more prone to invade the delicate endothelial tissue along inside the vascular bed. [00:22:00] Which you know, is going to be associated with the development of atherosclerosis and lesions that can contribute to coronary artery disease and cerebrovascular disease.

So. A lot of people will come into my practice and we run what’s called an NMR Lipo Profile. And you know, they get this wealth of information where we say, Hey, your lipids may be, your LDL count may be borderline high, but you skew towards this pattern A, the larger type of the LDL, and we can also see that your small LDL count is low.  And so those. Two things in conjunction with each other does provide a little bit of a buffer against you know, an LDL so, or an elevated LDL. So I think it’s very useful to look at it, you know, in that context it’s a much more comprehensive picture. And then we also look at things you know, for example, like lipoprotein little a, which has gained a lot of [00:23:00] attention over the past several years as being an independent risk factor.  For cardiovascular disease, lipoprotein little A is oftentimes construed as a non-modifiable risk factor, meaning no amount of diet, no amount of exercise is going to really change the number that we see there. On the lab. And so it’s very much genetically determined. If we look back at what lipoprotein little A does well, it’s an adhesive protein found on the outside of the cholesterol particle.

That probably dates back, you know. Hundreds of thousands of years in human evolution when we, you know, had no vascular intervention, we had no adequate medical care to heal an acute injury. And so this this particle or this, you know, this compound lipoprotein little a would be the type of thing that if there was vascular injury, if there was, you know, an acute issue [00:24:00] that needed to be dealt with. It, it is very sticky and it’ll adhere to the lining of the blood vessel and signal all these chemokines and cytokines or molecules you know, that will ultimately initiate and incite the repair process. But at the same time. It’s also going to result in more platelet adhesion and the adhesion of other repair factors that are found in the blood that can ultimately gunk up or clog up an artery.  So it is an independent risk factor. Generally, you know, I like to see that number you know, less than 90 in patients. The more we can drive that number down, I think is, you know, even better.

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Dr. Weitz:  I think you’re starting to hear more and more about lipoprotein a and the reason why is.  We’re getting set up for some drugs that will be on the market in the next few years to lower lipoprotein a. Right now there’s no drugs that are specifically targeting lipoprotein a. I think those drugs are gonna be big sellers. And the reason why most doctors are not testing for it is ’cause they don’t have a drug for it.  But aren’t there things we can do for lipoprotein little a?

Craig: Yeah, I think that, you know, at that point in time I’d be interested to look at those at the, you know, a new and emerging. Research on these medications ’cause I actually am not familiar with them. So that’s very fascinating to me.

Dr. Weitz:  Yeah. There’s like three or four that are in clinical studies now and will be on the market in the next couple of years, but that’s

Craig: fantastic.

Dr. Weitz: There are things we can do now to lower lipoprotein a, aren’t there?

Craig: So, yeah, what I always recommend to patients is that you know, the, we need to control some of the other factors, right?  So, you know, I try to push my patients away from statins and things of that nature. Not that statins don’t have their place, but there are other things that we can do to really sort of improve somebody’s. You know, cholesterol panel on a large scale. And so what we can do is implement things like Red Yeast, Rice, we can utilize citrus flavonoids like bergamot, gertin, no olein as well as vitamin E derivatives, such as tocotrienals and use those in combination with each other to have, you know, profound sometimes statin s.  Lowering of lipids and some of these agents even boost HDL. [00:28:00] You know, so we wanna focus on, on, on the potential benefits of that as well. And then yeah, you know, certainly looking at other, you know, dietary factors in conjunction with yeah, so

Dr. Weitz: niacin has been shown lower LP Lille by.

30 to 40% in a few patients, sure, as much as 70% a carnitine has some benefit, coq 10 has some benefit, flaxseeds have some benefit. So there’s a number of nutritional approaches that can help to lower lipoprotein a. Absolutely. Absolutely. And then minus polling had this whole concept of how we can use certain nutritional compounds to reduce the ability of lipoprotein a, to actually create this stickiness.

