Huberman Lab — Dr. Craig Koniver on Peptides & Performance Medicine

Provenance: clinical anecdote, not peer-reviewed evidence

This is a podcast transcript. Dr. Koniver speaks from clinical observation across his practice, not controlled trials. Treat every claim and protocol below as [anecdote] / [protocol] — expert opinion that supports and contextualises our evidence base, never as established fact. All framing remains research/educational use only. Where this conflicts with a kb-paper evidence node, the peer-reviewed source takes precedence. Source: YouTube — wRsX_ZkzxvQ

Claims & protocols by peptide

Each entry is [anecdote] (clinical observation) or [protocol] (dosing/usage Koniver reports using), with episode timestamp.

• BPC-157 — [anecdote] Broadly anti-inflammatory; used “almost with every patient”; reduces stiffness/soreness, helps recovery; post-viral use during pandemic. [protocol] Start ~500 mcg/day, titrated up to ~5,000 mcg/day; 5 days on / 2 off. Oral form localises to the gut (IBD, Crohn’s, colitis, leaky gut); injected SubQ works better even for gut issues and acts systemically (inject abdomen → benefit in a distant joint). Can be injected directly into tendons (often with PRP/PRF) — unlike steroids. [anecdote] Upregulates the growth-hormone receptor, so it pairs with GH-releasing peptides (more efficient GH binding → use less secretagogue). [note] Placed on FDA category-2 (compounding disallowed) Oct 2023. [00:18–00:29, 00:42–00:46]
• PDA (Pentadeca Arginate) — [anecdote] Proposed BPC-157 substitute; “basically the same molecular structure as BPC except they’ve swapped out an acetate for arginate” (one amino-acid substitution). Early but “very close to BPC” clinically. [protocol] 250–500 mcg injected daily, Mon–Fri. (No catalog product / KB peptide note yet — candidate.) [00:43–00:45]
• Ipamorelin — [anecdote] GH secretagogue with the cleanest “flavor”: most specific for the GH receptor but the weakest pulse; people lean out, sleep better, no real side effects. [protocol] 100 mcg max (ceiling to bind the receptor), pre-sleep, no carbohydrates within ~45 min. [warning] Rare anaphylaxis reported when people push 200–400 mcg; don’t use flushing/tingling as a “it’s working” signal. [00:49–00:53]
• Tesamorelin — [anecdote] GHRH analog; targets visceral fat; FDA-approved for HIV-associated lipodystrophy; Koniver observes it “works better in females than males.” [protocol] ~2 mg (2,000 mcg) per dose. [00:54–00:56]
• CJC-1295 — [anecdote] GHRH analog classically stacked with a GHRP (e.g. ipamorelin/GHRP-6) to extend GH in the system. [note] Episode states FDA removed CJC-1295 from compounding; the recorded intro update notes CJC-1295, ipamorelin, and thymosin (beta/alpha) were subsequently re-allowed for prescription in the US — status is in flux. [00:03–00:04, 00:54–00:55]
• Thymosin Alpha-1 — [anecdote] “Best peptide for immune modulation”: dial down an overactive immune system (autoimmune: lupus, RA, celiac, type-1 diabetes) or dial up a lagging one (long COVID, post-COVID). [protocol] ~5,000 mcg/day, sometimes IV. [note] Removed by FDA. [01:41–01:42]
• Pinealon — [anecdote] Khavinson bioregulator thought to regenerate pinealocytes; Huberman reports it roughly doubled his REM sleep (tracked), an effect that persists on nights he doesn’t dose; Koniver reports the same response across patients. [protocol] Injectable, combined with glycine (glycine also dosed orally 3–5 g, up to 10 g, at bedtime). [01:24–01:31]
• Epithalon — [anecdote] Russian peptide used for circadian rhythm and telomere/DNA-repair contexts; explored in animal studies for retinal degeneration. [note] On FDA do-not-compound list. [01:27]
• PT-141 (bremelanotide) — [anecdote] Melanocortin agonist; FDA-approved (Vyleesi) for female hypoactive sexual desire; neurogenic mechanism for erectile dysfunction (not blood-flow based). [warning] Narrow therapeutic window → nausea if over-dosed. [02:07–02:09]
• Melanotan II — [anecdote] Stimulates melanocyte-stimulating hormone → tanning “from the inside out”; MSH may bolster immune response / energy; downside is an unnatural orange tan. [02:08–02:09]
• HCG — [anecdote] Used to restore the HPG axis / sperm production after testosterone-induced suppression; paired with clomiphene. [00:33–00:34]
• Tirzepatide / Retatrutide (GLP-1 class) — [protocol] Micro-dose compounded tirzepatide/semaglutide, start very low, go slow; keep loss ≤2 lb/week to preserve lean mass; encourage adequate protein + resistance training; avoid rapid loss (“Ozempic face”). [anecdote] Compounds tirzepatide + sermorelin to offset muscle loss. Beyond weight loss: cognitive benefits, lowered inflammation, and reduced thyroid-peroxidase antibodies in a Hashimoto’s patient. [00:11–00:18, 00:37]
• GH secretagogues — general ([[Secretagogue]], [[GH Secretagogue]]) — [anecdote] GHRP-6: also binds prolactin/ACTH → cortisol + strong appetite spike; go-to for mass/strength. Hexarelin: clean morning energy/endurance, no appetite spike; 100 mcg AM. MK-677: oral, GHRP-6-like, appetite spike — “don’t take at bedtime.” Most GHRPs cap at 100 mcg. [00:51–00:54, 01:17–01:20]

