How To Build Lasting Vitality With Dr. Alexsandra Gajer

Many active seniors struggle with unexpected weight gain and fatigue, but Hormone Peptide Therapy offers a clear way to restore your physical freedom. Host Zach Gurick connects with metabolic health expert Dr. Alexsandra Gajer to discuss how aging isn’t a slow decline when you have the right tools. You’ll learn why metabolic health forms the foundation of wellness and how bioidentical hormones protect your brain and heart. They discuss how targeted peptides repair stubborn injuries and rebuild the critical muscle mass you need to stay active. It’s time to stop chasing symptoms and start focusing on the root causes of vitality so you can thrive for decades.

The information presented in Fully Alive is for educational and informational purposes only and is not intended as a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified healthcare provider with any questions you may have regarding a medical condition or treatment and before making changes to your health regimen. Guests’ opinions are their own and do not necessarily reflect those of the podcast host, production team, or sponsors.

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3. How To Build Lasting Vitality With Dr. Alexsandra Gajer

The Shift From Emergency Medicine To Proactive Care

Welcome back to the show, where we are unlocking the secrets to your healthier, happier, longer life. I’m really excited about this conversation because we’re diving into something that so many people experience, but few truly understand. It’s why, as we get into our 40s, 50s, and beyond, our bodies start to change. The weight gain, fatigue, brain fog, even when we’re trying to do the right things. This guest is Dr. Alexsandra Gajer.

She’s a board-certified physician and founder of The Gajer Practice, where she focuses on metabolic health, hormone balance, and performance medicine. Her perspective is shaped by years in emergency medicine, where she saw firsthand what happens when we only treat symptoms instead of addressing root causes. That experience led her to a completely different approach, one that’s focused on proactively building energy, resilience, and long-term vitality.

In this episode, we talk about why metabolic health is foundational, how hormones and energy are deeply connected, what peptides are and how they’re used in modern medicine, and why lasting transformation requires more than just knowing what to do. If you’ve ever felt like your body isn’t responding the way it used to, then this conversation will give you a new lens and practical next steps to take. Let’s jump into my conversation today with Dr. Aleksandra Gajer.

Dr. Gajer, thank you so much for being here with us. You have this amazing story and journey and just a wealth of knowledge. I’m really excited to learn from you, for our audiences to learn from you. Thank you for being with us for this conversation.

Thank you so much for having me. I’m excited.

I know you wish you were outside enjoying this beautiful spring day, but we’ll make the most of it and get back out there.

I’ll still get sunlight.

Tell us, you spent years in emergency medicine and then you shifted into now more proactive, performance-based care. I’m just so curious about your journey. How did you end up in emergency medicine? What led you down the path to where you are now?

I went to medical school a little bit later than most people. I was 26 when I started, and it was an evolution for me. When I was still in college, I was not mature enough to make lifelong choices. I initially studied psychology, and then I wasn’t really into where that was taking me. I really liked math and science. I got to know some people who were on the track to go to medical school and decided to start taking some prereqs. I really wanted to help people in a meaningful way from the beginning. I did a number of internships and got to experience different settings. I wanted to find a way to use whatever gifts I was given in a way to actually make a difference.

I went through medical school. I struggled with my choice of residency. I liked a lot of different things. Eventually I chose emergency medicine because I really liked being at ground zero with patients. I actually enjoyed the chaos. I enjoyed the pace, and the training involves being able to deal with whatever comes through the door and make the best of the resources that you have, and being really adaptable rather than being stuck in any framework. I loved practicing emergency medicine for a while, but there were a lot of really meaningful things that I could do there. I developed a skillset that I was really proud of and that saved lives.

It was a meaningful part of my journey, but I felt in my gut like it wasn’t a fit long-term, for a number of reasons. One, my own health was starting to fall apart, and I was dealing with inflammation and numerous other issues. I transitioned to working nights exclusively because it was actually the best fit for my family at the time. Plus, I became a little disenchanted with the way I was able to help people. As everyone who’s ever been in the ER knows, it is a suboptimal place to be a real help. We can patch up a number of things, but I felt like there was this huge amount of chronic disease and suffering that there was just, there was no way to touch.

Years before I left, I just started studying a lot of these things on my own, and I became really interested in what creates a state of health. That’s really not what we’re taught in medical school. We really focus on disease, and Pharma is very influential in our medical education, and the model is drug equals disease or surgery. There’s not much outside of that. I really became interested in longevity and health. How do we meet people earlier in the path and help them create a state of health so they never get to this devastating place where I have to patch them up in the ER?

