Peptides: where to begin?
science.org209 points by A_D_E_P_T 16 hours ago
209 points by A_D_E_P_T 16 hours ago
I'm here for two probably contradictory comments.
The first is collagen: I'd love to see Lowe's take on recent peer review which says boosting oral collagen does appear to show signs of improved joint pain and skin resilience. Obviously modulated through how protein deprived you are, but for older people, eating enough protein can be an issue: it's not rapidly absorbed so you need 3 squares a day to get to the higher numbers. Collagen powders and vitamin C (oj) at breakfast might kick start this.
The second contradictory point is that this entire thread makes me want to shout GELL MAN AMNESIA because it's an exercise in otherwise intelligent people who can distinguish between anecdata, their personal experience and some cold hard facts in their core field, but not when it's self injecting unknown chemicals from China bought off-script.
I want to point out your own contradictory comments about absorption and specifically mentioning a typically highly processed food (orange juice), one which has been stripped of its natural fibers and flavors.
That age group (and all others) should be eating real/whole fruit or having the juice fresh (I.e. just juiced). They would be better served getting this advice than creating more anxiety about protein intake.
Is there any reason to think that freshly squeezed juice is chemically different from, for example, frozen juice concentrate?
There is reason to think the differences are biotic vs. abiotic, between the two. Our digestive system is dependent on healthy microbiota. Pasteurization would be the difference here.
yes it’s been frozen and concentrated..
Next question: Is there any reason to believe a dog isn’t a cat? They’ve both been domesticated and are smaller than a human and live with humans and have similar shapes. Have we just been pretending this whole time they’re different things?
For the first one, I assume you mean a systematic review, not a peer review? I guess you're talking about this one:
https://pmc.ncbi.nlm.nih.gov/articles/PMC10180699/
It has a Mechanism section which explains that when collagen is digested, one of the products of that is Gly-Pro-Hyp, which is what has the effects. I don't think that conflicts anything in this post?
I assume they're referring to the brief bit in the post that indicates that oral ingestion leads to a breakdown that makes oral supplements of amino acids pointless. They say it very briefly and they don't really outright assert it, it's just a sort of implied aside.
Here is the exact quote:
> You’re not going to be taking these things orally... These mail-order peptides are injectable items.
That's not the exact quote lol you cut out the exact part I was referring to.
> because unless a really substantial amount of engineering has gone into it, any given peptide is going get the same treatment from your digestive system as a chicken breast does, i.e. a complete teardown
> Every single YouTube video and blog post I have read about peptites is exclusively about injectable supplements.
Collagen peptides, ghk-cu, and many other peptide supplements are often taken orally.
Sweeping statements in biochemistry must be made with caution. It is well known that there are some small peptides that are absorbed following oral administration.
...BPC-157 itself is said to be among this class. As are certain milk tripeptides: https://en.wikipedia.org/wiki/Lactotripeptides
Interestingly enough, those two, as well as Gly-Pro-Hyp, are proline/hydroxyproline-rich, which might suggest that proline-rich small peptides are resistant to degradation in the gut.
Anyway, in general oral proteins and peptides are broken down prior to systemic absorption, but not always...
> It is well known that there are some small peptides that are absorbed following oral administration. ...BPC-157 itself is said to be among this class
Do you know of any studies that suggest BPC-157 absorption from gut?
https://onlinelibrary.wiley.com/doi/abs/10.1002/jor.21107
Among others. If you read the paper, it's actually apparent that there's little difference between i.p. and oral administration in terms of efficacy -- both were roughly equally effective in improving MCL ligament healing.
Admittedly the paper's in rats -- as are 99% of the others -- as there's no incentive for anybody to run human trials.
> you need 3 squares a day to get to the higher numbers.
> Collagen powders
In that case if you're eating collagen powder you could be eating just regular protein powder then?
Peptides are a revolution and you don't need to know how they work to know that they work (for various people for various conditions). There is a tension between empiricism and fundamentalism with much of medical science focusing on fundamentalism. Now with the ability to collect and search large amounts of empirical data and communicate it peer-to-peer people are picking up on a lot of things that work without knowing why they work. I think people are just going to circumvent the fundamentalist and chase after whatever works.