Cross-cutting themes

• Off-label prescribing ([[Research-Use-Only]]): most US prescriptions are off-label; a drug approved for one purpose can be prescribed for others (e.g. semaglutide diabetes → weight loss). [00:10, 01:05–01:08]
• Sourcing & purity ([[COA]], [[Purity]]): “research use only / not for human consumption” gray-market peptides may carry LPS endotoxin (cumulative inflammatory risk → anaphylaxis); compounding pharmacies are state Board-of-Pharmacy regulated, sterile-tested by outside labs for endotoxins. Work with a physician + compounding pharmacy, not gray/black market. [00:34–00:37, 00:41]
• Peptide stacking ([[Peptide Stacking]]): combine 3–7 peptides into a single daily shot via a compounding pharmacy (e.g. a “fat-loss” stack of BPC + ipamorelin + tesamorelin at bedtime). [00:56–00:57]
• FDA category-2 declassification (Oct 2023): BPC-157, CJC-1295, MK-677, thymosin alpha-1, epitalon, dihexa, cerebrolysin discussed as removed from compounding — driving users toward gray market. Koniver frames it as likely a mix of legitimate oversight + pharma profit incentive. [00:35, 02:11–02:15]
• Adjuncts discussed (non-catalog): NAD (IV loading 750 mg ×5 in 10 days, then monthly; SubQ 100 mg), methylene blue (10 mg AM, MAOI/mitochondrial), CoQ10 (200 mg+), methylated B vitamins / homocysteine, glycine (phase-2 liver detox + sleep), cerebrolysin & dihexa (BDNF/cognition). (Candidates for future kb-concept notes.)

Full transcript

Sponsor/ad reads and the closing newsletter/book promo have been trimmed (marked [sponsor segment omitted]); all substantive discussion is preserved verbatim with timestamps.

[00:00] Welcome to the Huberman Lab podcast, where we discuss science and science-based tools for everyday life. I’m Andrew Huberman, and I’m a professor of neurobiology and ophthalmology at Stanford School of Medicine. My guest today is Dr. Craig Koniver. Dr. Craig Koniver is a medical doctor who did his training at Brown University and Thomas Jefferson University. He is a world expert in what he refers to as performance medicine, which involves the use of peptides and other therapies for improving mental health, physical health and performance.

[00:32] A peptide is simply a small protein — insulin is a peptide; we have thousands of peptides in our brain and body performing a variety of roles. Dr. Koniver’s expertise is in the use of exogenous peptides for activating multiple pathways in the brain and body to augment health. Today we talk about novel peptides including GLP-1 (glucagon-like peptide analogs) — things like Ozempic and Mounjaro, which are a bit controversial — and we discuss micro-dosing those peptides, combining them with other peptides and behavioral practices to offset associated muscle loss.

[01:34] Then we dive into lesser-known peptides growing in use: BPC-157 (body protection compound-157) for inflammation and wound healing; peptides to increase growth-hormone secretion during sleep; and peptides that can dramatically increase REM sleep. We also discuss testosterone therapies for men and women, NAD, and specific supplements — Dr. Koniver is not a big proponent of supplements but mentions a few he finds useful, like CoQ10 and methylated B vitamins.

[02:30] Peptides sit somewhere between doing nothing (diet and exercise), supplementation, and more advanced hormone therapies (growth hormone, testosterone) that can shut down one’s own endogenous production via negative feedback. Peptides can augment specific hormone pathways and multiple processes without that negative-feedback shutdown — which is why they’re growing in popularity — though not without safety concerns. We discuss side effects, safety, and the critical issue of sourcing clean peptides and working with a board-certified physician.

[03:52] A recent update prior to release: three peptides — CJC-1295, ipamorelin (both growth-hormone secretagogues) and thymosin (beta/alpha, anti-inflammatory/tissue-repair) — are now re-allowed for prescription in the United States. At the time of recording we discussed some of these as recently banned by the FDA; they are now approved again for use in humans.

[04:56] [sponsor segment omitted — Juve red light, BetterHelp]

[07:30] Huberman: Dr. Craig Koniver, welcome. Koniver: Thank you, Andrew, I appreciate the invitation. Huberman: This space called peptides is picking up momentum even though it’s been around a long time. Many people are using peptides for specific purposes but most haven’t heard of the various peptides out there — and in years to come they’re going to be increasingly popular. The incredibly popular GLP-1 agonists are taking over. To orient everyone: what is a peptide?

[08:56] Koniver: At an elementary level, peptides are chains of amino acids. We call it a peptide if it’s 40 amino acids or fewer, a protein if it’s 41 or more. The body makes ~300,000 peptides; therapeutically we’ve used closer to 150 over the years. We’ve been using peptides for about 8 years — a long time, but still early in understanding how best to use them clinically.

[09:29] Huberman: Let’s talk GLP-1 first, because most people have heard of semaglutide and Mounjaro. How long ago did humans start injecting GLP-1 agonists to lose weight? Koniver: The weight-loss aspect is only a couple of years; it’s become the number-one prescribed in America. Semaglutide/Ozempic was approved longer ago for type-2 diabetics for glucose control, and weight loss was noticed as a side effect. Most medicines prescribed in America are prescribed off-label — the vast majority are never approved for what they’re used for. As a physician I can prescribe any approved drug for any reason, as long as we’re safe.

[11:32] So semaglutide went from helping diabetics lower blood sugar, to helping diabetics lose weight, to helping non-diabetics lose weight, and eventually got FDA approval specifically for weight loss. We’ve used primarily tirzepatide (semaglutide 2.0) for the past two years and learned a tremendous amount; my opinion has changed from working with people.

[12:05] Huberman: There seem to be two camps — one bullish, one pointing to drug dependency, expense, and lifestyle factors (exercise, caloric restriction, non-processed foods) as a better alternative. What do you think? Koniver: Both have their place. My philosophy: everyone should have access to things that are safe and that help them look, feel and perform their best. If we could all just exercise and eat our way out of it we wouldn’t have an epidemic — it’s really hard. The analogy I use: I like to help people win the race first, which motivates them to train for the next race. If I help someone lose weight first with tirzepatide/semaglutide, they get excited, the light bulb turns on, and they want more of that healthy momentum.

