Cold and flu season is approaching and one of the easiest ways to stay out of the emergency room or hospital this winter may take only a few minutes: make sure your vaccinations are up to date. Every fall and winter, we see an increase in influenza, COVID-19, RSV, pneumonia and other respiratory illnesses. For many healthy adults, these infections may mean several miserable days at home. But as we get older or develop conditions such as heart disease, lung disease, diabetes, obesity, kidney disease or a weakened immune system—the consequences can be much more serious. At Beverly Hills Institute, our goal is not simply to treat illness after it occurs. Preventive medicine means reducing your chances of becoming seriously ill in the first place. Flu Is Not “Just the Flu” During the 2024–2025 influenza season, the CDC estimated approximately: 51 million flu illnesses 23 million medical visits 710,000 hospitalizations 45,000 deaths The same CDC analysis estimated that influenza vaccination prevented approximately 10 million illnesses, 5 million medical visits, 180,000 hospitalizations and 12,000 deaths during that season. Vaccination does not guarantee that you will never contract influenza. That's not the appropriate way to measure its value. The more important question is: If you become infected, are you less likely to become severely ill, end up in the emergency department, require hospitalization or die? The evidence says yes. The 2026–2027 Flu Vaccine Is Trivalent All influenza vaccines in the United States for the 2026–2027 season are trivalent, designed to protect against three major influenza viruses expected to circulate this season. Beverly Hills Institute currently has the 2026–2027 Flublok Trivalent Influenza Vaccine in stock. This is indicated for all age groups, but in particular for adults 65 and older. What About COVID-19? COVID has not disappeared. It continues to cause substantial illness, emergency visits, hospitalizations and deaths, particularly among older adults and people with underlying medical conditions. Vaccination remains especially important for adults at higher risk of severe disease. Beverly Hills Institute currently offers COVID-19 vaccines for our higher-risk adult patients. We can review your age, medical conditions, prior vaccines and previous COVID infections to determine the appropriate timing for you. RSV: An Important Vaccine Many Adults Still Don't Know About Respiratory Syncytial Virus—or RSV—can cause serious respiratory illness in older adults. Current recommendations include: Age 75 and older: RSV vaccination is recommended. Age 50–74: RSV vaccination is recommended for adults at increased risk for severe RSV disease. Unlike influenza vaccination, RSV vaccination is not currently an annual vaccine. This vaccine is offered at most pharmacies. Don't Forget Pneumonia and Shingles Pneumococcal Vaccine — Starting at Age 50 Pneumococcus can cause pneumonia, bloodstream infections and meningitis. Pneumococcal vaccination is recommended for all adults age 50 and older who have not previously received the appropriate vaccine, as well as younger adults with certain medical risk factors. Shingles Vaccine — Starting at Age 50 Approximately 1 in 3 Americans will develop shingles during their lifetime. The Shingrix vaccine is recommended as a two-dose series for adults 50 and older, and for certain immunocompromised adults beginning at age 19. It is more than 90% effective at preventing shingles and postherpetic neuralgia in immunocompetent adults 50 and older. Your Adult Vaccine Checklist Age 18–49 Annual influenza vaccine, updated COVID vaccine, Tdap/Td as appropriate, Hepatitis B when indicated, and HPV, MMR, varicella or other vaccines depending on age, prior immunization and risk factors. Age 50–64 All of the above, plus Shingrix and pneumococcal vaccination. RSV vaccination should be considered if you have risk factors for severe RSV illness. Age 65–74 Particular attention should be paid to influenza, COVID, pneumococcal and shingles vaccination. Enhanced influenza vaccines are preferred when available. Age 75+In addition to the above, RSV vaccination is recommended if you have not previously received it. Vaccines Are Important, But They Are Not the Only Way to Reduce Infection Vaccination is one of our strongest tools for reducing severe illness, but everyday behavior also matters. Respiratory viruses commonly spread through droplets, aerosols and contaminated hands or surfaces. A few simple habits can meaningfully reduce your exposure: Avoid touching your eyes, nose and mouth with unwashed hands. These are major entry points for respiratory viruses. Wash your hands frequently with soap and water for at least 20 seconds. When soap and water are not available, use an alcohol-based hand sanitizer. Avoid close contact with people who are actively ill, when possible. If you are sick, stay home and avoid exposing others, particularly older adults and people with weakened immune systems. Cover coughs and sneezes with a tissue or your elbow rather than your hands. Consider wearing a well-fitting mask in crowded indoor environments when respiratory viruses are circulating heavily or if you are at high risk for complications. Improve indoor ventilation when possible by opening windows, using appropriate air filtration and avoiding poorly ventilated crowded spaces. Regularly clean frequently touched surfaces such as phones, door handles and shared work areas. Maintain good sleep, adequate nutrition, hydration and regular exercise, which support overall immune function. If you develop symptoms, consider early testing for influenza or COVID, because antiviral treatment works best when started early. These steps are especially important before travel, during holiday gatherings, and when spending time with elderly relatives or individuals with chronic medical conditions. Social Media Is Not Medical Research Vaccines have become one of the areas of medicine where a viral social-media post can sometimes receive more attention than decades of scientific research. Popularity is not evidence. A podcast, TikTok, Facebook post, Instagram reel or celebrity opinion does not carry the same scientific weight as controlled clinical trials involving thousands of people, ongoing safety surveillance involving millions of doses, peer-reviewed research and real-world hospitalization and mortality data. It is entirely reasonable to ask questions about a vaccine. In fact, you should ask questions. But make health decisions based upon reliable evidence and a discussion with a medical professional who understands your health, not an algorithm designed to maximize clicks, shares and outrage. Science is rarely about claiming that an intervention has zero risk or provides 100% protection. Medicine is about comparing risks and benefits. When it comes to influenza, COVID-19, RSV, shingles and pneumococcal disease, the evidence demonstrates that vaccination can substantially reduce serious illness and, most importantly, help keep patients out of the emergency room and hospital. Prevention Is the Goal At Beverly Hills Institute, we believe that good medicine should be proactive rather than reactive. It is far better to spend a few minutes preventing a serious infection than several days—or weeks recovering from one. Before winter arrives, we encourage our patients to contact our office and allow us to review their immunization history. We can determine which vaccinations you need, which ones you don't need, and the optimal timing based on your age and individual medical history. Beverly Hills Institute currently has the 2026–2027 Flublok Trivalent Influenza Vaccine and COVID-19 vaccine for high-risk adults in stock. And remember: if you do become ill this winter, CALL US FIRST. Early diagnosis and treatment can often prevent an unnecessary urgent-care visit, emergency-room visit or hospitalization. Stay protected. Wash your hands. Keep your hands away from your eyes, nose and mouth. And when it comes to your health, trust evidence, not social media.