I owe my health to early adoption of experimental peptides, I have life long ME/CFS and there is no known treatment for this nor is there any on the horizon. At least they finally have a diagnostic test and know it's not psychosomatic but I could have told them that from day 1. Most doctors are not researchers and have little understanding on statistics instead preferring to rely on discrete classifications and simple decision tress. As someone with hEDS from TNXB I am a walking bag of symptoms and yet not a single doctor could figure it out. I had to research it myself which involved post-doc level textbooks and research journals. I came across the work done by Prof. Khavinson (USSR) and it did appear to me that peptides were incredibly under-explored. Given the poor quality of life with ME/CFS I was willing to take serious risks so previous trials were helpful to give an idea on dosing and lethality, I went through most of the research peptides one by one. I actually waited on semaglutide a bit because I suspected there was a small minority who would have hyper sensitivity and I both expected that to appear in the data, which it did, and I expected to have hypersensitivity, which I did. Others who were less careful ended up with pretty bad gastroenteritis. Semaglutide has been the most effective and with it and a few others I am largely able to lead a normal life. I was getting gray market from the US but now I get it direct from China.
> There is a tension between empiricism and fundamentalism with much of medical science focusing on fundamentalism.
This is a deeply unfair statement, and also a false dichotomy. Medical science is of course empiric. What you call "fundamentalism" is that compounds need to undergo a rigorous regiment of empiric testing before they are given to potentially millions of people. And no, it's not just because of Thalidomide. Many, many compounds fail clinical trials because of severe side effects, like liver toxicity, severe immune reactions or heart problems. Then there's of course increased risk of cancer, which can take many years to manifest itself empirically. You argue that you prefer living with these uncertainties rather than ME/CFS, and that's of course entirely understandable, but disparaging the field of medical science as focused on "fundamentalism" because we do not give large patient cohorts untested compounds is polemic. I understand where you are coming from, and I'm sorry that you suffer from this terrible condition, but likewise, you should try to understand the other side.
>compounds need to undergo a rigorous regiment of empiric testing before they are given to potentially millions of people
Particularly when the mechanism behind most of these peptides comes down to "promotes more rapid cell growth". The intent may be to repair the skin, muscles, or ligaments, but biology is rarely that specific.
I think the grandparent meant "fundamentalism" as "mechanistic", and lots of things we can know (as you say using the scientific method) to be useful long before we have a good mechanistic explanation of how they work.
Some examples: aspirin (willow bark used for thousands of years, drug synthesized in 1897 and mechanism explained almost 100y later), or general anesthesia used again since mid 1800s and the mechanism is quite still debated.
This is not to downplay all the long term, or developmental, risks that using something novel can result in. But we can empirically know something about the effects without having good mechanistic models.
But it is usually not necessary for approval of a compound to be able to describe how it works on a molecular or cellular level. What you need to show are three things: efficacy, safety and quality, so basically: the compound has the intended clinical benefit, has an acceptable safety profile and can be produced with a consistent manufacturing quality. Most compounds fail because of lack of efficacy (roughly half), and roughly a third because of lack of acceptable safety.
Non blinded self experimentation is not a useful branch of empiricism.
I had an ME/CFS patient that had tried 100s of things and documented the effects thoroughly. She had a quite impressive list. Roughly 30% had had an effect to begin with, but the trend she observed was that it lasted for around a month at most. Placebo was her overall conclusion, but she occasionally got relief anyways so we both agreed that there was no harm in continuing. I'm sure several "peptides" is on her list by now.
There is nothing new under the sun, and fad cures for diffuse conditions have come and gone many times before. This is especially the case for conditions involving pain or tiredness, which are extremely sensitive to both placebo and nocebo.
What would be revolutionary would be 2-3 double blinded RCTs showing a lasting effect. Which would be great if someone did! But you have to actually bother to do it. And personally I would put money on the outcome being "no effect".
I'm pretty sure there is no diagnostic test for ME/CFS. What are you referring to?
Also I don't understand how semaglutide did help you while you're at the same time part of a minority risk group with a hypersensitivity to it. Isn't that a contradiction?
I think I would need to see testing on a control group of housebound patients with other conditions to believe this. It's easy for ME testing to pick up markers for being housebound and limited exercise for an extended period of time.
> Peptides are a revolution and you don't need to know how they work to know that they work
I agree with this, but we don't have a good understanding of the mechanisms of how most drugs work, and what else they do. That's why, generally speaking, we require actual observational safety data, and not just a thorough description of the mechanism(s) of a drug. And sometimes we find out years or even decades later we were badly wrong. "Safe" is a very qualified term when it comes to drugs. What actually distinguishes $randompeptide from $approveddrug is the safety data - there are papers all about the proposed mechanisms for most of them.
Im sorry for your quality of life problems but calling doctors bad at statistics and then giving anecdotal evidence as proof has to start ringing some logical bells right? You dont even have to take our word. Use an LLM as judge. Paste your comment into chatgpt and see what it says.
I didn't read their whole comment, but I worked in the Internal Research department of a medical school. I did their statistical studies and built software for analysis pipelines.