Craig: Oh, that’s fascinating. Yeah.

Dr. Weitz: Yeah. So you’ll have to check that out. So what are some of the other important parts of a lipid profile to look at? And also, do you have certain strategies for [00:29:00] reducing small dance LDL or increasing LDL particle size? How do we move that LDL advanced profile to a better health?

Craig: Yeah, absolutely. I think, you know, diet is where I really try to focus in those patients, you know, highlighting the importance of omega threes in supporting LDL, healthier LDL profiles, supporting HDLs you know, so this comes in the form of you know, again, flax, as you mentioned. Avocado oil you know, and other foods that are really dense in omega threes.

Dr. Weitz:  Do you measure Omega-3 levels?

Craig: I do sometimes I you know, as if somebody is really chronically inflamed you know, just to make sure that you know, they have appropriate activity there from an anti-inflammatory standpoint. And, you know, omega sixes as well can be very beneficial to, to look at.

But not in everybody, you know, everything is certainly. Sometimes cost [00:30:00] prohibitive and you know, it’s the type of thing that ideally if I could, I would but it’s not, you know, something that, that suits every, everybody, 

Dr. Weitz:  all my patients are getting Omega-3 levels measured. That’s all.  So what do you think about HDL? HDL is kind of this interesting molecule that we’ve thought of as protective, and there’ve been attempts to try to raise HDL with drugs and they’ve proven to be ineffective at lowering risk. And people have tried to look at HDL particle size and we know that HDL can be beneficial because it can do reverse cholesterol transport.  It can take exactly cholesterol from the artery and bring it back to the liver. But other than that it, there’s still some confusion as how do we know when HDL is higher? Is it even good or not? Because it’s also acknowledged that when HCL gets above a certain level, it’s not as functional.

Craig: Sure.  I think you know, I’d be interested in seeing continued research on that. I always try to shoot for HDL in you know, men and women definitely above 50 if we can on a standard lipid panel. Right. I think, you know, once we’re seeing HDL levels, you know, in the eighties, nineties you know, then we’re getting into the realm of, you know, how beneficial is this really?  You know, the size and the density of the HDL really does play a role in its ability to. Participate in that reverse cholesterol transport. So we do have to look at those factors as well when we look at something like you know, an lipid particle size and number. 

Dr. Weitz:  Yeah, I think we really need a better test for HDL functionality that’s widely available.

Sure. Absolutely.

Craig: Have you seen anything you know, coming about in down the pipeline with regard to that? Yeah,

Dr. Weitz: they’re definitely working on new tests. I know Cleveland has a test for HDL functionality, but not to [00:32:00] that have many people run it. And I think there’s more to understand about HDL and when HDL is beneficial and when it’s not.  So I think the HDL story is still to be flushed out and told completely, but in general, having a slightly higher HDL is good versus a lower HDL. I’ve certainly seen certain approaches where things drastically lower HDL, like for example bodybuilders who take anabolic steroids drastically lower HDL and that definitely is part of their having an increased cardiovascular.  Yeah, absolutely. So, let’s go into peptides. I know that I know that you utilize peptides frequently with patients, and why don’t we start with America’s favorite drugs, the GLP ones, which yes, make people, dance through the streets and sing. And why does every drug commercial have [00:33:00] people dancing and singing?

And you have no idea what the commercial’s even about. But so apparently these GLP ones now we’re hearing from recent studies reduce every chronic disease and are like the greatest drug since you know, mother’s milk. And I’ve even talked to patients who are taking them for longevity purposes, but.  I particular am very skeptical. Sure. To begin with, I’ve seen a number of patients who lost a bunch of weight. They lost 40, 50 pounds and then they gained 60 pounds back and now they have less muscle when they stop taking ’em. And I’ve seen a number of patients with side effects. They tend to lose muscle.  They get gut problems because it slows down gut motility. I’ve seen patients with vision problems, so I’m kind of skeptical. Why don’t you tell me about GLP ones and what’s your experience?