The Growing Interest in Peptides “Doc, what do you think about peptides?” I get asked this question almost every day. BPC-157, TB-500, CJC-1295, Ipamorelin, MOTS-c—new names seem to appear almost as quickly as new social media posts promoting them. Someone hears about a peptide on a podcast. An influencer claims it transformed their recovery. A clinic promises better sleep, increased muscle mass, faster healing, or even a longer life. Suddenly, an experimental compound starts to resemble established medicine. However, before we delve into individual peptides, we must clarify one crucial point: How Do We Actually Know Whether a Treatment Works—and Whether It Is Safe? I Am Not Anti-Peptide On the contrary, we believe peptides have already transformed medicine. Insulin is a peptide hormone. Modern incretin medications have revolutionized the treatment of obesity and diabetes. Additionally, other peptide-based drugs are utilized throughout endocrinology and various other medical fields. Some experimental peptides currently under discussion may eventually become vital therapies. However, a significant distinction exists between a medication studied in thousands of humans and a compound that produced intriguing results in a mouse. They may both be peptides, but they do not share the same level of evidence. How Does an Idea Become Medicine? Medical research typically progresses through several stages: Laboratory Research → Animal Research → Human Trials → Regulatory Review → Ongoing Safety Monitoring Each step addresses different questions. Laboratory Research Researchers may initially study a compound in cells or tissues. This can help demonstrate how something might work. However, a cell in a laboratory dish is not a person. A molecule entering the human body may affect the immune system, metabolism, hormones, organs, and biological pathways that were never part of the original experiment. So, when someone asserts: “Studies show this works.” My first question is: What Kind of Studies? Animal Research Animal studies are valuable. They can help researchers understand biological effects, dosing, metabolism, and potential toxicity. However, animals and humans are different. Something that dramatically improves healing in a mouse may not yield the same results in a human. Similarly, something that appears safe during a short animal experiment may pose risks when used by people for months or years. When I encounter exciting animal research, my response is not: “It doesn't work.” Instead, I say: “Great. Now let's study humans.” That is how science should operate. Then Come Human Trials Even human research exists on different levels. Phase 1 Early studies primarily examine safety, dosing, and how the body processes a drug. Phase 2 Researchers begin to investigate whether it appears to work. Phase 3 Larger studies provide much stronger information about benefits and risks. This distinction is crucial. A compound being “studied in humans” does not imply it has been proven effective. Twenty people using something for a few weeks cannot inform us about what may happen when thousands of people use it for years. Study Size Matters Study Duration Matters What Researchers Actually Measured Matters A Better Number Does Not Always Mean a Healthier Person This is another area where hype can outpace science. A peptide may alter a hormone level, inflammatory marker, growth factor, or body-composition measurement. Interesting? Absolutely. However, the more important questions are: Did people actually feel better? Did they heal faster? Did they function better? Did they avoid disease? Did they live longer? What risks accompanied the benefits? A biological effect does not automatically translate into a meaningful health outcome. The Most Dangerous Phrase: “There Is No Evidence It Is Dangerous” We must exercise caution. That statement can imply: We studied this extensively and have not found a major safety problem. Alternatively, it can mean: Almost nobody has studied this properly, so we have no idea what the risks are. These are entirely different situations. UNKNOWN RISK ≠ LOW RISK Not knowing that something is dangerous is not synonymous with knowing that it is safe. And What Is Actually in the Vial? This question is often overlooked. Even when a particular molecule is scientifically interesting, the product being sold still matters. Is it genuinely what the label claims? Is the dose accurate? Is it sterile? Is it contaminated? Has it been stored correctly? A scientific study using a carefully manufactured product does not automatically validate every vial carrying the same peptide name. The molecule matters, but so do purity, sterility, dose, and manufacturing quality. Then Came Social Media Social media has empowered patients to become more informed and engaged. However, it has also created a significant problem: Social Media Moves Much Faster Than Science A good clinical trial may take years to complete. In contrast, a viral video can gain traction in seconds. The algorithm does not inquire whether a treatment has been properly studied; it only asks whether you clicked. This is why repetition can begin to resemble proof. But: Popularity Is Not a Phase of Clinical Research Testimonials Are Not Clinical Trials A Million Views Do Not Equal One Well-Designed Human Study My Position We are excited about the future of peptide medicine. Some of today's experimental compounds may become tomorrow's essential therapies. Others may fail. Some may reveal risks we do not yet understand. That is normal. That is science. What concerns us is when we bypass the process—when animal data becomes a treatment claim, a theoretical mechanism becomes a guarantee, and patients effectively become the experiment. Innovation is vital, but we should never have to abandon scientific standards to pursue it. Before Trying Any New Peptide, Ask Five Questions Has it actually been studied in humans? How many humans were involved? What benefit was actually proven? How long were people followed? Where did the product actually come from? These five questions can eliminate a remarkable amount of medical misinformation. The Bottom Line We believe peptide medicine has an exciting future. However, the future of medicine should be built on evidence—not algorithms. We should remain open to innovation while being honest about what we know, what we do not know, and what may still carry unknown risks. Sometimes the most responsible answer a physician can provide is: “We Don't Know Yet.” That may not go viral, but it may keep patients safe. Next: Part 2—What Exactly Is a Peptide? Next, we will explore what peptides actually are, how they function in the body, why some have become extraordinary medications, and what distinguishes established peptide medicine from the rapidly expanding world of experimental peptide therapy. Evidence over hype. Science over social media. Patient safety first. — Alex Foxman, MD, FACP, ABOM Double Board-Certified in Internal Medicine & Obesity Medicine Beverly Hills Institute This article is for general educational purposes and does not constitute individualized medical advice.

Protect Yourself Before Flu Season Arrives Beverly Hills Institute is pleased to announce that the 2026–2027 Influenza vaccine is now available in our office for adults 18 years of age and older. This year, we are offering Flublok® Trivalent, a recombinant, egg-free and preservative-free influenza vaccine. WHY GET VACCINATED? Influenza is more than a bad cold. It can cause serious illness, pneumonia, emergency room visits, hospitalization and even death. Flu vaccination can significantly reduce your risk of serious illness and hospitalization. Recent CDC data demonstrate the benefit: ↓ Approximately 30% lower risk of flu-related hospitalization in adults during the 2025–2026 season. During the severe 2024–2025 flu season, the CDC estimates that vaccination prevented approximately: 10 MILLION flu illnesses5 MILLION medical visits180,000 hospitalizations12,000 deaths Even when vaccination does not completely prevent influenza, vaccinated individuals who develop the flu may have less severe illness and a lower risk of serious complications. FLU VACCINATION IS RECOMMENDED FOR ADULTS OF ALL AGES Annual influenza vaccination is recommended for all adults, not just those considered high risk. It is especially important if you: • Are 65 years of age or older • Have heart or lung disease • Have diabetes or other chronic medical conditions • Have a weakened immune system • Are pregnant • Live with or care for someone at increased risk Even healthy adults should be vaccinated. Influenza can cause significant illness at any age, and vaccination also helps reduce the risk of spreading influenza to family, friends and vulnerable members of our community. ABOUT OUR 2026–2027 VACCINE Flublok® Trivalent ✓ Egg-free ✓ Preservative-free ✓ Antibiotic-free ✓ Recombinant vaccine technology ✓ Updated for the 2026–2027 influenza season ✓ One of the influenza vaccines preferentially recommended for adults 65 years and older DON'T WAIT UNTIL FLU IS SPREADING It takes approximately two weeks after vaccination for your immune system to develop protection. Getting vaccinated before influenza activity increases gives your body time to build immunity and helps protect you throughout the upcoming flu season. Schedule Your Flu Vaccine Today Please contact Beverly Hills Institute to schedule your 2026–2027 Influenza vaccination, at your convenience. Protect yourself. Protect your family. Stay healthy this flu season. Beverly Hills Institute Alex Foxman, MD, Inc. (310) 274-0657 Info@BHInstitute.com

MOTS-c, Semax, Selank, Epitalon, KPV and DSIP: Can a Peptide Really Make You Live Longer—or Think Better? The bigger the promise, the stronger the evidence should be. Unfortunately, in the longevity peptide world, the opposite often seems to be true. By Alex Foxman, MD, FACP, ABOM Double Board-Certified in Internal Medicine and Obesity Medicine Founder, Beverly Hills Institute “Doc, is there a peptide that can slow aging?” This may be the ultimate peptide question. Once we move beyond injury recovery, muscle and weight loss, the claims become even bigger: More energy. Better memory. Improved sleep. Less inflammation. Healthier mitochondria. Slower cellular aging. A longer life. MOTS-c, Semax, Selank, Epitalon, KPV and DSIP are increasingly promoted under the broad umbrella of longevity, brain health and anti-aging medicine. Some have fascinating biology. Some have intriguing animal rese. A few have been used or studied outside the United States. But when we ask the question that has guided this entire series What has actually been proven in humans? The story becomes much less exciting. MOTS-c: The “Exercise Mimetic” Peptide MOTS-c may be one of the most scientifically interesting peptides in this series. It is unusual because it is encoded within mitochondrial DNA. Researchers first described it in 2015, and laboratory and animal studies suggest that it may influence glucose metabolism, fat metabolism, cellular stress responses and energy regulation. In mice, synthetic MOTS-c has been associated with reduced diet-induced obesity and improved insulin sensitivity. That has led to dramatic marketing claims: Improves metabolism Burns fat Increases exercise performance Protects against aging Improves mitochondrial function