I love what creates a state of health. I love that mindset and that question. When we talked before, you said it seemed like you were just putting band-aids on chronic illness. You would have people return a few months later, a couple of months later, in a softer state than the time they came in before that shift. What does that shift really look like, that true transformation looks like, moving away from band-aid medicine to really a state of health, like you said?

Why Modern Humans Outlive Their Natural Hormones

I like to think about this in an evolutionary perspective. Humans have been on Earth for about 200,000 years. For most of that time, 99% of that time, we have lived until age 40. It’s only been the last 150 years that we’ve lived past 40. Our genes adapted over this incredibly long span of time to help us reproduce and then die. Modern medicine is absolutely incredible. Again, I’m grateful for what I got to do in the ER. We have bought humans an extra 40 years of life. Where I come in is that a lot of the support that we had in the first 40 years of hormones has naturally produced peptides of anti-inflammatory signals.

All that goes away after age 40 because, again, the body has basically marshaled all its resources to keep us alive, reproduce, and then now we get to live longer. We actually have a lot of tools to guide that machinery to create health in that second half of life, so that we’re not just living, we’re also thriving, and we’re happy, and we’re vital, and we feel good. That’s the future of my little realm of medicine. That we’re not just going to be alive, and we do not take the wear and tear of aging as a certainty. There are certain things that we can do to make those years even better.

That’s so interesting to think about. Hundreds of thousands of 200,000 years now that humans have been on Earth. To think of it from that perspective, I’ve never really thought about it from that perspective. Why do our hormones start to decline at this certain age? I’ve thought about it up until 150 years ago. People died because of acute infections. Oftentimes, before we had antibiotics and things like that. Now we’re treating those, and therefore we live longer. Why do we decline? Why do we age? I know about the twelve hallmarks of aging and physiological processes that break down. At the core, underneath all of that, maybe is like you said. Hormones and peptides.

We’ve bought humans an extra forty years of life. Our job now is to make sure we are thriving, vital, and happy in those extra years.

Our genes change very slowly. Our environment on Earth has actually changed incredibly quickly, but our genes evolve slowly. We still have caveman genes, and those govern what those peptides and hormones are doing. The twelve hallmarks of aging, wonderful. We understand that now. There are certain commonalities that we can affect in those hallmarks. The big ones are our metabolic health, inflammation, oxidative stress, and mitochondrial health. Those are all really big words.

The big thing. How do we keep our bodies cleaner and not have some of that wear and tear that causes inflammation and oxidative stress? Metabolic health relates to what happens to food after we put it in our mouth. Do we store it as fat, which becomes this inflammatory organ, or do we use it for energy, and oxidative stress damages our DNA and causes chronic disease and aging? Those are the four things where I feel like we have the most ability to intervene, both with lifestyle modifications and with hormones and peptides and supplements, and I’m a believer in putting all our resources to use.

No peptide, no medication, no supplement will do the heavy lifting that your lifestyle can do. Some people are burned out. Some people are living a life that demands so much from them that they cannot get up and exercise even three times a week that they cannot. Sometimes giving the body some biochemical support to create a little more energy to reduce cravings for less healthy food, I think, can help people get to those lifestyle factors. I’m a believer in both that we can use the tools at our disposal and at the same time do our best with what we’re given to live the healthiest lives that we can.

I want to back up, though, for just a second. You said a couple of things I want to just tie together. You said that in medical school, you’re really taught about managing disease. You made this shift to more proactive preventative healthcare. How did you learn what you needed to learn to create the practice that you now have, The Gajer Practice?

I read a lot of books. I listened to a lot of videos and podcasts. I read original papers, and I took courses. Honestly, just curiosity that drew me to different things. Some of it was for myself, where I knew that what I learned in medical school was not enough to feel. I had a big life, and I wanted to be able to feel good while doing it. I felt like medical school did not teach me that. It taught me how to put a chest tube in if somebody has a pneumothorax. I did not have the tools to sustain my emergency medicine career, my hobbies, my exercise, my family. I was driven to. There has to be more. This has to be out there. Slowly over many years, I put things together.

You mentioned that you had your own health issues with chronic inflammation and things like that. Were you able to reverse a lot of that through some of the things that you now teach in your practice?

