Can anyone answer? 50 y/o male former pro hockey player- not improving
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Can anyone answer? 50 y/o male former pro hockey player- not improving
- This topic has 16 replies, 5 voices, and was last updated 6 months, 1 week ago by
Kristelle Reyes.
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March 18, 2025 at 8:22 pm #33723
50 year old male former pro hockey player, complaints of worsening joint pain, and weight gain after plan below for 30 days.
- History
- Reports not feeling well, lacking energy and vitality
- Wakes up without feeling excited
- Experiencing abnormal body fat distribution
- Fatigue and heaviness in legs started after first COVID infection 4-5 years ago
- Has had COVID 3 times; first episode included 103°F fever for 8 days
- Long COVID symptoms: persistent leg heaviness, exhaustion, difficulty with energy levels
- Morning fatigue and grogginess particularly severe
- Low libido
- Joint pain, particularly shoulders: bilateral shoulder pain and stiffness 7-8/10 for past 6 weeks
- Recurring rash with itchy blisters appearing in same locations (wrist and side) 4 times in past 6 months, lasting 2-3 weeks each episode
- Recent episode of sustained low heart rate (30s-40s) with associated lightheadedness and nausea lasting 5 days
- Slow healing: cuts taking approximately 2 weeks to heal
- Impact on daily activities: difficulty with exercise, unable to maintain previous strength levels
- Previous strength training capacity significantly reduced: pull-ups reduced from 15 to 3
Past Medical History:
- History of atrial fibrillation post-COVID, ablation surgery 2 years ago
- 14 prior surgeries including multiple shoulder reconstructions
- History of multiple fractures and soft tissue injuries
- Heavy metal toxicity: previous chelation therapy resulted in 50% reduction in mercury levels but increased lead levels
- Mold exposure: multiple incidents of toxic black mold exposure in residences
- Sleep apnea identified in previous sleep study, untreated
We have done this plan below for 30 days so far:
Gut health
– BPC125/KPV gut-tides 1 cap once daily must be on an empty stomach.
– 100% remove dairy and glutenSleep
– Suggest sleep study and sleep optimization.Vitamin D
– Injection 25000 IU IM, then start D3/k2 5000 IU daily with food.Muscle weakness
– Start SS31 due to GFR below 90. Inject 100 units subq twice weekly
– For immune regulation, cognitive function, improved endurance and optimal exercise
– Coq10 200 mg daily in combo with SS-31 to boost functionGut health
– BPC125/ KPV 1 daily on an empty stomach. Oral formulation is more impactful for gut healing.
– VIP nasal spray: 2 sprays into each nostril for anti-inflammatory effect and increased blood flow to GI tract. Helps energy intake, metabolism. Last dose before 3 pm dailyHashimotos
– Increase NP thyroid 150 mg
– Low dose naltrexone 1.5 mg at bedtime, increase to 3 mg after 3 weeks, then to goal of 4.5 mg after another 3 weeks. This is to lower inflammatory response and autoimmune activity.
– MethylB12 injections weekly for 8 weeks, then every other week for 8 weeks, then monthly
– Methyl Protect 1 tab twice daily with food. Last dose earlier to prevent it impacting sleep
– Curcumin Cucuplex-95 1000 twice daily – 2 daily with foodNext steps????
I thought about adding Thymosin Alpha 1
His testosterone levels were actually good, but I am rechecking them next week.
Would GHRH be helpful?
March 20, 2025 at 8:57 am #33724Anyone? LOL!
March 31, 2025 at 8:38 pm #33725@kristelle can you get anyone to help with this question for me? thanks
April 2, 2025 at 6:28 pm #33726Hello @tiffanysalusintegrative-health, Absolutely! I’ll also forward this to our team.