Extends healthspan It sounds almost like exercise in a syringe. Unfortunately: Humans are not mice. FDA reviewers found no published studies in which compounded MOTS-c products were administered to humans and no adequate human exposure data from which to determine safety. FDA specifically continues to list MOTS-c among substances for which it lacks sufficient information to know whether administration to humans may cause harm. That doesn't mean MOTS-c will ultimately fail. It means we are still near the beginning of the story. But Didn't the FDA Advisory Committee Just Vote for MOTS-c? Yes—and this is where patients need to understand the regulatory language. In July 2026, the FDA Pharmacy Compounding Advisory Committee recommended that MOTS-c be added to the 503A Bulks List, potentially allowing qualifying pharmacies to compound it under specific circumstances. The same committee also supported several other controversial peptides. But FDA's own scientific reviewers had recommended against including MOTS-c because of the lack of human effectiveness and safety information. The committee recommendation is nonbinding, and it is not FDA approval. It does not mean MOTS-c has been shown to treat obesity. It does not mean it improves longevity. And it certainly does not mean it has been demonstrated to extend human life. Access and evidence are two completely different questions. Epitalon: Can We Manipulate Aging Itself? Epitalon may have one of the boldest reputations in the peptide world. It is promoted for: Anti-aging Telomere support Improved sleep Melatonin regulation Immune function Increased lifespan Much of the excitement comes from older preclinical work and reports suggesting effects on the pineal gland, telomerase activity and lifespan in laboratory models. But the leap from changing a cellular process to making a human live longer is enormous. At its July 2026 meeting, FDA specifically evaluated Epitalon for insomnia, not as a longevity therapy. FDA scientific staff recommended against adding it to the 503A Bulks List. The agency states that it has not identified adequate safety information for the proposed route of administration and has concerns involving peptide aggregation, impurities and potential immune reactions. The advisory committee nevertheless narrowly recommended its inclusion for compounding. Again: A vote allowing possible compounding is not proof that Epitalon slows human aging. We currently do not have large, rigorous, long-term randomized trials demonstrating that Epitalon extends human lifespan or prevents age-related disease. Semax: A “Nootropic” Peptide for the Brain Semax is frequently promoted as a cognitive-enhancing or “neuroprotective” peptide. Claims include: Improved memory Better concentration Reduced anxiety Stroke recovery Neuroprotection Increased BDNF Improved mental performance Semax has a history of medical use and investigation in Russia and some other countries, particularly in neurologic conditions. But international use is not the same as FDA approval. At the July 2026 meeting, FDA evaluated Semax for cerebral ischemia, migraine and trigeminal neuralgia. FDA staff again recommended against inclusion on the 503A Bulks List, citing insufficient evidence and limited safety information for proposed compounded routes. The advisory committee ultimately recommended Semax for inclusion. FDA nevertheless continues to state that compounded Semax may pose immunogenicity risks because of aggregation and peptide-related impurities, and that human safety information remains limited. This is where the same rule from Part 1 applies: A biological effect in the brain is not the same as improved cognition in a healthy human being. Increasing BDNF or affecting neurotransmitter pathways may be scientifically interesting. It does not prove that taking Semax will make you smarter or prevent dementia. Selank: The Anti-Anxiety Peptide Selank is often mentioned alongside Semax. It is marketed for: Anxiety reduction Stress resilience Improved focus Better mood Cognitive performance Unlike Semax, Selank was not one of the peptides reviewed at the July 2026 advisory committee meeting. However, FDA currently lists Selank acetate among substances for which important human safety information is lacking and identifies potential concerns involving peptide aggregation, impurities and immunogenicity. There are published studies from Russia and surrounding regions, but the evidence base does not resemble the large, multicenter randomized trials we would expect before recommending a drug broadly for anxiety or cognitive enhancement in healthy Americans. For now, I would consider Selank investigational—not established neuropsychiatric medicine. KPV: The Tiny Anti-Inflammatory Peptide KPV is a three-amino-acid fragment associated with alpha-melanocyte-stimulating hormone. It is promoted for: Gut inflammation Skin disease Autoimmune conditions Wound healing “Systemic inflammation” There is interesting laboratory evidence suggesting anti-inflammatory activity. But as of the FDA's latest review, the agency reported that it had identified no human exposure data for drug products containing KPV through any route of administration. Yet the July 2026 advisory committee recommended it for inclusion on the 503A Bulks List. That provides perhaps the clearest example of the distinction we have discussed throughout this series: A regulatory recommendation does not manufacture missing clinical data. KPV may ultimately become useful. Today, we simply do not have enough human evidence to know. DSIP: The “Sleep Peptide” Delta sleep-inducing peptide—now referred to by FDA as emideltide—has been marketed for years for: Insomnia Deeper sleep Stress reduction Pain Opioid withdrawal Hormonal regulation Its name alone is great marketing. Who doesn't want a peptide called “delta sleep-inducing peptide” if they cannot sleep? But names do not determine effectiveness. At the July 2026 advisory meeting, FDA reviewed emideltide for opioid withdrawal, chronic insomnia and narcolepsy. FDA staff recommended against inclusion on the compounding list because adequate effectiveness and safety evidence were lacking. Unlike MOTS-c, Semax, KPV and Epitalon, the advisory committee did not recommend emideltide/DSIP for inclusion. FDA also states that it has not identified adequate safety information for the proposed administration route. For a substance promoted for decades, that should make patients stop and ask: If this is such an effective sleep treatment, where are the convincing modern human trials? What About Thymosin Alpha-1? Thymosin alpha-1 deserves its own category. It has been studied internationally for immune modulation and is approved for certain indications in some countries, but it is not an FDA-approved drug in the United States. It is promoted domestically for immune “boosting,” infection resistance and longevity. But more immune activity is not necessarily better immune function. The immune system needs regulation, not simply stimulation. FDA currently states that available safety information for compounded thymosin alpha-1 is inadequate to fully characterize potential risks and notes concerns involving immunogenicity and peptide-related impurities. The Biggest Problem With “Longevity” Claims If someone tells me a drug helps pain, we may be able to test pain. If someone tells me a drug lowers cholesterol, we can measure cholesterol. But if someone claims: “This peptide slows aging.” The scientific burden becomes enormous. Does it reduce heart attacks? Cancer? Dementia? Frailty? Disability? Mortality? Does it improve healthspan rather than simply alter a laboratory marker? And how many years were people followed? Changing a biomarker associated with aging is not the same as slowing human aging. Telomeres are not longevity. Mitochondrial signaling is not longevity. A higher BDNF level is not dementia prevention. Reduced inflammation in a mouse is not proof that a human will live longer. These may be clues. They are not answers. My Physician Verdict MOTS-c One of the more scientifically intriguing experimental peptides, particularly from a metabolic and mitochondrial standpoint. But there is not yet adequate human clinical evidence to recommend it for obesity, performance or longevity. Semax Interesting neurologic pharmacology and international experience, but insufficient high-quality evidence for routine cognitive enhancement or brain-health use in healthy adults. Selank Interesting but investigational. Not enough high-quality human evidence for routine anxiety or cognitive treatment. Epitalon Longevity claims dramatically exceed the evidence. There is no convincing evidence that it extends human lifespan. KPV Interesting anti-inflammatory biology, but essentially absent meaningful human exposure data. DSIP / Emideltide An appealing concept with an appealing name—but inadequate modern clinical evidence to recommend it as an established sleep treatment. Thymosin alpha-1 A biologically active immunomodulator with legitimate research history, but current U.S. wellness and longevity claims go beyond established FDA-approved medicine. So After Five Parts, What Do I Actually Think About Peptides? I began this series with the question patients ask me almost every day: “Doc, what do you think about peptides?” My answer after reviewing the science is the same—but more nuanced. Peptides are not the problem. Bad evidence is. Some peptide medications have revolutionized medicine. Insulin saves lives. Modern incretin therapies have transformed obesity and diabetes treatment. Other peptide medications have proven indications in osteoporosis, endocrinology and other diseases. And many experimental peptides deserve serious scientific investigation. But something troubling has happened. The commercial peptide market has begun treating the beginning of scientific discovery as though it were the end. A mouse study becomes a treatment. A mechanism becomes a promise. A biomarker becomes “longevity.” A podcast becomes informed consent. And a regulatory discussion about compounding becomes “FDA approved” on social media. That is not how medicine should work. My Rule Is Simple I am willing to be early on promising science. I am not willing to be ahead of the evidence when my patient's safety is involved. Innovation and evidence-based medicine are not enemies. The best medicine requires both. We should absolutely investigate MOTS-c. Study BPC-157 properly. Determine whether Semax has meaningful neurologic applications. Explore peptide therapies for metabolic disease, inflammation, tissue repair and aging. But do the trials. Measure the outcomes. Follow patients long enough. Monitor the complications. And then let the evidence—not the algorithm—tell us what works. The future of peptide medicine may be extraordinary. But the future should arrive through science. Not through hype. Evidence over hype. Science over social media. Patient safety first. — Alex Foxman, MD, FACP, ABOM Double Board-Certified in Internal Medicine & Obesity Medicine Beverly Hills Institute Regulatory information reviewed through August 17, 2026. FDA advisory committee recommendations discussed above are nonbinding and should not be interpreted as FDA drug approval. This article is intended for general educational purposes and does not constitute individualized medical advice.