Yes. I got Lyme disease when I was actually a resident. It really turned my life upside down, and I had two children, one in medical school, one in residency, and in between those two I had this bout with Lyme. Even though I recovered, it was like my body wasn’t the same. I couldn’t maintain the same level of fitness, energy, and sleep was disrupted. It’s part of what drove me to explore these fundamentals. After modern medicine did what it could with antibiotics, I had to fix what the Lyme did, the damage and try to get my body back to a state where I feel good and where I feel like I can live the life that I want. Yes, I’m not perfect, and I still have setbacks, but I’m functioning at a level that I’m really happy with.

You’ve brought up hormones and peptides a couple of times. I would love to dive into those things. I know you’re now an expert on those two areas and I know that that’s something that both of those areas are getting a lot of hype right now. Some of the data from the hormone studies that were done, unfortunately, were misinterpreted and now debunked, thankfully. I know that’s getting a lot of growing in popularity of bioidentical hormone replacement therapies. I’m curious to dive into all things peptides with you as well. Where do you want to start? Which one do you want to tackle first?

Conquering Insulin Resistance To Fuel Your Longevity

Let’s do a quick foundation on hormones. Actually, I’m going to back up one more step because, for me, I think metabolic health is the first foundation, and it’s for me that fits in the category of hormones, and these things can be tackled at the same time, but body composition makes a huge impact on how we feel and our future risk of disease. If you compare just exercise head to head with any medication that was ever created in terms of what it can do to prevent disease, it really outperforms anything, any supplement, any medication we ever had.

Insulin is the main hormone that governs our metabolic health because of our modern food environment. Again, we have this long human history of having periods of famine and then short periods where we really needed a lot of nutrients fast. Our system developed to really crave and look for sweets and oils because those are highly nutrient-dense. We are heavily rewarded with pleasure signals when we find oils, fats, and sugars. We understand that we’re heavily rewarded by the fact that most people have become overweight. That’s not their fault.

That’s because we are working with machinery that heavily gratifies us when we find those things because they are essential to our survival. Now they’re everywhere, and they’re more available than anything else. A lot of people develop what’s called insulin resistance, which means that insulin is a hormone that allows blood sugar into all cells of the body. Without blood sugar, cells cannot function, and they cannot stay in the bloodstream because they basically degrade blood vessels, and they need to come into cells. Insulin resistance is when the cells start saying no, and insulin knocks on the door.

Insulin is knocking on the door saying, “I have some blood sugar to deliver. I need you to open this channel so I can bring it in.” The cells are saying, “No, you’ve done this too much. You’ve come to our door too many times. We’re not opening the door.” Insulin is a fat storage hormone. Your fat stores are locked in when you have high insulin. This is really an epidemic, and a lot of people are walking around with what’s called insulin resistance. That means that you’re producing too much insulin, your cells are not responding to it, and your body’s constantly saying, “We cannot burn this fat. We need to hold on to it.”

Some of them, I’ll tell you just the quick little hits of what people can do for insulin resistance. Of course, the GLP ones have come out, and they’re very helpful, but resistance training, strength training can be very helpful. Taking a walk after a big meal, even if it’s ten minutes long, can dramatically reduce insulin resistance because the muscles are the only tissue that can take up blood sugar while actively working without relying on that insulin. Whether it’s taking a walk or walking around your sofa four times or doing some sit-ups, moving your muscles for ten minutes after a big meal can dramatically shift insulin resistance.

Trying to keep your food intake during daylight hours is another tip or trick. Not eating after it gets dark is another tool. There are a number of other ones. Of course, we need to avoid saturated, high-concentration sources of sugar. That’s your candy, chocolates, and sweets. Those have a place when it comes to celebrations, and we shouldn’t deprive ourselves entirely. It cannot be a part of your daily stress management. It cannot be what takes the edge off at the end of the day because it’ll destroy your metabolic health. Everything we talk about from here on out will be useless if your metabolic health is not in place.

Simple strength training and taking a ten-minute walk after meals can dramatically shift insulin resistance and optimize metabolic health.

Thank you for those. That’s so practical. We can all do that.

There are little things that move the needle.

That’s at the base. This metabolic health. Overriding insulin resistance. We can actually reverse that insulin resistance.