Doctors, at least 15 years ago, were definitely bad at statistics.
They were not required to take a statistics course at all. Most programs would require Algebra and Calculus as part of their science reqs.
Some would maybe take one basic research course, and they would then become obsessed with p values of 0.05.
They did not have a basic understanding of how to interpret research unless they were an auto didactic and went out of their way to improve. It's something my director (a doctor and software engineer), and the Dean complained about relentlessly.
> Paste your comment into chatgpt and see what it says.
Isn't one of the bigger problems with ChatGPT that it's much too supportive of whatever the human is talking about?
I guess it depends on how you frame it. "I've just posted this comment, what do you think" vs "Someone online has just posted this comment, what do you think".
But it does require to know the bias that LLMs have ahead of testing this.
Thats the point. If even such a sycophantic ai disagrees with your points you have a problem
Clinical trials are not looking for fundamental mechanisms, they are there to ensure an effect is strong enough to say a product should be sold for that purpose. Otherwise you end up with snake oil salesmen. Because how can you be sure you are even injecting the thing the sellers claim it is?
I would encourage everyone interested in peptides to read about the state of medical science before the establishment of the Pure Food and Drug Act of 1906.
> you don't need to know how they work to know that they work
Welcome to the powerful world of the placebo
I think we are sort of in the worst of both worlds right now re: medicines/supplements/gray market.
FDA approval is expensive slow process. Doctors train for a long time and then work 40+ years entire careers, some without a ton of continuing education.
But then we have an entire gray market because enough legal and practical loopholes to drive a freight train through, such that people are self medicating with dubious substances of dubious origin of dubious purity sourced via dubious means.
Even if peptides work, you have no idea what side effects they have, or if the ones you are taking are even real, not contaminated/tainted in some manner, etc. Given a lot of the hype comes from social media for otherwise healthy people to take them for lifestyle / augmentation reasons.. to me the risks still outweigh the rewards.
Real solutions like regulatory reforms to find ways to bring down testing costs seem more important than reforms to make it easier to slap anything on the shelf at GNC as a completely untested “supplement”.
> some without a ton of continuing education.
Neither teachers nor administrators take continuing education seriously, in my local experience.
Not US, but the seminars to fill in the hours in my country were closer to legal bribes and/or holidays in often exotic places. They usually were provided/funded by the medicine lobby.
I used retatrutide for weight loss and went from 199.3 lbs to just under 175 lbs. I kept daily notes through the process. Here's a quick AI one-paragraph summary if you're curious: https://pastebin.com/XACNYKvs
Overall I'm quite pleased with the effects and many of the properties of this treatment that people dislike are actually properties I was looking for. Essentially, for pharmacological interventions I want impermanent effects with a clear dose-response relationship and ideally minimal or no adaptation.
So the fact that people gain weight when they go off it and then lose weight again when they go on it was good. That meant it's fairly easily undoable. The fact that the more you take the more you lose also was pretty good to know though for the majority of the time I took less than any tested dose (and the effects were quite strong on those).
I did experience quite a bit of adaptation so I needed to up the dose until I was in the range tested by the end. I've been off it for a month now and been pretty much flat, but we've been traveling since I stopped and so a lot has changed (no more lifting, lots more eating, lots more walking).
Rough cost for the retatrutide is $1.25/mg.
Was cost the reason you went for it over tirzepitide? I feel like retatrutide is still way too early to mess with, it's giving me real "vioxx" vibes of messing with too much at once.
No, I had access to free tirzepatide. I chose retatrutide because early results seemed promising and safe and since I was going to run a short-term self-trial I wanted the most effective peptide.
> Rough cost for the retatrutide is $1.25/mg.
Even with free healthcare that seems like a foolish place to save money when very widely used alternatives exist in the regulated market.
I know a couple of people that should know better (phds in biosciences but now doing corporate management) taking expensive weird Chinese peptides that would probably be better off if they did some cardio a few days per week and ate better.
I tried retatrutide for 10 weeks, here are my results: Before: 5'7, ~182lb
Bench 1rm: 315
Squat: 5x10 225
Deadlift: 5x5 315
After: same height lol, 154lb
Bench 1rm: 285
Squat: 5x10 205
Deadlift: 5x5 275
Suffered some anhedonia towards the end but that went away ~1wk after stopping. Overall pretty good, not any side effects. Definitely fixed my food craving problem. I didn't have a high intake of protein during the 10 weeks, so I suspect thats why I lost muscle mass :/
I used a combo of low-dose retatrutide, tesamorelin, and ipamorelin and lost about 15lb over 45 days, including 60% of my visceral fat, and put on 4lb of muscle, per before-and-after DEXA scans. I lifted regularly, ate well, and prioritized protein, and while I definitely under-ate protein, I was very pleased to find that I was able to increase muscle mass while cutting the fat. My visceral fat was the primary target here, since I'd been unable to get it to budge despite consistent training and diet. Very pleased.