CJC-1295, Ipamorelin, Sermorelin, AOD-9604 and Tesamorelin: Can We Really Hack Growth Hormone Safely? Increasing a hormone is easy to measure. Proving that doing so makes a healthy person live longer, function better or age more slowly is a very different question. By Alex Foxman, MD, FACP, ABOM Double Board-Certified in Internal Medicine and Obesity Medicine “Doc, what about peptides for muscle, fat loss and anti-aging?” This is where the peptide conversation gets particularly interesting. CJC-1295. Ipamorelin. Sermorelin. AOD-9604. Tesamorelin. And often ibutamoren, which is commonly grouped with peptides even though it is not actually a peptide. They are promoted for increasing growth hormone, building muscle, burning visceral fat, improving sleep, accelerating recovery and even “reversing aging.” The biology behind some of these compounds is real. BUT once again: Real biology does not automatically equal proven medicine. First: What Are We Trying to Manipulate? Growth hormone, or GH, is produced by the pituitary gland. Its release is controlled partly by growth hormone-releasing hormone from the hypothalamus and other signaling systems. GH then influences tissues directly and stimulates production of IGF-1, another powerful growth signal. This system affects growth, metabolism, body composition and tissue function. That sounds like an attractive target for “optimization.” But here is the problem: More is not automatically better. If a drug increases GH or IGF-1, that proves the drug affected the pathway. It does not prove that a healthy adult will build meaningful muscle, lose dangerous fat, avoid disease, improve healthspan or live longer. And it certainly does not establish long-term safety. CJC-1295: Raising GH Is Not the Same as Improving Health CJC-1295 is a synthetic analog of growth hormone-releasing hormone. Certain versions were engineered to remain active considerably longer than natural GHRH. Small studies in healthy adults showed that CJC-1295 could increase GH and IGF-1 levels. That is frequently where the online story ends. But FDA reviewers found no human effectiveness data for CJC-1295 in patients with growth hormone deficiency, the condition for which the substance was being evaluated for possible compounding. The available human studies were small, short and conducted in healthy adults. Reported effects included dose-dependent increases in heart rate, injection-site reactions, dizziness, hypotension and other symptoms requiring further study. Then came an unusually important FDA advisory vote. In December 2024, the FDA Pharmacy Compounding Advisory Committee overwhelmingly recommended against placing the various CJC-1295 forms it reviewed on the 503A Bulks List. For most forms the vote was 13–0 against inclusion; CJC-1295 acetate was 12–1 against. FDA’s current compounding safety page continues to identify CJC-1295 as having limited clinical data and potential concerns involving immunogenicity, impurities and serious adverse reactions; the prior nomination is now listed as withdrawn. CJC-1295 can raise GH. What has not been established is that routinely raising GH with CJC-1295 makes otherwise healthy adults healthier. Those are very different claims. Ipamorelin: Popularity Is Not Evidence Ipamorelin stimulates the ghrelin receptor and causes growth hormone release through a somewhat different mechanism from CJC-1295. It is often promoted in “optimization” clinics for muscle, sleep, fat loss and recovery—and frequently combined with CJC-1295. But FDA’s extensive review found insufficient evidence supporting ipamorelin for growth hormone deficiency or postoperative ileus through the proposed subcutaneous route. FDA also raised concerns about peptide impurities, aggregation and possible immune reactions. An intravenous study in postoperative patients reported hypokalemia, hyperglycemia, nausea, vomiting and other adverse events; two deaths occurred among ipamorelin-treated participants, although FDA specifically noted that it was unclear whether ipamorelin caused those deaths. In October 2024, the FDA advisory committee voted 0–12, with one abstention, against recommending either ipamorelin free base or ipamorelin acetate for the 503A Bulks List. One committee member made a point worth remembering: High prescribing frequency does not prove that a drug is safe and effective. As of 2026, FDA still lists ipamorelin acetate among bulk substances that may present significant safety risks for certain compounded uses. Sermorelin: A More Complicated Story Sermorelin deserves more nuance. It is a 29-amino-acid analog of naturally occurring growth hormone-releasing hormone. Unlike many peptides discussed in this series, sermorelin has legitimate FDA regulatory history: Geref (sermorelin acetate) received FDA approval in 1997 for growth hormone deficiency in children with growth failure. But that historical approval does not mean every sermorelin product being sold today is FDA-approved—and it certainly does not establish sermorelin as an anti-aging or longevity treatment. FDA has taken enforcement action against online sellers marketing sermorelin products for human use when no approved application existed for those products. This is exactly why the phrase “FDA-approved peptide” requires context. Approved which product? At what dose? For what population? For what condition? Using evidence from pediatric growth hormone deficiency to market sermorelin as a fountain-of-youth injection for healthy 55-year-olds is an enormous scientific leap. AOD-9604: The Fat-Burning Peptide With an Awkward Clinical Trial AOD-9604 is a modified fragment of human growth hormone developed with the hope of affecting fat metabolism without producing all of growth hormone's other effects. Online, it is marketed aggressively as a “fat-burning peptide.” But here we have something particularly useful: A reasonably large human trial was actually performed. A randomized study enrolled 536 adults with obesity and compared oral AOD-9604 with placebo alongside diet and exercise. It failed its primary weight-loss endpoint. FDA’s review noted that there was no statistically significant difference in weight loss at 12 weeks, and the company developing AOD-9604 subsequently terminated its obesity development program. FDA also found no human data supporting the subcutaneous route now commonly marketed by wellness clinics. In December 2024, the FDA advisory committee voted 12–0 against recommending AOD-9604-related substances for the 503A Bulks List. This is one of my favorite examples in the entire peptide series. Because when someone tells you: “The mechanism makes perfect sense.” Remember: The clinical trial still gets the final vote. Ibutamoren: Not a Peptide—but Part of the Same Hype Ibutamoren, also called MK-677, is often sold alongside peptides. Technically, it is not a peptide. It is an orally active growth hormone secretagogue that stimulates the ghrelin receptor. It has been investigated for conditions ranging from growth hormone deficiency to sarcopenia and osteoporosis. But in October 2024, the FDA advisory committee voted 13–1 against including ibutamoren on the 503A Bulks List. Committee members cited insufficient evidence of clinical efficacy and safety and raised concerns including fluid retention, hyperglycemia and congestive heart failure. Again, activating a pathway is not the same as improving long-term health. Then There Is Tesamorelin—and This Is Why Evidence Matters Tesamorelin provides an important contrast. It is also a growth hormone-releasing hormone analog. But unlike CJC-1295 or ipamorelin, tesamorelin went through substantial clinical development and became an FDA-approved medication. Current EGRIFTA WR is indicated specifically for reducing excess abdominal fat in adults with HIV-associated lipodystrophy. It is explicitly not approved for general weight-loss management. Two large Phase 3 studies involving more than 800 participants demonstrated approximately a 15% treatment effect on visceral abdominal fat at 26 weeks, with benefits maintained during continued treatment. That is what meaningful human evidence looks like. But notice something else. Even an FDA-approved growth hormone-releasing peptide carries important precautions. Current prescribing information calls for monitoring IGF-1 and glucose and warns about fluid retention, glucose intolerance or diabetes and concerns involving malignancy. Active cancer is a contraindication. That should tell us something. Manipulating the GH/IGF-1 pathway is not biologically trivial. If the FDA-approved member of this family requires careful patient selection and monitoring, why would we assume that less-studied versions sold for “optimization” are automatically harmless? And Then Comes “Stacking” This may concern me even more. Patients are sometimes prescribed combinations such as CJC-1295 plus ipamorelin—or multiple peptides layered on top of testosterone, growth hormone, GLP-1 drugs and supplements. The problem is simple: Evidence about Drug A plus evidence about Drug B does not equal evidence about A + B + C + D. Interactions can change physiology. Side effects can overlap. GH and IGF-1 may rise further. And when something goes wrong, identifying the responsible drug becomes much harder. A “stack” may sound sophisticated. Without appropriate clinical research, it can also be a sophisticated experiment. My Double Board Certified Physician Verdict Compound Where I Put It Today CJC-1295 Biologically active, but insufficient evidence for routine anti-aging, muscle or longevity use Ipamorelin Insufficient evidence and unresolved safety concerns Sermorelin Legitimate pharmacologic history, but current anti-aging/optimization claims go far beyond its established evidence AOD-9604 Particularly unconvincing for weight loss because a substantial human trial failed its primary endpoint Ibutamoren Not a peptide; investigational, with meaningful metabolic and fluid-retention concerns Tesamorelin Established evidence-based peptide medicine for a very specific FDA-approved indication, not general weight loss or anti-aging The Bottom Line The growth hormone system is powerful. That is precisely why I do not believe we should manipulate it casually. Can a compound increase GH? Maybe. Can it increase IGF-1? Possibly. But those are laboratory results. The questions that matter to me as a physician are harder: Will you actually be healthier? Will you function better? Will you avoid disease? Will you live longer? And what might happen after five or ten years of manipulating a growth pathway? For most of the “optimization peptides” being promoted today, we simply do not have those answers. And once again: “We don't know” is not anti-innovation. It is the scientifically correct answer until the evidence arrives. Do not confuse a higher hormone level with better health. Do not confuse a plausible mechanism with a proven outcome. And do not let the word “optimization” lower the scientific standard you would demand from any other medication. Next: Part 5—The Longevity and Brain Peptides MOTS-c. Semax. Selank. Epitalon. KPV. DSIP. Thymosin alpha-1. These are being promoted for longevity, cognition, mitochondrial health, sleep, inflammation and even slowing aging itself. And several of them were just placed directly under the microscope at the FDA's July 2026 peptide advisory meetings. For the final installment, we will ask the biggest question of the series: Can any peptide actually help us live longer—or has the marketing finally outrun the science completely? Evidence over hype. Science over social media. Patient safety first. — Alex Foxman, MD, FACP, ABOM Double Board-Certified in Internal Medicine & Obesity Medicine Beverly Hills Institute Regulatory information reviewed through August 10, 2026. This article is intended for general educational purposes and does not constitute individualized medical advice.