[14:29] I was initially cautious — worried about dependency and losing too much weight — but when something works and appears very safe, I think it’s worth discussing and like people having those options.

[15:21] Huberman: Adipose tissue produces hormones impacting the brain; many carrying excess body fat report brain fog. Thanks to Chris Palmer and a metabolic-psychiatry program at Stanford we’re appreciating the link between adipose tissue and brain health. On GLP-1: people criticize that a fair percentage of weight lost is lean mass — but that can be remedied with resistance training? Koniver: Resistance train, yes. Also, with conventional dosing people lose weight too quickly. We get semaglutide/tirzepatide compounded so we can micro-dose, start very low and go slow. As long as people lose ~2 lb or less per week they’re not losing muscle mass; we encourage adequate protein and resistance training. Micro-dosing has been a game-changer — when people lost 15 lb in three weeks they’d lose facial fat (“Ozempic face”) and rebound; going slowly lets us dial it in.

[17:19] Beyond weight loss we’re seeing cognitive benefits, lowered inflammation, autoimmune patients whose inflammation markers come down. Huberman: Direct effect on immune pathways, indirect via fat loss, or the positive psychology of feeling better? Koniver: All of the above. I have a 50-year-old Hashimoto’s patient whose thyroid-peroxidase antibodies — usually hard to lower — came down on GLP-1s. Something positive is going on that’s hard to fully explain.

[18:39] Huberman: Moving to the second most popular peptide — BPC-157, body protection compound 157 — lots of animal data, few if any human clinical studies, but many people taking it. What are known uses in your clinic? Koniver: BPC is the most-utilized peptide for us — we’d like to use it with almost every patient. It’s very anti-inflammatory. Most adults are stiff and sore as they age; athletes have inflammation; chronic disease involves inflammation. Across thousands of patients their inflammation comes down, they feel better, joints hurt less.

[20:22] We start with a conservative dose based on animal studies and titrate up. We started at 500 micrograms a day and got up to 5,000 micrograms a day, with a 5-days-on/2-days-off protocol. Helpful for many things, including post-viral during the pandemic. Anyone working out regularly will likely benefit — improved inflammatory status and recovery — and unlike antioxidants taken around training, it doesn’t seem to blunt adaptation.

[21:46] Huberman: Part of exercise adaptation is triggered by inflammation — which is why cold-water immersion in the 4–8 hours after resistance training can limit hypertrophy/strength gains. (To be clear, cold plunges have benefits — just do them outside that post-training window if hypertrophy/strength are the goals.) Back to BPC: strongly anti-inflammatory, and my understanding is it may upregulate growth-hormone receptors? Koniver: It does. So it pairs very well with a growth-hormone-releasing peptide (sermorelin, ipamorelin, GHRP-6): you help the pituitary put out more GH, and BPC upregulates the GH receptor so binding is more efficient — you get more out of it, and can use less of the releasing peptide.

[23:45] Koniver: BPC is a gut peptide, so oral forms survive the gut (most peptides are broken down). Oral BPC is more effective locally for GI issues — inflammatory bowel disease (Crohn’s, ulcerative colitis), IBS, leaky gut. Huberman: Has it been shown effective for those, or observed clinically? Koniver: Observed clinically — and interestingly I’ve seen a better clinical response when people inject it (SubQ, tiny 30–31 gauge insulin needle), even for GI issues. We thought you’d inject locally for an elbow injury, but it works systemically — inject in the abdomen or rear and still get benefit in the elbow and all joints.

[25:28] Huberman: BPC-157 can initiate fibroblast migration. It always perplexed me that such a small SubQ volume near the belly button could seek out an elbow or Achilles injury. There were wild anecdotes — an Olympic athlete with a torn Achilles back weeks later — chatter and fog. Koniver: We’ve seen it with stem cells too: radiographically tagged IV stem cells aggregated at a fracture site within 24 hours. There’s an innate intelligence; circulation moves incredibly fast (a saline infusion at the elbow reaches your toes in seconds).

[27:54] Where BPC shines is ligaments and tendons — where muscle connects to bone, where strains/sprains/tears happen. We can inject it directly into tendons (unlike steroids, which damage tendons), mixed with PRP/PRF, and get healing within days. Super safe.

[28:51] Huberman: I’m concerned about gray-market sources with contaminants — people buying BPC not from a physician or compounding pharmacy but “on the internet.” Until the recent FDA ban you could prescribe clean BPC. What’s the story now, and gray market vs compounded vs pharmaceutical? Koniver: There’s black market (someone sells you “BPC” — dangerous), like anabolic steroids. Most anabolic steroids can’t be obtained from a physician — except nandrolone (Deca), which can be prescribed and combined with testosterone above board.

[30:17] Huberman: Testosterone cypionate/enanthate and Deca can be prescribed because they’re FDA-approved (hypogonadal syndromes, TRT in men and women). Koniver: Nandrolone (Deca) works synergistically with testosterone, helps joints; I like it for men who’ve been on testosterone a long time and get less out of it (anything used continually becomes less potent). A Marine/Secret Service patient in his 80s with osteoporosis/osteopenia came back to life combining nandrolone with testosterone.