This is crazy. You lost 28 lbs (15% of your body weight) in 10 weeks. Why did your doctor to allow you to continue? By any common sense, that is an unhealthy pace to lose body weight.
You lost muscle because you lost around 1.54% of body weight per week, which is way too aggressive. The maximum recommended amount for losing weight while retaining muscle is around 1%. You will also most likely experience a weight rebound.
Hasn't this mostly been debunked? You lose muscle mass because you lost mass overall, and whether you lost it too quickly or not is not the major factor. AFAIK maintaining muscle mass while losing fat is borderline impossible for anyone who isn't extremely fat and/or very disproportionate composition to begin with.
You need to define how much muscle mass you expect to lose. The entire idea behind the bulk/cut cycle is that you want to net gain muscle after a full diet cycle.
It's also not borderline impossible to maintain the majority of your muscle mass, but it depends on how you eat and train. We don't know enough about the person above's diet, training, current body composition, etc. to say anything for certain.
Not as far as I know. The ratio of fat-to-muscle loss depends on several factors, most notably the rate of weight loss (see https://pubmed.ncbi.nlm.nih.gov/34371981/). In fact, retatrutide is popular notably because it is known to preserve lean body mass better than other weight loss drugs.
It's interesting you mention this (anhedonia), since the guardian just published this article: https://www.theguardian.com/science/2026/apr/06/is-retatruti...
How did you actually feel? Disinterested in stuff, ennui, or other?
Even if you hadn't lost any muscle mass, zero chance you're going to see the same exercise performance on a calorie deficit.
This is untrue. There are 100s of YouTube videos of amateur body builders preparing for a show. They are able to maintain their muscle mass while in a calorie deficit. Yes, it is insanely hard, but it can be done.
I didn't say that you can't maintain muscle mass. I'm saying your performance will suffer.
Those are sizable drops for 10 weeks unless you stopped lifting as well
Mentioned above, but "I worked out 6 days a week still, but swapped out 1 of my leg days for a run day (between 2-4 miles)"
Did you work out during those 10 weeks any? TBH if you went from regular lifting to not for 10 weeks I'd expect a similar decrease in your lifting numbers (though not a .4lb/day weight loss of course)
I worked out 6 days a week still, but swapped out 1 of my leg days for a run day (between 2-4 miles)
Dude, you must be jacked. Great lifts at those weights. Unreal bench haha. Good shit, dude.
I'm not inclined to be a guinea pig for these. I suspect maybe later in my child's life they will have been proven long-term safe (or not). I'll be old or dead at that point. I'm really wary of putting anything not known to be standard food or medicine into my body.
Reminds me of some family members, all about organic, no seed oils, no plastics, no using 5G, no EMF, no fillers, no preservatives, no stabilizers, no emulsifiers, etc.
And yet they use unhealthy amounts of avocado oil, consume unhealthy amounts of “good fats.” They discount caloric intake and solely focus on eating loads of what they consider to be good food.
The author is missing a massive segment of that gray market: people who buy FDA-approved weight loss drugs (e.g., semaglutide or tirzepatide) at 2–5% of the brand-name price. This route carries some risk, but there are ways to mitigate it, such as performing third-party testing. I assume most people who do this couldn't realistically afford the brand-name drug anyway, making this their only viable treatment.
Even if you test a batch once, do people who get testing done do testing on all batches?
The synthesis of peptides uses some NASTY chemicals. I would be worried about lax manufacturer policies leading to contamination, even if one batch passes. The costs of FDA certification are the effect of that protection.
But whatever, this is the same attitude that people have against owning insurance. It is hard to recognize the cost of risk.
I bought Semaglutide at 50c/mg and had it tested, it's the real deal. What's the normal price, $100/mg?
My gf is in medicine so she had a friend test it through their work.
Test what, exactly? Purity? LPS contamination? They cant test for every last picogram of material in it. Did they test for viral contamination?
Even drug addicts heat up the thing they inject so theyre actually safer than you can ever be. Dont inject things from China into your blood!
Won't be anywhere near that. I don't have prices handy, but Lilly sells tirzepatide (a bit better than sema, and usually a bit more expensive) at 500/mo (maybe a bit less now on the trump rx site, I don't recall). Depending on dose, that'll be about 10 bucks a mg give or take. At 50c/mg for sema you were paying a bit of a premium. These days even tirz is only about 30-35c/mg.
