BPC-157 and the peptide headlines

Philip Pape 0:00

If you lift weights and something starts to hurt, maybe your elbow, your shoulder, the outside of your hip, maybe you experience an injury, maybe you're going through recovery, and you've heard about BPC 157. Peptides are all over the news, all over social media right now. It supposedly heals tendons. The FDA supposedly just approved it. We're gonna get into all of these claims today. You'll learn what the FDA did and didn't do, how much human evidence there is for peptides in the context of tendons, and what the research showed actually helps people the most with stubborn tendon pain. Hint hint, no injection required. Welcome to Wits & Weights, the show that puts a popular piece of fitness advice under the microscope, finds the hidden reason it doesn't work, and gives you the deceptively simple fix that does. I'm your host, certified nutrition coach, Philip Pape, and peptides are everywhere right now. In fact, the latest episode of South Park made fun of listening to podcasts to get your health advice, and peptides are a big part of that. Now, BPC 157 is the big one that everybody knows. Uh, I've actually tried that myself. You'll hear it called the Wolverine Peptide, which kind of tells you how it's being marketed. And then in July of this year, 2026, there were headlines that an FDA panel had voted for it. And I've seen people talk online about it, like, hey, this is an approved drug now. So that kind of, you know, gives us the full legitimacy and credibility we need. But it isn't, it isn't. And we're gonna go through exactly what happened there. Now, I saw a post recently from a woman in her 50s that I keep thinking about in the context of peptides. She's had tennis elbow for over a year. She did physical therapy, she did shockwave, she did BPC-157, and she still has trouble gripping a dumbbell. And I want to answer her directly today through this podcast without revealing specifics on her identity, uh, because I think a lot of you are somewhere on that same path. You're trying the next thing and then the next thing. Just is this gonna work? Uh, and I have some skin in the game because back way back, I think it was episode 255 in December of 2024, I talked about my own BPC 157 experiment for my left shoulder. So part of this episode is what I tried then and what I think about it now. Stick around to the end because if you've ever been offered a cortisone shot as an option for something like a sore elbow, I'm gonna share some data from a JAMA trial that might help you out. Again, this is not medical advice. It's just what did we see in actual research when this is done on populations and larger sample sizes versus anecdotal experience and just listening to influencers or podcasts about uh, you know, what worked for them. So, first we're gonna go through what the FDA was all up into this summer, why the details matter a lot more than the headlines, as they always do. Nuance is so important. Then the actual evidence for BPC 157, which is mostly in rat studies, like a lot of this stuff is, plus what I learned from my own experiment, and then what works for tendon pain in reality, if you're lifting weights, especially on the older side, you're over 40, including what I would tell our friend who has the elbow issue. Okay, let's start with what BPC 157 is. It's a short chain of 15 amino acids. It's originally based on a protein found in stomach juice. A research group in Zagreb, Croatia has been publishing on it for a long time, since the early 90s, since I was a kid. People inject it usually under the skin, near whatever hurts. It's a local injection. You know, I did mine in my shoulder area. And the claim is that it speeds up healing of tendons, ligaments, muscle, and even the gut.