[31:47] Huberman: A brief editorial: many younger males (teens, 20s, 30s, early 40s) think they need synthetic testosterone to look/perform a certain way. For most of those ages it’s not necessary if they sleep, eat and train well — though there are growing use cases. With synthetic testosterone and Deca there’s a real concern: loss of fertility. Koniver: It’s known people get testosterone from trainers/“bros.” I have many patients who started in their late teens/early 20s. One came to me at 25, newly married, wanting kids — “I have zero sperm left.” He’d abused testosterone and growth hormone for years; the repercussion is big. We rebuild the system with clomiphene, HCG, and other agents. The larger point: having a knowledgeable physician matters; people get info from websites and “just try this peptide,” and some have had anaphylactic reactions to research-grade peptides not meant for human consumption.

[34:35] Huberman: Beyond black market there’s a “dark gray market”: companies selling peptides labeled “not for human or animal consumption, research purposes only,” whose potency and purity aren’t established — many contain LPS (lipopolysaccharide), which is inflammatory. You mentioned people with life-threatening consequences. Koniver: In October 2023 the FDA put many peptides (including BPC) on a category-2 list — no longer allowed to be compounded. That excludes research companies (outside FDA purview) but hit compounding pharmacies hard.

[36:08] Compounding pharmacies are distinct from black/dark-gray sources: they’re FDA/Board-of-Pharmacy regulated in every state, inspected regularly, and sterile compounds (anything injected, eye drops, IV/SubQ/IM) must be outside-lab tested for purity and endotoxins. The advantage: we can tweak dosage, combine synergistically. We’re now making a unique tirzepatide + sermorelin combination to offset muscle loss.

[38:22] [sponsor segment omitted — AG1]

[39:42] Huberman: So if interested in peptides for performance medicine, essentially only put peptides into your body that you obtain from a physician who sources from a compounding pharmacy — and who develops a relationship. Koniver: For any peptide we meet the patient, confirm fit and contraindications, and dial it up or down based on their life, medicines and conditions. Doing it alone on the internet, you’re walking on your own.

[41:08] Huberman: Anything labeled “not for animal or human use, research purposes only” — you can pretty much guarantee the endotoxin/LPS hasn’t been removed, and it can be cumulative; the tipping point is unknown. Koniver: Fifteen years ago someone took a TV-doctor’s oral weight-loss advice and came in with blood pressure ~220/140 (normal 120/80). Under a physician’s guidance we can clean up the mess.

[42:56] Huberman: Given BPC-157 is effectively removed from the legitimate market, what are alternatives (working with a physician)? Koniver: A newer peptide called PDA — pentadeca arginate. Basically the same molecular structure as BPC except an acetate is swapped for arginate — one amino-acid substitution. We’re getting really good results; early, but very close to BPC clinically. I think it’ll be this way with all these peptides — smart people creating amino-acid combinations that mimic BPC, thymosin alpha, epitalon, TB-500, etc. Some patients at the highest levels of the US government are aware and concerned the FDA changed the game — a huge setback.

[45:08] Huberman: With BPC sources drying up, I’m concerned people go to gray/black market. PDA may be a good physician-prescribed substitution — starting dose? Koniver: 250–500 micrograms; we use 500 mcg injected daily, Monday–Friday, weekends off. Probably can use more; that’s conservative. Huberman: And no side effects mentioned for BPC or PDA. Koniver: It’s been tremendous. We also used BPC intravenously as a bolus for acute injuries (torn ACL/meniscus) — IV is more of a “spark” (short pharmacokinetics); SubQ lasts longer. The sweet spot was both: IV spark to initiate the anti-inflammatory cascade, then a SubQ dose.

[46:32] Huberman: You prefer peptides to direct hormone manipulation in most cases. Koniver: With testosterone and growth hormone I don’t want to manipulate hormones beyond what you’d see in nature — that’s why I dislike testosterone pellets (concentrations we’d never see naturally); I’d prefer injection (day-to-day variation), topical or sublingual. With peptides like ipamorelin (a GH-releasing peptide), you inject SubQ, it travels to the pituitary, GH is released, goes to the liver to make IGF-1 — anabolic (growth, healing). As we age we make less GH; these peptides help push out a little GH and direct when it’s released.

[49:19] Huberman: The “every hour before midnight is worth two after” idea — the largest GH pulse is in the couple hours before midnight, so injecting ipamorelin at bedtime works within minutes (some flushing/tingling). Koniver: The dose of ipamorelin and most GH-releasing peptides should be 100 micrograms — that’s the max to bind the receptor. I’ve seen rare anaphylaxis with ipamorelin when people push 200–300–400 mcg. They feel amazing flushing (“it must be working”), then can spiral into circulatory collapse.

[50:41] Huberman: Using side effects as an indicator that something’s working is a terrible idea, but common. I’ve tried various peptides briefly and safely. Sermorelin gave me great sleep only in the first part of the night, nuked my REM in the second half, and consistently spiked my PSA (prostate-specific antigen) — on/off/on/off — so I stopped. Others love sermorelin with no issues; it can be very individual. Koniver: Agreed. I think of these GH-releasing peptides as having “flavors.” Ipamorelin is very clean — within 100 mcg, people lean out, sleep a bit better, no real side effects, taken pre-sleep, no carbohydrates in the previous ~45 minutes.

[51:58] GHRP-6 also binds — but you may bind prolactin, ACTH (→ cortisol), and get a hunger response and trouble sleeping. Where that’s beneficial: putting on mass/strength. Eat more protein; building muscle is resistance training + sufficient protein + an anabolic background (GH or testosterone). GHRP-6 can shine — within weeks people get big and strong — but you must understand the flavor.

[53:16] Huberman: For most of our audience the interest in GH secretagogues relates to better sleep and vitality — most want to be strong and lean without being big. So GHRP-6’s appetite spike is niche. Ipamorelin at 100 mcg or less pre-sleep is interesting. What are other GH secretagogues? (These stimulate release of your own endogenous GH — not taking GH.) Koniver: Two others we use: tesamorelin and sermorelin, which work on the GH-releasing-hormone aspect higher up the chain; you don’t necessarily need to add anything. Classically with ipamorelin/hexarelin/GHRP-6 we’d add CJC-1295 (works on GHRH) to keep the peptide and GH in your system longer — but we can almost set CJC aside now because the FDA took it out.