Hi @byurthgmail-com, @drhusaininterlinkedmd-com, @cpaigepaigemd-com, @andkeller2gmail-com, @dr-siobhannewmangmail-com, and @drmitchmdmindspring-com we would love to have your insights here. Thank you! 🙂
April 3, 2025 at 5:43 am #33727You’re already laying down a very strategic foundation, and now it’s time to take it further in a way that respects the redox balance and restores immune and cellular function without overwhelming the system. This patient is showing signs of immune metabolism dysfunction as the primary driver, with cellular metabolism and microbiome involvement as contributing factors. He has post-viral mitochondrial fatigue, likely low-grade viral reactivation, disrupted circadian redox rhythms, and chronic inflammation—especially joint and neuroimmune. Thymosin Alpha-1 is a very appropriate next step and should be initiated immediately. Start at 1.6 mg subcutaneously twice per week. It helps re-establish immune regulation by promoting T-reg cells, balancing Th1/Th2/Th17 dynamics, and downregulating NF-κB. It also enhances the antiviral response and may reduce viral persistence contributing to the recurring skin lesions and systemic symptoms. Low-dose methylene blue is also a smart addition. Use 10–20 mg daily (ensure G6PD testing is clear first). It bypasses dysfunctional Complex I in the mitochondria and donates electrons directly to Complex IV, restoring redox and improving ATP output, particularly in the brain and heart—both energy-demanding tissues affected here. Rather than the usual NAD+ precursors, consider adding 1-MNA (1-methylnicotinamide) at 100–200 mg daily. 1-MNA is a methylated metabolite of nicotinamide that activates the prostacyclin pathway, improves microcirculation, enhances SIRT1 signaling, and reduces systemic inflammation, especially in the vascular endothelium and nervous system. It’s a unique way to restore NAD+/NADH balance without overloading methylation pathways, which are already being taxed. Add ketone ester Bhb, 10-15 mL at night and optionally during the day before physical activity or when fatigue peaks. It improves NAD+/NADH ratio, reduces inflammatory markers like IL-6 and TNF-alpha, supports AMPK activation, and increases mitochondrial efficiency and resilience. It also supports GABAergic tone and can improve sleep and mood regulation—both major issues for this patient. Apigenin should be added at a dose of 400 mg in the evening. It supports mitochondrial biogenesis, acts as a natural MAO inhibitor, lowers cortisol, activates SIRT1, and helps promote deep sleep and redox balance. It’s also neuroprotective and supports the hippocampus, making it useful for both mood and memory. A GHRH/Ghrelin mimetic is well-suited given his low libido, poor recovery, and muscle loss despite decent testosterone levels. Tesamorelin at 1 mg subcutaneously pre-bed is ideal. It has significant benefits for visceral fat loss, cognitive function, and circadian GH pulse restoration. He’s likely experiencing viral reactivation (based on the rash), so consider Valacyclovir at 500–1000 mg daily for 30 days. This can be used temporarily alongside Thymosin Alpha 1 to suppress viral load and support immune recalibration. For local rash healing, topical ozonated olive oil is effective and accelerates tissue repair. Support the microbiome by adding butyrate (Tributyrin) at 300–500 mg twice daily and a spore-based probiotic like Bacillus subtilis. Butyrate reduces NLRP3 inflammasome activation, supports T-reg expansion, improves intestinal barrier integrity, and enhances mitochondrial output via HDAC inhibition and AMPK activation. Untreated sleep apnea is a major redox disruptor and cannot be overlooked. Oxygen desaturation at night drives oxidative stress, disrupts mitochondrial and hormonal rhythms, and impairs immune recovery. Prioritize getting this corrected via CPAP or a dental appliance. For the joint pain and inflammation, introduce Pentosan Polysulfate Sodium at 2 mg/kg weekly IM for 6 weeks. It inhibits cartilage degradation enzymes, reduces CRP, and improves joint matrix remodeling. TB-500 at 2 mg twice per week for 4 weeks can support systemic tissue repair, anti-fibrosis, and actin remodeling—especially important after his extensive surgical and injury history. Continue the current protocol including SS-31, CoQ10, curcumin (though BDMC curcumin may be considered later), BPC/KPV, VIP, LDN, and thyroid support. Consider pausing methyl B12 if symptoms of overmethylation are present—monitor for irritability, disrupted sleep, or overstimulation. This patient’s key to recovery lies in carefully re-establishing redox homeostasis while addressing immune dysfunction and mitochondrial derailment. Start with Thymosin Alpha 1, 1-MNA, apigenin, and ketone esters, then layer in TB-500, methylene blue, and Tesamorelin. Each tool moves the needle when introduced in the right sequence.
April 3, 2025 at 5:50 am #33728Wow thank you! Can you tell me where you prefer to get the 1-MNA, apigenin and ketone esters? I know NubioAge has a 1-MNA and Apigenin. What about the ketone esters?
I did decide to do the Pentosan and TB-500 as well while I was waiting for a response.
Thank you for this amazing response!
April 3, 2025 at 5:53 am #33729Also I forgot to say he is already into his sleep study as well!
April 3, 2025 at 5:55 am #33730For ketone esters, I exclusively use KetoneAid KE4. The shot tastes better, but the concentrate is more cost-effective.
I order 1-MNA directly from the company, though NuBioAge also offers a great option.
For Apigenin, I typically go with Nootropics Depot—they offer 200mg capsules—but NuBioAge is another solid choice.