Rebalancing Cortisol And Stabilizing Thyroid Health

We absolutely can. I wouldn’t necessarily say it’s easy. It depends on the person. It depends on your genetic makeup. It depends on how much extra weight you’re carrying. If it’s a hundred or 200 pounds, you probably need some support and some biochemical support, potentially for medications, but you can absolutely reverse it. The other hormones are built on top of that. We can talk about the hormones that both men and women have. Cortisol is another important hormone. That’s our stress hormone. For many people in our modern lives, with the demands on our time, with our constant availability and notifications and all these things, cortisol can run quite high.

That can also affect all the other hormones, your metabolic health, your overall wellbeing. Also, as part of the foundation, it’s really important for us to intentionally be engaging in some activities that lower cortisol. No medication or supplement will really do that, but we need to be giving ourselves something. That differs for different people. Some people will go for a walk in nature. That certainly does it, while other people will take some quiet time and read a book. Screen time does not lower cortisol. Sorry to take that one off the list. Some people like yoga and meditation.

Those are really great cortisol reducers. It’s not for everyone. You may need to do an adult coloring book, something that just calms your system and activates the parasympathetic nervous system, which is your rest and digest system. Sleep is really important for that, too. We really cannot have a healthy cortisol cycle if we’re not getting some restorative sleep. Making sure that we try to go to bed at an appropriate time, that we have a dark sleep environment, that’s a little bit cool, even having a little bit of light in the room.

Sleeping with a TV on will disrupt your cortisol production and cause insulin resistance. Just creating an environment where that can happen is important as well. Everybody should have their thyroid checked for thyroid disease. Usually that’s something that your primary care doctor will do with your annual physical. It is the most common autoimmune condition in the United States. It’s more common in women, where basically your immune system attacks your thyroid. For reasons I will not go into now, it is very common, unfortunately, and needs to be checked because it’s part of this whole foundation.

Optimizing Testosterone For Muscle And Vitality

We can talk about the sex hormones, which is what everybody thinks about when you think of hormones. For men, it’s mostly just testosterone, and men have lower testosterone now than we used to, mostly because of the chemical environment that we live in. Again, our bodies were adapted over all these years to live in this kind of clean earth environment, and now we have chemicals we’ve never seen. A recent study showed that the average testosterone for a 40-year-old man now is the same as that of a 65-year-old man 20 years ago.

On average, that’s a lot of time. That’s not that long.

As a 40-year-old man, testosterone might be the same as their father’s, which is sad. It shouldn’t be. That’s a really important hormone. For men in particular, when we start talking about peptides, which are interesting and can do a lot. If the testosterone is not optimized, it’s hard to make peptides work well. Wasted naturally improves testosterone. Fat tissue, adipose tissue, suppresses testosterone production.

Just weight loss and muscle gain will naturally improve a man’s testosterone production. Sleep is really important. Men do need some healthy fats in their diet in order to produce natural testosterone. Strength training, particularly with these compound movements, can improve testosterone for men. I just put a lot of information out there, and we can move on to women unless we want to pick apart any of that stuff.

I’m just curious when men come into your practice now, say over 40, are you finding that most of them need some additional testosterone support?

It’s interesting. A lot of the men that I see have optimized already with their lifestyle. The men who are strength training and eating well and making sure they’re sleeping, they can do okay and have decent natural testosterone production than people who are focused on health. The men who are coming in just starting a healthy journey, a lot of times their testosterone is too low.

Another thought is just how much one can improve their testosterone level just by some of those lifestyle factors, strength training, those sorts of things.

Quite a bit actually. When we think of total testosterone, I think most men feel best somewhere between 700 and 1000. There are other measurements too, but like free testosterone, which is more important than the total, but just to throw some numbers out there. Just improvement in diet, exercise, and sleep. I’ve seen men go up 200, 300 points in 2 to 3 months.

You can make a significant improvement.

You can make a significant improvement. Processed foods can also contain chemicals, and processed foods can really suppress some men’s testosterone. Switching to a more whole-foods-based diet, I’ve certainly seen men turn it around on their own.

There are endocrine disruptors. In a lot of foods and fragrances and things like that.

Yes, exactly. Just trying to go as clean as you can, without going crazy, but trying to keep chemicals out of your body.

Even like the laundry detergents that we use and things like that?

Yes. Some of those are actually low-hanging fruit. If you get a non-toxic Environmental Working Group, it’s called EWG. I have the website, and they have a list of clean products, and you can actually type in any product that you’re using, and they’ll tell you if it has those endocrine disruptors in there. Laundry detergent is a great place to start. It’s an easy transition. Body wash, lotions, things like that.