Craig: I think GLP ones can be very beneficial and I think that they have a lot of [00:34:00] potential

Dr. Weitz: By the way, for everybody who’s in know what we’re talking about.  We’re talking about drugs like Ozempic.

Craig: Yep, exactly. Ozempic, wegovy the, that’s the generic name for or I’m sorry. That’s the brand name for generic Semaglutide. On the Tirzepatide side of things we’re looking at Mounjaro Zep bound. And then some of the older medications Victoza, Saxenda, we’re talking about Liraglutide.  There’s also Dulaglutide or Trulicity. So you know, a whole class of medications that are basically classified as what we call Incretin mimetics. So, what they do is they promote a glucose dependent release of insulin from the pancreatic beta cell. Which helps with insulin sensi sensitivity in the body.  But they also work to slow the rate of gastric emptying. So the stomach empties into the duodenum. And the rate of emptying of food contents into the duodenum of the first portion of the small [00:35:00] intestine is slowed. So, what this does is it acts on stretch receptors at the, at the sphincter there, at the portion where the stomach enters into the small intestine which then sends messages to the hypothalamus and hunger centers in the brain, which can influence you know, satiety hormones and other signaling agents like leptin in the brain. And so, we’re… 

Dr. Weitz:  so patients eat less.

Craig: Exactly. Yeah. Or they have an earlier a sensation of fullness and they have a sensation of satiety and being satisfied by the meal that they’ve taken in. The other aspect is that they do work directly in the brain, in the hypothalamus in an area called the RQA nucleus. And this directly influences hunger and so cravings are reduced.  A lot of times there’s a reduction in food noise. Or what people consider, you know, food noise and that tendency to want to just, you know, graze and [00:36:00] snack and things of that nature. So. You know, multimodal approach with the GLP one medication to you know, reducing the amount of, ultimately reducing the amount of calories that people desire to take in.

Dr. Weitz:  And so how do we use these drugs more effectively than the traditional use?

Craig: Yeah. So the real problem comes in when people start, you know, just basically utilizing them as a tool for crash dieting, you know, so, yeah.

Dr. Weitz: They don’t change their diet, they don’t exercise. They’re not eating any healthier.  They’re just taking these drugs.

Craig: Right, exactly. They’re just taking the medication a lot times. 

Dr. Weitz:  They’re still eating junk food; they’re just eating less junk food.

Craig: Exactly. So, you know, once you get on that cycle say somebody is eating well below their basal metabolic rate, which is basically the rate at which your body is burning kilo calories throughout the day.  If you were to sit and do nothing but breathe all day on the couch, that’s your basal metabolic [00:37:00] rate. If you start dropping below that or start dropping.  Below your ki killer calorie needs for the day and your activity level ultimately you’re going to enter a state that is catabolic in nature. This is a state of breaking down tissues to supply energy for the body. And so people who are misusing GLP ones you know, maybe they are you know, not hitting their protein requirements, they’re not hitting their caloric requirements, they’re not hydrating and they’re certainly, you know, not exercising at that point.  They are going to have a net loss of muscle tissue. Muscle is the main metabolically active tissue in the body. And so as you lose muscle, you have significant declines in your basal metabolic rate. So look at these patients, you know, several months on you know, a year or so into their weight loss journey.  Yeah. They’ve lost 40, 50, 70 pounds. A lot of that if it has been muscle loss you know, has contributed to a [00:38:00] net decline in their basal metabolic rate. And then, you know, they say, okay, well I’ve reached my weight goal. I’m gonna come off the medication now. Long story short, all of the old habits come into play.  They start eating like they did previous, and they’re eating the same amount, right? They’re eating the caloric you know, they’re hitting the caloric thresholds that they were at previously and all of that excess calories as being stored again as fat. 

Dr. Weitz:  Oh, how do we utilize these drugs so that doesn’t happen?

Craig: Yeah, they’ve gotta be, you’ve gotta make sure that a, you are tracking people’s body composition. I don’t see how a GLP one prescriber can go through their practice, go, you know, continue to practice in a way where they’re not. Regularly mention measuring somebody’s body composition. And what I’m talking about in that regard is utilizing a device like InBody or volt something of that nature where you can [00:39:00] actually measure basal metabolic rate, where you can look at skeletal muscle mass for C to C.

