Peptides, Longevity & the Future of Anti-Aging Medicine with Dr. Jonathann Kuo
Posted posted on November 05, 2025
On This Week's Episode:
Peptides might be the buzziest word in wellness right now—but are they actually worth the hype? Dr. Anthony Rossi sits down with Dr. Jonathann Kuo, founder and CEO of Extension Health, to separate fact from fiction on the science of peptides and regenerative medicine.
From hormone balance and mitochondrial repair to inflammation control and “interventional longevity,” this conversation unpacks how peptide therapy is reshaping the future of aging. Plus, Dr. Kuo explains the real risks of buying peptides online and how to use them safely within medical-grade protocols.
Guest Bio:
Globally renowned for his work in regenerative and longevity medicine and peptide therapy, Dr. Kuo is who leaders in health turn to for care.
Dr. Kuo earned his MD from Boston University’s prestigious 7-year program and completed his training at New York Presbyterian Hospital / Weill Cornell. A double board-certified physician in anesthesiology and pain management and one of New York’s most respected interventional specialists, Dr. Kuo’s clinical network has treated 50,000+ patients and performed 140,000+ procedures.
As Founder & CEO of Extension Health, Dr. Kuo leads an unparalleled longevity clinic that offers the most advanced diagnostics and therapeutics in the country, all under one roof, including therapeutic plasma exchange, ozone therapy, regenerative medicine, peptide therapy, nervous system optimization, hyperbaric oxygen, and more. His mission is to optimize healthspan, cellular regeneration, and peak human performance.
Dr. Kuo’s pivot from pain management to regenerative and longevity medicine was personal as well as professional. After facing his own metabolic decline, Dr. Kuo became his own patient, refining the same strategies now offered to patients, who include elite athletes, high-performing CEOs, and celebrities. His expertise in interventional orthopedics, peptide therapy, and integrative medicine led him to transition from traditional pain management to proactive, precision-based care.
Dr. Kuo continues to collaborate with global regenerative medicine leaders and biotech innovators to redefine what’s possible in human health and longevity. His work is featured regularly in the leading media outlets, such as The New York Times, The Wall Street Journal, and The New Yorker.
Episode Transcript:
DR KUO: We're just scratching the surface of peptides right now. It's literally 7,000 peptides out there. And clinically, we really only use, like, 10 to 15 of them. I think this field's going to really explode.
DR ROSSI: Peptides are everywhere, from skincare TikTok hacks to IV drips. But what's the real data and do they really work? I'm Dr. Rossi and welcome back to Give Good Face, a podcast where we explore all things skincare, medicine, longevity. And today, I'm really fortunate to have Dr. Kuo here, the founder of Extension Health, a longevity and regenerative medicine clinic.
DR KUO: You know, the basic pillars of health that I see are mitochondrial health, metabolic health, and that kind of also leads to this category as inflammation, and the last is hormones.
DR ROSSI: I know what a peptide is. How do you explain it to your patients?
DR KUO: They're cellular messengers. They influence certain biological systems in our body. Peptides are really short chains of amino acids. Amino acids are the basic building blocks of proteins.
DR ROSSI: Can you overdose on a peptide?
DR KUO: Yes, you certainly can, okay? And there's dangers. There's a lot of considerations that you need to think about as well.
DR ROSSI: People, don't be getting your peptides at the gym. That's not where you want to be getting these sort of compound.
DR ROSSI: Thank you so much for being here.
DR KUO: Thank you so much for having me. It's such an honor to be on your show.
DR ROSSI: Oh yeah, this is great. I'm super curious about peptides, how they work and what they do. But your clinic is not just about peptides. Just tell us a little bit about yourself and how you came, how you came to start Extension Health.
DR KUO: Sure. My career started as an interventional pain specialist. I trained as an anesthesiologist and did an interventional pain fellowship. And then subsequently, I set up a pain management, interventional pain management practice here in New York called Hudson Health. That's been around for 16 years now. It's a very busy interventional, not kind of getting to the root cause or really fixing anything.
And so that kind of got me into the world of regenerative medicine around seven or eight years ago. I started doing a lot of cases with, you know, exosomes and stem cells, did some published studies on exosomes and how they helped with pain. And that kind of really naturally led me into the world of peptides. And this was like four or five years ago when peptides were not just on the tip of everyone's tongue.
I got really interested in kind of really understanding how they worked, what their mechanisms were, kind of the studies around them, and started really using them clinically, was probably one of the more original doctors kind of using peptides. And since, you know, those several years, we've gained a lot of clinical experience. We've probably treated several thousands of patients with combinations of peptides, understanding their clinical efficacy and their safety profile and how to use them safely in clinical practice.
DR KUO: How it's been in evolution over the years, you know, five or six years ago, this longevity medicine field wasn't really present, but now it's a hot topic. There's clinics popping up everywhere. But yeah, this is kind of my version of longevity. We do an inter, I call it interventional longevity.
So a lot of the, you know, things that we do are procedural ways like, you know, blood therapeutics, ozone, hyperbaric, plasma just, you know, thoughts about gene therapy, regenerative medicine. And these are kind of all the things that we kind of consider together in what I consider as a field of longevity.
DR ROSSI: That's amazing. We're going to get into all of this. You said you've been around for 16 years with Hudson Health.
DR KUO: Yes.
DR ROSSI: You look super young. So as a question I ask to all my guests, you know, what's your skincare routine? Because you look great. Everyone knows what I do because I have my skincare line that's focused on a peptide that calms down inflammatory aging by targeting a receptor in the skin. So what do you do in the morning and at night? And how do you incorporate your own medicine into your routine?
DR KUO: Sure, sure, sure. So, yes, I've been on this kind of personal path to improve my health for a very long time. I really suffered from a lot of personal health issues a few years ago as well. I was, you know, I had brain fog. I was, patients too as well in terms of skincare routine.
It's, you know, mine's not super complicated. I mean, I definitely use, you know, a retinol at night, definitely sunscreen, SPF 30 or above in the mornings.
DR ROSSI: We didn't even tell him to say that, you know.
DR KUO: And yes, I use peptide-based skincare and creams. I do. I'm a big believer in regenerative medicine so, you know, things like microneedling exosomes I do every quarter. I do injections of, I've had multiple rounds of stem cells injected in my skin, not as much into Botox and fillers and things like that. I have done Botox in the past. Yeah, I've even done like a, you know, a fat transfer, like fat cells, my own fat cells, kind of fat stem cells injected in my face. So I do try a lot of these things, but, you know, it's, I feel like sometimes they should be working.
I mean, I'm 46.
DR ROSSI: It's working, folks.
DR KUO: Yeah, I feel good. I feel, yeah, I feel a lot of energy these days. I feel good, you know, I feel better now than I did, you know, 10 years ago, certainly. And, you know, that's like, as time passes, there's definitely ways to continue to optimize yourself and, you know, improve your physiology and your strength and stamina and all these things by a combination of, you know, bolstering the kind of four key pillars of your body, you know, lowering your inflammation, managing your hormones, having good mitochondrial health, and metabolic health.
DR ROSSI: So those are your four pillars, right, out of Extension Health?
DR KUO: You know, to boil things down to the simplest, the basic pillars of health that I see are mitochondrial health, okay, making sure you have great mitochondria. Those are kind of powerhouses of every single cell in your body and how you produce energy and detoxify.
Metabolic health, okay, metabolic health as in making sure your body's metabolically tuned up, is responsive to insulin, that you don't have high glucose spikes that cause inflammation. And that kind of also leads to this third category, which is inflammation. Inflammation management is just so critical because inflammation really drives all of the kind of chronic disease that we can encounter in life.
And the last is hormones, okay. You must have great optimal hormones for any of this stuff to really work. So, you know, it's a real simplification of what you can do to be healthy, but to boil it down, you focus on those four categories.
Longevity really is a lot more complex as in then you kind of think about organ system health. Like all of our different organs kind of do have aging at different paces so there's ways to look at it through that kind of lens. But, you know, just boiling down for simplicity, I like simplicity. I want to be able to kind of really explain to patients, able to kind of target these four basic pillars. Once you get these optimized, you can really do a lot.
DR ROSSI: Yeah, I've been always talking a lot about chronic inflammation, how that damages our skin, you know, from the inside out. We know it happens in our joints, but it's happening in all of our organ systems.
DR ROSSI: Now that you've asked about my skincare routine, I would like…
This peptide is a short chain amino acid, about five of them, right, that's created into this peptide. That's more of a, you know, messenger peptide. It actually targets TRPV1 in the skin, which is a receptor in the skin, but it's also in a lot of organs that causes downstream inflammation. And my whole theory about how I approach the skin is decreasing this chronic inflammatory state that many of us live in, right, like what you were saying, exactly what you were saying.
So I think destruction, we can decrease extrinsic aging that's happening from environmental exposure, UV, pollutants, hydrocarbons. So everything that our skin is being bombarded by just living day to day. My whole line has that peptide woven into it in different formulations, using these steps just religiously. Great. It really helped me.
Of course, I augmented it with lasers. I love a good resurfacing laser. I'll probably have a post about that coming soon because I do that like once a year. Things like fractional CO2, fractional non ablative lasers like Thulium 1927, 1550 nanometer, all these different wavelengths really can help improve our skin because we're decreasing senescent cells.
