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Internal medicine and functional medicine physician Shiv K. Goel discusses the article “Why lifestyle matters more than BPC-157 and semaglutide.” Shiv explains how the modern longevity boom has trained patients to seek out quick fixes like peptides and weight loss injections while ignoring foundational habits. He shares a compelling patient story to illustrate why optimizing sleep, circadian rhythms, and stress management is far more powerful than any supplement drawer. Shiv argues that tracking endless biomarkers with wearables without understanding a patient’s personal story only creates anxiety. By prioritizing deep listening and addressing the root causes of metabolic dysfunction, clinicians can offer real solutions rather than just another health care transaction. Discover how aligning your daily routines with your biology is the ultimate biohack for a longer, healthier life.
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Transcript
Kevin Pho: Hi, and welcome to the show. Subscribe at KevinMD.com/podcast today. Welcome back, Shiv K. Goel, internal medicine and functional medicine physician. Today’s KevinMD article is “Why lifestyle matters more than BPC-157 and semaglutide.” Shiv, welcome back to the show.
Shiv K. Goel: Thank you for having me, Kevin.
Kevin Pho: All right. What led you to write this article, and then tell us about the article itself.
Shiv K. Goel: I was inspired by a very real patient encounter I had with a 45-year-old male who walked into my clinic with what I call a peptide shopping list: BPC-157 for joint pain, sermorelin for growth hormone, and semaglutide for weight loss. He didn’t come in asking about his sleep, his late-night laptop dinners, or the statins that had quietly been draining his energy for years. He already came in with that whole shopping list of things he had been on. In that moment I realized that he wasn’t alone. He was not the only person doing this. He was a mirror of our entire longevity culture, chasing protocols and compounds while skipping the most basic human questions like: “What are you eating? When are you eating? How are you sleeping? When are you sleeping, and does that sleep have any quality to it? What is really happening in your life?” That contrast between sophisticated tools and neglected fundamentals is what pushed me to write this piece.
Kevin Pho: So in terms of the peptides that particular patient came to you with, where were they getting that information from? Where did they hear about things like BPC-157, for instance?
Shiv K. Goel: You know, Kevin, before people used to use Google. Nowadays we use AI, and you can find all the information on AI. They hear it from the gym, their coworkers, and other sources they touch. They read about which peptide can help with sleep, how to improve their sleep, or they hear the name PT-141, or they hear the name BPC-157. That is how they keep on getting it. Nowadays, because there are so many companies out there under the “research label,” they have been selling peptides without any guidelines, without knowing if it is really going to help them or not.
Even semaglutide is known by everybody. Even those who are not overweight know about semaglutide and what it is because someone in their friend circle or family has been taking it. If you go to the gym, I think even 20-year-olds know what peptides are now. Ten years ago, nobody knew what peptides were. What surprised me is how far it has gone, like a new revolution has happened. It has become a more modernized approach of taking multiple tools which we think are going to fix the problems we are having without really looking into the root cause of the issue, which is fixing the fundamentals of our lifestyle. Peptides or any medication are just tools that work along with our lifestyle. On paper, that patient is on every kind of medication or peptide and taking all kinds of supplements as well. But they are only going to work when our fundamentals are fixed. If we are really eating on time, sleeping on time, having good sleep, spending time with ourselves in nature, and hydrating, they might work; otherwise, they are not going to work. It is simple.
Kevin Pho: I think a lot of these patients, of course, are looking for quick fixes, right? Sometimes fixing lifestyle doesn’t have the immediate results that some people want. But even with taking peptides, from my understanding, there isn’t a lot of data supporting the efficacy of many of the peptides that these wellness influencers promote on social media.
Shiv K. Goel: Yes, there is an issue, so it is like a double-edged sword. Yes, I agree that there hasn’t been much data about peptides. The second issue is why we do not have much data. It goes both ways because in order to generate data, you have to run large, big trials and studies on it. Because you can’t patent peptides, there is no pharmaceutical company that can patent them, and therefore there is no one to make the huge investment needed to study them. Now, peptides like BPC-157, to take an example, are produced by our bodies. It is not something that is foreign to us. It is produced even in our gut and in our system, but not in large quantities, and not in enough quantity. Plus, as we age, the production of those peptides keeps going down. When we are younger, up to the age of 20, we have growth hormone surges. After the age of 19 or 20, it starts to go down. So it is not that they are something foreign to us.