[55:16] Tesamorelin works on visceral fat reduction — FDA-approved for that purpose in HIV patients with lipodystrophy. My observation: it works better in females than males. Any GH-releasing peptide that makes GH more active improves sleep, skin tone/texture, resilience and durability (recovery from hard workouts, sprains, cuts). Taken before sleep, no food within 45 minutes.

[56:39] The magic is stacking: combine peptides at lower doses. A great combination — BPC + ipamorelin + tesamorelin at bedtime — gave SubQ fat reduction (ipamorelin), visceral fat reduction (tesamorelin), GH-receptor upregulation (BPC). We labeled it a “fat-loss” peptide, but people put on lean mass, slept better, had better skin, more durability, better thought process. Working with a compounding pharmacy we put 3–7 peptides into one shot a day.

[57:30] Huberman: Combining tesamorelin/sermorelin, ipamorelin and (now PDA instead of BPC) — every night, 5 days a week? Koniver: 5 days on, 2 days off — from how we’d dose growth hormone. I like breaks even with supplements (I don’t take them weekends) — anything you expose yourself to continually becomes less potent, like exercise or eating the same food daily.

[58:22] [sponsor segment omitted — Function, 8 Sleep]

[01:01:36] Huberman: You’re not a fan of taking massive amounts of supplements, but you take CoQ10, 200 mg/day in the morning. I also take CoQ10 for “general mitochondrial health.” What’s the rationale? Koniver: The mitochondria is the battery of the cell, making ATP. Three ways: glycolysis (glucose → two pyruvates → a little ATP), pyruvate → acetyl-CoA through the Krebs cycle (more ATP + intermediates, mainly NADH), then NADH shuttled to the mitochondrial membrane where the most ATP is made across five cytochromes — exchanging electrons for protons down an “assembly line” to turn the ATP wheel.

[01:03:38] Different nutrients hit each hub: cytochrome 1 = NAD; cytochrome 2 = riboflavin/B2 + succinic acid; cytochrome 3 = CoQ10 + vitamin K2; cytochrome 4 = methylene blue; cytochrome 5 = magnesium, vitamin A, copper. Include any or all and you maximize mitochondrial energy. For most people the “traffic congestion” is at cytochrome 1 — so upregulating NAD opens flow downstream. For some it’s cytochrome 3 (CoQ10) or 4 (methylene blue). CoQ10 has been studied safe up to 2,400 mg/day; for me it’s been dramatic for migraines, reducing them to near zero.

[01:05:28] Huberman: People may call this anecdote — but you’re a board-certified physician, and most prescribed drugs are off-label anyway. Koniver: An antibiotic gets approved against a specific bacterium, then through clinical use we learn it works for many infections (or azithromycin clearing acne). Same as semaglutide → weight loss. We also see repurposing of doxycycline, metformin, and mebendazole (an antiparasitic) in cancer therapy by sophisticated oncologists.

[01:07:58] Huberman: Pharmaceutical companies are very interested in other uses of already-approved drugs (the R&D/safety process is expensive) — so they want to take a safety-approved drug and find new uses, as happened with Ozempic. Koniver: I write prescriptions and there’s a time and place, but it’s challenging operating in a paradigm where chronic disease is essentially failing — we’re not denting heart disease, cancer, autoimmune or neurodegenerative disease while spending exorbitantly. I started a traditional Family Medicine practice in 2006, began using nutritional IVs (before “hangover IVs”), and learned they help people feel better quickly. My model: help people feel better first.

[01:09:57] Your podcast has been so successful at a time when people lost trust during the pandemic — you provide stable, vetted information people can trust. Every day my patients say “I heard this on the Huberman Lab podcast.” The problem with physicians is a paternalistic model. In medical school in the ’90s a study collected trash outside physicians’ offices and found >30% of prescriptions written that day were thrown away by patients — because people came not for a prescription but to be listened to, validated, and to feel better. There are many other tools.

[01:12:30] When I help people feel better first, that builds trust — I work with peak performers, athletes, celebrities, royalty. Weight loss is hard partly because people don’t value themselves enough to make hard disciplinary choices — and they don’t have people they trust.

[01:13:22] Huberman: The podcast was born during the pandemic because people were anxious and their circadian rhythms disrupted — areas of my lab. I read papers on the importance of morning sunlight while colleagues got “the tenure look,” aging rapidly. I wanted to avoid that. The post-pandemic years have drawn attention to taking agency in one’s own healthcare — no pill, potion or injection replaces good behaviors, though they can augment them. Even the wealthiest now boast about health and vitality rather than yachts.

[01:15:18] Koniver: A lot of social-media messaging is additive — high-intensity workout daily plus sauna plus cold plunge plus dieting — and that stress is cumulative. A wise, affluent, generous friend told me: “I look for every opportunity to surrender” — to people you trust to guide you, so you’re not the quarterback of everything. It’s not always about adding; it’s creating space to be in flow.

[01:17:02] Huberman: These are tools, a buffet. Most agree sleep, exercise, nutrition, and social connection are key. On growth-hormone secretagogues: we covered GHRP-6 (appetite). What about MK-677? It sounds like a weapon. Koniver: It’s like GHRP-6 but absorbed well orally — stimulates appetite, can raise cortisol/prolactin. Not for most people, but useful for, e.g., a successful man in his early 60s on testosterone, eating and training well, who can’t put on muscle mass (maintaining healthy muscle gets harder with age). MK-677 was taken off the compound list by the FDA. I tried it at bedtime once, woke an hour later starving — destroyed my sleep — so don’t take it at bedtime.