The FDA timeline and the July panel vote

Philip Pape 3:48

Okay, now the regulatory story, the regulatory reality, I should say, or story, depending on the narrative, is where a lot of the confusion comes from that I hear. So I'm gonna go through it in order so we can piece it all together. Okay, in 2023, the FDA put BPC-157 on a list of compounding ingredients that present significant safety risks, or may present significant safety risks. Then in February of this year, 2026, good old health secretary RFK Jr. went on Joe Rogan's podcast and said that about 14 peptides would now become more accessible. And then in April of this year, 2026, BPC 157 came off the safety risk list. It didn't come off because the FDA decided it was safe. It came off because the companies that nominated it withdrew their nominations, and the FDA's own page still has the safety language. And then on July 23rd, an FDA advisory committee voted eight to six, there was one abstention, to recommend adding BPC 157 to the list of ingredients that pharmacies can compound. Now, I remember way back when talking to some folks who were helping their patients with this, some clients and uh, you know, aestheticians and things like that. And they were talking about the nuances of compounding pharmacies and when it went on this list, how they could no longer compound it, and you had to buy the research grade version of it on your own and take that risk. You know, it was a whole mess. And so this supposedly clarifies all of this and makes it easier to access, but not necessarily for the right reasons or having gone through the right process. So I want you to know this is not a political assessment on my end. This is the reality of the steps that were taken that was probably highly unusual. And it results in, hey, the FDA approved these peptides, which is technically true, but not per the normal process where it goes through a consensus scientific, you know, approval via safety, uh, you know, agreement on their safety. So when we look at the vote, an advisory committee doesn't approve anything. Okay, they make a recommendation and then the FDA has to publish a proposed rule, they take public comments, and then they publish a final rule. I checked the Federal Register on October 12th, and there is no proposed rule. There's no deadline for a rule either. In a previous round of the same process, if you look at how this is done in the past, it took a little over two years to get from the proposed rule to the final rule. So as I record this, a pharmacy still can't legally compound it. The second thing is that the FDA zone scientists recommended against it. And that's, I guess, the bigger issue here. They had a briefing document, it said the evidence weighed against adding it to the list, and they approved it anyway, or they they recommended it anyway. And that's where there's the political piece of this. The third thing about this, and maybe it's the most interesting, is the committee wasn't looking at tendon health. The only use the FDA evaluated was ulcerative colitis, and that's a bowel disease. I've actually had some clients with that. It's pretty awful. It's kind of like IBS and some of these others, or it really messes with your gut. Tendinitis was on the nomination, but the FDA didn't evaluate it because the nomination didn't include enough information to do so. So the one that everything, everybody cares about, you know, its use on tendons wasn't even included in the scope, let's say. The FDA also notes that if it does get listed, the listing may not be limited to a specific use. So that opens the door where a doctor could eventually prescribe it for your elbow, your tendons, based on this review, which had to do with the gut with ulcerative colitis. Now, that's very interesting. Now, again, I I don't know what to make of that. I'm not a doctor. I know there's always off-label use of things. Does this qualify? I'm not sure. Again, I'm not a doctor, but it's it always it's very, very interesting. If you, if your conspiracy hackles are up, probably for good reason, you know, in in all different directions here. So if the shortcut isn't there for BPC 157, we're gonna get into more of the evidence on this.

Training, food, and time for a sore joint

Philip Pape 7:52

What do you do when your elbow or your hip hurts? I'm gonna get to the evidence-based answer, but for many of you, when a joint starts hurting, this is what I see. The instinct is to stop lifting completely or go find some sort of quick fix because you think it can be, you know, fixed or healed quickly, whether that's a peptide or shot or cord, you know, it could be a cortisone shot, could be some new gadget, could be a massage thing, could be any number of treatments. What usually works better is the boring stuff. Okay. It's following a training program that works around and with your injuries in a smart way, where you're not letting scar tissue form and you're not over-resting where it actually gets worse, where you're actually using the tissue and using the tendons in the right way. It's also having enough food to recover. See, many of you, you go into these situations where, well, I'm not training as much, so I shouldn't eat as much food because I'm gonna get fat. Well, the problem is it both of those go against each other. If you're not eating enough food to recover, your body doesn't have what it needs to rebuild the tissue. And then, of course, you need enough time and patience. Maybe that's the hardest for many of us. So, just as a quick aside, that is exactly what we do. You know, I'm always pitching my stuff here because I really care about helping people find the right path to do this. We have something called Eat More Lift Heavy. It's a 26-week coaching program where when you join, the week you join, you get a training program matched to your schedule, your equipment, your injury status, all of that, and guidance to adjust for that, right? So within a few days, you get a launch plan that has that, your protein targets, your first steps, and then the lessons walk you through week by week with support from a community, from coaches, from live calls, however, you want to take advantage of that, no pressure, where we can work through things live or we can work through things asynchronously, as they say in the business. Okay, and then we have different tiers where you can get your own coach. It's not physical therapy, obviously. If something is injured, you should definitely go see a physician or get imaging or talk to a physical therapist. But if you want to work around stuff smartly and work on rehab, work on recovery from that perspective and stick with them, be consistent, and actually deal with that, you know, elbow tendinitis or that hip issue you have, check us out. Go to eatmore liftheavy.com. Go to eatmoreliftheavy.com. All right, let's get back to BPC 157. And I want to cover two things before we