I used to buy from Peptide Sciences so I was certainly paying a premium for reputation at $20/mg. I think Semaglutide is now at a bit of a premium due to it falling out of favour and most people switching to Triz and Reta. I only take a low dose and am happy to stick with what's working.
There must be an irony that it was Trumps crackdown on peptides, I presume to prop up his prescription company, that forced me to switch to Chinese supply. By doing it all at once it created a critical mass for that market.
IIRC the biggest impetus for cracking down was Lilly throwing a fit about the gray market supplying reta well before it even becomes available via the normal channels (who knows when that will be). But as you say, it just pushes people to buy direct from Chinese vendors (and it is basically impossible to stop direct imports like that). Would be safer if more reputable US-based sellers could supply it semi-openly as before. Nexaph is still selling it, but I figure the clock is ticking on that.
> and it is basically impossible to stop direct imports like that
How so? Is there a particular characteristic of the US that makes it so, or of the channels through which this is done? I get that in general it's impossible as with recreational drugs, but when you look at cocaine then at least to traffick it to most wealthy countries it takes a large amount of resources and is at high risk of getting caught. Which is why they're increasingly starting to use narco submarines. This greatly increases the price of the product. Why can't the same happen to peptide imports?
> had it tested, it's the real deal
How did they test encapsulation? I thought the whole problem is your stomach acid breaking it down.
Last I checked, Ozempic (Semaglutide) is around $1000/month in the US. A typical 1 month pen is 4-8mg, so around $250/mg to $500/mg. So yeah, I may have understated how much cheaper the gray market version is.
Semaglutide is effectively $99/month in the US. Not from shady sources.
Do you mean with health insurance? Novo Nordisk still lists it at $1000+ on their website: https://www.novopricing.com/ozempic.html
I meant from the various compounding pharmacies. But in the worst-case you go with GoodRx and get it for $350/mo (after $199/mo for the first two).
I imagine it's legally risky to buy a large quantity, test it, and then resell smaller quantities. That's a shame because the alternative is probably that some folks settle for products of dubious quality and end up getting hurt.
Yes, I believe most people buy directly from somewhat shady Chinese factories. I tried contacting a few and they all refuse to meet or send samples from within China, so I assume what they're doing is illegal in China. In the US, it's legal to sell them as a "research chemical" but the FDA is cracking down on companies that are clearly engaging in b2c.
There's this company that offers free testing: https://finnrick.com/
Another popular testing company is https://janoshik.com
Some other useful resources: https://graymarket.substack.com/ and https://glp1forum.com/
There are a few subreddits as well.
FWIW, I never ended up buying any myself.
Right, but I don't know the people at those companies. I have local chemists that I trust. I'm just lamenting the fact that developing that kind of trust network everywhere, so everybody can be similarly sure of what they're putting in their body, is likely to run afoul of local laws.
FWIW, finnrick's claim to fame is being free. Someone is paying for it. They have also failed blind tests in the past, Janoshik (IIRC) never has. There are several US-based labs but none of them have the same reputation as Janoshik.
Actually, you just described most of the tele-health and compounding pharmacies that carry GLP1s!
Where do you think Hims, Ro, Brello, or the rest get the APIs they sell to their customers? They get them from grey market suppliers in China. They don't go to Ely Lilly or NovoNordisk and say, "politely sir, may I skirt around your IP and sell your drugs for 10x what they cost instead of 10,000x what they cost?" Hopefully, they test them and filter them and use sterile/pharma processes for what they sell to their customers. Well, except for the Medspas, those are just wild west snake oil farms.
This actually isn't true. Hims compounded the GLP1s themselves. They broke/are breaking the law. Theres lawsuits.
Things have changed a little, but during the time that compounding was explicitly allowed, the licensed pharmacies were buying from FDA approved manufacturers, sometimes in China, and sometimes the same manufacturers who also do contract manufacturing for Lilly.
Today ... who knows? It might just be the same gray market stuff us plebes can get.
It probably is, but that does not stop people from effectively doing it. There are a number of groups that specialize in conducting group buys, doing a bunch of testing on randomized samples, and then shipping out the product to individuals.
Also, if you plan to be on it a good long time, you can buy a bunch of kits yourself (a kit is 10 vials), run a bunch of tests, and then just have a nice stockpile that will last you years. The testing will likely cost as much or more than the product itself, but given how inexpensive the product is, you still come out way ahead financially.
>I imagine it's legally risky to buy a large quantity, test it, and then resell smaller quantities
It is illegal, but it doesn't stop people from doing it. In fact, if you don't have any sort of test results for your peptides people will absolutely avoid buying your wares until you have them. Purity and mg/ml are the 2 basic test results that any shop worth their stuff will have.