[01:19:33] Huberman: For typical patients who don’t want appetite stimulation — male and female — what do you compound? Koniver: Tesamorelin (no appetite stimulation I see) and hexarelin. Hexarelin’s “flavor” is energy/endurance — used in the morning for a clean (non-jittery) energy burst, good for endurance athletics; no appetite spike. Dose 100 micrograms, same as ipamorelin/GHRP-6. We used to compound it with CJC-1295, but CJC is out per the FDA.

[01:20:58] The two doses that differ: tesamorelin ideal dose 2 mg (2,000 mcg); sermorelin has a broad range, ~200 mcg up to 3,000 mcg depending on goals.

[01:21:29] Huberman: Back to supplements — besides CoQ10, what do you take? You mentioned methylated B vitamins. Koniver: A SNP (single-nucleotide polymorphism) like MTHFR means things don’t flow as easily; you can be heterozygous or homozygous. Homocysteine is an emerging cardiovascular-risk lab marker — elevated is >7 by some labs, >9 by most — and the best way to lower it is ample methylated B vitamins: methyl-B12, methyl-folate, trimethylglycine (TMG), methionine — methylation donors that help your liver detox pathways. I don’t think MTHFR is as profound as some claim; you overcome it with sufficient methyl-B vitamins. I take them in the morning; for a 3 p.m. slump, try more methyl-B vitamins instead of coffee.

[01:24:23] Huberman: A perfect segue to sleep — peptides that improve sleep beyond GH release. For the last 4–6 months I’ve tried injectable pinealon combined with glycine, and never before have I found something that increases my REM sleep. Tracking with the Eight Sleep tracker, it’s roughly doubling my REM (e.g., from ~1.5 to nearly 3 hours). Even Bryan Johnson commented on the sleep score. My understanding is pinealon may stimulate regeneration of pinealocytes (the pineal). Koniver: You’ve nailed it. Your response is what we see with patients. The glycine combination — I’m a big fan of glycine, and injecting it works really well.

[01:27:16] Pinealon is one of the smallest peptides but one of the most profound. We used to combine it with epitalon (the Russian peptide for circadian rhythm; also involved in DNA repair, explored in animal studies for retinal degeneration) — but epitalon is on the do-not-compound list. Pinealon stays. There’s likely a circadian aspect, helping melatonin production. I think there’s more to the pineal gland than we understand.

[01:28:49] Huberman: Millions suffer from lack of REM sleep — loss of neuroplasticity, impaired removal of emotional “labels” on memories, impact on depression and most mental-health issues. I raise pinealon with some trepidation — it’s not a miracle drug, but it has this effect. There’s also a recently FDA-approved sleep drug class, the dual orexin receptor antagonists (e.g., Quviviq), meant to increase REM by suppressing wakefulness; for me it was a disaster (woke at 3 hours) and expensive. Pinealon has been incredible, and interestingly it seems to improve my sleep on nights I don’t take it — consistent with regenerating melatonin-producing pinealocytes. Koniver: Yes — something you could pulse now and again and get nightly improvement. It’s very safe; I’ve never seen a negative side effect from pinealon.

[01:30:43] Huberman: Why combine with glycine? Koniver: Glycine is an inhibitory neurotransmitter; I start with it when people have trouble settling at night — not sedating, but it tones the nervous system. Orally, most start with 3,000–5,000 mg, and you can go up to 10 grams. Glycine also works on phase-2 liver detoxification (amino-acid conjugation), helping the liver — valuable given exposures (glyphosate, heavy metals).

[01:32:08] Huberman: Many ask about metal and mold toxicity. Koniver: We’re water-soluble organisms in a fat-soluble world; the liver makes fat-soluble things water-soluble to excrete them, in two phases. Phase 1 (P450 enzymes) is “trash in the can to the curb”; phase 2 (amino-acid conjugation) is “the truck picks it up.” Few things in nature induce phase 2 independently of phase 1 — polyphenols (the reds/blues pigments), matcha (strong phase-2 inducer), glutathione, and glycine. Most pharmaceuticals induce the whole P450 system (speeding phase 1), piling more “trash” curbside without speeding pickup.

[01:34:49] Huberman: If someone can’t access injectable pinealon/glycine, can they take glycine orally? Koniver: Yes — well absorbed, sweet-tasting, smallest amino acid. Start 3–5 g at bedtime; if no effect after a few nights, double to 10 g — most people notice it then (not sedation, but a toned-down nervous system, easier sleep onset, more efficient overnight detox). I’m still a fan of magnesium threonate, apigenin (a chamomile derivative). There are oral bioregulator peptides (developed by the Russian scientist Khavinson, with published research); pinealon reportedly survives stomach acid, but I prefer injectable for bioavailability — and an injectable pinealon is probably easier to find than an oral one.

[01:36:41] Huberman: People will start selling pinealon after this — you need to know you’re actually getting pinealon (someone could throw melatonin in and call it pinealon). Koniver: This is why the compounding-pharmacy + physician + research approach matters.

[01:37:07] Huberman: Will pharmaceutical companies move into these other peptides? Koniver: Tesamorelin (visceral fat) and sermorelin are FDA-approved; GLP-1 agonists are FDA-approved — the FDA won’t pull those (Blockbusters, big money). The concerning part with GLP-1s: they’ve been compoundable due to a shortage (they’re patented for the delivery system/pen, not the peptide), making them far more affordable. Rumor is the pharma companies now have supply back and will remove the ability to compound them — so people stick to traditional dosing and lose access (≥$1,500/month uninsured).