Who voted yes and who's using BPC-157

Philip Pape 10:16

get to the evidence. The first is who voted yes on the FDA panel. Health affairs went through the each of the committee members and they found that at least seven of the eight yes votes came from people with ties to peptide clinics, telehealth companies, or compounding pharmacies. This is not news. You guys have seen this in the news. The no votes included the patient representative, the consumer representative, and a physician from MD Anderson. One of the yes voters even said publicly he was disappointed in how incomplete the data were, and he voted yes anyway. There was a publicly traded telehealth company that sells this kind of product whose stock jumped more than 10% during the day of the vote. Now, I'm not saying anybody did anything illegal. I'm saying that there's massive conflicts of interest here, and this is no surprise to anyone. This is kind of old news at this point, but it's really good to get refreshed on what happened and when we make health decisions for ourselves that we are truly informed. The second thing is how many people are using BPC 157 and peptides in general. It is not a niche thing anymore, niche, whatever word you prefer. There was a data company that searched more than 15 million medical records, 15 million, and they found that documented use went up 33 fold from 2020 to 2026. The average new user was 49 years old. So this is our age group. I'm turning 46 in a couple weeks. So, you know, I'm in that age group. Now, the report itself hasn't been peer-reviewed. It's probably under counting, let's be honest. Okay, it's probably under counting because we just don't know how many people are using these who will not disclose it or admit it. So, what does the human evidence look like?

Human studies, rat studies, and safety

Philip Pape 11:57

Well, I went looking, I went searching on your behalf for every human study of BPC-157, and it didn't take very long. It didn't take very long. There are not many. There is a chart review where they looked at people's charts in a clinic of 16 people that had different kinds of knee pain, and they got BP BPC 157 injected into their knee, some of them alongside with another peptide. 14 of the 16 said, Hey, I felt better. There was no control group. The patients had different diagnoses, and the authors were connected directly to the clinic doing the injections. Okay, so take a, you know, take that for what it's worth. There was a pilot study of 12 women with a bladder pain condition. There's a safety report that had two people. There's an abstract from 2005 of a colitis trial using an enema, never published. That's pretty much what I could find. So I don't think there's much research, and it makes sense, right? Because you don't get much, you know, people say, well, of course there's not research because it wasn't approved or wasn't available. I get all that. I it's just like with herbal remedies or something like Ashwagandha, or even like Western Ayurvedic, Chinese medicine, I get that there are potentially legitimate treatments and all of that that the science hasn't caught up to or will not look at for various, you know, reasons or incentives or lack thereof. But when the FDA themselves added up all the research, because the FDA, guess what, has to look at this stuff to identify safety, they counted about 81 people who've been given BPC 157 in studies. And the longest anyone took it was for two weeks. So kind of useless, is my point. A 2025 systematic review looked for every study relevant to orthopedic and sports medicine. They found 35 animal studies and one human study. And the human study wasn't on tendons. So there really is no controlled trial of BPC 157 for any tendon, ligament, or muscle injury in people. There is a trial registered for people recovering from rotator cuff surgery, but it hasn't posted results yet. So there may be results eventually. The more this is used, the more this is studied. Totally fair. Now, I want to be fair to the work on animals because there is a lot of that and it's pretty consistent. In rats, BPC 157 does seem to speed up healing of tendons that were surgically cut. The proposed mechanisms involve growing new blood vessels and nitric oxide signaling. But two things we okay, nuance. Let's get into nuance, guys. First of all, a surgically cut rat tendon is a little bit different than a 52-year-old woman's elbow that's been irritated for a while. All right. Very different problems. Oh, you always have to look at how they did these things. I get a little bit skeeved out actually when I look at how they how they treat rats in some of these studies. You know, maybe I'm a bleeding heart in that context, but I have two daughters and we talk about these things around the dinner table, and they're like, they would they do what to animals in research? So yeah. And then more than 80% of the BPC 157 papers are by the same researcher, or at least they had the same researcher in common, Pedrag Sikerich, I think that's how you pronounce it, who first described it and has been named inventor on patents for it. A 2025 review said that that that kind of self-replication raises the risk of confirmation bias. And his group, the researcher's group, published a rebuttal saying, hey, all the criticisms should be dismissed. So there's an ongoing disagreement in the literature. It's interesting to see it happen publicly like that, but the disagreement is about the rat studies. There's no human studies, so it's good to know. Safety. What about safety? Same story. The big theoretical concern is that the blood vessel growth that people are looking for here with healing their tendons runs through the same mechanism that some cancer drugs try to block. That's kind of the paraphrasing of how this might work. But it hasn't been tested in humans in either direction. If you are, you know, let's say a breast cancer survivor, which a lot of women listening might be, I'd want you to have that conversation with your oncologist, right, before doing anything else. The FDA's other concerns were immune reactions and of course the quality of the drugs or the material. You know, when they look at certificates of analysis from the people selling this stuff, the documents are limited in what they show. Sometimes they'll show a purity percentage and not much else. They won't list impurities, they don't do any testing for endotoxins. So even if the molecule worked, you don't really know it's in the vial that you bought. And again, it would often say for research purposes only or only use in animals or something like that. And that's that's what I used a few years ago when I tried