And these are those zombie cells that sort of turn off as we're aging, similar to what you talk about going on in the body. It's just these cells sort of stop working and they just become dormant. And then they're not giving off those messages to grow collagen or proliferate. So we're sort of turning those back on. And by decreasing the chronic inflammation that's happening in our skin, you can really augment the skin from the outside in.
Amazing. What do you think of retinols? Should people be on those daily?
As a dermatologist, I'm very much of a purist. I love the retinoid compound. Our retinoids are our prescription retinoids. Retinol is the derivative of it, the aldehyde derivatives. So retinols are weak, you know, but that's why they're over the counter. So they're weak compounds. They don't do as much as you can get with a prescription retinoid.
I love a prescription retinoid. So I do give that prescription to patients. You have to mix it with a moisturizer. Otherwise, you'll get this retinoid dermatitis, we call it, that irritation, that redness. And it feels very inflamed. So when you mix it with the moisturizer, like my night one, that's what it was designed for, because I don't have retinol in my line.
Because I want people to use retinoids. And now there are some over the counter retinoids, ones that were prescription, but now over the counter, things like Differin, which is used for acne. That's adapalene, that used to be a prescription, but now it's over the counter. So there's some little hacks. So I say, save the money on the retinol, get the retinoid.
DR ROSSI: Okay. Basic 101, you know, someone Googles the word peptide and they're really not sure what it is. You know, I know what it is. How do you explain it to your patients or when they first come to you? What's the intake and how does that relate to the things that they're feeling?
DR KUO: Sure, sure. I mean peptides, you know, the basic way to think about them is they're cellular messengers. They influence certain biological systems in our body. You can think of peptides as really short chains of amino acids. Amino acids are the basic building blocks of proteins. So peptides are really just small little proteins.
You can think of it as like an alphabet. The amino acids would be the letters. Peptides would be words. And then the proteins would be like full sentences. The proteins are just much more larger and complex. They fold and they complex into.
Whereas peptides are just really small chains. And some of these are just literally like three amino acids linked together. Many of these are naturally occurring in our body, okay. Things like insulin is a peptide. Our body naturally produces insulin.
The clinical use of peptides is we can actually introduce some of these short little chains of amino acids or small little proteins into our body that can then ask our body to perform certain functions. So there's many different categories of peptides, but some of them promote healing. Some of them promote collagen synthesis. Some of them promote a little extra growth hormone. Some of them modulate your immune system. Some of them help with mitochondrial health.
So those are kind of broad categories that you can think of, how peptides exert their influence on our biological systems. You know, and some people may have won the genetic lottery. Their organ systems are just functioning really well, but unfortunately, we live in an environment that is always constantly taxing us as well. So things like diet, nutrition, environmental exposures, these all sort of degrade our body over time.
DR ROSSI: So you're saying by introducing these at specific time points or with specific conditions you can really help optimize.
DR KUO: Correct, correct. You could augment your physiology in some of these beneficial ways.
A very common example is BPC 157, right. This is a peptide that is probably the most commonly used.
DR ROSSI: This is a peptide that I see ads for all the time.
DR KUO: Yeah. Yes, yes. It's everywhere now. This is naturally made in your stomach. It's an anti inflammatory. And so when you use BPC 157, either in an injection or an oral form, it can accelerate the healing response in your body. So it's a healing peptide. It's a healing peptide. It's an anti inflammatory and a healing peptide.
DR ROSSI: So after injury, do you recommend that?
DR KUO: Yes, yes, yes, after injury, after kind of illness or elevated inflammatory state.
But however, you know, we all have levels of inflammation in our system, just even regardless of whether you feel it or not. There's always kind of basal levels of inflammation. And so there's theories where even people that are not experiencing pain can also still be on cycles of BPC 157.
At the very least, it does kind of accelerate recovery even after workouts. And so it can really improve benefits of working out as then you just recover so much faster from your workouts and you're able to do more and recover faster. And so even in patients that once again are not suffering from an injury, many times we'll put them on cycling courses of BPC 157, a little thymosin beta 4, sometimes GHKCU. These three are in the categories of anti inflammatory, collagen synthesis. They help grow blood vessels. So those are kind of the peptides we use for that.
DR ROSSI: Yeah. So you're treating inflammation from the inside out.
DR KUO: Correct. Correct. Most of the times we prescribe injectable peptides that kind of reduce systemic inflammation. Peptides such as the BPC and the TB4 can be actually injected locally into areas of damage as well.
So you can either inject, you know, we have patients kind of injecting them close to an injury site. We are also using them in procedures. And so when I inject a joint or the spine or ligaments or tendons, we actually use concentrated peptides in my injections as well. We do nerve hydrodissections with peptides.
They're useful. And once again, tissue, when you actually inject them site specific under x ray or ultrasound guidance, we find that a really nice adjuvant to some of the more traditional things that we inject into ligaments and joints, in addition to, you know, sometimes it's steroids, sometimes it's PRP, sometimes it's exosomes or stem cells. I think peptides are a really useful adjuvant.
DR ROSSI: Very cool, yeah. I mean, you're combining a lot of traditional medicine that we know of, that we learn about in med school, but sort of on the next frontier using these biosimilar peptides now.
DR KUO: Yeah. I mean, through clinical experience, you know, we found them to be very helpful, very efficacious with a very high safety profile, very few side effects to even relatively high doses of BPC 157 and TB 500. But yes, you still do have to be careful. I mean, they're not completely without risk.
DR ROSSI: Yeah, what is the safety data? I mean, I know you like to see the data and talk about it as well. Can you overdose on a peptide?
DR KUO: Yeah, yes. Yes, you certainly can, okay, and there's dangers. You know, there's a lot of considerations that you need to think about as well. I mean, especially with some of the growth hormone stimulating peptides. You have to have some thought around that.
But even things like BPC 157, these things do promote some angiogenesis, okay. So angiogenesis is growing of the blood vessels. So yes, if you have pre existing tumors or if you have pre existing cancers, could you potentially be feeding that tumor with additional blood vessels and kind of neoplastic growth. Those are considerations. And so cancer screening is something that we take very…
DR ROSSI: People, don't be getting your peptides at the gym. You know, I go to the gym every morning and there's so many people talking about injecting things and telling their friends, but that's not where you want to be getting these sort of compounds, right. Because yeah, growth hormone may sound really attractive, but it really needs to be under the guidance of a doctor.
DR KUO: Yeah, yeah, for sure, for sure. That's definitely how I recommend that you do it. You know, there's hundreds of research chemical websites out there that are selling peptides.
Poisoning. Like, I have seen it. So it's not just a theoretical thing. We do see that.
DR ROSSI: Yeah, because these are compounded medications. You have to know where you're getting them from, the quality control measures. I've seen patients come in with abscesses in their skin because they're injecting foreign material. They're contaminated. They got it online from a not reputable source. So I think it's really important that we talk about that just so people are aware that not every place is trustworthy.
DR KUO: Yeah, totally. I mean, you really do have to think of them as medications. Yes. They're not really supplements. They do have a much safer safety profile than your traditional medications. But you do have to kind of give them the respect that they're due. You are injecting these things into your body.
And so pharmaceutical grade, work with clinicians or people that actually really know how to do this. The FDA is also there for a reason. Some of these, all these compound facilities should be FDA inspected, CGMP, pharmaceutical grade. So these are things that we should pay attention to.
DR ROSSI: No, I love that. That's a great, that's a great warning. And you're also combining peptide therapy with pheresis or EBOO. Can you talk to us about that? You know, I don't think many people are familiar with that.
DR KUO: Some of the other modalities that we use quite frequently are some of the blood therapeutics, and the blood therapeutics include plasmapheresis, which is therapeutic plasma exchange. This is a procedure where we actually remove around two liters of plasma from your system.
This plasma is the clear liquid component of your blood. It's your blood minus the cells in your blood. So plasma contains over time a lot of pro inflammatory proteins and immune complexes. Some of these like cytokines, inflammatory mediators. And some of these things you can't excrete yourself over time.
DR ROSSI: Is that like dialysis in kidney, renal function?
DR KUO: Basically it's a very similar thought process. Actually the same machines are used for that as well. We take your blood, we separate out your cells, we remove two liters of this plasma and then we replace it with saline and human albumin. So clean filtered human albumin.
And so this is, you can think of it as an oil change for your body. It just kind of cleans out your system. That's a good metaphor.
The other blood therapeutic is EBOO, which is ozone therapy. Ozone dialysis. We do take out your blood, we circulate it through a machine, we pass it through a filter, we apply ozone, we apply oxygen, and then we run it through a whole series of UV and LED lights.
And so what ozone does is it is an oxidative stress to your system. It creates this oxidative reaction which in layman's terms triggers your immune system to respond. I deem it as exercise for your immune system. As we age, our immune system function does go down. And restoring immune system health is actually one of the critical pillars of longevity.
And so it is my belief that periodic controlled exposure to ozone is helpful for boosting immune system function. It also does help with mitochondrial function. And then one of the biggest benefits is that ozone is toxic to bacteria, mold, and it can inactivate viruses.
And so we've used this for people with long COVID, mold exposure, things like that with good results. We're seeing really good clinical results with that. And so ozone is usually combined with some of the other therapeutics that we do. Hyperbaric oxygen therapy is something else that we do quite frequently.
DR ROSSI: You got a hyperbaric oxygen chamber too?
DR KUO: Yeah, yeah, yeah, we do. It's a two person walk in, medical grade, two atmospheres. And, you know, hyperbaric oxygen has been widely studied and has probably the best data in longevity, what the cells need for optimal survival. It's a couple's therapy chamber. Two people can go in at once.