[01:39:07] Huberman: You mentioned stem-cell therapies — not FDA-approved here? Koniver: Using “stem cell” is a problem; “autologous cell” (like PRP) is the same idea — take your blood, spin it down, give it back within four hours, which is allowed under FDA guidelines. A Florida clinic touting stem cells for macular degeneration injected stem cells into patients’ eyes and they went blind quickly — a severe setback to the field. (Gene therapy was similarly set back ~a decade after a patient died.) This country is very conservative about new therapeutics. I’m excited about stem cells, exosomes, PRP/PRF as biologics, taken from your own body and given back per FDA guidelines.

[01:41:12] Huberman: Thymosin alpha-1 — did the FDA nuke it? Koniver: They did. From my observation it’s the best peptide for immune modulation: for an overactive immune system (autoimmune — lupus, RA, celiac, type-1 diabetes) we’d tone it down; in post-COVID where the immune system hasn’t caught up we’d dial it up. We used 5,000 mcg/day, sometimes IV, with great results and no issues — but it’s off the table now.

[01:42:47] Huberman: Brain fog with long COVID — cerebrolysin is interesting and more available in Europe. Koniver: We’ve used a lot of cerebrolysin (IV and SubQ) — I have a clinic in London and one in Charleston, and we’ve used it more in the UK. It’s been used for decades post-stroke and post-TBI. The trouble: some people have a day or two where their mood shifts to a dark place, then come out of it — most don’t like that, so we mostly stopped. Cerebrolysin is a cocktail that collectively increases BDNF. Dihexa — supposedly the most potent way to increase BDNF — was also removed by the FDA.

[01:44:14] Huberman: On cognitive function — methylene blue. I used to clean fish tanks with it. What is it and does it turn your tongue blue? Koniver: It does (not permanently). It was the first pharmaceutical ever prescribed in this country (late 1800s). It binds cytochrome-C oxidase on the mitochondrial membrane; traditionally used for carbon-monoxide poisoning (helps red blood cells displace CO and put oxygen there) — I think of it as an oxygenator. Huberman: Performance-enhancing in endurance sport? Koniver: Check your governing body; I don’t believe it’s on the banned list.

[01:46:26] Methylene blue is well absorbed orally (bigger oral than IV doses tolerated; IV can cause vein spasm). A good dose is no more than 10 mg in the morning — a cognitive stimulant. We compound it with a little caffeine and B vitamins; people say it’s great for recall/memory. It will turn urine green/blue for ~24 hours — and if it doesn’t, that’s clinically interesting: it may mean your mitochondria aren’t working well (you used it all, no spillover). It’s also a mild MAOI (lets serotonin work longer) and seems antiviral (probably via mitochondrial efficiency). It’s a prescription drug, though now sold over the counter as supplements — be careful. Sometimes in-office we give up to 50 mg with IV treatments (blue gums/lips for an hour or two). I take it about three times a week.

[01:50:08] Huberman: Earlier you mentioned faster recovery from COVID. The second time I got COVID I had a strong test band, felt ~6/10 malaise, no fever. I did an NAD infusion (told them I had COVID) — ~750 mg over ~45 minutes, with the usual “elephant on your legs” / chest-cramp feeling. The next day the band was absent and symptoms dropped to ~2/10; within 48 more hours I was good. Correlation isn’t causation (could be the saline), but the shift from dark band to no band was dramatic. Thoughts? Koniver: We’ve seen it many times. We’ve used NAD longer than most; I was given the original Mexican infusion protocol, and 750 mg is what we settled on in my office (now widely adopted). NAD goes A-to-Z quickly in inexplicable scenarios — including COVID and other viral infections. I’ve been more impressed with NAD than any other agent.

[01:54:34] Huberman: I take sublingual NMN daily — makes my hair and nails grow fast (n-of-1; I have no stake in any NAD company). Charles Brenner encouraged me to try NR (NAD minus a phosphate), which I took orally but couldn’t distinguish and stopped (expensive vs NMN). There’s some human literature that NR reduces inflammation; less for NMN. Koniver: Right — with oral NMN/NR you’re not having the transformational within-a-week experiences we see with NAD infusions. I had a patient with chronic Epstein-Barr (reactivated mono), depressed and on disability; after a loading dose (five treatments in 10 days) his wife came back crying — “within a week my husband is back.” I can’t fully explain it via the NAD:NADH ratio alone — there’s something beyond the mitochondrial effect.

[01:57:25] Huberman: At a foundation meeting I saw unpublished data: researchers did metabolomics on people with major depression and found clusters deficient in particular B vitamins; supplementing those back produced remission. Not all depression is one vitamin (or “just serotonin”) — but nutritional deficiencies as a source of mental illness was striking. So NAD raising the tide across biological processes makes sense. Koniver: I like how you described it.

[01:59:21] Huberman: How often do you have healthy patients do NAD infusions, and dosages? (Costly — ~$500–$1,000+, especially in LA.) Koniver: We do a loading dose: 750 mg IV, five treatments in 10 days. (In the ’90s, Mexican protocols for substance abuse used 3,000 mg over 10 straight days — 6–10 hours per infusion.) 750 mg over 45 min–2 hours is the sweet spot. ~95% of people report after the loading dose that their “brain is bigger,” more creative, elevated mood, can sleep less with more energy, colors brighter, language easier — affecting the nervous system first (mitochondrial density per neuron). Physical recovery benefits come later.

[02:02:36] People come back at 3–4 weeks feeling less good, so we do a once-a-month maintenance dose (some weekly, some quarterly). During the pandemic we started SubQ NAD, 100 mg, 5 days on/2 off (a little stomach cramping). NAD isn’t absorbed orally well — you have to inject or infuse. If I had to pick one thing, NAD would be it — more impactful than any agent from where I sit.