To be fair, most everyone I know who is buying on the gray market considers vendor tests to be minimally required, but still insufficient -- there is no assurance they tested the product they shipped to you. Plan on testing it yourself. I'm sure some people do trust nexaph enough, though, to not worry so much. Whether that trust is well placed, that is a separate discussion.
With most of these you can really tell if they work or not and there is a pretty predicable dose dependent reaction profile. With slow meds like semaglutide you'd maybe not notice it in the first week but you will by week 3. I had mine tested but if that wasn't available I probably would have considered the anecdotal evidence to be sufficient. It appears that most of the scamming is just people taking the money and not shipping anything.
The most dangerous failures I've seen have been sending the wrong peptide. 15 mg of tirzepatide and 15 mg of semaglutide is a very different experience.
After nearly getting hosed in a group buy (I did get refunded, but that is far from a guarantee) because of a product mismatch, I decided to just pay for nexaph. Love him or hate him, his popularity relies on his reputation and he has been more careful than most suppliers to cultivate it with more extensive testing and quality control.
That makes sense, I don't like that the bottles are unlabelled so the first thing I have to do is label them. The box is labelled and this seems to be standard practice. Semaglutide is falling out of favour so I guess they're substituting. I have 4 years supply now so I guess I'll check back then and see where the market is at.
> I have 4 years supply now
<Insert that "one of us, one of us..." GIF here>
I know a bunch of people with multi-year stockpiles. I've got ~5 years of reta and ~6 years of tirz. This is too much, of course, but I determined a while back that under no circumstances do I ever intend to find myself unable to source it. My life is immeasurably better after losing 110 pounds.
Could you direct me to some resources you used to figure out dosing and sourcing? I’ve been interested in trying it out (need to lose a lot of weight) but have been paralyzed by too much contradictory information.
Lowe has a point, but the FDA has painted itself into a corner by (a) forcing up the costs and the various bureaucratic demands associated with clinical trials, (b) allowing drug advertising , but then forcing those comical "may cause death" disclaimers, both of which have become totally ubiquitous, and (c) inconsistently following its own rules, and in some cases flouting its own rules.
At this point, broscience is considered no less valid than actual clinical trials, and the FDA should blame itself for this. Not "human nature being what it is in this fallen world" in a sort of general or abstract sense.
Another point I could raise is that telemedicine has turned the entire prescription system into nothing more than a parasitic middleman/gatekeeper.
FDA reform is very badly necessary. That ought to come before harsher enforcement, and I think that much of the populace already intuitively understands this.
When medicine ignores nutrition entirely, and nutrient supplements are still complete unknowns, you have to wonder who the FDA is working for.
Medicine doesn't really ignore nutrition, but the problem is:
1. Most people don't believe it anyway. People want to hear they can eat hamburgers and milkshakes and be healthy. Telling them "we know that gives you heart disease and cancer" does nothing.
2. Nutrition is complicated and different for every person, because everyone has different things they can tolerate. The "perfect" diet is actually worthless because it has a 0% success rate. Really, we have to optimize for how miserable people are willing to be.
3. Most people are unhealthy enough that nutrition is the least of their concerns. That sounds crazy, I know, but if you're obese (which most people are!), then priority is being not obese. Not your nutrition. I know those sound related but they're way less related than you think.
> Most people don't believe it anyway
Maybe because so much of it is wrong, or (very charitably, as much is industry-biased) outdated?
Lifestyle modification is a definite challenge and I’m not dismissing it.
Still, hamburgers and milkshakes don’t give you heart disease and cancer. Overeating, oxidative stress from low-quality ingredients, etc might.
> hamburgers and milkshakes don’t give you heart disease and cancer
They absolutely do, particularly if you're getting most of your calories from them. If evidence-based medicine doesn't convince you, uh, hamburgers and supermarket milk tends to be processed.
They absolutely do not, unless you’re getting too many calories.
Individual foods are—with some exceptions—neither bad for you nor good for you. A healthy diet can occasionally include doughnuts, and milkshakes. Your overall diet is what matters.
Most green vegetables you can eat unlimited amount and stay healthy. They are absolutely "good" food. (Please don't reply with something trite like "oh, but what about the pesticide residues?") The same can be said for high fiber (soluable and insoluable) fruits like apples, oranges, and bananas. As long as eaten whole (minus skin for oranges and bananas), it is almost impossible to overeat these and they are absolutely "good" foods.
Sure, they are not mercury-level toxic. However, these recommendations are for people who consume way too much of these dishes, and it's a safe assumption that this is the case for a significant part of the population.
