Barbell Medicine Podcast

An FDA advisory committee just voted to open a legal compounding supply line for six of seven peptides, including BPC-157 and TB-500, over the objection of the FDA's own scientists, who recommended against all seven. Dr. Jordan Feigenbaum walks through what the Pharmacy Compounding Advisory Committee actually voted on, why a vote about ulcerative colitis ends up governing tendon and joint use, what the single human BPC-157 trial does and doesn't show, and why "a pharmacy makes it safe" and "there's no money to study it" don't hold up. Evidence-based, no hype, no nocebo.

Timestamps:
 | 00:00:00 | The FDA voted 8-6. What it actually means
 | 00:01:25 | What I am, and am not, claiming
 | 00:03:21 | How they got here: Category 2 and the paperwork
 | 00:07:17 | Who was in the room: the panel that flipped
 | 00:10:57 | What they voted on: compounding and the bulks list
 | 00:15:37 | "No money in it, you can't patent it"
 | 00:18:24 | The trials already run: Plevna and MK-677
 | 00:22:55 | "I took it and it worked": placebo and fake surgery
 | 00:27:02 | The one human trial: Ruenzi 2005
 | 00:32:28 | Is it natural? Is it even a drug?
 | 00:36:58 | Harm reduction, or follow the money?
 | 00:42:45 | Three times a missing trial went wrong
 | 00:50:58 | Safety: known, unknown, and unknowable
 | 00:55:22 | The other six peptides
 | 00:58:22 | What I'd actually tell you
 | 01:02:08 | What actually works, and what would change my mind