I’ve used that EWG website before for water testing and things like that. I can get reports, but I’ve never tried it for other products. I’ll have to try that out.

They’re great for that.

What about women’s hormones and what you’re seeing there? I’m curious.

Reclaiming Cognitive Focus With Bioidentical Hormones

Women are more complicated. As we know, we have a menstrual cycle. We reproduce. We carry babies. Menopause is a natural part of our lifespan. Many people are familiar now that, twenty years ago, we had this big trial called the Women’s Health Initiative that prompted most doctors to take women off hormones. The issues were really about who we were treating and the hormones we were using. We were using synthetic hormones at that time, particularly estrogen created from pregnant horse urine. It was called Premarin, and it literally stood for pregnant mare’s urine.

It was not biochemically similar or identical to the estrogen that women made. We did this big study that showed an increased risk of breast cancer, heart disease, and a number of other scary factors that then prompted doctors to just pull women off hormones. In recent years, that has completely changed. Now we have started using bioidentical hormones, which means hormones that are the exact same biochemical configuration as what your body makes. The study on those hormones shows something completely different.

Synthetic hormone fears were based on outdated research. Bioidentical hormones safely protect cognitive function, your brain, and heart.

Those hormones actually support women’s bodies, really support cognitive health and brain health, reduce the risk of heart disease and strokes, and can really optimize women’s bodies. Again, I think it’s this downregulation that happens that actually tends to hit women a little bit harder. There are a number of studies that show that although women live longer, the quality of life in the last twenty years of life tends to be significantly lower than men’s. We know that women have more trouble with weight and other things. A lot of that is hormonally driven.

Every woman should have perimenopause that starts well before the actual menopause transition, when women stop having periods, and having hormones checked in a woman’s 40s, I think, is really beneficial. The hormones we’re talking about in women are estrogen, progesterone, and testosterone. Women actually produce more testosterone than estrogen in their bodies. It’s an important hormone for us as well. That can make a big impact on body composition and drive.

The earlier a woman starts bioidentical hormones in her transition, whether in late perimenopause or early menopause, the safer it is. The body doesn’t like to see a time period where there are no hormones and then have them added back. If we start within the ten years of menopause, bioidentical hormone treatment is very safe and can significantly reduce inflammation and oxidative stress, improve metabolic health and mitochondrial health, and just significantly improve a woman’s wellbeing, which is really important.

That’s the primary window when you want to capture that or begin that treatment. I’ve heard of people and other longevity clinics that will even treat people in their ‘80s or ‘90s with some hormone replacement therapy. It’s not going to have the same impact, or still have some impact?

Yes. I do sometimes treat older women. I saw a woman who was 81 earlier. We try to stay away from estrogen in those women because that’s where the data is still not 100% certain in my head, especially after that ten-year break. If a woman has already developed some atherosclerosis, there’s some concern that it could aggravate those plaques and cause heart attacks or strokes or something like that. I will treat older women with testosterone and progesterone, and I get so much out of it.

That’s super helpful. These things are at the foundation of what our body needs to do what it naturally wants to do. You can actually supplement with peptides on top of that.

How Target Peptides Accelerate Deep Tissue Healing

Peptides are a really cool class of, um, medications slash supplements. Really their own class that is also naturally produced in our bodies. We’ve been using them quietly in medicine with elite athletes for probably 30 years. More recently, more people have become interested in peptides. That there are multiple applications. Peptides are usually used short-term, unlike hormones, and they will optimize some function in the body. I usually think of a few different categories that peptides can help with, and there’s a number in each category. The first is body composition.

Ozempic and the GLP-1 ones were the proof of concept that peptides can meaningfully change body composition. Now we have a number of other ones. Chronic inflammation and injuries have been a category that has been really helpful in my practice, where now if you have a chronic injury, your options are surgery, physical therapy, or long-term ibuprofen and Tylenol, which are not good options for a lot of people. We do not have any other options really to heal a chronic injury, a chronic rotator cuff, arthritic knee. There are a number of peptides that have healing properties that can actually go in and make a substantial difference and actually start working on the root cause of the injury.

BPC-157 is one of these. Are a number of animal trials on BPC-157 that show tendons, especially the Achilles tendon, basically growing back together where it should have been severed. I have a lot of success stories with those peptides that have made life-changing differences for patients. I want to take a quick step back and just say that most peptides are investigational and not FDA-approved. Some are FDA-approved and have gone through large trials, but a lot of them are used in this investigational fashion.

