Page 117 - JSOM Winter 2024

to target specific receptors. For example, hGH secretagogues
(hGH-releasing peptides, sermorelin, ipamorelin, and ibuta-
moren (known as MK677)) are synthetic substances that
stimulate the release of hGH. Products containing peptide hor-
mones and hormone-releasing agents have been marketed for
performance enhancement, anti-aging (smoothing wrinkles),
FIGURE 1 Label muscle-building, fat loss, and sexual vitality. 29,36
found on product
marketed to
Servicemembers. Most of the synthetic peptides and hormone-releasing agents
sold on the internet are drugs for research or medical use (as
prescription or experimental drugs to treat disorders and dis-
eases). These substances are not appropriate ingredients in any
DS, and their misuse can cause serious health problems. The
World Anti-Doping Agency (WADA) prohibits the use of pep-
tide hormones and their releasing agents at all times – in and
out of competition – as class S2 on the WADA prohibited list:
are acquired from the Internet, users typically consume them in PEPTIDE HORMONES, GROWTH FACTORS, RELATED
doses much higher than dosages in clinical trials. 22 SUBSTANCES, AND MIMETICS. 37
The quality of these products is questionable. One 2017 study Besides a lack of quality assurance regarding safety and potency,
analyzed 44 products marketed and sold as SARMs. Among DSs associated with peptide hormones and hormone-releasing
those 44 products, only 23 (52%) contained one or more agents can be mislabeled. Marketing language, or even a prod-
SARM, and 17 products (39%) contained other unapproved uct’s name, might suggest the presence of a peptide hormone;
drugs, including ibutamoren (a human growth hormone (hGH however, examining the product’s Supplement Facts panel of-
or HGH) secretagogue), cardarine (a peroxisome prolifera- ten reveals no peptide hormone in the list of ingredients.
tor-activated receptor delta (PPARδ) receptor agonist), and
other non-DS ingredients. 23 Misleading language on the intake route is also an issue of
concern. DSs must be consumed orally and ingested. Because
The FDA issued a strong warning in 2017. Despite the warn- orally consumed peptide hormones (depending on their length)
24
ing, SARM abuse continues to be popular among recreational are broken down into individual amino acids during diges-
and professional athletes, who perceive SARMs as alternatives tion, some companies market products to be taken buccally
25
to anabolic steroids. Recent reports indicate that social me- (through the cheek membranes inside the mouth) or sublin-
dia is likely contributing to the use of SARMs by publishing gually (under the tongue) to help avoid digestive breakdown.
and circulating misinformation. 26 Such products (like transdermal (skin) patches, skin creams,
and injectables) are not considered DSs. Although some drug
Among SARM users, over 50% reported experiencing signif- companies are developing peptide hormones for effective oral
icant side-effects, including mood swings, decreased testicular delivery as therapeutic agents, these products will likely be
31
27
size, and acne. Adverse effects include numerous cases of categorized as drugs to treat a medical condition and not as a
drug-induced liver injury, rhabdomyolysis, and tendon rup- DS ingredient.
25
ture. As a result, between 2020 and 2023, the FDA issued
warning letters to companies selling unapproved products The stable gastric pentadecapeptide BPC 157 is an emerging
marketed as SARMs and pursued criminal actions for distrib- peptide “native to and stable in human gastric juice.” BPC
38
utors of these products. Additionally, the FDA released a warn- 157 is not a peptide hormone, so WADA prohibits it under
ing video in April of 2023 to discourage the use of SARMs the class S0: NON-APPROVED SUBSTANCES. This interest-
by teens and young adults and to increase awareness of their ing peptide is proposed to expedite recovery from soft tissue
side-effects. The bottom line is that SARMs cannot be legally injuries, such as those in tendons and ligaments. 38,39 However,
28
marketed in the U.S. as a DS or drug at this time, yet they are studies to date have been limited to animal models; dosage
readily available for purchase. and the safety profile for humans have not been established.
As an “unapproved drug,” BPC 157 is on the DoD Prohibited
Peptides Dietary Supplement Ingredients List.
Peptides are typically short chains of 2-50 amino acids; pro-
teins are polypeptides with more than 51 amino acids. Pep- In contrast to the peptides above, collagen peptides are legal.
tide hormone sizes range from 10 to a few hundred amino Collagen is considered the most abundant protein in the hu-
acids. Peptides and peptide hormones serve prominent roles man body and a critical component in hair, skin, nails, tendons,
in physiologic processes such as energy homeostasis, metab- and ligaments. 40–43 However, the large size and rigid structure
olism, growth, appetite control, gastrointestinal and cardio- prevents the transportation of ingested collagen to the ap-
vascular function, and reproduction. 29–35 Examples of peptide propriate target. As such, collagens from animals are broken
hormones that are naturally produced by the body include down into smaller fragments (commonly known as collagen
erythropoietin (EPO), hGH, human chorionic gonadotrophic hydrolyzates) to yield amino acids and various sizes of poten-
hormone (commonly known as hCG or hCGH), insulin, and tially bioactive collagen peptides. 40,44–47 Research on collagen
insulin-like growth factors (including IGF-1). 29 peptides is intensely active because the final molecular struc-
tures of orally administrated collagen peptides determine their
Peptides, peptide hormones, and hormone-releasing agents effectiveness or full utilization. Consumers typically take col-
can also be synthetically produced (made in the laboratory) lagen peptides to prevent and minimize wrinkles, strengthen

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