High-profile patient case with a past drug history abuse – Would you repair the gut or brain first for optimal brain function?

[Miguel Bertonatti]

Its. Dr. Rudy here,

We’ve got a patient with a seven-year abuse history of Oxycodone (180mg per day) & Percesot (20 mg/650 mg per day). He has been drug-free for three years but has lost brain function, optimal cognitive performance, creativity, and has been experiencing ever since short-term memory. 

Since the brain-gut axis is all interconnected, and opioids and & narcotic analgesics have been shown to disrupt multiple areas of gut homeostasis, what would you treat first? The gut and then the brain or the brain first?

The pt has not done a stool test yet but shows moderate symptoms of possible dysbiosis.

For the brain restoration peptide protocol, we had in mind Cerebrolysin at 5mls (1076mgs) daily for 4 wks, then 4 wks of FGL at 2,000mcg daily (intranasal spray) b/c injectable is not available, followed by Dihexa at 40mgs (oral) 4wks, and 6 wks of Semax 750mcg & Selank 750mcg spray combined. 

The pt is currently taking (Testosterone cypionate injectable 50mg 3x per wk/ Pregnenolone 50mg nightly/ NMN 1000mg QD/ Berkley Life Nitric Oxide 500mg BID with / Tadalafil 5mg QOD/ Vitamin D 10,000iu QD/ NSF certified Omega (3 grams of EPA/DHA combined)/ Amino Acid blend QD/ Magnesium glycinate 480mg QD/ Resveratrol 1000mg QD/ Digestive Enzyme with Betina HCL BID with meals). He has a chef who cooks daily for him organic and freshly made paleo meals, eats 2-3 meals a day.

The pt feels phenomenally better with our therapy program but for the brain aspect of his recovery, he feels a lot of work is needed.

Any suggestions on dosing structure, dosing schedule, and what to treat first would be greatly appreciated. 

PS: I plan to keep this community updated on this case b/c this pt is a high-profile celebrity willing to publicly support the peptide community and its FDA restrictions if he gets excellent results. 

[Clyde Boswell]

Epithalon in drug remission has been a game changer for my patients. 50mg-100mg total dosing over 10 days (100 recommended in Khavinson studies), Selank x 4 weeks, Dihexa 40mg x 4-6 weeks or topical dosing behind neck. Cold water exposure upon waking and vigorous exercise (personal trainer since he can afford).

With these patient’s I really do not focus on “what I am treating”. With addicts it is multiple things. They adapt well to athletic goals in particular. Set these goals with the patient in the office. There is a psych component that can not be ignored.

[Miguel Bertonatti]

Thank you! So you think the rest of the peptide protocol looks good? Would you treat the gut prior to doing the peptide protocol?

PS: Forgot to mention that he has a personal boxing trainer, weight resistance trainer and yoga/stretch instructor. He works out 5-6 days a week.

[Abid Husain]

Definitely treat the gut at the same time as using the neuromodulating peptides.  If his gut is not being treated, ther could be existing sources of inflammation working against the neuropeptides.

I would recommend stool testing.  That will help to formulate an individualized treatment protocol.  If stool testing can’t be done for some reason, I’d start BPC157 , thymulin and oral butyrate at a minimum.

[Miguel Bertonatti]

@drhusaininterlinkedmd-com thank you so much for this answer! This is exactly what I was looking for…. Anyone else feel free to contribute to this celebrity that can help our industry.

 

Have a great weekend!

[Valsa Madhava]

Wondering if it would be useful to do an Organic Acids Test if he has not had one done already. It may show a depletion of nutrients that would benefit from supplementation.

Most folks with drug use have gut microbiota imbalances- so would be good to do a test.

Individuals who are actively using drugs have hypoglycemia. This may not be the case with him since he has been drug-free for a while and is eating regular meals..just a thought.

[Anant Vinjamoori]

If it hasn’t been attempted already, I’d strongly recommend a course of IV NAD+ treatment. I know you mentioned he’s on oral NMN, but IV NAD+ is much more effective in my experience. There is some science suggesting that intravenous NAD+ can be more efficacious than oral NAD+. This paper is interesting into the kinetics of IV NAD+: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6751327/

Notably, uptake is so dramatic that metabolites do not show up in the plasma urine for over 2 hours post infusion. These implies substantial utilization of NAD+ by cells, through all the mechanisms we’ve discussed here (SIRT, PARPs etc) as well as others. This can complement what you are doing with peptide signaling very nicely- nearly all of the mechanisms you are activating with your peptides can benefit from increased NAD+ levels.

I know there are some that are dubious about IV NAD+ but in the hands of people who’ve done a lot of it, the results are night and day between oral NAD+. I really wish someone would do a head to head study of oral vs IV NAD+…

With all this said, I’d recommend a standard loading protocol- 750mg IV NAD+ over 6 sessions, done within a 14 (ideally 10) day period. It can be a game changer. Keep us posted!

[deborah dunn]

 

Agree with Anat. For chronic substance abuse, it is a game changer after supporting micronutrients, lipid membranes and other cellular pathway mechanisms.

 

[Miguel Bertonatti]

Thank you guys!

[Alexandra Farnsworth]

What about option of NAD+ IM instead of IV?

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