They tend to be safer than most medications just because they are something that we naturally produce. We produce BPC-157 in our guts. The amount we produce just goes down as we get older. It’s a conversation that I have with every patient to make sure that they understand that this isn’t risk-free. Nothing is risk-free, and to get an understanding of whether the risks outweigh the benefits for your particular situation. A lot of times, if I can get a man or a woman active again, that tends to happen, and they can build muscle and get active and fix their metabolic health and get a quality of life that they couldn’t have before. Usually the benefits outweigh any potential risks.

There’s the compounding effect. If you have an injury, then you cannot lift weights, then your metabolic health, your body composition, all of those things go down. Something like BPC-157 can be really helpful for some. Do you have supplement companies that you trust? I’ve tried BPC-157. I’ve tried TB-500. There are so many companies out there. Some are cheaper than others. Do you just buy the most expensive one, or do you have certain companies that you source from or compounding pharmacies?

We have transitioned almost entirely to compounding pharmacies now, because that is really the safest way to go, because every compounding pharmacy is overseen by the Board of Pharmacy and the FDA, and lab-created peptides. Although I think there are probably some labs that are doing a good job and have certificates of analysis that are clean and accurate, the water has become so muddy that there are just so many companies out there now. The process of creating a peptide naturally produces something called an endotoxin when it’s created in a lab.

There’s another step that has to be taken to remove those endotoxins and then to test the peptide to make sure they’re not in there. Cheap peptides will have endotoxins, and those can cause severe inflammation in the body and cause lifelong issues, especially cheap peptides that are coming from China. We’ve seen a lot of issues, unfortunately, with those making people more sick than healthy. I prescribe peptides from a compounding pharmacy rather than rely on a lab.

Cheap, untested peptides often contain dangerous endotoxins. Always work with a professional and source from compounding pharmacies.

Can anyone go to a compounding pharmacy and buy a compound, or do you need a prescription?

You have to have a prescription. I’m not saying there aren’t safe labs out there. If you do go the route of a lab, you have to make sure they have certificates of endotoxicity, purity, and sterility, because those are three different things that have to be tested. Unfortunately, with how this has blown up, we have seen a number of companies show fake certificates of analysis, or ones for one batch, and then most of the peptides aren’t actually tested. It’s the wild west out there. Of course, I think everybody should go through a doctor if you’re going to inject something into your body.

That’s my other question then, especially with something like a BPC-157. Do you find any benefit from oral, or is it all injectables?

The injectables work a lot better. Most peptides, pretty much all peptides, do not survive the gut because they are just short chains of amino acids, which is what proteins are made of. The moment they leave your mouth, they are digested by the enzymes in your stomach, and they’re broken up into their amino acids, and they leave your body, or you may absorb individual amino acids as if you’re just eating a steak. The benefit of that combination goes away.

Unfortunately, the gut. Some companies work on oral strips that actually adhere to your mouth and are absorbed in that way. They do not have to go through the stomach where all those enzymes are. That’s promising technology. I am not 100% sure where they are yet. Within the next year, we’re going to have some oral strips that will probably be pretty reliable. Already, the smaller molecular weight peptides like glutathione, I think, can work with these oral strips. Oral BPC, if you have gut issues, sometimes it can help a little bit, but most of the time, I think the injections work best.

That’s interesting. I have tried the oral strips before the buccal strips that you’ve, there’s a BPC version of that that I’ve tried. I have a little bit of shoulder twins right here that’s lasted now almost a year. I’m trying different things. I probably just need to go ahead and get the injections.

It’s about the molecular weight for the buccal strips and the lower molecular weight, and VPC is somewhere in the middle. They’ve been trying to get insulin. They’ve been trying to get insulin into an oral strip for like ten years, and they’ve spent a billion dollars on research. It’s one of these larger chemicals that just, it’s too big to be absorbed. Again, some peptides I think will work. Some I have some reservations about.

What else? What are your other favorite go-to things in your practice now?

There are a number of peptides that help with mitochondrial health. We touched on mitochondria when we talked about the very beginning, when we talked about aging. Mitochondria are the powerhouses of all your cells. One of the hallmarks of aging is degradation of that mitochondrial function. That’s why we get more tired as we get older. There are, MOTS-c is a mitochondrial peptide. is something that we naturally produce in the body that really improves the way the mitochondria work and can give people more energy and improve insulin sensitivity.

