elevated IGF-1 and peptides

[Ashley Johnson]

Our clinic checks an IGF-1 and Prolactin (with other labs) on all patients before starting CJC/Ipamorelin.  I recently had a patient with an elevated IGF-1, prolactin is normal.  She is insulin resistant and has PCOS.  She is overweight.  I’m wanting to use it for weight loss assistance, AOD is too expensive at this time for her.  Should I recheck her IGF-1?  should I prescribe the peptides?  How concerned should we be with elevated IGF-1 on initial labs?

Thank you

[Kristelle Reyes]

Hello @leonard-pastranagmail-com and @byurthgmail-com, would love to have your insights here. Thank you! 🙂

[Leonard Pastrana]

@jnwlovemomyahoo-com cjc/ipamorelin can further increase IGF-1 and can cause a transient increase in blood sugar. While I still believe using cjc/ipamorelin is a good long-term strategy for cellular efficiency and improvements in insulin resistance in the short term you may not see that. For a patient like this,  considering a GLP-1 like semaglutide is a great place to start before adding cjc/ipamorelin. GLP-1 improves insulin resistance and is a potent weight loss peptide.

GLP-1 was specifically looked at in PCOS here https://pubmed.ncbi.nlm.nih.gov/28276778/

There are also ongoing studies looking at it in PCOS because “visceral fat dysfunction is an important factor in the onset of PCOS. GLP-1 receptor agonist is a glucagon-like peptide 1 analog, which is related to improving blood sugar control, weight loss and appetite suppression, and reducing cardiovascular risk”.

https://clinicaltrials.gov/ct2/show/NCT04876027

 

Semaglutide titration:

0.25mg weekly X 4 weeks

0.5mg weekly X 4 weeks

1.0mg X 4 weeks

 

 

[Miguel Bertonatti]

Ozempic’s (Semaglutide) original dosing schedule is

Week 1-4 – 0.25mg

Week 5-8 0.5mg

Week 9-12 1mg

Week 13-16 1.7mg

Week 17+ 2.4mg

[Cynthia Keller]

I would also absolutely recheck IGF-1, and likely recheck prolactin again at that time (even though it was normal initially).  For me, I would close this issue (by at least knowing that it isn’t escalating, and having a stated plan for future follow up if still high) before starting peptides.

I think this is partly just the right thing to do, but I’m mentioning it here specifically as a CYA thing (especially when using something off-label/non-traditional, etc).

Cynthia

[Ashley Johnson]

Thank you

All very helpful

 

[Annie Sewell]

This is interesting. I have a client with PCOS. We are checking many labs before starting a GLP-1 including IGF-1 and prolactin.

B/c  of her Dx I fully expect her IGF-1 to be elevated however, we are not going to be doing any GHRH/P peptides. My question is, if we avoid GHRH/GHRP’s will an elevated IGF-1 be of concern as far as peptide therapy?

Plan is Thymalin, (senolytic, autophagy, immune modulation) oxytocin (modulate ACTH stimulation, hopefully), and Tirzepatide.

I wonder too, which is the best GLP-1 for POCS? GLP-1 only or GLP-1/GIP?

Thank you!

[Craig Mullen]

Hi Annie,

You may want to consider retatrutide as an option for PCOS given the visceral fat loss potential.

I’m seeing success in a couple PCOS patients… their InBody visceral fat scores are trending down even at the lowest doses of this therapeutic.

I request they administer in the evening before bed and on a two hour fast to enhance overnight metabolic activity and fat oxidation.

Here is a great study from June ‘23 and another article synopsis.

https://www.nejm.org/doi/full/10.1056/NEJMoa2301972

https://www.vcuhealth.org/news/retatrutide-wiped-out-fat-in-liver-of-obese-patients/?utm_source=chatgpt.com

 

 

[Maggie Peklo]

I am just getting into peptides (I’ve completed the peptide foundations course and currently working through peptide world congress) where do I find protocols/labs that should be checked prior to starting each peptide? dr. seed did not go over this in the lectures.

[Craig Mullen]

Hi Justin,

Welcome! I am not sure there is a protocol per se for specific peptides with regard to labwork. Generally, when it comes to GHRH/GHRPs, it can be useful to have a baseline IGF-1 level, but there are several practitioners who don’t believe this is absolutely necessary.

You will find that the best “protocols” will be derived from your own working knowledge of how peptides affect various cellular functions, and moreover, each situation can be different given how your patients uniquely present, and what you are trying to achieve in treating/healing them.

[Maggie Peklo]

Thank you craig! would you want to avoid the GHRH/GHRPs if IGF-1 was elevated? and then if it’s not elevated, monitor to ensure it does not rise too much once GHRH/GHRPs are used?

[Craig Mullen]

This is a great question. I am curious what the experts on this forum think, but my inclination would be that several of the downstream effects of hGH that are IGF-1 independent to an extent COULD still allow for utilization of GHRH/GHRP, even if IGF-1 levels are upper level “normal” or elevated. My inclination would be towards short term and carefully monitored use.

Under such circumstances the utilization of GHRH/GHRP would need to be evaluated very carefully against the risks of IGF-1 levels that are grossly or chronically elevated. The potential downsides (cancer, metabolic dysregulation, organ enlargement, chronic mTOR activation, downregulation of AMPK and FOXO3 longevity genes, potential acceleration of aging) necessitate due diligence and caution.

 

[Annie Sewell]

Thank you Craig.

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