DR ROSSI: Yeah, yeah, yeah, yeah. We have people who can go on dates. That's amazing. That could be a first date.
DR KUO: Yeah, yeah. We have, you know, we take meetings in there all the time.
DR ROSSI: It's the next level of Hinge. Get healthy at the same time. That's cool, yeah.
DR KUO: So, yeah, those three modalities, I think, are useful. And those are some of the modalities that we use in addition to peptide. Some of these, also, we do a lot of nervous system resets as well, kind of known for this procedure. We call it the neuro reset. It's an injection here in the neck.
DR ROSSI: In like the vagus nerve or?
DR KUO: Yeah, yeah. We actually inject the sympathetic chain, the stellate ganglion and the superior cervical ganglion at these two areas in your neck, the C6 and the C4 level, that really we can block and reset the entire fight or flight response, which is the sympathetic nervous system. And then along the vagus nerve, we actually inject the vagus nerve as well.
So the thought process behind this is to really rebalance the autonomic nervous system. By reducing and resetting the sympathetic fight or flight response and by augmenting and improving the parasympathetic response, you can get a reset and rebalancing of the autonomic nervous system.
A lot of people these days live in a constant stressed out environment. They're always in this fight or flight. It's New York City, you know, a lot of anxiety, PTSD, sleep disorders can be as a result of an overactive fight or flight state. And so by blocking and resetting that, it's like hitting a reset button on your neurological computer.
DR ROSSI: Interesting. Would that work for things like POTS syndrome?
DR KUO: Yes, exactly. Exactly. So, you know, we've done studies on POTS and this autonomic dysfunction, especially after long COVID. We do see a high population of these patients in our clinic. It does work by kind of modulating that sympathetic response. It can be helpful for POTS, MECFS, dysautonomia.
And so we do have clinical, we did a 20 person clinical study on that. And then there's also been other recent clinical studies published by Dr. Liu in Alaska on the effects of dual sympathetic blocks and treating dysautonomia.
DR ROSSI: Oh, yeah. So this is fascinating. We're taking a deep dive. And so you're pairing, does the patient have to be healthy to begin with? Or can they come in, you know, are you working with people who are also on traditional medications and you're trying to help them along this journey?
DR KUO: Yeah. I mean, you know, we still see people that have illness, long COVID, we treat a lot of, long COVID, mold, Lyme, some of these chronic illnesses that have kind of bounced around the traditional medical system and haven't really found the results that they're looking for. So a segment of our population is that.
But then we also do see a lot of very healthy people that are really just trying to achieve a next level of optimization. They're really looking for that extra 20 percent of unlock that you just can't get to with even an ideal diet, sleep, and exercise. There's just some levels to unlock with optimizing those four pillars that we talked about.
DR ROSSI: Very cool. And are you combining this with traditional diagnostic tests like DEXA scans or equipment that we have traditionally?
DR KUO: Yes, yes, for sure. I mean, the DEXA scan is kind of one of the gold standard measurements that we do on basically everyone, for bone health but also understanding your body composition. The body fat percentage, but also how much skeletal muscle that you have and then importantly visceral fat. You want to really know the amount of fat that surrounds your organs because that's highly inflammatory and a really great predictor of longevity.
The other thing is VO2 max. If you look at what are the two or three most important tests, it's going to be DEXA scans, VO2 max, and something like grip strength. Those three things can already predict how well you're going to do.
So yeah, there are the basic diagnostic tests in addition to very advanced blood and biomarker testing. We do focus a lot on the mitochondria these days. Mitochondrial testing, there are better tests that are coming out these days.
DR ROSSI: Yeah, tell us about those. Not really familiar with how you can test that.
DR KUO: Yeah. Mitochondrial testing has traditionally been difficult to test. The gold standard was, you know, you had to get a muscle biopsy.
DR ROSSI: Yeah. I've been asked to do those for some people.
DR KUO: Yeah. I mean, that's obviously super invasive and not easy to get. There's many companies working on tests these days. We use one that's come out recently. It's called MeScreen.
And it can basically, with just blood testing, look at mitochondrial capacities, the mitochondria, how they perform under stress, how they perform at rest, their oxidative capacities, their communicative capacities. It's still at the infancy. As in, mitochondrial strategies, we really want to be able to guide our mitochondrial strategies. We are still kind of evaluating how these guide our strategies of optimizing mitochondria.
And so there are the peptides that you can use, the SS31, the MOTS-c, the Humanin, the kind of NAD that you use as peptides, other things like methylene blue and the EBOO ozone therapy, exogenous ketones. There's quite a few things that you can do to help mitochondrial health these days.
This is going to be a really big topic because a lot of fundamental chronic disease stems from mitochondrial dysfunction. So we are paying a lot more attention to this these days. But once again, the tools and the knowledge that we still have are still relatively crude, but I think that field is going to advance a lot in the next few years. And I'm kind of excited to dive a lot deeper into mitochondrial physiology and how to really improve that.
DR ROSSI: Yeah, so just basically more people are developing tests to look at these compounds and see their effect and how we can measure them.
DR KUO: Yes, yes, yes. I mean the mitochondria is complex. The different kinds of mechanisms, you have to really think of the electron transport chain and how all the cytochrome complexes work together and how to improve function of your mitochondria. It really takes you back to Biochem 101.
DR ROSSI: Yeah. I'm getting PTSD. I forgot it all. And now I'm going back into, you know. You're really breaking it down to the cellular level. So really taking it all the way down to the individual cellular level.
DR KUO: Yeah. But once you understand the processes, we've known about these processes for a long time. It's just doctors haven't really come back to this basic biochemical cellular signaling.
You know, for instance, everyone's on NAD these days, but how many people really understand how NAD works, how it gets into cells, the pathways, how do you really augment and improve NAD levels, how much NAD is too much NAD, what are the precursors to use, whether it's IV or subq or oral.
DR ROSSI: Is injectable better than oral? Or oral or?
DR KUO: And this is the debate. There's so much debate on this. The precursor NAD supplements such as NMN or NR can certainly increase your levels of NAD that your cells can use.
I think IV NAD is kind of something that's going out of fashion these days. They're expensive, they're painful, they take a very long time. These days there is something that we use called Niagen, which is an NAD precursor that can go in a lot more easily, raise NAD levels higher than an IV NAD can. I think it can be used by cells a lot better than just traditional IV NAD.
Clinical responses are kind of all over the place. There are certainly people that respond very well to IV NAD. We have used them for chronic disease, for things like alcoholism. Some people really do respond well to IV NAD.
We typically have people just doing injections of subq NAD these days, especially if you're on mitochondrial protocol. You use a little subq NAD in addition to things like MOTS-c or SS31. It kind of gives you a little more substrate for these mitochondrial peptides to work on.
And, you know, interesting other pathways these days, what I really recommend if you're going to do NAD is also really thinking about the two salvage pathways that NAD can break down into. And one of them is this CD38 pathway, which you might want to take some apigenin to kind of modulate.
I take a little NMN, 1MNA, in addition to some of the mitochondrial peptides. And that little protocol is, you know, I've seen people respond pretty well to that with increased energy levels and stuff like that.
DR ROSSI: I can really see these pathways in my brain. I'm getting flashbacks of studying them and salvage pathways. But you're really thinking not only about the immediate compound, but also the downstream, how these compounds get broken down or recycled basically in our body.
DR KUO: Correct. And there is such a thing as taking too much NAD. You can kind of overspill your bucket. And when you overspill that, you can actually cause more damage and oxidative stress. So no, I do not recommend people get NAD infusions once a week or something like that. I think that's just probably way too much.
It's actually really difficult to assess what is the optimal NAD dosing. There are companies that do intracellular NAD testing. The jury's still out on that. I've used it quite a bit. Are the results as reproducible and reliable all the time? I'm just not sure. There's still, I think, a lot of science that needs to be done in this field.
DR ROSSI: If you had an infinite budget, like Brian Johnson, you could take all this stuff. What do you wish people stopped wasting their money on? Or what is overhype?
DR KUO: I think oversupplementation is a real thing these days.
DR ROSSI: Like oral supplementation?
DR KUO: Yeah, just oversupplementation in general. I mean, I have patients come in and they will haul in all their supplements and it's…
DR ROSSI: Oh, you don't want to see my cabinet.
DR KUO: It's this gigantic bag of all sorts of stuff and it's like, you know, what's necessary versus what's not. If you kind of listen to every wellness person out there, everyone's kind of selling something else or selling their own compounds, selling their own things.
And like, you know, should you take prebiotics? Should you take postbiotics? Should you take Akkermansia? Should you take urolithin A or CoQ10 or DHA or methylated B vitamins or folate? There's an infinite list of things that are peddled.
It's hard to say. I'm not specifically very pro one thing versus another. I kind of try to use data and clinical experience to guide me on this. Most people do not need a lot of supplements. The main things that you really need are quite simple. It's vitamin D, it's magnesium, it's the omegas, omega 6-3s in a good combo.
But a lot of people, you can get that through a great diet as well. And so, if you boil down to the basics, a lot of people I test are deficient in vitamin D. Magnesium, yes, some people can be deficient in that, but that's really kind of it.
DR ROSSI: I love a good prenatal vitamin.
DR KUO: Yeah, I mean, things like the multivitamin or even vitamin B complexes, you probably don't need it for most people, if you have a good diet.