BPC-157, TB-500 and GHK-Cu: Promising Science—or Patients Getting Ahead of the Evidence? Your tendon is not a mouse, your injection is not a clinical trial, and an influencer testimonial is not a safety study. By Alex Foxman, MD, FACP, ABOM Double Board-Certified in Internal Medicine and Obesity Medicine Founder and Medical Director, Beverly Hills Institute “Doc, can peptides help my injury heal faster?” This may be the question I hear most often about peptide therapy. At gyms, med spas, wellness clinics and online, BPC-157, TB-500 and GHK-Cu are promoted as tools for repairing tendons, rebuilding ligaments, healing wounds, reducing inflammation and accelerating recovery. The promise is extremely appealing. Who would not want to recover faster from an injury, surgery or years of joint pain? But the excitement surrounding these peptides has moved much faster than the human evidence. BPC-157: The Internet’s Favorite “Healing Peptide” BPC-157 is a synthetic peptide containing 15 amino acids. It is commonly described as a fragment of a protective compound associated with gastric juice and was first synthesized by researchers in Croatia during the early 1990s. It is not an FDA-approved medication. It is promoted for: Tendon and ligament healing Muscle and joint recovery Gut repair Reduced inflammation Postoperative healing Much of the enthusiasm comes from laboratory and animal research. In rodents, BPC-157 has been associated with effects on tendon, ligament, muscle and gastrointestinal healing. Proposed mechanisms include changes in inflammatory signaling, nitric oxide pathways, growth-factor activity and angiogenesis—the formation of new blood vessels. That biology is interesting. But interesting biology is not the same as a proven human treatment. What Human Evidence Exists? The FDA’s 2026 review identified only five small published human studies involving BPC-157. The routes and doses varied considerably: Rectal administration in healthy participants Rectal administration in patients with ulcerative colitis Injections into painful knees Administration into the bladder Intravenous infusions in only two people The studies were small, brief and exploratory. Safety monitoring was limited or unclear in several of them. A registered Phase 1 oral study was also identified, but results had not been posted and the FDA could not locate an associated publication. Most importantly, the FDA did not identify clinical trials establishing that BPC-157 heals human tendons or ligaments. The agency specifically did not evaluate its use for tendonitis because adequate supporting information and relevant clinical studies were not available. Pain relief is not proof of tissue regeneration. A person may report less knee pain after an injection. That does not prove that cartilage regenerated, a tendon repaired itself or a ligament became structurally stronger. To establish healing, researchers would need appropriately controlled trials using meaningful functional outcomes and, when appropriate, imaging or other objective measurements. Two People Are Not a Safety Trial A 2025 report described two adults who received intravenous BPC-157 over two days without a serious short-term complication being observed. That may be reassuring for those two people. It does not establish safety for thousands of patients using BPC-157 for weeks, months or years. A two-person study cannot reliably identify uncommon immune reactions, cardiovascular effects, reproductive risks, organ toxicity or delayed complications. This is a perfect example of how a technically accurate statement can become misleading online. “BPC-157 was safely given intravenously to humans” sounds impressive. “Two people received it for two days” tells the more complete story. What About Angiogenesis and Cancer Risk? BPC-157’s proposed ability to stimulate new blood-vessel formation is often presented as a reason it may help damaged tissue heal. That same biological pathway also deserves careful long-term study. This does not prove that BPC-157 causes cancer. However, FDA reviewers found no carcinogenicity studies and noted that its molecular targets and mechanisms remain poorly understood. Limited animal toxicology also produced signals involving clotting measurements and liver-related laboratory findings that require further investigation. The responsible conclusion is not that BPC-157 is definitely dangerous. It is that long-term risk remains inadequately defined. Is the Product in the Vial the Same as the Research Compound? Not necessarily. FDA reviewers found inconsistent naming involving BPC-157 free base and BPC-157 acetate. These are distinct active pharmaceutical ingredients that may differ in stability, solubility, pharmacology and clinical effects. The agency also identified gaps involving identity, purity, peptide-related impurities, aggregation, microbial quality and bacterial endotoxins. So even when a study examines something called “BPC-157,” that study does not automatically validate every commercially sold vial carrying the same name. For injected products, the questions extend far beyond whether the molecule might work: Is it sterile? Is the concentration accurate? Has it degraded? Does it contain bacterial endotoxins? Were impurities adequately measured? Peptides can aggregate during manufacturing or storage, potentially altering activity and increasing the risk of an immune response. FDA concluded that there is insufficient clinical information to characterize BPC-157’s safety and raised particular concerns about immunogenicity, aggregation and peptide-related impurities. TB-500: Not the Same as Thymosin Beta-4 TB-500 is promoted for: Tissue repair Muscle recovery Flexibility Wound healing Reduced inflammation It is generally described as a seven-amino-acid fragment related to thymosin beta-4, a naturally occurring protein involved in cellular movement and tissue biology. But this distinction is essential: TB-500 is not full-length thymosin beta-4. Research involving naturally occurring thymosin beta-4 cannot simply be applied to the smaller synthetic fragment marketed as TB-500. In fact, the references submitted to the FDA in support of TB-500 involved thymosin beta-4—not human studies in which TB-500 itself was administered. What Human Evidence Exists? According to the FDA’s 2026 scientific review, NONE. The agency found: No human treatment studies No human pharmacokinetic studies No human pharmacodynamic studies No clinical safety trials No identified human exposure data through any route FDA therefore concluded that TB-500’s potential risks in humans remain unknown. That does not mean TB-500 has been proven harmful. It means there is not enough reliable human evidence to determine whether it is safe or effective. No reported side effects are not reassuring when there are no adequate human studies from which to report them. FDA also raised concerns about impurities, peptide aggregation and immune reactions—particularly when TB-500 is administered by injection. What the New FDA Advisory Vote Actually Means In July 2026, the FDA’s Pharmacy Compounding Advisory Committee voted narrowly to recommend adding BPC-157 and TB-500-related substances to the 503A Bulks List, which could eventually permit qualifying pharmacies to compound them under certain conditions. FDA scientific staff had recommended against inclusion because of the evidence and safety gaps discussed above. This was not FDA approval. The advisory recommendation is nonbinding; the FDA has not completed its final determination, and the committee was considering eligibility for compounding—not proving that BPC-157 heals tendons or that TB-500 accelerates recovery. The FDA evaluated BPC-157 for ulcerative colitis and TB-500 for wound healing, not the full range of claims being made online. Even if the FDA ultimately permits compounding, compounded drugs are not FDA-approved and are not reviewed before marketing in the same way for safety, effectiveness and quality. A compounding pathway is not a clinical trial. Greater access is not stronger evidence. GHK-Cu: Topical Skin Science Is Not Injectable Anti-Aging Medicine GHK-Cu is a naturally occurring copper-binding tripeptide promoted for: Skin rejuvenation Collagen production Hair growth Wound healing Anti-aging There is laboratory and animal research suggesting effects on inflammation, tissue remodeling and wound repair. Some topical products and small studies have explored cosmetic or post-procedure skin uses. However, much of the broader anti-aging narrative continues to rely on preclinical findings rather than large, high-quality human trials. The route matters enormously. Evidence involving a topical cream does not validate injecting the same peptide. Topical application, microneedle delivery, subcutaneous injection and intravenous infusion create very different levels of exposure and potentially different risks. The FDA specifically lists injectable GHK-Cu among compounded substances for which there are limited human safety data. It has raised concerns about aggregation, peptide-related impurities and possible immunogenicity. A cosmetic ingredient applied to the skin should not automatically be transformed into a whole-body “longevity treatment.” My Double Board Certified Physician Verdict BPC-157 Scientifically interesting and worthy of legitimate human research. Not supported by enough high-quality human evidence for me to recommend it as an established treatment for tendon, ligament, muscle, gut or postoperative healing. If I wouldn't recommend this to my family, I am not going to recommend it to my patients. The RISK still greatly outweighs the benefit. TB-500 Even less supported. FDA reviewers found no clinical studies or adequate human exposure data involving TB-500 itself. I would not recommend its routine use outside a properly regulated clinical trial. The RISK still greatly outweighs the benefit. GHK-Cu Topical use has a different—and somewhat more plausible—evidence and safety discussion than systemic injection. Injectable GHK-Cu lacks sufficient human safety evidence for routine anti-aging, hair-growth or recovery treatment. The RISK still greatly outweighs the benefit. The Bottom Line These compounds may have a future. But today, the marketing remains far ahead of the proof. Your tendon is not a mouse. A reduction in pain is not proof of tissue regeneration. Research involving thymosin beta-4 does not prove that TB-500 works. A topical cosmetic study does not validate an injectable anti-aging protocol. And an FDA advisory recommendation about compounding does not convert an experimental peptide into an FDA-approved treatment. Your body deserves more than a theory, a testimonial and a vial. It deserves real science. Next: Part 4—Growth Hormone Peptides and the “Optimization” Market CJC-1295. Ipamorelin. Sermorelin. AOD-9604. Tesamorelin. Can manipulating growth-hormone pathways safely improve muscle, recovery, fat loss and healthspan—or are we activating powerful biological signals without adequately understanding their long-term consequences? Evidence over hype. Science over social media. Patient safety first. — Alex Foxman, MD, FACP, ABOM Double Board-Certified in Internal Medicine & Obesity Medicine Founder and Medical Director, Beverly Hills Institute Current regulatory information as of August 3, 2026. This article is intended for general educational purposes and does not constitute individualized medical advice.