My BPC-157 shoulder experiment

Philip Pape 16:39

it. If you compete in tested masters lifting, be aware, BPC 157 has been on the World Anti-Doping Agency's prohibited list since 2022, banned at all times. And that doesn't change based on the FDA decision. So let's quickly talk about my shoulder because I mentioned I use this in the past. I described injecting BPC-157 five days a week for six weeks after my first rotator cuff surgery. Uh, then later I had to have a cortisone shot for bursitis. My shoulder did feel a little tiny bit better, hurt less, felt stronger, bench overhead went up. But I also was eating more. I went into a surplus, I switched into a higher volume strength program. You know, I was still recovering from the cortisone shot. I was doing mobility work, I was using a sling shot, I was using pressing variations that were easier on the shoulder. Talk about so many variables, you can't possibly make sense of it all. I wanted it to work, even the placebo effect in my head, like I wanted it to work. So my conclusion back then was I'm not really sure if this did anything. And in hindsight, I was having issues where the rotator cuff wasn't fully healed to begin with. So would it have worked better if it was fully repaired in surgery and helped me recover faster? Who knows? I do know that now, after my second surgery, I've recovered fast. I recovered way faster than the first time, and I did not take it. And that's because the surgery went better. So, see, it's hard to tease apart the variables. Now, how I see that experiment on myself back then is like useless because I changed so many things at once. It's basically the same as the quality of human research on BPC 157 in general. Okay. So when someone says, hey, it worked for me and I feel great, and you see on Reddit and you see online or people on YouTube, the hate hater comments that are like, yeah, no, this is a, you know, I took it and my cousin took it, and we recovered so much faster. How do you know you wouldn't have recovered fast without it? How do you know something else like lifting weights wouldn't have helped? You just don't know. And until we have population-level human trials, we won't know, I'll say scientifically. Now, I'm not saying that it definitely doesn't work, right? Don't misconstrue one extreme for the other. The lack of evidence is not proof that it fails, right? Evident absence of evidence isn't evidence of absence, right? Animal data, hey, those rat studies are interesting enough that I would like to see a real human trial and all this stuff. I, you know, if we can find some magic compounds that can help people, awesome, go for it. I'm not saying the FDA is always right, that's for sure. I definitely have a lot of skepticism for our government in all directions. You've got to be in control and you've got to make your own choices, right? People are buying this stuff from gray market websites. So a regulated compounding pharmacy, if you can get it through that, it's probably going to be cleaner, safer, et cetera, than the alternative. But that's more of a safety or a harm reduction argument related to the quality of the product, not actually the evidence that this stuff works or helps with your tendons, et cetera. I'm not judging anyone who's tried it. I did it myself. I'm just saying nobody has tested it in people like you for the problem you have. And if you're gonna spend money and injections and months on this and we're, you know, take a risk with safety and everything, just go no go in knowing it's still experimental. And even more important, it probably shouldn't be your first move, in my opinion. So, what does work?