There is some good evidence on urolithin A. I've seen good stuff on that. Maybe Akkermansia as well. But yeah, there's just so much stuff out there. It is impossible for us to really figure it all out.
But, you know, back to the topic of peptides, this is where we really see bang for the buck. Most people feel great on peptides. They really do.
DR ROSSI: That's great. Yeah. I feel like you probably see those patients who maxed out on all these oral supplements that they've, you know…
DR KUO: I'm more interested in the testing, the assays, and the compounds themselves, or a mixture of both. I mean, I think AI drug discovery is going to really change the game so much. There's so many newer gene therapies and mRNA and siRNA. Some of these newer therapeutics are really going to completely change the game, I think, peptides.
The true level of biohacking. True level. Already you can solve a bunch of diseases and genetic conditions with gene editing. Gene therapy is going to be a huge thing. Already we have follistatin gene therapy that I've seen moderate to good results with already. So I think a lot more in that realm is going to come.
Some of these newer medications are truly phenomenal in so many different realms like immunotherapy, cancer therapy, reducing cholesterol. The list goes on and on. I think we're just scratching the surface of peptides right now. Peptide drug discovery. There's literally 7,000 peptides out there. And in clinical use, we really only use like 10 to 15 of them.
And so as more and more peptides come out with even more very specific biological functions and we can really elucidate their true mechanisms of action, I think this field's going to really explode. It's really targeted. Really targeted. Some of our unique therapies that we can put together are almost like a total system reboot kind of deal where we really try to change physiology and augment your cellular systems in these one to two day intensives.
Yeah, it's a long visit. It's several hours a day, but we're going through a whole sequence of procedures similar to what we discussed.
DR ROSSI: Very cool. And then in combination with good diet, good exercise, traditional, you know.
DR KUO: For sure. I mean, that cannot be understated at all. Diet, sleep, and exercise can get you 75, 80 percent to optimal health. Some of the things that we do is really unlocking that extra 20 percent. People, you can have a sharper mind. Most people do live with some degree of brain fog. If you really do things to optimize that, you can really unlock cognitive capabilities, physical capabilities, cognitive capabilities, just by peptides, hormones, inflammation, mitochondria, those four things. Optimize those and you just feel a lot better.
DR ROSSI: Yeah, I remember, I'm sure you felt this way too. In med school, you could study for hours and hours on end and not sleep and get through everything. You feel that diminish over time. And that's why people should be on hormones. And that's why people should consider augmenting your physiology with peptides.
I mean, I know men naturally decline their testosterone from a peak in their 20s or so. Whereas women usually, once they hit menopause, that's their really sharp decline. So men are more gradual, women are more sharp declines.
DR KUO: Yeah. I mean, on that topic, I see so many guys, so many men, just late 30s, early 40s with plummeting testosterone levels. And, you know, 300s, 400s is a combination of environmental toxins and stress and modern day lifestyles or some of our hormone leading food system. Alcohol. But this is a real issue.
If you see average testosterone levels in the 1950s versus the levels now, it's a dramatic decrease. Sperm quality, testosterone levels, big plummet. So managing testosterone is a big thing that we do.
DR ROSSI: We'll have to have you back on for a whole other discussion about hormones and optimization. Yeah. We're going to play this little game called Myth or Medicine.
Sure. So I'm going to tell you some quick fire statements. You tell me myth or real medicine.
Collagen peptides can rebuild your skin barrier. That's a tough one to start.
DR KUO: Yeah, it's a tough one, you know. I would actually say that that's a myth. Collagen peptides, you ingest it in your stomach, most of that stuff is just broken down. It's broken down into amino acids and protein. I don't feel like that's just ingesting protein.
DR ROSSI: So skip.
DR KUO: Yeah, I would skip that.
DR ROSSI: Copper peptides, best for skin care or there's better peptides out there?
DR KUO: It's very helpful. I do really love copper peptide. GHKCU is a great peptide for skin.
DR ROSSI: Is that injectable?
DR KUO: It is injectable, but you can actually use it topically as well. And so GHKCU is a really simple tripeptide. But when you bind it to copper, it becomes a potent signaling molecule. It stimulates wound healing, stimulates collagen, similar to elastin, angiogenesis as well. I really like GHKCU. So it's a signaling peptide that I think works pretty well, both topically and injected.
DR ROSSI: This might be controversial. But peptides are safer than Botox?
DR KUO: If you think about some of these things in your body and whether that has any kind of systemic effects, I think peptides are safer than Botox, but Botox to me is pretty safe.
DR ROSSI: Yeah. Using millions of patients.
DR KUO: As long as you don't get that counterfeit botulinum toxin that they're using in Florida. Unfortunately, that's a thing. They went to not reputable people and they were using counterfeit botulinum toxin that really hurt people. I mean, that was scary. That was not purified. So I think there was an alarming, people were like, oh, Botox is not safe. But real cosmetic and medical grade Botox, you know.
DR ROSSI: Yeah, we use that every day. Totally.
DR KUO: Myth or medicine, all peptides are basically the same.
DR ROSSI: I think you…
DR KUO: No, that's definitely not true. Different categories and signaling pathways. So that's not true.
DR ROSSI: Can peptides overcome bad diet and poor sleep?
DR KUO: No, they can't. They really can't. You got to get the fundamentals right before these peptides can really exert their function. I really do not recommend, if you can't do the basics, then don't even be on the peptides.
DR ROSSI: It's kind of how I see those people at the gym. They're injecting all this stuff, but they're not working out. And I'm like, it doesn't just grow the muscle. You actually still have to have the right stimulus to have these things work. You need the physiologic stimulus, the tension on the muscle.
Big into my world is peptides can just get rid of all your wrinkles. I wish that was the case, but.
DR KUO: No, that doesn't happen. I mean, you can improve collagen and then, you know, by some of these, the GHKCU and things like that. But no, it's not going to eliminate wrinkles.
DR ROSSI: The peptides that you're injecting, are they the exact same thing as something like growth hormone or is it like a biosimilar?
DR KUO: It's a biosimilar, I would say. Some of the growth hormone stimulating peptides, the GHRH or growth hormone releasing peptides, they stimulate your pituitary to release more growth hormone and so they're biosimilar. They're not exactly the same, but they biostimulate. And they're not what back in the day people were injecting, anabolic steroids. Very different. Very different.
HGH, straight HGH is very different than a growth hormone stimulating peptide. HGH is non physiological. And, yeah, you can definitely get into problems with that. But we see much less issues with growth hormone stimulating peptides.
DR ROSSI: Is that what you think some of the actors are on in Hollywood, who are just massive and huge? You see these guys with huge jaws and…
DR KUO: Yeah. I mean, that's most likely testosterone. Most likely some people are on a combination of some of the anabolic as well. If you're familiar with the bodybuilding community, yes, there's quite a few other anabolics that you can use in addition to testosterone or straight HGH as well.
I mean, most of some of these big guys at the gym are on a combination of T, HGH and some anabolics. They're almost like walking experiments. You see them.
Yeah, I mean, I do treat them. A few professional bodybuilders, including some people that are really at the top of their game. But long term use of these anabolics and HGH, you can really get into a lot of trouble. It causes a lot of cardiovascular stress, it stresses out your kidneys, and so some of these things may or may not be reversible.
DR ROSSI: Yeah, I think there was a Dutch study that showed the use of anabolic steroids, so not what we were talking about with peptides, but the use of anabolic steroids with all comers in these young men actually led to increased mortality and decreased lifespan, which was for all causes of death.
DR KUO: For sure.
DR ROSSI: Yeah, so, you know, again, don't get any of these at the gym.
And then fitness trackers, myth or medicine? What do you think?
DR KUO: I think the tracking of your data is really important these days. The continuous data is really gold and assesses feedback. Data is everything. The more data you have, the more insights you can get into improving some of your health markers.
So, yeah, we recommend quarterly blood work, DEXA scans twice a year, knowing your HRV scores and sleep scores and stress levels, using Whoop and Oura. We continuously monitor.
DR ROSSI: I have an Oura ring. It's probably out of battery right now, but I got to charge it.
DR KUO: The battery should last long. I actually use both. I actually use both. I think Oura is great for sleep. I don't think it's great for daytime activity tracking or anything like that. But the Whoop, I think, is really good for monitoring activity levels and stress during the day and HRV.
But I like both. I think they're both valid.
DR ROSSI: Yeah. All right. And, you know, last question, this show is called Give Good Face. So what does Give Good Face mean to you in terms of longevity, peptides, Extension Health?
DR KUO: It means you got to be healthy from the inside out. You want a good face, you just kind of need to be good on the inside as well, because everything on the inside reflects on the outside.
DR ROSSI: I love that. Yes. Yes. All right, good. All right, thank you, Dr. Kuo. You know, if people want to get in touch with Extension Health, where do they go?
DR KUO: Extension.health is our website. You can also follow me at @dr.kuo, or K U O, on Instagram or Extension Health on Instagram. So, you know, I try to be educational. I try to talk about…
DR ROSSI: I love your social, yeah.
DR KUO: No, thank you so much. I try to spread knowledge and get people excited about some of these newer techniques and technologies. And, yeah.
DR ROSSI: This was a great conversation. So thank you so much for coming. And I hope to have you back and we'll talk more about hormones and how we can optimize that.
DR KUO: Yeah, such a pleasure to be here. And thank you for having me.
DR ROSSI: Amazing. It was wonderful. And remember everyone, if you like this conversation, subscribe, follow, and we'll have all this content coming out for you.