“Peptide” is a scientific category—not a seal of safety, purity, or effectiveness. By Alex Foxman, MD, FACP, ABOM Double Board-Certified in Internal Medicine and Obesity Medicine Founder, Beverly Hills Institute “Doc, are peptides safe?” That question sounds simple. It is not. Asking whether peptides are safe is like asking whether medications are safe. Which medication? At what dose? For what condition? Manufactured by whom? And supported by what evidence? Insulin is a peptide. Semaglutide and tirzepatide are peptide-based medications. So are glucagon, teriparatide, tesamorelin and many other legitimate treatments. But BPC-157, CJC-1295 and a vial purchased online marked “research use only” also get placed under the same broad peptide label. These are not scientifically equivalent. What Is a Peptide? Peptides are short chains of amino acids—the same basic building blocks used to construct proteins. Your body naturally produces peptides that act as biological messengers. They help regulate appetite, metabolism, blood sugar, growth, inflammation, reproduction and many other functions. Many peptides work by attaching to receptors on cells and delivering a biological instruction: Release insulin. Reduce appetite. Stimulate bone formation. Trigger or suppress a hormone. Change an immune response. Because peptides can target specific receptors, they can produce powerful and relatively focused effects. That precision has made them an increasingly important area of drug development. Recent scientific reviews describe approximately 100 peptide therapies approved in major markets, with hundreds more being evaluated in clinical and preclinical programs. But “powerful” does not automatically mean “beneficial.” A strong biological signal can create a therapeutic effect, an adverse effect—or both. Why Are Many Peptides Injected? Most ordinary proteins and peptides are broken apart by digestive enzymes. That is why swallowing insulin does not work like injecting insulin. The digestive system treats it more like food than medicine. Many peptides also have short half-lives, meaning the body breaks them down quickly. Pharmaceutical scientists may alter their structure, attach other molecules or develop specialized delivery systems to help them remain active longer. This engineering is one reason semaglutide can be administered weekly rather than repeatedly throughout the day. And the technology is advancing. In July 2026, the FDA approved enlicitide, the first oral PCSK9 inhibitor for lowering LDL cholesterol. Enlicitide is a highly engineered macrocyclic peptide designed to survive oral administration—something that historically has been extremely difficult for peptide medicines. That is real peptide innovation. It followed laboratory development, controlled human trials, manufacturing review and FDA evaluation. It did not begin and end with an influencer testimonial. The Four Very Different Peptide Categories When someone says they are “taking peptides,” I want to know which of these categories they mean. 1. FDA-Approved Peptide Medication These medications have been evaluated for a defined formulation, dose, route and medical indication. Examples include insulin, semaglutide, tirzepatide, teriparatide and tesamorelin. FDA approval does not mean a drug has no risks. It means its benefits and risks have been formally studied for specific uses and its manufacturing must meet defined standards. Approval of one peptide does not validate every peptide—or even every product claiming to contain that same molecule. 2. Legitimately Investigational Peptide An investigational peptide may have encouraging early evidence and be studied under a formal clinical-trial protocol. That does not make it fraudulent. It also does not make it proven. Investigational means researchers are still determining whether it works, what dose is appropriate and what risks may emerge. 3. Compounded Peptide Compounding can serve an important role when a patient's needs cannot be met by an available FDA-approved product. But compounded drugs are not FDA-approved. The FDA does not review each compounded product for safety, effectiveness or quality before it reaches patients. Problems with potency, contamination, sterility and labeling can create serious risks. The words “made by a pharmacy” should not be confused with “FDA-approved.” 4. Internet or “Research Use Only” Peptide This is the category that concerns me most. In 2026, the FDA issued multiple warning letters to online peptide sellers offering injectable products while labeling them “research use only” or “not for human consumption.” The agency concluded that marketing claims showed the products were actually intended for human use and emphasized the additional danger posed by injectables that bypass the body's natural defenses against contaminants and microorganisms. A disclaimer on a vial does not guarantee purity. It may be a warning that the seller is trying to avoid responsibility. The FDA Is Drawing a Sharper Line The current FDA message is not that peptides are inherently bad. The message is more precise: Well-studied peptide medicines can be extraordinary. Unapproved products should not borrow credibility from approved ones simply because they share the word “peptide.” The FDA continues to identify limited human safety information and potential concerns involving impurities, aggregation and immune reactions for frequently promoted compounds such as BPC-157, CJC-1295, injectable GHK-Cu and ipamorelin. That does not prove every one of these compounds will ultimately fail. It means the evidence has not yet earned the confidence of established medicine. My Bottom Line I am not anti-peptide. I prescribe peptide medications when the science, indication and expected benefit justify their use. I am also excited about where peptide engineering may take medicine next. But the word peptide tells you what kind of molecule something is. It does not tell you: Whether it works Whether it is safe Whether humans have studied it Whether the vial is sterile Whether the dose is accurate Whether the long-term risks are known So the next time someone says: “It is only a peptide.” Remember: “Natural” does not mean harmless. “Experimental” does not mean proven. And “research use only” certainly does not mean safe to inject. Next: Part 3—BPC-157, TB-500 and the Promise of Faster Healing These may be the most aggressively promoted recovery peptides on the internet. What do the animal studies actually show? What human evidence exists? What risks remain unknown? And would I recommend them to my own patients? Evidence over hype. Science over social media. Patient safety first. — Alex Foxman, MD, FACP, ABOM Double Board-Certified in Internal Medicine and Obesity Medicine Beverly Hills Institute This article is intended for general educational purposes and does not constitute individualized medical advice.