Sure. We’re saying roughly the same thing. For most Americans, hamburgers cause heart disease because we don’t exercise enough or eat enough plants. If you’re backpacking twenty miles a day, sure, eat whatever, you won’t suffer inflammation or obesity from it. (Though you may run nutritional deficiencies. And you’re building bad habits for when your activity necessarily tapers off.)
I agree 100% with your follow-up. In the last 30 years of medical research, I do not recall anything but negative health results from eating red meat (beef). The real culprit is saturated fat. It is the cigarettes of food. There is almost no healthy level to consume, so keep it to 20g per day or less.
Reading this chain of responses from the original is making my internal bullshit alarm (Brandolini's law) go "wee woo wee woo".
> Still, hamburgers and milkshakes don’t give you heart disease and cancer. Overeating, oxidative stress from low-quality ingredients, etc might.
What? “Oxidative stress”? Oh come on, at least go full “seed oil” if we’re going to talk nonsense.
We already left the land of reason far behind by the time OP implied hamburgers and milkshakes give people cancer.
Depends on the nutrients that comprise them to the extent they contain a lot of omega-6 or not. Not heart disease so much but the other killer - might as well mention in this context. 'A high omega-3, low omega-6 diet with FO for 1 year resulted in a significant reduction in Ki-67 index, a biomarker for prostate cancer'. https://doi.org/10.1200/JCO.24.00608. Also Prostate Cancer and Prostatic Diseases (2024) 27:700 – 708 'Our preclinical findings provide rationale for clinical trials evaluating ω-3 fatty acids as a potential therapy for prostate cancer'.
Seed oils are not as bad as painted but some caution is needed given for instance the industrial processes used to bring them to market sometimes. Plus the way the oils are cooked when they create free radicals. This is not nonsense.
You don’t have to wonder. It’s public record that 45% of the FDA’s budget incomes from user fees that companies pay when they apply for approval of a medical device or drug.
In the drug division specifically, the number is about 75%.
Naive question: What is wrong with this? Lots of gov't agencies in highly developed countries operate similarly. User fees account for a non-trivial portion of department budgets. A more simple example: Should the Dept of Motor Vehicles (DMV) charge zero, low, medium, high, or infinity money to get a driver's license?
In principle there is nothing wrong with it, as long as the FDA or other testing body retains an appropriate impartiality or lack of bias (perceived or real). The issue, however, would be a lax system that allows revolving door access between the approval body and the industry that is seeking approval. Ironically, the common refrain becomes that their industry specific knowledge means they "must" be the only possible candidates for the role, which just so conveniently starts the revolving door swinging between leadership in industry and upper roles in regulatory bodies.
Nutrition is run on fads - see whole fitness and healthy food bullshit. Nutrition supplements ended up being a loophole that allows pharmacies and pharma companies to sell all kinds of random stuff that they can't or don't want to, show is safe, or doing anything at all.
Medicine doesn't ignore nutrition, you just don't like the answers.
And it shows on the research: e.g. does creatine help muscle building? No.[1] But cue some anecdote from someone where they also changed a dozen other things at the same time but are sure it was that.
[1] https://www.unsw.edu.au/newsroom/news/2025/03/sports-supplem...
Creatine is probably the most well-studied nutritional supplement we have, and one of the most efficacious. You are presenting a single study to counter that. Not even a meta-analysis, but a single study of just 54 participants who did not exercise at all previously (from the study; "Apparently healthy individuals, with a body mass index of ≤30 kg/m2 and not meeting current physical activity guidelines of at least 150 min of moderate-intensity exercise were included. Individuals who undertook [resistance training] within the previous 12 months were excluded"). The general consensus is that it is absolutely helpful in muscle-building. See, for example [0] and [1]. Beware the man of one study. https://slatestarcodex.com/2014/12/12/beware-the-man-of-one-...
[0]: https://pmc.ncbi.nlm.nih.gov/articles/PMC12665265/ - Meta analysis results; "after intervention, the Cr group exhibited significant strength gains"
[1]: https://www.mdpi.com/2072-6643/17/17/2748 - "A total of 69 studies with 1937 participants were included for analysis. Creatine plus resistance training produced small but statistically significant improvements... when compared to the placebo."
But there's a core problem with this, in many states doctors are legally forbidden to give nutrition advice. The academy of nutrition and dietetics has worked very hard to make it so that only dietitians can provide nutrition advice. Take Ohio for example, a medical doctor in Ohio is legally forbidden and actually in jeopardy of losing their license and going to jail if they were to provide nutrition advice without a dietetics license. Dietitians are not doctors, but the academy of nutrition and dietetics wants you to think they are.
