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The BPC and TB4 are great options. I am currently treating these patients with mitochondrial peptides (Humanin, SS31) with a GHRH/GHRP. Dr. Seeds went over muscular dystrophy in his recent mitochondria mastermind which you should definitely check out.
If using glp-1 in new onset dementia or cognitive decline, I recommend beginning at 0.125mg semaglutide or 1.25mg Tirz because often times these patients already have a decrease in appetite.
In addition to GLP-1 therapy, I always check nutrition status. These patients are often in caloric deficits. If need be, recommend meal prep companies like Factor for convenience.
Other considerations include Ta1, which I use in nearly every cognitive decline patient. Humanin as well, and I have found a lower dose of 25 units daily to be very effective and will alternative with other mitochondrial peptides. I do get a baseline IGF-1 level and often will rx CJC/Ipamorelin twice daily with daily exercise.
I also advise patients to begin a neuro plasmalogen in the morning (3-4 caps) and Glia plasmalogen at night) 3-4 caps. Ketone esters have been a hallmark in treatment of these patients in my experience and I have been limiting use to before 1pm due to some sleep pattern issues I’ve noticed.
Hope this helps
Absolutely!
this is why Skyrizi is one of the few biologics I use due to the select activity on IL23.
Really need to check the LFTs initially and after 6 months of use. Then 3 months thereafter. Most patients are receiving too high of a dose initially from GI or Derm.Psoriasis:
- Check vitamin D level and I will often run these patients quite high 80-120
- Check a zonulin: If I do test I typically do a blood spot and a stool sample (KMBO gut barrier and Diagnostic solutions stool). If positive 500mcg larazotide 2-4 times per day.
- Med therapy pro/darm reapir: 1 scoop twice a day for 3-4 months
- Short chain fatty acids + Lactulose
- Thymosin alpha 1: I use this in almost all of my patients with psoriasis.
- If lesions are on the face, behind ear ect, consider topical rapamycin
- Consider use of Red light therapy (My patients go to Mayo Clinic for red light and have had good results)
For severe cases I use a biologic (skyrizi) and have recently been adding TA1 and the other protocols listed above.
Sorry for short response, but this has worked well in my practice in the past.
I have patients report that when they use TB4 before bed (which I do not recommend) that they can have sleep pattern disturbances. As for autonomic symptoms and what this patient is describing, this seems unlikely.
What was the patient’s current dose?
What is the patient being treated for?
Any prior medical history related to these symptoms?
Clyde Boswell
Miguel, did the elastace go back normal when dose GLP-1 was discontinued? Also you said 7mg, are you referring to semaglutide? That’s concerning as it relates to acinar cell damage causing chronic exocrine pancreatic insufficiency.
Dr Keller,
Do you have concerns with using cyproheptadine in pediatrics, or is it something you find beneficial for those on the low end of growth chart or perhaps FTT?
Where are you sourcing ARA 290? I have patient’s with extensive small fiber neuropathy that this has worked wonders for. NuBioAge is no longer compounding it.
Your dosing is typically 250mcg BID to 500 mcg BID. I would start at 250mcg at age 3, but the studies involving MIS-C was 10mcg/kg QID.
Get the bowel moving first with some lactulose or miralax then start the larazotide. soon after.
You can get Alinia 500mg tabs and split them or crush them also. I use CarePoint Pharmacy who the is the distributor for Alinia.
Hope this helps,
Clyde Boswell
Something to consider here,
If he is ketogenic then this can drastically increase SHBG if other work up looks normal. I have had multiple patients where this was an issue, however, they are seniors, not younger adults.