Even if we take them, suppose there is obesity in the younger population now, it doesn’t mean that they do not have endogenous peptides which can help us. But if we don’t fix our lifestyle, if we do not watch our thought processes, because it all starts in our thoughts I think, and if we are just using them as a tool and thinking that this peptide will cure me, this peptide will fix my lifestyle, this peptide will make me sleep better, or this peptide will take all my worries away, that is where we are lacking. If we do not have our original, normal circadian rhythm, peptides do help. But first of all, not many physicians are involved. What surprised me is that the person had been taking all those peptides, but there was no physician watching it. There was no health care professional involved.
Everybody is just writing prescriptions for peptides nowadays, even medical spa staff, because you do not have to be a physician. Pharmaceutical companies that are selling it without prescriptions or without patient-specific compounding leave you with no idea what it contains because they are not for human use. A lot of times I have seen people producing them in bulk and selling the peptides, but 40 percent of the peptides lose their efficacy once you fail to maintain your lifestyle. So there are a lot of things out there. Even when you are taking it, are you getting the right treatment? Is there any physician involved? What is the dosing of it? Is that dose really effective for you? Everybody is different. Peptides are not one size fits all. A person who is a 70-year-old weighing 150 pounds, a 50-year-old weighing 200 pounds, and a 30-year-old weighing 190 pounds will all have different dosing depending upon their body composition as well. You have to build a proper regimen and protocol for them based on their fat mass and muscle mass, and they have to follow it.
Everything in excess has a side effect. Excess growth hormone can cause issues like acromegaly, carpal tunnel syndrome, and many other problems. So just because it is a peptide doesn’t mean it is simply going to be good for us and we can just keep taking it. Instead of helping, sometimes it can cause an issue too. It is very important for each person not to take a shortcut, not to just get it from the market because it has not been approved by the FDA or it is not available for human use. There is a reason for that too. Whenever I prescribe a peptide, I usually go through in detail whether this peptide is really going to help the person or not. Is there something I can do along with that, or before that, which is going to give him a better result? If his sleep is completely off, his hormones are not optimized, or he has a severe deficiency of vitamin D, which 90 percent of people have, that needs to be addressed. Vitamin D is so essential as a precursor for all steroidal hormones. While people are aging, especially women going through perimenopause or menopause, deficiencies can accelerate menopause. We are also aging faster than we should be, all because of our lifestyle of stress and deficiencies. We don’t spend any time outside nowadays, as we are always in front of a computer.
Kevin Pho: And some of these peptides are injected, and as you said, they are not regulated. You don’t know what you are injecting yourself with, and exactly, sometimes that dose needs to be individualized for the patient. Have you heard of any side effects or real negative effects from people self-injecting peptides that they may have gotten from a compounding pharmacy or whatever? Have you heard stories of really terrible side effects?
Shiv K. Goel: Yes, I have, depending upon which peptide they are taking, because every peptide has a different side effect. If they are taking semaglutide and tirzepatide, I have heard horrible stories of people injecting improper doses. Even a lot of providers don’t understand that every person is different when we are dosing it. It is not that if you started one person on 0.5 milligrams of semaglutide, everybody should be on that or on one milligram. It has to be very individualized. A lot of pharmacies nowadays make different concentrations because of cost-effectiveness, so they make concentrations of like five milligrams per ml or 10 milligrams per ml. The whole dose varies.
If people are not educated and are just buying it from those medical spas or those pharmacies, they might think 20 units is simply 20 units. They don’t know how much those 20 units equal; it could be two milligrams, it could be one milligram, or it could be 0.5 milligrams. So they come in with severe dehydration, nausea, and vomiting. I had one case of pancreatitis too, which I have seen. A lot of times, people who are diabetic can go into hypoglycemia and have seizures. Growth hormone is another thing I have seen issues with. This is not seen as much with sermorelin because sermorelin acts more like a growth hormone-releasing hormone, so it acts on the pituitary. There is still a negative feedback loop which can prevent issues because, after a certain point, the pituitary won’t keep producing growth hormones once you have saturated the receptors. In fact, it can downregulate the receptors.
But people who are taking direct growth hormone, because growth hormone is also a peptide hormone as we know, can experience side effects. It has caused people to have carpal tunnel syndrome, and their migraines get bad. You have to be especially cautious with people who have a family history of malignancy. People who are on multiple things, such as testosterone therapy and growth hormone, have started having BPH. This is normal in most aging people, but that prostatic hyperplasia can turn into malignancy. It is a very real risk. That is why it is important to remember that just because everybody wants to remain looking 30, it doesn’t mean it is good for you. Society must embrace that longevity doesn’t mean looking young. Longevity means having a quality of life for as long as we can, and that has to be fixed way before we get there.