Usually it’s a short-term bioregulator that I find really helpful for women in hormonal transitions. I like that one a lot. SS-31 is another mitochondrial peptide that stabilizes the mitochondrial wall. That one is actually FDA-approved for patients with a genetic mitochondrial disease. It’s promising in the field of longevity as well to maintain our mitochondrial health as we’re aging. Again, people usually feel like their aerobic capacity, exercise capacity, is better. They have more energy, and hair, skin, and nails improve. Everything just feels like a little bit of an upgrade. NAD, which is not truly a peptide.

It is a mitochondrial cofactor that’s necessary for the production of ATP. It’s a derivative of vitamin B9, but it tends to be in short supply in depleted bodies. NAD can also really help with that mitochondrial health and energy. In terms of other peptides, there are some peptides that are longevity peptides, especially epitalin and penelion. Those can protect telomeres and actually protect the mitochondria and the DNA to some degree from the degradation that happens with aging. We use a number of the growth hormone-promoting peptides for body composition. Again, I think that muscle is the most important currency of health that you can hold on to.

If there’s anything you can do to maintain or up-level your muscle, that is probably the most protective thing for aging. There are a number of studies that show that the amount of muscle mass is the number one predictor of how long you’ll live. For people getting a diagnosis of cancer, the number one predictor of survival. It’s the amount of muscle mass you have going into the disease. Again, anything you can do to maintain, protect that muscle, I think it’s very healthy and can add to your overall longevity and health span.

I’m curious for you personally, like you’re healthy, you’re optimizing. What is your personal stack or protocols? How do you utilize these things? You said a lot of these have a short-term use. You cycle them off and on that thing too?

I absolutely do. The Lyme disease caused some immune system damage for me that showed up in limitations on my athletic performance. The biggest game changers for me have been the anti-inflammatory peptides, BPC-157. I rotate them. I never do more than three at a time, but BPC-157, KPV, thymus, and alpha-1. KPV is another peptide that also improves gut health and is very good for autoimmunity and taming inflammation, and thymus in alpha one is another peptide that is an immune regulator and can actually help the immune system search out cancer cells and prevent cancer.

It is approved in Europe for some indications and can also balance our pro and anti-inflammatory state, help our bodies fight off viruses a little bit better. Those are the three that I lean on in terms of my inflammatory damage that my body went through, and that has gotten me back to a level of activity and athleticism that feels really good. I’ve used the mitochondrial peptides every six months, at least for a month. That mitochondrial upgrade is helpful for anybody who’s trying to perform at a high level professionally or personally.

All those sorts of things to keep the body going. There are a number of growth hormone-promoting peptides that help you put on and keep muscle. I use the weakest one, which is samoralin, just because I prefer the lower end of it. It also improves your sleep. That one has gone through FDA approval as well for children with short stature. Again, like every six months, it’s nice to rotate through it and get a little bit more out of workouts and make sure that we’re holding onto that muscle.

There are so many competing demands on life. That’s really helpful to note, too, that you do it for about a month every six months. Maybe two months out of a month here.

I rotate them. I’m on something all the time, pretty much for a single peptide. They all have their optimal time window. MOT-c is one that we only use for about a month or two months. With Sermorelin, we can do it for about four months. BPC is usually two months on, one month off. It depends on somebody’s goal. I have some people who just come in once a year and do a cycle just to optimize. They’re already healthy. They’re not really fighting anything or trying to repair. That works, whereas other people have more wear and tear, more damage. We’re actively trying to bring the body back into a state of homeostasis. We tend to cycle more through different peptides.

That’s helpful to think about too, that a lot of times you start adding these up. This one’s a hundred dollars a month. That one’s 50, this one’s 80, and you start adding, and then you add in supplements and hormone therapy and everything else. It’s like, “Wow.” To know that you can cycle off and on to optimize different things at different times. Maybe you have a peptide budget for the month, but you’re taking different ones at different times.

I definitely think less is more. The things that are going to move the needle the most in your life.

Having someone active, helping you actively monitor that and optimize it yourself, is probably very helpful. I know we’re running out of time, but I’m just so curious, like how do you work with people when someone comes to your practice? How do you onboard them and get them into these protocols and into optimal health? How could someone work with you that’s listening?

We do offer telemedicine consults throughout the country. Usually, in the first appointment, first of all, there’s a free introductory call on our website, which the directors of my practice are absolutely amazing. They can give you an idea whether this would be worthwhile for you or not, and you can always start there. During the intake visit, I really try to get to know people and try to understand if there is any health history or any active issues that we’re trying to work through. I do a comprehensive history and try to understand each area of life and where you are.