April 3, 2025 at 6:03 am #33731That is great that he is enrolled in a sleep study! In addition to the obvious issues with sleep apnea it can have a large impact on the microbiome. During sleep apnea, your breathing repeatedly stops and starts, cutting off the oxygen supply and creating low-oxygen episodes, also known as hypoxia. These drops in oxygen trigger a stress response throughout the body, including in the gut. When breathing resumes after an apnea event, the body experiences a surge of oxygen. This back-and-forth between low oxygen and reoxygenation causes instability, and one of the places it shows up is the colon. The colon is normally a low-oxygen (anaerobic) environment, which supports the growth of beneficial anaerobic bacteria. But these oxygen surges can disrupt that balance by allowing oxygen-loving (aerobic) bacteria to overgrow. A useful analogy is to picture a dark, cozy cave where certain creatures thrive in the darkness. If someone keeps shining a flashlight into the cave, light-loving creatures will move in, displacing the original inhabitants. The same thing happens in your colon—the oxygen-sensitive bacteria are pushed out by oxygen-tolerant ones, leading to dysbiosis, or an imbalanced microbiome. This imbalance can lead to increased inflammation, poor digestion, leaky gut, changes in neurotransmitter production, and disruptions in immune function. In short, untreated sleep apnea can have a profound impact on gut health by altering oxygen levels in places that depend on stability.
April 3, 2025 at 6:43 am #33732Goodness last question! Where do you prefer to get peptides from? I have been using Progress but they don’t have everything. Thank you again!
April 3, 2025 at 6:45 am #33733I like Pure Pharmacy, VPI and Brooksville
April 3, 2025 at 9:24 am #33734I would recommend ValAsta for his chronic inflammation along with TA1, TB4, BPC-157/KPV (Guttides), and CJC-1295+Ipamorelin, as well as constitutional homeopathic medical therapy (www.gnhshealing.com).
Check his D-Dimer levels, and, if elevated, give Nattokinase NSK and Plasmanex-1 two capsules of each BID. Dr. Castore’s recommendations are excellent.
April 3, 2025 at 11:00 am #33735The ketone product that I have been using recently using hydroxybutyrate glycerides is from Approved Medical Solutions (https://approvedmedicalsolutions.com/products/ketone-hydration-drink-2oz). It is safer than ketone salts and butane esters, tastes way better than Ketone Aid and I have had zero complain of nausea and vomiting during intense exercise from my athletes. 12 grams in 2oz shot converts everyone that I have tested into ketosis in under 1 hr.
April 3, 2025 at 11:30 am #33736I am curious to lean more about why you like the hydroxybuterate glycerols over KetoneAid mono ester. It seems like the studies that are generally referenced generally use KetoneAid’s ketone monoester, D-BHB bound to R-1,3 butanediol, is the most researched and bioavailable form of exogenous ketones available. It delivers pure D-BHB, the enantiomer actively used by human mitochondria, without the baggage of L-isomers, excess salts, or caloric byproducts that accompany hydroxybutyrate glycerides. I thought glyceride esters contain a glycerol backbone that can raise insulin and blunt fat oxidation. My understanding of the metabolism is that R-1,3 butanediol is metabolized in the liver into D-BHB in a slow, controlled manner. This creates a dual-phase ketone delivery system: the D-BHB ester is absorbed immediately, elevating plasma ketones within 15–30 minutes, while the R-1,3 butanediol component is gradually converted by the liver, maintaining elevated ketone levels for hours. This prolongs therapeutic effects and prevents the crash associated with faster-acting glyceride esters. Additionally, the R-enantiomer of 1,3-butanediol used by KetoneAid is more efficient than racemic versions used in generic esters. It produces higher levels of D-BHB per gram, reducing the total dose required for a given effect, and lowering the risk of GI distress or overconsumption of exogenous calories. From a metabolic standpoint, the ketone monoester enhances mitochondrial efficiency, upregulates PGC-1α, and activates sirtuins, AMPK, and other longevity-associated pathways more potently than salts or glyceride esters. It doesn’t produce a mineral load, unlike ketone salts, and no glycerol load, unlike glyceride esters. It seems like this makes it safer for individuals with cardiovascular, renal, or metabolic conditions. In studies and in my experience KetoneAid’s monoester has consistently outperformed other exogenous ketones in raising plasma D-BHB levels, enhancing endurance performance, improving cognitive function under hypoxia, and reducing markers of inflammation and oxidative stress. To me KetoneAid’s monoester is the gold standard for exogenous ketone delivery: cleaner, more efficient, and more physiologically compatible than hydroxybutyrate glycerides or any of the other options with broader applications across performance, brain health, metabolic disorders, and longevity but, it is very possible I am missing something.
April 4, 2025 at 10:45 am #33737Thank you so much everyone!! I truly appreciate it!
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