Kevin Pho: Now, how do you convince patients to adopt a lifestyle route when they are so resistant and insistent on taking these quick fixes? Let’s go back to that patient you introduced us to, who brought you all these peptide requests. What happened next? How did you convince that patient that lifestyle changes would be better for them?
Shiv K. Goel: He actually came here because he wanted more peptides. He wanted more BPC-157, he wanted to have CJC-1295, and more semaglutide. But underneath all of that, he was really asking for relief from a life out of rhythm with his own biology. His life was completely out of rhythm with chronic stress, late-night eating, and fragmented sleep. That is what he wanted to fix, but he didn’t know what he was doing. We seek alternatives, whether it is peptides or medications, because we know something is not right and we want to fix it.
First, making him realize why he wanted them was key. I asked him if he just wanted the peptides, or if he wanted them because of these issues and wanted to fix them. He realized he wanted them to fix his issues. I explained that we have all kinds of peptides, GLP-1s, CGMs, and advanced biomarkers nowadays, but many people are more anxious and disconnected from their own bodies. They need to understand their own body physiology, why they want these things, and what they are actually trying to get out of it, rather than just hearing or seeing something and wanting it. My argument is that numbers and molecules, whether peptides or anything else, do not heal by themselves. They only make sense when they are woven into a story, your story, your rhythm, and your environment. If that doesn’t work, no peptide, no molecule, nothing is going to work.
He had been on those peptides for months, and I asked him if he got better. He wanted to increase the doses and add more peptides. He said he felt a little better, which is a placebo effect. I told him I would prescribe what he wanted, but I wanted him to do three things for the next four weeks, and then we would talk about it next time. I told him if he still thought peptides would solve all the issues, I didn’t have a problem prescribing them. When he came back next time, he was able to sleep better. When we did all his blood tests, he was severely deficient in vitamin D. He had chronic adrenal fatigue, and his morning cortisol level, which should be at least about nine or ten, was four. His body was already giving up because semaglutide is not an anabolic medication; it is causing more stress on your body. It decreases your appetite, suppresses your brain receptors, increases your gastric empty time, and increases your insulin level, leading to insulin resistance. Chronic stress also causes insulin levels to go up, so his fasting insulin level was way higher even though he was not diabetic.
When we address a person’s whole story and listen to them about why they have been sleeping so late and what is bothering them, we can help them make small lifestyle changes, maybe sleeping one hour earlier. You don’t expect people to change their lifestyle immediately. But while they are making changes, I use these medications as a tool, not as a solution. We have to know when to use those tools and when to bring them into action. We shouldn’t just keep prescribing them, otherwise they will end up causing more damage to your body than benefit.
Kevin Pho: It sounds like the key, of course, as you wrote in your article, is deep listening and going back to the history and physical. That is the core of treating these patients, not just these quick fixes like peptides.
Shiv K. Goel: Exactly. I think it is very important for a lot of patients to understand that it is not that they don’t know what they are doing. They just don’t know when to do those things.
Kevin Pho: We are talking to Shiv K. Goel, internal medicine and functional medicine physician. Today’s KevinMD article is “Why lifestyle matters more than BPC-157 and semaglutide.” Shiv, as always, let’s end with take-home messages that you want to leave with the KevinMD audience.
Shiv K. Goel: Yes. My message to all my fellow colleagues is not to let the peptide manual replace the patient’s story. In the article I wrote, the most healing thing in the room is not the molecule; it is the relationship. It is the relationship you build with your patients. Patients may open by asking if you can prescribe BPC-157 or semaglutide, but that is often a doorway into their deeper fears about aging, energy, weight, and time. So practically, that means starting with questions that change everything. Ask what they are eating, what time they are sleeping, and how the quality of their sleep is. Ask what their stress story tells you, what the common stresses in their life are, and how they are feeling. Just start with open-ended questions. Let the story unfold by itself, and then you will realize that these molecules are not always the solutions. They have to work synergistically alongside making changes in their lifestyle.
Kevin Pho: Shiv, thank you again for sharing your perspective and insight. Thanks for coming back on the show.
Shiv K. Goel: Thank you for having me again, Kevin.