How’s your energy, how’s your sleep, how’s your athletic performance, how’s your recovery? Do you have these injuries? Do you have a family history? A lot of data points that help me understand where someone is. Most of the time, if someone has labs that they can bring, that’s fantastic. If not, then we will often do some labs again. I can have a better understanding of where we’re starting, of how good our foundation is, of where we need to build people up. I also want to understand who people are.

What are the demands on your life? What are your goals? A huge range, and I never want to assume what’s important to someone. I want to understand what your biochemical picture looks like. I want to understand your life and what your goals are and how we can work towards them. Usually we craft a plan together and meet every three months or so to see how things are going. Sometimes it’s just longevity and creating a state of health and preventing illness. Other times we’re working on some very active and difficult-to-manage issues that will take time to dig out of.

You’re seeing your patients a lot more often than the typical once-a-year doctor’s check-in for seven minutes.

That first visit is usually 45 minutes to an hour. Being known is something that we’ve lost in medicine. The relationship can also be really transformational and healing. What I love most about my job is that I get to know the people in front of me and we get to take this journey together.

I love that. Last question is, when you think about the future, and you think about the future of health and health care, what do you see as possible, especially with now hormone therapy becoming mainstream and then all of these peptides that are coming on and other things that you’re doing? I’m sure there are many, many other things that we did not get to talk about, but when you look out five years from now, ten years from now, what do you think is possible? What do you think is coming or what’s most exciting to you?

We are seeing that medicine is continuing to advance, and we’ve made so many advancements when it comes to chronic illness and longevity. I do think that a lot more people are turning their attention to quality of life. The younger generation of doctors is questioning the status quo and the way that I was trained and wants to go beyond band-aid solutions. My hope is that more and more of our insurance model and the pharmaceutical industry is going to take a long time, but we need to start understanding. Most medicine is chasing the smoke rather than looking for the fire. There are a lot of people who are now speaking loudly about the fact that we need to be looking for the fire in order to protect our bodies from disease before it comes. More root cause stuff.

Muscle mass is the number one predictor of how long you’ll live. Protect and build your muscle to shield your body against aging.

That’s exciting. I love that visual of chasing smoke instead of looking for the fire. Thank you for the work that you’re doing in terms of getting to the root causes and putting out those fires for people and getting people into a state of health. How can they connect with you?

You can find us at TheGajerPractice.com, which is online. Again, you can start with that free introductory call. It’s TheGajerPractice.com. We’re also on Instagram under the same handle at @TheGajerPractice. You can always shoot us a DM. That free intro call is a great way to just have a chat and talk about where you’re at.

It sounds good. This is really helpful and so fun to dive into all of these conversations around the different peptides and the use cases and hormone therapy as well, and understanding metabolic health as the foundation and getting to those root causes. Thanks so much for sharing with us. Thank you for your time, and thank you for the great work that you’re doing. It’s really a privilege to know you. Thank you for being with us.

Thank you so much.

Bye-bye.

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Thanks for tuning in. I hope you enjoyed that conversation and learned some new things, perhaps about peptides or hormones or metabolic health. Those are the three main topics that we dove into with Dr. Gajer. One of the things for me is just normalizing peptides. It sometimes seems like they’re futuristic or not sure which ones to take or how to take them. Obviously, having a guide and someone like Dr. Gajer to help.

We talked about the intentionality behind utilizing a physician in a compounding pharmacy, and the safety and efficacy there is important, but also cycling off and on different ones at different times for optimizing different parts of our health. That was really helpful to me. I definitely need to try some of that, some BPC injections on my shoulder, I think.

Maybe you’ll explore and experiment with some of those things yourself. We talked about metabolic health, some practical things, just simple things like taking a walk after a big meal, strength training. Obviously, we hear that over and over again on this podcast, and the importance of that in terms of our body composition and then insulin resistance and everything from cognitive health and everything else. Hormones we talked about, and we’ve talked about that before. We’ll talk about it again.

With other folks coming up here on the show. They’re really foundational for so many things, mechanisms within our bodies. Thanks for tuning in. I hope you will follow up with Dr. Gajer if you’re interested in checking her out. It’s TheGajerPractice.com. You can find her website there. You can find that introductory call, as she mentioned. Thanks for tuning in. We’ll see you back here next time on the show. Have a great day.