Dr. Weitz:  Yeah, we use bio impedance in our office.

Craig: Yeah, it’s critical. I mean, you know, so you gotta measure for you know, fat reduction, you gotta measure for visceral fat reduction, which is a primary goal. In these metabolic, you wanna see

Dr. Weitz: when they’re losing weight, that they’re losing fat. You wanna make sure they’re not losing muscle and you’ve got understand that sometimes people lose water, which is not really fat loss.

Craig: Exactly. Yep. So that’s, you know, step number one. Doing the body composition analysis and routinely so, you know, the other major components are ensuring that they are hitting their protein requirements. Generally, I recommend. Anywhere from 1.2 to 1.6 grams per kilogram per day for an individual to prevent that sort of catabolic change where they’re losing muscle mass.  And then, you know, it’s also a major focus that they need to be [00:40:00] working on resistance training. And what that means is, at a minimum, using body weight, using re resistance bands, but really looking to also capitalize at you know, heavier lifting or utilizing weights. Utilizing machines in the gym to you know, basically precipitate muscle hypertrophy and growth or preservation at a minimum which also benefits bone density.  We see a lot of, you know, older patients who come to us and they’ve been on GLP once and they’ve become so catabolic that they’ve actually induced, you know, osteopenic and osteoporotic changes by way of having significant declines in. You know, muscle loss and you know, hydration as well.

Dr. Weitz: So what do you do about the fact that when people stop these drugs, they tend to lose, they gain their weight back?

Craig: I think that it’s really important to nail down those fundamental lifestyle aspects. Right. You know, so

Dr. Weitz: If they’re gonna continue to eat healthy and [00:41:00] exercise do you use a lower dosage so they’re less likely to have that kind of withdrawal effect?

Yes. If

Craig: somebody I try to stay as low as possible. Throughout the duration of treatment, if somebody, for example, on something like Semaglutide has you know, plenty of benefit from a 0.25 or 0.5 milligram dose weekly, that’s the level we stay at a provides. 

Dr. Weitz: So there is the standard protocols to just keep titrating a up till they get to a higher level, right?

Craig: I would say, you know, maybe standard in some practices, but definitely not mine, you know? Right. If we have efficacy and therapeutic benefit at those low doses keeping them there leaves more room to titrate up in the future if sensitization. Tolerance happens to the medication, it also minimizes the risk for side effects.  So in that way I think that, you know, small dosing or microdosing sometimes even breaking up a dose, you know, a low dose a few times a [00:42:00] week and doing a microdosing approach like that can be very beneficial. And the reason you have

Dr. Weitz: patients taking ’em for a long period of time.

Craig: Yeah. Including myself personally, I think that they’re very beneficial. And, you know, they have the potential to really support a lot of different metabolic, so, so

Dr. Weitz: you’re taking a GLP one.

Craig: Absolutely. I cycle back and forth between all three of them or, you know, I cycle back and forth between Semaglutide Tirzepatide and I’ve utilized Reddit, Tru Tide as well.

So I think that there’s, you know, significant benefit and personally subjectively I feel you know, substantial improvement in certain other things.

Dr. Weitz: Do you think there, outside of just what are some of the other things you think has benefited you?

Craig: So I have Tourette syndrome. And one of the things that I have as a result of that is some early degenerative osteoarthritic changes in my neck and my shoulders.  You know, which is, that’s like ultimately a [00:43:00] chronic inflammatory process. You know, they say osteoarthritis is not. An inflammatory disease, but you know, when you look at the cellular level, it really is, you know, I think we

Dr. Weitz: now recognize that there’s a big inflammatory component.