Peptides, Longevity & the Future of Anti-Aging Medicine with Dr. Jonathann Kuo
On This Week's Episode:
Peptides might be the buzziest word in wellness right now—but are they actually worth the hype? Dr. Anthony Rossi sits down with Dr. Jonathann Kuo, founder and CEO of Extension Health, to separate fact from fiction on the science of peptides and regenerative medicine.
From hormone balance and mitochondrial repair to inflammation control and “interventional longevity,” this conversation unpacks how peptide therapy is reshaping the future of aging. Plus, Dr. Kuo explains the real risks of buying peptides online and how to use them safely within medical-grade protocols.
Guest Bio:
Globally renowned for his work in regenerative and longevity medicine and peptide therapy, Dr. Kuo is who leaders in health turn to for care.
Dr. Kuo earned his MD from Boston University’s prestigious 7-year program and completed his training at New York Presbyterian Hospital / Weill Cornell. A double board-certified physician in anesthesiology and pain management and one of New York’s most respected interventional specialists, Dr. Kuo’s clinical network has treated 50,000+ patients and performed 140,000+ procedures.
As Founder & CEO of Extension Health, Dr. Kuo leads an unparalleled longevity clinic that offers the most advanced diagnostics and therapeutics in the country, all under one roof, including therapeutic plasma exchange, ozone therapy, regenerative medicine, peptide therapy, nervous system optimization, hyperbaric oxygen, and more. His mission is to optimize healthspan, cellular regeneration, and peak human performance.
Dr. Kuo’s pivot from pain management to regenerative and longevity medicine was personal as well as professional. After facing his own metabolic decline, Dr. Kuo became his own patient, refining the same strategies now offered to patients, who include elite athletes, high-performing CEOs, and celebrities. His expertise in interventional orthopedics, peptide therapy, and integrative medicine led him to transition from traditional pain management to proactive, precision-based care.
Dr. Kuo continues to collaborate with global regenerative medicine leaders and biotech innovators to redefine what’s possible in human health and longevity. His work is featured regularly in the leading media outlets, such as The New York Times, The Wall Street Journal, and The New Yorker.
Episode Transcript:
DR KUO: We're just scratching the surface of peptides right now. It's literally 7,000 peptides out there. And clinically, we really only use, like, 10 to 15 of them. I think this field's going to really explode.
DR ROSSI: Peptides are everywhere, from skincare TikTok hacks to IV drips. But what's the real data and do they really work? I'm Dr. Rossi and welcome back to Give Good Face, a podcast where we explore all things skincare, medicine, longevity. And today, I'm really fortunate to have Dr. Kuo here, the founder of Extension Health, a longevity and regenerative medicine clinic.
DR KUO: You know, the basic pillars of health that I see are mitochondrial health, metabolic health, and that kind of also leads to this category as inflammation, and the last is hormones.
DR ROSSI: I know what a peptide is. How do you explain it to your patients?
DR KUO: They're cellular messengers. They influence certain biological systems in our body. Peptides are really short chains of amino acids. Amino acids are the basic building blocks of proteins.
DR ROSSI: Can you overdose on a peptide?
DR KUO: Yes, you certainly can, okay? And there's dangers. There's a lot of considerations that you need to think about as well.
DR ROSSI: People, don't be getting your peptides at the gym. That's not where you want to be getting these sort of compound.
DR ROSSI: Thank you so much for being here.
DR KUO: Thank you so much for having me. It's such an honor to be on your show.
DR ROSSI: Oh yeah, this is great. I'm super curious about peptides, how they work and what they do. But your clinic is not just about peptides. Just tell us a little bit about yourself and how you came, how you came to start Extension Health.
DR KUO: Sure. My career started as an interventional pain specialist. I trained as an anesthesiologist and did an interventional pain fellowship. And then subsequently, I set up a pain management, interventional pain management practice here in New York called Hudson Health. That's been around for 16 years now. It's a very busy interventional, not kind of getting to the root cause or really fixing anything.
And so that kind of got me into the world of regenerative medicine around seven or eight years ago. I started doing a lot of cases with, you know, exosomes and stem cells, did some published studies on exosomes and how they helped with pain. And that kind of really naturally led me into the world of peptides. And this was like four or five years ago when peptides were not just on the tip of everyone's tongue.
I got really interested in kind of really understanding how they worked, what their mechanisms were, kind of the studies around them, and started really using them clinically, was probably one of the more original doctors kind of using peptides. And since, you know, those several years, we've gained a lot of clinical experience. We've probably treated several thousands of patients with combinations of peptides, understanding their clinical efficacy and their safety profile and how to use them safely in clinical practice.
DR KUO: How it's been in evolution over the years, you know, five or six years ago, this longevity medicine field wasn't really present, but now it's a hot topic. There's clinics popping up everywhere. But yeah, this is kind of my version of longevity. We do an inter, I call it interventional longevity.
So a lot of the, you know, things that we do are procedural ways like, you know, blood therapeutics, ozone, hyperbaric, plasma just, you know, thoughts about gene therapy, regenerative medicine. And these are kind of all the things that we kind of consider together in what I consider as a field of longevity.
DR ROSSI: That's amazing. We're going to get into all of this. You said you've been around for 16 years with Hudson Health.
DR KUO: Yes.
DR ROSSI: You look super young. So as a question I ask to all my guests, you know, what's your skincare routine? Because you look great. Everyone knows what I do because I have my skincare line that's focused on a peptide that calms down inflammatory aging by targeting a receptor in the skin. So what do you do in the morning and at night? And how do you incorporate your own medicine into your routine?
DR KUO: Sure, sure, sure. So, yes, I've been on this kind of personal path to improve my health for a very long time. I really suffered from a lot of personal health issues a few years ago as well. I was, you know, I had brain fog. I was, patients too as well in terms of skincare routine.
It's, you know, mine's not super complicated. I mean, I definitely use, you know, a retinol at night, definitely sunscreen, SPF 30 or above in the mornings.
DR ROSSI: We didn't even tell him to say that, you know.
DR KUO: And yes, I use peptide-based skincare and creams. I do. I'm a big believer in regenerative medicine so, you know, things like microneedling exosomes I do every quarter. I do injections of, I've had multiple rounds of stem cells injected in my skin, not as much into Botox and fillers and things like that. I have done Botox in the past. Yeah, I've even done like a, you know, a fat transfer, like fat cells, my own fat cells, kind of fat stem cells injected in my face. So I do try a lot of these things, but, you know, it's, I feel like sometimes they should be working.
I mean, I'm 46.
DR ROSSI: It's working, folks.
DR KUO: Yeah, I feel good. I feel, yeah, I feel a lot of energy these days. I feel good, you know, I feel better now than I did, you know, 10 years ago, certainly. And, you know, that's like, as time passes, there's definitely ways to continue to optimize yourself and, you know, improve your physiology and your strength and stamina and all these things by a combination of, you know, bolstering the kind of four key pillars of your body, you know, lowering your inflammation, managing your hormones, having good mitochondrial health, and metabolic health.
DR ROSSI: So those are your four pillars, right, out of Extension Health?
DR KUO: You know, to boil things down to the simplest, the basic pillars of health that I see are mitochondrial health, okay, making sure you have great mitochondria. Those are kind of powerhouses of every single cell in your body and how you produce energy and detoxify.
Metabolic health, okay, metabolic health as in making sure your body's metabolically tuned up, is responsive to insulin, that you don't have high glucose spikes that cause inflammation. And that kind of also leads to this third category, which is inflammation. Inflammation management is just so critical because inflammation really drives all of the kind of chronic disease that we can encounter in life.
And the last is hormones, okay. You must have great optimal hormones for any of this stuff to really work. So, you know, it's a real simplification of what you can do to be healthy, but to boil it down, you focus on those four categories.
Longevity really is a lot more complex as in then you kind of think about organ system health. Like all of our different organs kind of do have aging at different paces so there's ways to look at it through that kind of lens. But, you know, just boiling down for simplicity, I like simplicity. I want to be able to kind of really explain to patients, able to kind of target these four basic pillars. Once you get these optimized, you can really do a lot.
DR ROSSI: Yeah, I've been always talking a lot about chronic inflammation, how that damages our skin, you know, from the inside out. We know it happens in our joints, but it's happening in all of our organ systems.
DR ROSSI: Now that you've asked about my skincare routine, I would like…
This peptide is a short chain amino acid, about five of them, right, that's created into this peptide. That's more of a, you know, messenger peptide. It actually targets TRPV1 in the skin, which is a receptor in the skin, but it's also in a lot of organs that causes downstream inflammation. And my whole theory about how I approach the skin is decreasing this chronic inflammatory state that many of us live in, right, like what you were saying, exactly what you were saying.
So I think destruction, we can decrease extrinsic aging that's happening from environmental exposure, UV, pollutants, hydrocarbons. So everything that our skin is being bombarded by just living day to day. My whole line has that peptide woven into it in different formulations, using these steps just religiously. Great. It really helped me.
Of course, I augmented it with lasers. I love a good resurfacing laser. I'll probably have a post about that coming soon because I do that like once a year. Things like fractional CO2, fractional non ablative lasers like Thulium 1927, 1550 nanometer, all these different wavelengths really can help improve our skin because we're decreasing senescent cells.
And these are those zombie cells that sort of turn off as we're aging, similar to what you talk about going on in the body. It's just these cells sort of stop working and they just become dormant. And then they're not giving off those messages to grow collagen or proliferate. So we're sort of turning those back on. And by decreasing the chronic inflammation that's happening in our skin, you can really augment the skin from the outside in.