Cancer care is undergoing a significant transformation. For decades, the focus has been on identifying cancer after symptoms appear or when the disease has advanced. Today, two major areas of research are steering us toward a more proactive model: early detection of cancer and reducing metabolic conditions that may increase cancer risk or progression. At the 2026 American Society of Clinical Oncology Annual Meeting, two topics stood out: new data on the GRAIL Galleri® multi-cancer early detection blood test and emerging research on GLP-1 medications, including semaglutide and tirzepatide, and their potential relationship to cancer outcomes. At Beverly Hills Institute, we believe the future of preventive medicine is not merely treating disease after it appears. It is about identifying risks earlier, acting sooner, and helping patients live longer, healthier lives. The GRAIL Galleri Test: A Blood Test Designed to Look for More Than 50 Cancers The Galleri test is a blood test designed to detect cancer signals from DNA shed into the bloodstream by cancer cells. It is important to note that it is not a genetic risk test. It does not indicate whether you may develop cancer in the future. Instead, it looks for signals that may suggest cancer is already present and may help predict where in the body that cancer signal originates. This is crucial because many dangerous cancers do not currently have routine screening tests. We routinely screen for breast cancer, colon cancer, cervical cancer, prostate cancer in selected patients, and lung cancer in high-risk smokers. However, many cancers, including pancreatic, ovarian, liver, esophageal, and other aggressive cancers, are often diagnosed late due to the absence of practical screening tools for the general population. Galleri is intended to be used in addition to, not as a replacement for, standard recommended cancer screenings such as mammography, colonoscopy, PSA testing when appropriate, cervical cancer screening, and lung cancer screening for eligible patients. What Was Presented at ASCO 2026? At ASCO 2026, GRAIL presented promising new data from two significant studies: the NHS-Galleri trial and the PATHFINDER 2 study. Together, these studies suggest that the Galleri multi-cancer early detection blood test may help identify more cancers earlier, including those that do not currently have routine screening options. The NHS-Galleri trial included over 142,000 adults aged 50 to 77 in England. While the study did not meet its primary endpoint of reducing the combined number of stage III and stage IV cancers, the results showed important benefits over repeated annual testing. Among 12 prespecified deadly cancers, Galleri reduced stage IV cancer diagnoses by 9% in the first screening round, 22% in the second round, and 26% in the third round, leading to an overall 14% reduction after three rounds. The study also revealed a 16% increase in stage I and II cancer diagnoses, a four-fold increase in screen-detected cancers, and a 25% reduction in cancers diagnosed after emergency presentation. These findings suggest that Galleri may help shift cancer detection earlier, when patients may have more treatment options and better outcomes. The PATHFINDER 2 study involved 35,878 adults aged 50 and older in the United States and Canada. When Galleri was added to standard recommended screening, cancer detection by screening increased 6.5-fold. More than half of the new cancers detected by Galleri, 53.0%, were stage I or II, and 70.9% were detected at stages I to III. Importantly, 71.3% of the new cancers detected had no USPSTF A or B recommended screening option. Galleri also demonstrated strong test performance in PATHFINDER 2, with a positive predictive value of 60.3%, specificity of 99.6%, a false-positive rate below 0.4%, and cancer signal origin accuracy of 91.3%. The key takeaway is that Galleri does not replace standard cancer screening, but the 2026 ASCO data supports its role as an additional tool that may help detect more cancers earlier, reduce stage IV diagnoses over time, and identify cancers that are often missed until they are advanced. What Does This Mean for Patients? The most important message is this: early detection matters. Cancer outcomes can differ dramatically when cancer is found before it spreads. A stage I or II cancer may be treatable with curative intent. In contrast, a stage IV cancer is often much harder to treat and may require systemic therapy, complex treatment decisions, and long-term disease management. The Galleri test is not flawless. A negative result does not rule out cancer. A positive result necessitates appropriate follow-up testing, such as imaging or other diagnostic evaluations. False positives and false negatives can occur. Additionally, the test has not been cleared or approved by the FDA, although it is performed in a CLIA-certified, CAP-accredited laboratory. However, the new ASCO data contributes to a growing body of evidence that multi-cancer early detection may become an essential part of a modern preventive medicine strategy. Beverly Hills Institute Recommendation At Beverly Hills Institute, we recommend the GRAIL Galleri multi-cancer early detection blood test annually for patients over age 50. We also suggest considering annual Galleri testing for patients under age 50 who have a personal history of cancer or a significant family history of cancer. This recommendation does not replace standard screening. Patients should still complete appropriate routine screenings, including colonoscopy or stool-based colon cancer screening, mammography, cervical cancer screening, prostate cancer screening when appropriate, dermatologic skin checks, and lung cancer screening for eligible patients. Our approach is additive: we utilize the best standard tools available and, when appropriate, incorporate newer technologies that may help detect cancers that routine screening may miss. GLP-1 Medications and Cancer: Another Important ASCO 2026 Topic Another significant topic at ASCO 2026 was the relationship between GLP-1 receptor agonist medications and cancer progression. These medications include drugs such as semaglutide and tirzepatide, which are widely used for type 2 diabetes, obesity, and medical weight management. A real-world analysis presented at ASCO evaluated 12,112 patients with stage I to III cancer and compared patients who received GLP-1 medications with those who received DPP-4 inhibitors. The cancers studied included breast cancer, prostate cancer, non-small cell lung cancer, colorectal cancer, liver cancer, kidney cancer, and pancreatic cancer. The study found that GLP-1 use was associated with reduced progression to stage IV disease in several obesity-related cancers. Statistically significant reductions were observed in non-small cell lung cancer, breast cancer, colorectal cancer, and hepatocellular carcinoma. For instance, progression to stage IV disease occurred in 10% of GLP-1 users versus 22% of DPP-4 inhibitor users in non-small cell lung cancer, 10% versus 20% in breast cancer, 13% versus 22% in colorectal cancer, and 19% versus 28% in hepatocellular carcinoma. The study also indicated that higher tumor GLP-1 receptor expression was associated with a 33% lower risk of death across the tumor types studied, and a 45% lower risk of death in breast cancer. This does not prove that GLP-1 medications prevent cancer progression. The study was observational, meaning it can show an association but cannot establish cause and effect. Researchers appropriately noted that randomized controlled trials are needed. Still, the findings are intriguing and align with a broader medical reality: obesity, insulin resistance, inflammation, and metabolic disease are deeply intertwined with cancer risk and overall health. The Bigger Picture: Prevention, Metabolism, and Early Detection The future of medicine will likely integrate several strategies: Earlier cancer detection Enhanced use of imaging and blood-based screening Personalized risk assessment Metabolic optimization Weight management Exercise and muscle preservation Reduction of inflammation and insulin resistance More aggressive prevention before disease becomes advanced At Beverly Hills Institute, this is precisely how we approach preventive care. The annual wellness visit is no longer just a basic physical. It is an opportunity to review cancer risk, cardiovascular risk, metabolic health, body composition, family history, medications, lifestyle, and advanced screening options. The goal is not merely to live longer. The aim is to live better, with more years of strength, independence, and quality of life. Final Thoughts The ASCO 2026 data does not imply that we have resolved cancer screening. It does not suggest that one blood test can replace colonoscopy, mammography, PSA testing, cervical cancer screening, or other proven tools. However, it does indicate that cancer screening is evolving. The GRAIL Galleri test may assist in identifying cancers that currently lack routine screening options. GLP-1 medications may have broader effects on metabolic and cancer-related outcomes than previously understood. Together, these developments reinforce a central idea: prevention and early detection are becoming increasingly powerful. At Beverly Hills Institute, we believe patients should have access to thoughtful, advanced, evidence-informed preventive care. For many patients, especially those over 50 or those with a personal or family history of cancer, annual GRAIL Galleri testing should be part of that conversation.

“Doc, what do you think about peptides?” I get asked this question almost every day. BPC-157. TB-500. CJC-1295. Ipamorelin. MOTS-c. Semax. Selank. GLP-1s. The list keeps growing—and social media is moving much faster than the science. Some peptides have transformed modern medicine. Others are being injected into people with surprisingly little meaningful human data. Those are not the same thing. Over the next several weeks, I’m launching a 5-part series on peptides on BHInstitute.com that will take a hard, scientific look at what we actually know. We’ll start with something that social media almost never explains: How does medical research actually work? • What does a mouse study really tell us?• What is the difference between a Phase 1 trial and a Phase 3 trial?• What does FDA approval actually mean? And perhaps most importantly: When someone says, “There is no evidence that this peptide is dangerous,” does that actually mean it is safe? The answer may surprise you. Then we’ll go peptide by peptide—separating established medicine from legitimate emerging science, experimental therapies, internet hype, and products that may simply be getting dangerously ahead of the evidence. My position is simple: I am not anti-peptide. I am anti-bad science. Some of these compounds may ultimately become important therapies. But your body is not a laboratory. A million views do not equal one well-designed human clinical trial. And “promising” should never be confused with “proven.” As physicians, our responsibility is not to chase every trend. It is to understand the science, evaluate the evidence, protect our patients, and still remain open to where medicine is going next. The future of peptide medicine may be incredibly exciting. But we should never have to sacrifice patient safety just to get there first. Coming soon: PART 1: Before You Inject the Hype—How Medical Research Actually Works Follow along here and on BHInstitute.com. Alex Foxman, MD, FACP, ABOM Double Board-Certified in Internal Medicine & Obesity Medicine

As we head into the Fourth of July weekend, we want to wish you a safe, healthy, and joyful holiday. Please remember that our team is available 24/7 for your medical needs. If a health concern comes up over the holiday weekend, call us first before going to urgent care, the emergency room, or the hospital — unless it is a true life-threatening emergency. Many issues can be handled quickly by phone, telehealth, or, when appropriate, an in-home visit. Calling us first may help you avoid unnecessary urgent care visits, long ER waits, hospital exposure, and added stress. When to Call Us First Please reach out for concerns such as: Fever, cough, sore throat, urinary symptoms, or possible infection Medication questions, side effects, missed doses, or refill concerns Mild to moderate injuries, cuts, sprains, or falls Dehydration, nausea, vomiting, diarrhea, or stomach pain Blood pressure, blood sugar, or heart rate concerns New or worsening symptoms that worry you For chest pain, severe shortness of breath, stroke symptoms, severe allergic reactions, major trauma, or loss of consciousness, please call 911 immediately. Quick Health Tips for the Holiday Weekend Stay hydrated. Heat, alcohol, salty foods, and time outdoors can quickly lead to dehydration. Be mindful with alcohol. Alcohol can interact with medications, worsen dehydration, increase fall risk, and raise blood pressure. Protect yourself from the sun. Use sunscreen, wear a hat, seek shade, and avoid prolonged heat exposure. Watch for heat illness. Dizziness, weakness, headache, nausea, confusion, or feeling faint can be warning signs. Be careful around fireworks and grills. Keep children away from fireworks and use caution around flames, propane, and hot surfaces. Do not ignore symptoms. Urinary symptoms, respiratory symptoms, wounds, infections, or worsening pain should be addressed early. Keep medications on schedule. Make sure you have enough medication before traveling or leaving for the weekend. Call Before You Go Urgent care, ER, and hospital visits are sometimes necessary — but not always. Our goal is to help you get the right level of care at the right time. This Fourth of July weekend, please remember: We are here for you 24/7. Call us first with any medical needs. Wishing you and your family a happy, safe, and healthy Fourth of July weekend.