Tendon pain after 40 and progressive loading

Philip Pape 19:57

That's a good segue. Like, what does work? Well, the first thing is it helps to know that this isn't in your head, and it is also very common at our age. Tennis elbow peaks in your 40s. In one large study, women in their 40s had it more often than men did. Pain on the outside of the hip from the gluteal tendons is about three times more common in women than men. There's a reasonable theory that falling estrogen changes tendon tissue. Although I'll say that the human data, again, human data on hormone therapy and tendons are pretty thin and sometimes mixed. A trial in postmenopausal women with hip tendon pain found HRT helped only in a subgroup of leaner women, for example. What I think is the best evidence is guess what? Loading the tendon progressively over time. That means lifting weights smartly with progression. The best example I found is a Danish trial in people with tennis elbow published in 2022, where everyone did a 12-week home program using elastic bands. Three times a week, they did wrist extension, wrist flexion, and rotating of their forearm. Each rep was slow, about three to four seconds in each direction. So you could assume there's some isometrics going on there. They started with sets of 15, worked down to sets of six as the band got heavier, and they were allowed to feel pain up to about a five out of 10 during the exercise, as long as it settled down shortly afterward. This sounds a lot like some of the lifting strength coach rehab guys I've had on the show, talking about a similar thing of like there's some level of pain that's acceptable, and then beyond that, probably not. And that's where you have to find that balance. Now, in this study, they were randomized to a cortisone shot, a needling procedure into the tendon, or a fake injection just under the skin. And all three groups improved. Adding the shot or the needling didn't help further. So, guess what? The exercise program did the work. I actually really like how they designed that study. I'm gonna come back to cortisone at the end of the episode, so stay tuned for that. But I think it's fascinating the way they designed it so that you can see the improvement was the same, meaning you didn't really need this other stuff. Now, I don't want to oversell this because there's another review from 2021 of 30 trials in tennis elbow that found that exercise beats passive treatments, but the effects are small. And a lot of cases just get better on their own with enough time. That's the key there is that you know, maybe trying to do something is the problem, like just let it resolve. But on the other hand, you don't want to make it worse, right? So not doing certain things and avoiding things that make it worse is also important. That's actually the general philosophy I use today that works quite quite well is don't do things that aggravate it and do everything else as usual. And generally it will improve over time. There was a trial where 83% of the people in the wait and see group that just waited, just didn't do anything specific, they were successful at one year later. So loading of the tissue isn't necessarily magic. It's, I'll say, the option that has the most evidence behind it. It's also cheap or free in the sense that you should be doing it anyway. You're gonna be lifting weights anyway. It's not like an extra thing you have to do or extra time you have to take. You don't have to do special mobility work necessarily, although that could be part of it. So let's go back to our friend with the year-old tennis elbow that I mentioned earlier. She tried physical therapy, shockwave, and BPC 157. Now, BPTC 157 has never been tested for this in a human, so I wouldn't have expected a lot from it. I know a lot of people take it, it doesn't do anything for them. Shockwave has mixed evidence. There was an analysis that found no tennis elbow treatment beat placebo in the first six weeks. And PT, physical therapy, can mean a lot of different things. So my questions for her would be these: did the loading get heavier over time and keep progressing for at least 12 weeks? Was your grip trained directly? Did anything change about the daily tasks that keep irritating it? So if you're doing all the right things in those, now when I say grip trained directly, that could be a pro or con, depending, because sometimes using your grip overusing your grip when you have a tenant issue could actually be a problem versus a looser grip, let's say, on something like a squat or press or pull. So I would want a sports medicine doctor, somebody who's really good at all this stuff to take a look, somebody who understands athletes, somebody understands lifting, and also somebody understands, you know, tendon pain and physical therapy type things, and always rule out things like nerve problems or referring of pain. And that's an important one, guys. Referring of pain. Something in your neck could refer pain to your arm. Oftentimes a squat grip where your wrist is very extended, that refers the refers the load of the barbell sitting on your hand down into your elbow area and causes tendinitis for a lot of people. So the simple version is forget about peptides for now. Don't do anything fancy. Pick one or two slow controlled exercises for the painful area. Start light enough so you can finish your sets and add load every session or every week or two, depending on the frequency. You know, let it hurt a little, up to about that five out of 10, as long as it settles down soon after. And I was going through a little bit of golfer's elbow recently, and I thought, okay, I just need to not aggravate it. I need to keep lifting. If it's a little bit painful, that's okay. If it's not, if it's more, maybe don't do that exercise, maybe do a set less. And by taking that measured approach, it started to improve. All right. Keep lifting everything else that you can lift where there's no pain. Don't make excuses. And you got to be measuring and tracking things, right? Like what load are you using? What works better for you? What volume or rep ranges work better for the pain, et cetera? So you're judging it by the data and not how it just quote unquote feels. All right. This is a habit that I have from coaching, but I always encourage it in you, dear listener, is to track things so that you can measure what's working. Then finally, I have this advice.