Amazing. What do you think of retinols? Should people be on those daily?
As a dermatologist, I'm very much of a purist. I love the retinoid compound. Our retinoids are our prescription retinoids. Retinol is the derivative of it, the aldehyde derivatives. So retinols are weak, you know, but that's why they're over the counter. So they're weak compounds. They don't do as much as you can get with a prescription retinoid.
I love a prescription retinoid. So I do give that prescription to patients. You have to mix it with a moisturizer. Otherwise, you'll get this retinoid dermatitis, we call it, that irritation, that redness. And it feels very inflamed. So when you mix it with the moisturizer, like my night one, that's what it was designed for, because I don't have retinol in my line.
Because I want people to use retinoids. And now there are some over the counter retinoids, ones that were prescription, but now over the counter, things like Differin, which is used for acne. That's adapalene, that used to be a prescription, but now it's over the counter. So there's some little hacks. So I say, save the money on the retinol, get the retinoid.
DR ROSSI: Okay. Basic 101, you know, someone Googles the word peptide and they're really not sure what it is. You know, I know what it is. How do you explain it to your patients or when they first come to you? What's the intake and how does that relate to the things that they're feeling?
DR KUO: Sure, sure. I mean peptides, you know, the basic way to think about them is they're cellular messengers. They influence certain biological systems in our body. You can think of peptides as really short chains of amino acids. Amino acids are the basic building blocks of proteins. So peptides are really just small little proteins.
You can think of it as like an alphabet. The amino acids would be the letters. Peptides would be words. And then the proteins would be like full sentences. The proteins are just much more larger and complex. They fold and they complex into.
Whereas peptides are just really small chains. And some of these are just literally like three amino acids linked together. Many of these are naturally occurring in our body, okay. Things like insulin is a peptide. Our body naturally produces insulin.
The clinical use of peptides is we can actually introduce some of these short little chains of amino acids or small little proteins into our body that can then ask our body to perform certain functions. So there's many different categories of peptides, but some of them promote healing. Some of them promote collagen synthesis. Some of them promote a little extra growth hormone. Some of them modulate your immune system. Some of them help with mitochondrial health.
So those are kind of broad categories that you can think of, how peptides exert their influence on our biological systems. You know, and some people may have won the genetic lottery. Their organ systems are just functioning really well, but unfortunately, we live in an environment that is always constantly taxing us as well. So things like diet, nutrition, environmental exposures, these all sort of degrade our body over time.
DR ROSSI: So you're saying by introducing these at specific time points or with specific conditions you can really help optimize.
DR KUO: Correct, correct. You could augment your physiology in some of these beneficial ways.
A very common example is BPC 157, right. This is a peptide that is probably the most commonly used.
DR ROSSI: This is a peptide that I see ads for all the time.
DR KUO: Yeah. Yes, yes. It's everywhere now. This is naturally made in your stomach. It's an anti inflammatory. And so when you use BPC 157, either in an injection or an oral form, it can accelerate the healing response in your body. So it's a healing peptide. It's a healing peptide. It's an anti inflammatory and a healing peptide.
DR ROSSI: So after injury, do you recommend that?
DR KUO: Yes, yes, yes, after injury, after kind of illness or elevated inflammatory state.
But however, you know, we all have levels of inflammation in our system, just even regardless of whether you feel it or not. There's always kind of basal levels of inflammation. And so there's theories where even people that are not experiencing pain can also still be on cycles of BPC 157.
At the very least, it does kind of accelerate recovery even after workouts. And so it can really improve benefits of working out as then you just recover so much faster from your workouts and you're able to do more and recover faster. And so even in patients that once again are not suffering from an injury, many times we'll put them on cycling courses of BPC 157, a little thymosin beta 4, sometimes GHKCU. These three are in the categories of anti inflammatory, collagen synthesis. They help grow blood vessels. So those are kind of the peptides we use for that.
DR ROSSI: Yeah. So you're treating inflammation from the inside out.
DR KUO: Correct. Correct. Most of the times we prescribe injectable peptides that kind of reduce systemic inflammation. Peptides such as the BPC and the TB4 can be actually injected locally into areas of damage as well.
So you can either inject, you know, we have patients kind of injecting them close to an injury site. We are also using them in procedures. And so when I inject a joint or the spine or ligaments or tendons, we actually use concentrated peptides in my injections as well. We do nerve hydrodissections with peptides.
They're useful. And once again, tissue, when you actually inject them site specific under x ray or ultrasound guidance, we find that a really nice adjuvant to some of the more traditional things that we inject into ligaments and joints, in addition to, you know, sometimes it's steroids, sometimes it's PRP, sometimes it's exosomes or stem cells. I think peptides are a really useful adjuvant.
DR ROSSI: Very cool, yeah. I mean, you're combining a lot of traditional medicine that we know of, that we learn about in med school, but sort of on the next frontier using these biosimilar peptides now.
DR KUO: Yeah. I mean, through clinical experience, you know, we found them to be very helpful, very efficacious with a very high safety profile, very few side effects to even relatively high doses of BPC 157 and TB 500. But yes, you still do have to be careful. I mean, they're not completely without risk.
DR ROSSI: Yeah, what is the safety data? I mean, I know you like to see the data and talk about it as well. Can you overdose on a peptide?
DR KUO: Yeah, yes. Yes, you certainly can, okay, and there's dangers. You know, there's a lot of considerations that you need to think about as well. I mean, especially with some of the growth hormone stimulating peptides. You have to have some thought around that.
But even things like BPC 157, these things do promote some angiogenesis, okay. So angiogenesis is growing of the blood vessels. So yes, if you have pre existing tumors or if you have pre existing cancers, could you potentially be feeding that tumor with additional blood vessels and kind of neoplastic growth. Those are considerations. And so cancer screening is something that we take very…
DR ROSSI: People, don't be getting your peptides at the gym. You know, I go to the gym every morning and there's so many people talking about injecting things and telling their friends, but that's not where you want to be getting these sort of compounds, right. Because yeah, growth hormone may sound really attractive, but it really needs to be under the guidance of a doctor.
DR KUO: Yeah, yeah, for sure, for sure. That's definitely how I recommend that you do it. You know, there's hundreds of research chemical websites out there that are selling peptides.
Poisoning. Like, I have seen it. So it's not just a theoretical thing. We do see that.
DR ROSSI: Yeah, because these are compounded medications. You have to know where you're getting them from, the quality control measures. I've seen patients come in with abscesses in their skin because they're injecting foreign material. They're contaminated. They got it online from a not reputable source. So I think it's really important that we talk about that just so people are aware that not every place is trustworthy.
DR KUO: Yeah, totally. I mean, you really do have to think of them as medications. Yes. They're not really supplements. They do have a much safer safety profile than your traditional medications. But you do have to kind of give them the respect that they're due. You are injecting these things into your body.
And so pharmaceutical grade, work with clinicians or people that actually really know how to do this. The FDA is also there for a reason. Some of these, all these compound facilities should be FDA inspected, CGMP, pharmaceutical grade. So these are things that we should pay attention to.
DR ROSSI: No, I love that. That's a great, that's a great warning. And you're also combining peptide therapy with pheresis or EBOO. Can you talk to us about that? You know, I don't think many people are familiar with that.
DR KUO: Some of the other modalities that we use quite frequently are some of the blood therapeutics, and the blood therapeutics include plasmapheresis, which is therapeutic plasma exchange. This is a procedure where we actually remove around two liters of plasma from your system.
This plasma is the clear liquid component of your blood. It's your blood minus the cells in your blood. So plasma contains over time a lot of pro inflammatory proteins and immune complexes. Some of these like cytokines, inflammatory mediators. And some of these things you can't excrete yourself over time.
DR ROSSI: Is that like dialysis in kidney, renal function?
DR KUO: Basically it's a very similar thought process. Actually the same machines are used for that as well. We take your blood, we separate out your cells, we remove two liters of this plasma and then we replace it with saline and human albumin. So clean filtered human albumin.
And so this is, you can think of it as an oil change for your body. It just kind of cleans out your system. That's a good metaphor.
The other blood therapeutic is EBOO, which is ozone therapy. Ozone dialysis. We do take out your blood, we circulate it through a machine, we pass it through a filter, we apply ozone, we apply oxygen, and then we run it through a whole series of UV and LED lights.
And so what ozone does is it is an oxidative stress to your system. It creates this oxidative reaction which in layman's terms triggers your immune system to respond. I deem it as exercise for your immune system. As we age, our immune system function does go down. And restoring immune system health is actually one of the critical pillars of longevity.
And so it is my belief that periodic controlled exposure to ozone is helpful for boosting immune system function. It also does help with mitochondrial function. And then one of the biggest benefits is that ozone is toxic to bacteria, mold, and it can inactivate viruses.
And so we've used this for people with long COVID, mold exposure, things like that with good results. We're seeing really good clinical results with that. And so ozone is usually combined with some of the other therapeutics that we do. Hyperbaric oxygen therapy is something else that we do quite frequently.
DR ROSSI: You got a hyperbaric oxygen chamber too?
DR KUO: Yeah, yeah, yeah, we do. It's a two person walk in, medical grade, two atmospheres. And, you know, hyperbaric oxygen has been widely studied and has probably the best data in longevity, what the cells need for optimal survival. It's a couple's therapy chamber. Two people can go in at once.