Craig: Exactly. Yeah. So, you know, utilizing semaglutide at low dose has a pronounced benefit in reducing some of the pain signals and the inflammation that I feel on a regular day-to-day basis.  And I’ve seen that sustained throughout the course of my utilization, which is, you know, well over. You know, a year and a half now, it’s probably bordering on two years that I’ve been utilizing these therapeutics. And you know, it also gives me, I think a little bit of a leg up when I have patients come to me and they’re looking to begin a journey with a GLP one peptide.  You know, I can explain to them what this feels like. I can explain you know, some of the potential side effects that they may encounter. And, you know, that gives them a little bit of confidence and understanding that they have somebody [00:44:00] that, you know, really can support them through that PO process.

Dr. Weitz: So what are some of your other favorite peptides? And I’m thinking about things like BPC 157 and Thyosin beta 4, et cetera.

Craig: BPC 157 is a must have tool in the shed for regenerative healthcare practices health span optimization practices,

Dr. Weitz:  Oral, injectable, or both?

Craig: Yeah. BPC 157. It’s a 15 amino acid sequence that is found naturally in human gastric juice.  Essentially when utilized orally, it can help to prevent and heal peptic ulcer disease. It’s shown some, you know, anecdotal improvements in healing mucosal injury in autoimmune conditions, such as, ulcerative colitis and in Crohn’s disease, which are both autoimmune inflammatory bowel diseases does help to modulate gaba serotonin and [00:45:00] dopamine pathways in the gastrointestinal tract as well.  So it can be an excellent option for balancing neurotransmitters and working with patients who have chronic anxiety and depressive symptoms from the standpoint of. You know, blood flow and improvements in tissue repair. It does promote an enhanced synthesis of nitric oxide and it supports nitric oxide pathways in the body.  So it’s very good at, you know, helping to support normal and healthy blood pressure. And it also upregulates VEGF or vascular endothelial growth factor, which is associated with. Capillary Genesis and the formation of new blood vessels. So, it can be very beneficial. Interesting.

Dr. Weitz: I never heard about the connection between BPC and and nitric oxide.

Craig: Yep. One of the, one of the major pathways that it definitely works on. And you know, that’s why PA patients a lot of times will have these improved recovery times. I [00:46:00] say patients, but a lot of times, you know, clients who are in. The bodybuilding or fitness or sports world will come to me and they’ve had an acute injury or they’re getting a little bit older and they’re just feeling as though their recovery time is a little bit prolonged you know, longer than what it used to be.  And they’re having to wait a few days before they really feel like they can give it their all in the gym again. And so, implementing a course of BPC 1 57. Is, you know, very much beneficial for improved blood flow tissue recovery. It basically helps to enhance collagen and elastin formation and synthesis and helps with collagen deposition that’s actually organized as opposed to, you know, disorganized collagen which can promote fibrosis and scarring.

Dr. Weitz:  And so what do you think about these guys from the gym that are buying these peptides like BPC online and administering ’em themselves?  Scary.

Craig: I don’t like it. I’m not a fan. I think that it’s [00:47:00] unregulated. It’s a commercial grade product for research use only or for animal use only.  And that, you know, there, there’s many reasons why that’s problematic. It could be adulterated. We never know the quality of the ingredients that are being utilized in those peptides. And the other aspect is that these are powerful agents. These are cell signaling agents. And so when you’re ordering something whether it’s a nutraceutical or a peptide online and you’re ordering commercial grade, you as the consumer have no recourse.  If something were to go awry, if you were to use. An injectable peptide and you have a negative or untoward response, you have no recourse. You have no, you know, ability to say, Hey I, you know, received this from my provider. And now I’m having, I. X issue. So there’s no consumer protection there, really.

Dr. Weitz: So utilize now in terms of the FDA and these peptides, [00:48:00] I know that the FDA has in the last couple years has been limiting the use of peptides. Where are we with that?