How to judge any peptide claim

Philip Pape 25:51

When you're evaluating a peptide or supplement claim of any kind, ask three questions. Number one, has it been tested in humans for my specific problem in people like me? But definitely in humans, start with start there. Number two, is it approved, listed, recommended by a panel? Or is it more of a research, experimental chemical? Like retatrotide or retatrutide, however you want to pronounce it, is still in the research phase. So it's technically, you know, you're technically taking a risk and it's experimental until it's approved. And then finally, is the person who is telling you about it also selling you it? Okay. Are they's the person telling it selling it? Very important. If BPC 157 had really good answers to all three of these questions, we would have a different conversation. I probably wouldn't have to make this episode. All right, before we wrap up, I promised you some advice when it comes to cortisone shots that I'll give you in just a second. But first, if this episode is helping you think through or, you know, make choices or get inspired to lift weights and not waste money on peptides if you don't need them. And you like this podcast, just leave a review. That's all I'm asking for. Leave a review on Apple Podcasts or leave a rating on Spotify. Should just take 30 seconds. Please do that right now. Pause the show. It's a great way to support us. If you like the show, it's a great way to get to keep getting this free content and have others find it as well. So again, a review on Apple Podcasts or rating on Spotify. All right.

Bonus: cortisone shots for tennis elbow

Philip Pape 27:17

So if you do have tennis elbow or golfer's elbow or some other sort of, you know, tendon pain like that, and a person, I'll I'll just say it could be a medical professional, it could be a clinic, whatever, offers you a cortisone shot. I'm gonna share some a couple pieces of information from the research that might help. In a trial of 165 adults with tennis elbow, this was in Journal of American Medicine or yeah, JAMA, some got a cortisone shot and some got a placebo. And at four weeks, the shot group was doing better. But at one year, 83% of the shot group had recovered or were much better, but 96% of the placebo group had recovered or were much better. And the pain actually came back in 54% of the shot group compared to only 12% of the placebo group. Now, I'm not a doctor, this isn't medical advice. There's a situation where a shot does make sense. But it is totally fair to ask your doctor what the plan is for a year from now, because there some doctors are just like, we'll just give you a shot, see what happens, we can give you another one. And then eventually they're like, well, we can't give you any more. But what does that tell you? Maybe that is just a band-aid for some of you, and that's not the best solution. Now, whatever you decide to do, keep lifting what you can while it heals. Because again, a gradual plan of loading and progression is still probably your best bet, has the most evidence behind it, and you should be doing it anyway to get stronger and build that muscle. All right, until next time, keep using your wits, lifting those weights. And remember, the best evidence for a cranky tendon is still lift some weights, load it, work around it, be smart with your routine. I'm Philip Pape, and I'll talk to you next time here on the Wits & Weights Podcast.