DR ROSSI: Yeah, yeah, yeah, yeah. We have people who can go on dates. That's amazing. That could be a first date.
DR KUO: Yeah, yeah. We have, you know, we take meetings in there all the time.
DR ROSSI: It's the next level of Hinge. Get healthy at the same time. That's cool, yeah.
DR KUO: So, yeah, those three modalities, I think, are useful. And those are some of the modalities that we use in addition to peptide. Some of these, also, we do a lot of nervous system resets as well, kind of known for this procedure. We call it the neuro reset. It's an injection here in the neck.
DR ROSSI: In like the vagus nerve or?
DR KUO: Yeah, yeah. We actually inject the sympathetic chain, the stellate ganglion and the superior cervical ganglion at these two areas in your neck, the C6 and the C4 level, that really we can block and reset the entire fight or flight response, which is the sympathetic nervous system. And then along the vagus nerve, we actually inject the vagus nerve as well.
So the thought process behind this is to really rebalance the autonomic nervous system. By reducing and resetting the sympathetic fight or flight response and by augmenting and improving the parasympathetic response, you can get a reset and rebalancing of the autonomic nervous system.
A lot of people these days live in a constant stressed out environment. They're always in this fight or flight. It's New York City, you know, a lot of anxiety, PTSD, sleep disorders can be as a result of an overactive fight or flight state. And so by blocking and resetting that, it's like hitting a reset button on your neurological computer.
DR ROSSI: Interesting. Would that work for things like POTS syndrome?
DR KUO: Yes, exactly. Exactly. So, you know, we've done studies on POTS and this autonomic dysfunction, especially after long COVID. We do see a high population of these patients in our clinic. It does work by kind of modulating that sympathetic response. It can be helpful for POTS, MECFS, dysautonomia.
And so we do have clinical, we did a 20 person clinical study on that. And then there's also been other recent clinical studies published by Dr. Liu in Alaska on the effects of dual sympathetic blocks and treating dysautonomia.
DR ROSSI: Oh, yeah. So this is fascinating. We're taking a deep dive. And so you're pairing, does the patient have to be healthy to begin with? Or can they come in, you know, are you working with people who are also on traditional medications and you're trying to help them along this journey?
DR KUO: Yeah. I mean, you know, we still see people that have illness, long COVID, we treat a lot of, long COVID, mold, Lyme, some of these chronic illnesses that have kind of bounced around the traditional medical system and haven't really found the results that they're looking for. So a segment of our population is that.
But then we also do see a lot of very healthy people that are really just trying to achieve a next level of optimization. They're really looking for that extra 20 percent of unlock that you just can't get to with even an ideal diet, sleep, and exercise. There's just some levels to unlock with optimizing those four pillars that we talked about.
DR ROSSI: Very cool. And are you combining this with traditional diagnostic tests like DEXA scans or equipment that we have traditionally?
DR KUO: Yes, yes, for sure. I mean, the DEXA scan is kind of one of the gold standard measurements that we do on basically everyone, for bone health but also understanding your body composition. The body fat percentage, but also how much skeletal muscle that you have and then importantly visceral fat. You want to really know the amount of fat that surrounds your organs because that's highly inflammatory and a really great predictor of longevity.
The other thing is VO2 max. If you look at what are the two or three most important tests, it's going to be DEXA scans, VO2 max, and something like grip strength. Those three things can already predict how well you're going to do.
So yeah, there are the basic diagnostic tests in addition to very advanced blood and biomarker testing. We do focus a lot on the mitochondria these days. Mitochondrial testing, there are better tests that are coming out these days.
DR ROSSI: Yeah, tell us about those. Not really familiar with how you can test that.
DR KUO: Yeah. Mitochondrial testing has traditionally been difficult to test. The gold standard was, you know, you had to get a muscle biopsy.
DR ROSSI: Yeah. I've been asked to do those for some people.
DR KUO: Yeah. I mean, that's obviously super invasive and not easy to get. There's many companies working on tests these days. We use one that's come out recently. It's called MeScreen.
And it can basically, with just blood testing, look at mitochondrial capacities, the mitochondria, how they perform under stress, how they perform at rest, their oxidative capacities, their communicative capacities. It's still at the infancy. As in, mitochondrial strategies, we really want to be able to guide our mitochondrial strategies. We are still kind of evaluating how these guide our strategies of optimizing mitochondria.
And so there are the peptides that you can use, the SS31, the MOTS-c, the Humanin, the kind of NAD that you use as peptides, other things like methylene blue and the EBOO ozone therapy, exogenous ketones. There's quite a few things that you can do to help mitochondrial health these days.
This is going to be a really big topic because a lot of fundamental chronic disease stems from mitochondrial dysfunction. So we are paying a lot more attention to this these days. But once again, the tools and the knowledge that we still have are still relatively crude, but I think that field is going to advance a lot in the next few years. And I'm kind of excited to dive a lot deeper into mitochondrial physiology and how to really improve that.
DR ROSSI: Yeah, so just basically more people are developing tests to look at these compounds and see their effect and how we can measure them.
DR KUO: Yes, yes, yes. I mean the mitochondria is complex. The different kinds of mechanisms, you have to really think of the electron transport chain and how all the cytochrome complexes work together and how to improve function of your mitochondria. It really takes you back to Biochem 101.
DR ROSSI: Yeah. I'm getting PTSD. I forgot it all. And now I'm going back into, you know. You're really breaking it down to the cellular level. So really taking it all the way down to the individual cellular level.
DR KUO: Yeah. But once you understand the processes, we've known about these processes for a long time. It's just doctors haven't really come back to this basic biochemical cellular signaling.
You know, for instance, everyone's on NAD these days, but how many people really understand how NAD works, how it gets into cells, the pathways, how do you really augment and improve NAD levels, how much NAD is too much NAD, what are the precursors to use, whether it's IV or subq or oral.
DR ROSSI: Is injectable better than oral? Or oral or?
DR KUO: And this is the debate. There's so much debate on this. The precursor NAD supplements such as NMN or NR can certainly increase your levels of NAD that your cells can use.
I think IV NAD is kind of something that's going out of fashion these days. They're expensive, they're painful, they take a very long time. These days there is something that we use called Niagen, which is an NAD precursor that can go in a lot more easily, raise NAD levels higher than an IV NAD can. I think it can be used by cells a lot better than just traditional IV NAD.
Clinical responses are kind of all over the place. There are certainly people that respond very well to IV NAD. We have used them for chronic disease, for things like alcoholism. Some people really do respond well to IV NAD.
We typically have people just doing injections of subq NAD these days, especially if you're on mitochondrial protocol. You use a little subq NAD in addition to things like MOTS-c or SS31. It kind of gives you a little more substrate for these mitochondrial peptides to work on.
And, you know, interesting other pathways these days, what I really recommend if you're going to do NAD is also really thinking about the two salvage pathways that NAD can break down into. And one of them is this CD38 pathway, which you might want to take some apigenin to kind of modulate.
I take a little NMN, 1MNA, in addition to some of the mitochondrial peptides. And that little protocol is, you know, I've seen people respond pretty well to that with increased energy levels and stuff like that.
DR ROSSI: I can really see these pathways in my brain. I'm getting flashbacks of studying them and salvage pathways. But you're really thinking not only about the immediate compound, but also the downstream, how these compounds get broken down or recycled basically in our body.
DR KUO: Correct. And there is such a thing as taking too much NAD. You can kind of overspill your bucket. And when you overspill that, you can actually cause more damage and oxidative stress. So no, I do not recommend people get NAD infusions once a week or something like that. I think that's just probably way too much.
It's actually really difficult to assess what is the optimal NAD dosing. There are companies that do intracellular NAD testing. The jury's still out on that. I've used it quite a bit. Are the results as reproducible and reliable all the time? I'm just not sure. There's still, I think, a lot of science that needs to be done in this field.
DR ROSSI: If you had an infinite budget, like Brian Johnson, you could take all this stuff. What do you wish people stopped wasting their money on? Or what is overhype?
DR KUO: I think oversupplementation is a real thing these days.
DR ROSSI: Like oral supplementation?
DR KUO: Yeah, just oversupplementation in general. I mean, I have patients come in and they will haul in all their supplements and it's…
DR ROSSI: Oh, you don't want to see my cabinet.
DR KUO: It's this gigantic bag of all sorts of stuff and it's like, you know, what's necessary versus what's not. If you kind of listen to every wellness person out there, everyone's kind of selling something else or selling their own compounds, selling their own things.
And like, you know, should you take prebiotics? Should you take postbiotics? Should you take Akkermansia? Should you take urolithin A or CoQ10 or DHA or methylated B vitamins or folate? There's an infinite list of things that are peddled.
It's hard to say. I'm not specifically very pro one thing versus another. I kind of try to use data and clinical experience to guide me on this. Most people do not need a lot of supplements. The main things that you really need are quite simple. It's vitamin D, it's magnesium, it's the omegas, omega 6-3s in a good combo.
But a lot of people, you can get that through a great diet as well. And so, if you boil down to the basics, a lot of people I test are deficient in vitamin D. Magnesium, yes, some people can be deficient in that, but that's really kind of it.
DR ROSSI: I love a good prenatal vitamin.
DR KUO: Yeah, I mean, things like the multivitamin or even vitamin B complexes, you probably don't need it for most people, if you have a good diet.