Artificial intelligence is quickly becoming one of the most talked-about topics in health care. Patients are hearing that AI can review scans, interpret lab results, predict disease risk, summarize medical records, and even suggest possible diagnoses. At Beverly Hills Institute, we believe this is an exciting moment in medicine — but also one that requires clarity. AI can be a powerful medical tool. It can help physicians organize information, recognize patterns, improve efficiency, and support more personalized care. In the right setting, AI may help identify risks earlier and allow doctors to make better-informed decisions. But AI is not a physician. It does not perform a physical exam. It does not know your full medical history unless the information entered is complete and accurate. It does not understand your personal goals, family history, lifestyle, medications, risks, or subtle changes in how you feel. It cannot independently diagnose, order testing, prescribe medication, or take responsibility for your care. That distinction matters. Patients are increasingly using online AI tools to interpret symptoms, lab results, imaging reports, and medication questions. While these tools may provide general education, they can also miss important warning signs, misunderstand context, or provide information that sounds confident but may not apply to the individual patient. At Beverly Hills Institute, our approach is different. We combine modern medical technology with physician-led care. As a concierge internal medicine and preventive care practice, we focus on understanding the whole patient — not just a lab number, scan result, or algorithm-generated answer. Our goal is to help patients make informed decisions based on their personal risk factors, medical history, lifestyle, family history, and long-term health goals. This is especially important in preventive and longevity medicine. The future of medicine is moving toward earlier detection, better risk prediction, more personalized testing, and proactive health planning. AI will likely play an important role in that future. But technology should support the physician-patient relationship, not replace it. A computer can process data.A physician applies judgment. A computer can identify a pattern.A physician understands the patient behind the pattern. A computer can provide information.A physician helps determine what that information means for you. The best medical care happens when advanced technology is combined with clinical experience, careful interpretation, and a trusted physician who knows the patient personally. AI is changing medicine — and that is a good thing. But your health decisions should still be guided by a licensed medical professional who understands you, your risks, and your goals. At Beverly Hills Institute, we use innovation to enhance care, not replace the human connection that great medicine requires. Bottom Line AI is a powerful tool, but it is not your doctor. The future of medicine will be smarter, faster, and more personalized — but it still requires physician guidance, medical judgment, and a relationship built on trust.

Why Advanced Heart Risk Testing May Be One of the Most Important Preventive Health Conversations This Year For decades, patients have been told to “check your cholesterol.” Most people know their LDL cholesterol, often called “bad cholesterol,” and HDL cholesterol, often called “good cholesterol.” But the newest cholesterol guidance from the American College of Cardiology and American Heart Association makes something very clear: traditional cholesterol testing is important, but it may not tell the whole story. The updated 2026 cholesterol guideline emphasizes a more personalized approach to cardiovascular prevention, including earlier treatment, clearer LDL cholesterol goals, and selective use of additional tests such as coronary artery calcium scoring, Lipoprotein(a), and Apolipoprotein B. These tools can help identify hidden cardiovascular risk before a heart attack or stroke occurs. At Beverly Hills Institute, this is exactly the kind of prevention we discuss during an Annual Wellness Visit: not just whether your cholesterol is “normal,” but whether your overall cardiovascular risk is truly being understood. Why “Normal Cholesterol” Can Be Misleading A standard lipid panel usually includes total cholesterol, LDL cholesterol, HDL cholesterol, and triglycerides. These numbers are very useful, but they do not always fully capture a patient’s true risk. Two people can have the same LDL cholesterol level but very different risk profiles. One may have no plaque in the arteries, while the other may already have early coronary artery disease. One may have a strong family history of heart attack. Another may have diabetes, elevated inflammatory risk, high triglycerides, or a genetically elevated Lipoprotein(a). That is why modern preventive medicine is moving beyond simply asking, “Is your cholesterol high?” and instead asking, “What is your actual risk of developing plaque, heart attack, or stroke?” LDL Goals Are Back One of the most important updates in the 2026 guideline is the return of LDL cholesterol treatment goals. For prevention of a first heart attack or stroke, the guideline identifies LDL-C goals based on risk level. For many patients at borderline or intermediate risk, the LDL-C goal is less than 100 mg/dL. For high-risk patients, the goal is less than 70 mg/dL. For patients with known cardiovascular disease who are at very high risk, the goal may be less than 55 mg/dL. This matters because cardiovascular disease is not something that suddenly appears at age 65. Plaque builds over years and decades. The earlier we identify risk, the more opportunity we have to intervene with lifestyle, nutrition, exercise, weight management, blood pressure control, diabetes prevention, and when appropriate, medication. Coronary Artery Calcium Scan: Seeing Plaque Before Symptoms A coronary artery calcium scan, often called a CAC scan, is a low-radiation CT scan that looks for calcified plaque in the coronary arteries. It does not require contrast dye, and it can help determine whether a patient already has early evidence of coronary artery disease. The new guideline supports selective use of CAC scoring in men age 40 and older and women age 45 and older who have borderline or intermediate 10-year cardiovascular risk when the result would help guide a decision about statin therapy. Any amount of coronary artery calcium supports a more serious discussion about LDL lowering, with lower LDL goals recommended as the calcium score increases. In practical terms, this test can be very helpful for patients who say: “My cholesterol is borderline, but I don’t want to take medication unless I really need it.” Or: “My cholesterol does not look that bad, but heart disease runs in my family.” A CAC scan can help move the conversation from guesswork to evidence. Lipoprotein(a): The Genetic Risk Many Patients Have Never Checked Lipoprotein(a), or Lp(a), is a cholesterol-related particle that is largely genetically determined. Unlike LDL cholesterol, it is not significantly changed by diet, exercise, or weight loss. That does not mean lifestyle is unimportant. It means that if Lp(a) is high, we need to know about it so we can manage the rest of the patient’s risk more aggressively. The 2026 guideline states that Lp(a) should be measured at least once in adulthood. A high Lp(a), defined as 125 nmol/L or greater or 50 mg/dL or greater, is associated with increased long-term risk of heart attack and stroke. Very high levels are associated with even greater risk. This is especially important for patients with: A family history of early heart diseaseA personal history of unexplained cardiovascular diseaseHigh cholesterol despite a healthy lifestyleAortic valve diseaseA heart attack or stroke at a younger age Many patients with elevated Lp(a) have no idea they carry this risk because it is not included in a routine cholesterol panel. Apolipoprotein B: Counting the Dangerous Particles Apolipoprotein B, or ApoB, is another advanced marker that can help refine cardiovascular risk. ApoB reflects the number of atherogenic particles in the blood, meaning the particles that can enter the artery wall and contribute to plaque formation. In some patients, LDL cholesterol can look acceptable while ApoB remains elevated. This is more common in people with insulin resistance, metabolic syndrome, diabetes, high triglycerides, obesity, or cardiovascular-kidney-metabolic risk. The guideline notes that ApoB may be useful to assess residual cardiovascular risk and guide treatment in certain patients, particularly those with type 2 diabetes, high triglycerides, cardiovascular-kidney-metabolic syndrome, or known cardiovascular disease. In other words, ApoB may help answer a more precise question: how many plaque-forming particles are actually circulating in the bloodstream? Prevention Is No Longer One-Size-Fits-All The most important message from the new cholesterol guidance is that prevention should be personalized. For some patients, a standard lipid panel and healthy lifestyle counseling may be enough. For others, especially those with family history, metabolic risk, diabetes, elevated triglycerides, obesity, inflammatory conditions, or unclear risk, additional testing can provide a much clearer picture. This does not mean every patient needs every test. It means the right patient should get the right test at the right time. What We Discuss During an Annual Wellness Visit At Beverly Hills Institute, preventive care is not just about checking boxes. During an Annual Wellness Visit, we review cardiovascular risk in a more complete way, including: Blood pressureCholesterol and triglycerides Blood sugar and insulin resistance risk Weight, waist circumference, and body compositionFamily historySmoking history Sleep, stress, nutrition, and exercise Medication options when appropriate Advanced testing such as CAC score, Lp(a), and ApoB when clinically useful The goal is not simply to treat a number. The goal is to prevent the heart attack, stroke, hospitalization, disability, or loss of quality of life that may occur years later if risk is missed. The Bottom Line Your cholesterol panel is important, but it may not be enough. The newest cholesterol guideline reinforces what preventive physicians have been seeing for years: cardiovascular risk is more complex than a single LDL number. Coronary artery calcium scoring, Lipoprotein(a), and Apolipoprotein B can help uncover hidden risk and guide a more personalized prevention plan. If you have a family history of heart disease, borderline cholesterol, diabetes, high triglycerides, elevated blood pressure, weight concerns, or simply want a deeper understanding of your long-term health, this is a conversation worth having. At Beverly Hills Institute, our goal is to help patients live longer, healthier, and better lives by identifying risk early and creating a prevention plan that is personalized, proactive, and based on the latest science.