Craig: These are still categorized as you know, bulk substance, bi biologics, you know, a lot of the peptides that had formally been utilized, and that has limited the number of compound pharmacies that are willing to engage in the process of manufacturing and supplying these peptides to patients.  Now, fortunately, there have been several. I call them Bastions of hope because there are several compounding pharmacies out there that are still going full speed ahead with their compounding operations. And, you know, this is an area that I’ll let them and their legal teams, you know, wrangle with.  But for now, you know, that’s the only, those are the only places where I will source peptides for patients. You know, it’s gotta be a 5 0 3 a. Compounding pharmacy,

Dr. Weitz: so, so don’t buy peptides [00:49:00] online. You don’t know what you’re getting. And themselves. See a doctor practitioner like yourself. And get them from a compounding pharmacy.

Craig: Exactly. Get work with a clinician who’s trained in peptides. Ideally somebody who’s gone through some sort of rigorous training or certification program. There’s several programs out there for people who may be interested. So, you know, a four M has a Peptide therapy certification course, Dr. William Seeds with the SSRP or the Seeds Scientific and Research. Performance Institute has a phenomenal peptide therapy certification program. You wanna work with a provider who knows what they’re dealing with, who’s, you know, familiar with protocols, who’s familiar with the cellular mechanisms and the pathways that these peptides are really capitalizing on.  So, if you can avail yourself of a practitioner who is comfortable in, in that realm.

Dr. Weitz: Great. [00:50:00] So, let’s wrap up this interesting discussion. Any final thoughts and then tell us about your contact information.

Craig: Yeah, sure. Final thoughts? I’m gonna hit everybody with my favorite peptide right now.  SS 31, also known as Eptide. This is a powerhouse mitochondrial peptide in the wake of COVID-19. In the wake of, you know, all of these changes that we’re seeing in the American populace with regard to you know, immune dysregulation because of the cascade of inflammation that resulted from.  Metabolic syndrome you know, we need to have mitochondrial repair options. And so SS 31 works on the inner mitochondrial membrane. It stabilizes a molecule compound known as. Cardiolipin which basically is the scaffolding of the mitochondria on which all of our proteins that are associated with energy generation and energy metabolism are [00:51:00] situated.  So, that’s, you know, look up SS 31. It has FDA research for treatment of certain mitochondrial disorders.

Dr. Weitz: What dosage do you like for that?

Craig: Yeah, I usually start people on around four milligrams a day of SS 31. And then I titrate them up to around 10 milligrams a day. The four milligram to six milligram is more of like a.  You know, longevity, health span, optimizing approach. And then for the people who have a lot of mitochondrial dysfunction and, you know, they’re really having poor energy output. I utilize the higher doses anywhere from, you know, 12 to even upwards I’m sorry, 10 to upwards of 12 or 15 milligrams a day at times.  And so. That is it’s my favorite peptide. It’s a powerhouse peptide. It, you know, can really help with cognition and focus. It can help restore sleep patterns and circadian rhythms help with [00:52:00] glucose metabolism and energy optimization overall. So, you know, major. That’s

Dr. Weitz: great. A good clinical pearl for us.  I appreciate that. How can patients, of course and listening to this or watching this contact you.

Craig: So Remedy functional health.net is my website, www.remedyfunctionalhealth.net on Instagram. I am@remedy.functional.health. Post there all the time. And my practice. Is here in Salisbury, Maryland.  My number is 443-342-4141. And I do telehealth across the state of Maryland for people who are looking to revitalize and rejuvenate their life and work with patients very closely here, one-on-one locally. So, you know, reach out.

Dr. Weitz:  That sounds great. Thank you so much. Excellent.

Craig:  Hey, thank you, Dr. Weitz I really appreciate it. You have a great day.

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Dr. Weitz: Thank you for making it all the way through this episode of the Rational Wellness Podcast. For those of you who enjoy listening to the Rational Wellness Podcast, I would very much appreciate it if you could go to Apple Podcast or Spotify and give us a five star ratings and review.  As you may know. I continue to accept a limited number of new patients per month for functional medicine. If you would like help overcoming a gut or other chronic health condition and want to prevent chronic problems and wanna promote longevity. Please call my Santa Monica Weitz Sports chiropractic and nutrition office at 310-395-3111 and we can set you up for a consultation for functional medicine and I will talk to everybody next week.