There is some good evidence on urolithin A. I've seen good stuff on that. Maybe Akkermansia as well. But yeah, there's just so much stuff out there. It is impossible for us to really figure it all out.
But, you know, back to the topic of peptides, this is where we really see bang for the buck. Most people feel great on peptides. They really do.
DR ROSSI: That's great. Yeah. I feel like you probably see those patients who maxed out on all these oral supplements that they've, you know…
DR KUO: I'm more interested in the testing, the assays, and the compounds themselves, or a mixture of both. I mean, I think AI drug discovery is going to really change the game so much. There's so many newer gene therapies and mRNA and siRNA. Some of these newer therapeutics are really going to completely change the game, I think, peptides.
The true level of biohacking. True level. Already you can solve a bunch of diseases and genetic conditions with gene editing. Gene therapy is going to be a huge thing. Already we have follistatin gene therapy that I've seen moderate to good results with already. So I think a lot more in that realm is going to come.
Some of these newer medications are truly phenomenal in so many different realms like immunotherapy, cancer therapy, reducing cholesterol. The list goes on and on. I think we're just scratching the surface of peptides right now. Peptide drug discovery. There's literally 7,000 peptides out there. And in clinical use, we really only use like 10 to 15 of them.
And so as more and more peptides come out with even more very specific biological functions and we can really elucidate their true mechanisms of action, I think this field's going to really explode. It's really targeted. Really targeted. Some of our unique therapies that we can put together are almost like a total system reboot kind of deal where we really try to change physiology and augment your cellular systems in these one to two day intensives.
Yeah, it's a long visit. It's several hours a day, but we're going through a whole sequence of procedures similar to what we discussed.
DR ROSSI: Very cool. And then in combination with good diet, good exercise, traditional, you know.
DR KUO: For sure. I mean, that cannot be understated at all. Diet, sleep, and exercise can get you 75, 80 percent to optimal health. Some of the things that we do is really unlocking that extra 20 percent. People, you can have a sharper mind. Most people do live with some degree of brain fog. If you really do things to optimize that, you can really unlock cognitive capabilities, physical capabilities, cognitive capabilities, just by peptides, hormones, inflammation, mitochondria, those four things. Optimize those and you just feel a lot better.
DR ROSSI: Yeah, I remember, I'm sure you felt this way too. In med school, you could study for hours and hours on end and not sleep and get through everything. You feel that diminish over time. And that's why people should be on hormones. And that's why people should consider augmenting your physiology with peptides.
I mean, I know men naturally decline their testosterone from a peak in their 20s or so. Whereas women usually, once they hit menopause, that's their really sharp decline. So men are more gradual, women are more sharp declines.
DR KUO: Yeah. I mean, on that topic, I see so many guys, so many men, just late 30s, early 40s with plummeting testosterone levels. And, you know, 300s, 400s is a combination of environmental toxins and stress and modern day lifestyles or some of our hormone leading food system. Alcohol. But this is a real issue.
If you see average testosterone levels in the 1950s versus the levels now, it's a dramatic decrease. Sperm quality, testosterone levels, big plummet. So managing testosterone is a big thing that we do.
DR ROSSI: We'll have to have you back on for a whole other discussion about hormones and optimization. Yeah. We're going to play this little game called Myth or Medicine.
Sure. So I'm going to tell you some quick fire statements. You tell me myth or real medicine.
Collagen peptides can rebuild your skin barrier. That's a tough one to start.
DR KUO: Yeah, it's a tough one, you know. I would actually say that that's a myth. Collagen peptides, you ingest it in your stomach, most of that stuff is just broken down. It's broken down into amino acids and protein. I don't feel like that's just ingesting protein.
DR ROSSI: So skip.
DR KUO: Yeah, I would skip that.
DR ROSSI: Copper peptides, best for skin care or there's better peptides out there?
DR KUO: It's very helpful. I do really love copper peptide. GHKCU is a great peptide for skin.
DR ROSSI: Is that injectable?
DR KUO: It is injectable, but you can actually use it topically as well. And so GHKCU is a really simple tripeptide. But when you bind it to copper, it becomes a potent signaling molecule. It stimulates wound healing, stimulates collagen, similar to elastin, angiogenesis as well. I really like GHKCU. So it's a signaling peptide that I think works pretty well, both topically and injected.
DR ROSSI: This might be controversial. But peptides are safer than Botox?
DR KUO: If you think about some of these things in your body and whether that has any kind of systemic effects, I think peptides are safer than Botox, but Botox to me is pretty safe.
DR ROSSI: Yeah. Using millions of patients.
DR KUO: As long as you don't get that counterfeit botulinum toxin that they're using in Florida. Unfortunately, that's a thing. They went to not reputable people and they were using counterfeit botulinum toxin that really hurt people. I mean, that was scary. That was not purified. So I think there was an alarming, people were like, oh, Botox is not safe. But real cosmetic and medical grade Botox, you know.
DR ROSSI: Yeah, we use that every day. Totally.
DR KUO: Myth or medicine, all peptides are basically the same.
DR ROSSI: I think you…
DR KUO: No, that's definitely not true. Different categories and signaling pathways. So that's not true.
DR ROSSI: Can peptides overcome bad diet and poor sleep?
DR KUO: No, they can't. They really can't. You got to get the fundamentals right before these peptides can really exert their function. I really do not recommend, if you can't do the basics, then don't even be on the peptides.
DR ROSSI: It's kind of how I see those people at the gym. They're injecting all this stuff, but they're not working out. And I'm like, it doesn't just grow the muscle. You actually still have to have the right stimulus to have these things work. You need the physiologic stimulus, the tension on the muscle.
Big into my world is peptides can just get rid of all your wrinkles. I wish that was the case, but.
DR KUO: No, that doesn't happen. I mean, you can improve collagen and then, you know, by some of these, the GHKCU and things like that. But no, it's not going to eliminate wrinkles.
DR ROSSI: The peptides that you're injecting, are they the exact same thing as something like growth hormone or is it like a biosimilar?
DR KUO: It's a biosimilar, I would say. Some of the growth hormone stimulating peptides, the GHRH or growth hormone releasing peptides, they stimulate your pituitary to release more growth hormone and so they're biosimilar. They're not exactly the same, but they biostimulate. And they're not what back in the day people were injecting, anabolic steroids. Very different. Very different.
HGH, straight HGH is very different than a growth hormone stimulating peptide. HGH is non physiological. And, yeah, you can definitely get into problems with that. But we see much less issues with growth hormone stimulating peptides.
DR ROSSI: Is that what you think some of the actors are on in Hollywood, who are just massive and huge? You see these guys with huge jaws and…
DR KUO: Yeah. I mean, that's most likely testosterone. Most likely some people are on a combination of some of the anabolic as well. If you're familiar with the bodybuilding community, yes, there's quite a few other anabolics that you can use in addition to testosterone or straight HGH as well.
I mean, most of some of these big guys at the gym are on a combination of T, HGH and some anabolics. They're almost like walking experiments. You see them.
Yeah, I mean, I do treat them. A few professional bodybuilders, including some people that are really at the top of their game. But long term use of these anabolics and HGH, you can really get into a lot of trouble. It causes a lot of cardiovascular stress, it stresses out your kidneys, and so some of these things may or may not be reversible.
DR ROSSI: Yeah, I think there was a Dutch study that showed the use of anabolic steroids, so not what we were talking about with peptides, but the use of anabolic steroids with all comers in these young men actually led to increased mortality and decreased lifespan, which was for all causes of death.
DR KUO: For sure.
DR ROSSI: Yeah, so, you know, again, don't get any of these at the gym.
And then fitness trackers, myth or medicine? What do you think?
DR KUO: I think the tracking of your data is really important these days. The continuous data is really gold and assesses feedback. Data is everything. The more data you have, the more insights you can get into improving some of your health markers.
So, yeah, we recommend quarterly blood work, DEXA scans twice a year, knowing your HRV scores and sleep scores and stress levels, using Whoop and Oura. We continuously monitor.
DR ROSSI: I have an Oura ring. It's probably out of battery right now, but I got to charge it.
DR KUO: The battery should last long. I actually use both. I actually use both. I think Oura is great for sleep. I don't think it's great for daytime activity tracking or anything like that. But the Whoop, I think, is really good for monitoring activity levels and stress during the day and HRV.
But I like both. I think they're both valid.
DR ROSSI: Yeah. All right. And, you know, last question, this show is called Give Good Face. So what does Give Good Face mean to you in terms of longevity, peptides, Extension Health?
DR KUO: It means you got to be healthy from the inside out. You want a good face, you just kind of need to be good on the inside as well, because everything on the inside reflects on the outside.
DR ROSSI: I love that. Yes. Yes. All right, good. All right, thank you, Dr. Kuo. You know, if people want to get in touch with Extension Health, where do they go?
DR KUO: Extension.health is our website. You can also follow me at @dr.kuo, or K U O, on Instagram or Extension Health on Instagram. So, you know, I try to be educational. I try to talk about…
DR ROSSI: I love your social, yeah.
DR KUO: No, thank you so much. I try to spread knowledge and get people excited about some of these newer techniques and technologies. And, yeah.
DR ROSSI: This was a great conversation. So thank you so much for coming. And I hope to have you back and we'll talk more about hormones and how we can optimize that.
DR KUO: Yeah, such a pleasure to be here. And thank you for having me.
DR ROSSI: Amazing. It was wonderful. And remember everyone, if you like this conversation, subscribe, follow, and we'll have all this content coming out for you.