> Dietitians are not doctors
And doctors are not dietitians.
Doctors in the US receive an average of under 20 hours of training in nutrition over four years of medical school. What little they do receive is often focused on nutrient deficiencies rather than on meal planning for health and chronic disease prevention. Less than 15% of residency programs include anything on nutrition.
To become a registered dietician requires at least a Master's degree in dietetics or nutrition or a related field, and at least 1000 hours of supervised internships.
PS: before any Europeans hold this up as an example of the poor US health care system, doctors in Europe average 24 hours of nutrition training.
Aren't doctors actually exempted specifically from such regulations in almost all states? AFAIK they can actually give nutritional advice legally in nearly every jurisdiction in the US.
> prescription system into nothing more than a parasitic middleman/gatekeeper
Agree. Unless it's addictive or in short supply, you should be able to buy it OTC.
The FDA didn’t push up clinical trial costs, thalidomide did.
So you are stating that there has been no change in how clinical trials are required to be run, and the associated costs, since the changes immediately following the thalidomide catastrophe?
> Another point I could raise is that telemedicine has turned the entire prescription system into nothing more than a parasitic middleman/gatekeeper.
I’m curious what you mean by this. I’m not sure what you mean by “prescription system” specifically.
I'll give you a case in point. This article was discussed the other day:
> https://www.nytimes.com/2026/04/02/technology/ai-billion-dol...
People want GLP-1 drugs. They can't get them without a prescription. They pay $$$ to a "telemedicine" "doctor", recite a list of well-known symptoms, and buy the prescription.
The system is that you can't buy these drugs without the piece of paper, and the piece of paper is basically something that anybody can buy regardless of whether or not they actually need the drug. Wanting it is usually enough.
I think access is a good thing. The issue isn't with telemedicine but the fact that there's a prescription wall for helpful meds like GLP-1 in a country where we've failed people by creating one of the worst food environments.
Also, most doctor's visits aren't any different from getting it if you want it except it's gated on the mood/attitude of the doctor, maybe your ability to sell some sob story. And then you book a different doctor until you get it. Telemedicine just makes the process easier an arbitrary system.
GLP-1 prescriptions are easy to get in the US. It's filling the prescription that is the problem, because insurance rarely covers it and it is beyond the disposable income of most Americans.
The prescription hurdle is absolutely necessary -- these are not drugs that anyone can safely take without guidance. It's the price that needs to be fixed.
> these are not drugs that anyone can safely take without guidance.
Unless that risk is egregious, informed adults should be able to accept it if they so choose.
I know a lot of people on GLP-1 meds and even took a dose myself out of curiosity.
You take a dose every two weeks. And if you accidentally double dose because you misread 1U to mean 1 dose, it just gives you some nausea.
Are we going to pretend it's hard to take this drug now too? Or that the doctor has some magical insight into your getting-on? Remember to eat. That's it. I guess a few people might need the doctor to go "you're eating, right?" but I don't believe in infantilizing everyone over that.
> You take a dose every two weeks
Weekly, if you are following guidelines correctly. The half-life of most GLP1 peptides is 5-6 days.
I otherwise agree with your point entirely. Though anecdotally, I may have given my brother-in-law a single small vial of tirzepatide at his request so that he could experience it, and the results were ... not good. Turns out he's an idiot, thought that 'more is better', 'drinking enough water is for weenies', and 'I am not an alcoholic even though I get plowed most evenings.' All against my very specific advice on how to give it a try. Whoops.
My fault, yes, I should have realized he was too stupid to do it without adult supervision. He made himself so sick he almost went to the ER. Nothing really dangerous, of course, tirzepatide is pretty safe stuff, but overdosing on it can make you feel very shitty for a few days until the blood concentration drops.
One dose is one thing -- but there are other risks that can lead to complication or death here if taken improperly for a long period of time. Musculoskeletal issues, cardiac issues, thyroid issues, etc.
Additionally, getting the correct dose is not straightforward for a layperson as it is for other OTC drugs with standard doses.
There are similar risks, and probably more likely, to all sorts of consumables that aren't regulated at all. It is reasonable to ask whether the prescription regime for GLP-1s makes sense. It isn't the only substance posing that conundrum! Ondansetron is OTC in a lot of countries, but not in the US, Canada, or UK. But ondansetron is arguably less dangerous and more helpful than pseudoephedrine.
Pseudoephedrine, of course, isn't BTC because it's dangerous to take or complicated to dose. It's there because of the war on drugs. But I do agree that not all drugs are regulated appropriately. Marijuana also comes to mind.
I do think GLP-1s are just about right. It is appropriate to take them under personalized professional guidance.