[02:04:33] Huberman: The fastest I’ve had it dripped was ~40 minutes. Koniver: The record I’ve heard is 3 minutes 26 seconds (500 cc saline) — insane; we wouldn’t allow it. During the infusion you feel bad enough to get irritable — an interesting window into empathy for people in pain (like seasickness; someone walks in and you wonder why they’re “walking like that”). When you remove the infusion you feel great and people seem delightful again. We use an 8-chair IV room and make it social — there’s healing in community.

[02:06:20] Huberman: For people who can’t afford infusions, injections next, then sublingual NMN over NR? Koniver: Yes — NMN over NR. Most expensive to least: IV → SubQ → NR → sublingual NMN. You can do NAD topically/patches, but the patch adhesive irritates skin. (Listeners may recall the episode with Dr. Peter Attia on NAD/NMN/NR focused on the research literature; I’m a clinician — my evidence is observing many people.)

[02:07:51] Huberman: A couple of FDA-approved peptides — PT-141 (in the melanocortin pathway; brand Vyleesi) for female hypoactive sexual desire, also used for libido in men. Koniver: It can be — a neurogenic mechanism for erectile dysfunction (not just blood flow). It’s a fragment/derivative of melanotan, stimulating alpha-MSH, which is in play with mold toxicity (MSH as a “general” for hormonal pathways) and may bolster immune response and energy. The downside of melanotan: it stimulates melanocytes → tanning “from the inside out,” an orange, unnatural look. PT-141 came from rats copulating more; in humans the therapeutic window is narrow — too much causes nausea quickly, and some (especially women) dislike the tanning look.

[02:09:59] Huberman: The medial pituitary origin of these peptides is interesting; Zachary Knight noted some GLP-1 nausea relates to receptors in the area postrema (primitive nausea-generating areas). Koniver: If we micro-dose the GLP-1s and go slow, nausea is virtually unheard of — people get into trouble “shotgunning” the dose and overwhelming the system.

[02:10:56] Huberman: A controversial question: the FDA presumably wants our safety, yet there’s a “clawing back” of peptides and a handoff to pharma with huge profit margins. mk-677, thymosin alpha-1, BPC-157 clawed back. Good intentions, or a plan to enable high-margin sales — or both? Koniver: Probably both. I work at a major medical school but speak freely: I think these bodies have some people with good intentions — I don’t believe it’s villains taking kickbacks. But it’s weird that a huge class of clearly beneficial compounds is clawed back. Government often overreaches; there are ways to understand how things work without removing them from the market. And from a pharma view, if you see 15–20 peptides really working, it’s not a leap to turn a commoner’s peptide into a drug (as happened with melanocortin pathways → Vyleesi).

[02:14:42] We have to operate within boundaries, but honestly we’re “not even close to talking about the truth for most things” — why people get chronic disease, overprocessed food, toxicities (glyphosate/Roundup interfering with many pathways while being called safe). You have to be your own best advocate; you can’t rely on the government for permission. Do your own research, seek reliable information (your podcast is a safe starting point), then explore what works for you — like a recipe you adjust to taste, with experienced physicians to guide you.

[02:16:34] Medicine is great for life-and-death things. In August 2020 I had terrible abdominal pain; a CT showed a blood clot in the vein to my liver — I almost died and am forever grateful pharmaceuticals (blood thinners) saved my life. But those same medicines won’t help me lead my best life. We were educated in a system dominated by pharma (the Flexner report ~1915 pushed out alternative modalities — chiropractic, acupuncture, nutrition). We’re deemed “healthy” by the pills we take, but those pills largely aren’t making us healthy or even well. People often feel better seeing their trainer at the gym — which is why things drift to gray/black market: people get results. The pharma companies are greedy and like making money, but also like helping people; the government corrals that but overreaches. We need honest, non-threatening discussions — even agreeing to disagree.

[02:19:19] Huberman: I rely on prescription drugs now and again (e.g., an antibiotic after surgery) — not anti-antibiotic, but don’t eat them like M&Ms. You’re clearly a truth-teller from the clinical perspective with broad optics. I’d like to finish on something you mentioned: positive thoughts. You’re a physician, not a psychologist, but you have great powers of observation. There are neuroimmunological data that chronic stress makes us sick while short-term stress helps, and that positive thoughts can enhance immune function. Clinically, what’s your observation about mindset and health?

[02:20:53] Koniver: We’re scratching the surface, but it’s the most profound way to affect your life. Two things: one, no good has ever come from a negative thought; and since we have a choice in every decision, it’s best to slant it positive — not fake, because people really suffer and this is a stressful time. But pivoting toward positivity yields more positivity. We didn’t choose our eye color, family, or upbringing, but we choose how we respond. The more positive I am, the more I can influence and plant seeds in others — and it can never be taken from you. Positivity has to be part of success, longevity and health span; the mindset will override almost everything.

[02:23:27] In 2010 I stopped taking insurance — not a money thing, but because I felt no longer valuable seeing 40 patients a day for 5–7 minutes just writing prescriptions. My purpose is fulfilled having real conversations and getting to know people. Peptides and NAD are gateways to build trust, so I can help an individual learn to be more positive and find their purpose — because finding purpose is where life gets magical. Most people don’t get there because they’re in pain, tired, or suffering; helping walk them through that is what I enjoy.

[02:24:28] Huberman: Beautifully said — grateful you made that decision to align with your purpose and expand into public education. We’ll provide links to your practice and education efforts. So often we hear from scientists or physicians and forget the human component; your humanity really comes through — I can tell you really care, and our listeners can too. As this field evolves, please come back. Koniver: Love to. I respect and love the work you’re doing and the light you’re shining; it’s a true honor.

[02:26:28] [closing — newsletter, book (“Protocols: An Operating Manual for the Human Body”), and social/sponsor outro omitted]