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1. US Food and Drug Administration. FDA Briefing Document: Pharmacy Compounding Advisory Committee Meeting. July 23-24, 2026. Silver Spring, MD: FDA; 2026.
2. US Food and Drug Administration. FDA review of BPC-157-related bulk drug substances. PCAC Briefing Document. July 23-24, 2026. Media 193343. Accessed July 24, 2026. https://www.fda.gov/media/193343/download
3. US Food and Drug Administration. FDA review of TB-500-related bulk drug substances. PCAC Briefing Document. July 23-24, 2026. Media 193349.
4. US Food and Drug Administration. FDA review of KPV-, MOTS-c-, Semax-, Epitalon-, and Emideltide-related bulk drug substances. PCAC Briefing Documents. July 23-24, 2026.
5. US Food and Drug Administration. Questions for the Pharmacy Compounding Advisory Committee. July 23-24, 2026.
6. US Food and Drug Administration. Pharmacy Compounding Advisory Committee meeting roster. July 23-24, 2026. Media 193772.
7. US Food and Drug Administration. Pharmacy Compounding Advisory Committee meeting roster. 2022. Media 159040.
8. openFDA. FAERS adverse event reports for BPC-157. Accessed July 24, 2026. https://open.fda.gov
9. Pharmacy compounding; 503A bulk drug substances. 21 CFR §216.23 (2026).
10. Federal Food, Drug, and Cosmetic Act §503A, 21 USC §353a (pharmacy compounding).
11. Abigail Alliance for Better Access to Developmental Drugs v von Eschenbach, 495 F3d 695 (DC Cir 2007).
12. United States v Rutherford, 442 US 544 (1979).
13. Trickett Wendler, Frank Mongiello, Jordan McLinn, and Matthew Bellina Right to Try Act of 2017, Pub L No. 115-176, 132 Stat 1372 (2018).
14. US Food and Drug Administration. Regulatory considerations for human drug products containing peptides. Guidance for Industry (draft). 2020.
15. Ruenzi M, Stolte M, Veljaca M, et al. Efficacy and safety of PL 14736 (BPC 157) in patients with active ulcerative colitis [abstract]. Gastroenterology. 2005. Meeting abstract; full study not published.
16. Staresinic M, Petrovic I, Novinscak T, et al. Effective therapy of transected quadriceps muscle in rat: gastric pentadecapeptide BPC 157. J Orthop Res. 2006;24(5):1109-1117. doi:10.1002/jor.20089
17. Gwyer D, Wragg NM, Wilson SL. Gastric pentadecapeptide body protection compound BPC 157 and its role in accelerating musculoskeletal soft tissue healing. Cell Tissue Res. 2019;377(2):153-159. doi:10.1007/s00441-019-03016-8
18. Sikiric P, Skrtic A, Gojkovic S, et al. Stable gastric pentadecapeptide BPC 157 and hemorrhage/thrombosis. Pharmaceuticals (Basel). 2026;19(3):463. doi:10.3390/ph19030463
19. Stavchansky VV, Filippenkov IB, Dergunova LV, Limborska SA. The role of glyprolines in the regulation of gene expression: focus on Semax. Genes (Basel). 2022;13(12):2380. doi:10.3390/genes13122380
20. Mendias CL, Awan TM. The safety and efficacy of approved and unapproved peptides. Sports Med. 2026. doi:10.1007/s40279-026-02437-0
21. Moseley JB, O'Malley K, Petersen NJ, et al. A controlled trial of arthroscopic surgery for osteoarthritis of the knee. N Engl J Med. 2002;347(2):81-88. doi:10.1056/NEJMoa013259
22. Cobb LA, Thomas GI, Dillard DH, Merendino KA, Bruce RA. An evaluation of internal-mammary-artery ligation by a double-blind technic. N Engl J Med. 1959;260(22):1115-1118.
23. Dimond EG, Kittle CF, Crockett JE. Comparison of internal mammary artery ligation and sham operation for angina pectoris. Am J Cardiol. 1960;5:483-486.
24. Alfredson H, Pietila T, Jonsson P, Lorentzon R. Heavy-load eccentric calf muscle training for the treatment of chronic Achilles tendinosis. Am J Sports Med. 1998;26(3):360-366. doi:10.1177/03635465980260030301
25. Kongsgaard M, Kovanen V, Aagaard P, et al. Corticosteroid injections, eccentric decline squat training and heavy slow resistance training in patellar tendinopathy. Scand J Med Sci Sports. 2009;19(6):790-802. doi:10.1111/j.1600-0838.2009.00949.x
26. Langberg H, Skovgaard D, Karamouzis M, Bulow J, Kjaer M. Metabolism and inflammatory mediators in the peritendinous space measured by microdialysis during intermittent isometric exercise in humans. J Physiol. 1999;515(Pt 3):919-927. doi:10.1111/j.1469-7793.1999.919ab.x
27. Coombes BK, Bisset L, Brooks P, Khan A, Vicenzino B. Effect of corticosteroid injection, physiotherapy, or both on clinical outcomes in patients with unilateral lateral epicondylalgia: a randomized controlled trial. JAMA. 2013;309(5):461-469. doi:10.1001/jama.2013.129
28. Kearney RS, Ji C, Warwick J, et al. Effect of platelet-rich plasma injection vs sham injection on tendon dysfunction in chronic midportion Achilles tendinopathy: a randomized clinical trial. JAMA. 2021;326(2):137-144. doi:10.1001/jama.2021.6986
29. Pavlova AV, Shim JSC, Moss R, et al. Effect of resistance exercise dose components for tendinopathy management: a systematic review with meta-analysis. Br J Sports Med. 2023;57(20):1327-1334. doi:10.1136/bjsports-2022-105754
30. Weintraub M, Sundaresan PR, Madan M, et al. Long-term weight control study I (weeks 0 to 34): fenfluramine plus phentermine versus placebo. Clin Pharmacol Ther. 1992;51(5):586-594. doi:10.1038/clpt.1992.69
31. Connolly HM, Crary JL, McGoon MD, et al. Valvular heart disease associated with fenfluramine-phentermine. N Engl J Med. 1997;337(9):581-588. doi:10.1056/NEJM199708283370901
32. Centers for Disease Control and Prevention. Cardiac valvulopathy associated with exposure to fenfluramine or dexfenfluramine: interim public health recommendations, 1997. MMWR Morb Mortal Wkly Rep. 1997;46(45):1061-1066.
33. Bombardier C, Laine L, Reicin A, et al; VIGOR Study Group. Comparison of upper gastrointestinal toxicity of rofecoxib and naproxen in patients with rheumatoid arthritis. N Engl J Med. 2000;343(21):1520-1528. doi:10.1056/NEJM200011233432103
34. Graham DJ, Campen D, Hui R, et al. Risk of acute myocardial infarction and sudden cardiac death in patients treated with cyclo-oxygenase 2 selective and non-selective non-steroidal anti-inflammatory drugs: nested case-control study. Lancet. 2005;365(9458):475-481. doi:10.1016/S0140-6736(05)17864-7
35. Smith RM, Schaefer MK, Kainer MA, et al; Multistate Fungal Infection Outbreak Response Team. Fungal infections associated with contaminated methylprednisolone injections. N Engl J Med. 2013;369(17):1598-1609. doi:10.1056/NEJMoa1213978
36. Adunsky A, Chandler J, Heyden N, et al. MK-0677 (ibutamoren mesylate) for the treatment of patients recovering from hip fracture: a multicenter, randomized, placebo-controlled phase IIb study. Arch Gerontol Geriatr. 2011;53(2):183-189. doi:10.1016/j.archger.2010.10.004 [Trial terminated early for a congestive-heart-failure safety signal.]
37. Nass R, Pezzoli SS, Oliveri MC, et al. Effects of an oral ghrelin mimetic on body composition and clinical outcomes in healthy older adults: a randomized trial. Ann Intern Med. 2008;149(9):601-611. doi:10.7326/0003-4819-149-9-200811040-00003
38. Van Wagoner RM, Eichner A, Bhasin S, Deuster PA, Eichner D. Chemical composition and labeling of substances marketed as selective androgen receptor modulators and sold via the internet. JAMA. 2017;318(20):2004-2010. doi:10.1001/jama.2017.17069
39. ECRI and Institute for Safe Medication Practices. Unapproved peptide products: safety and quality concerns [white paper]. Plymouth Meeting, PA: ECRI; April 2026.
40. Center for Science in the Public Interest. What are injectable peptides, and are they safe? Accessed July 24, 2026. https://www.cspinet.org
41. World Anti-Doping Agency. The 2026 Prohibited List. Montreal, QC: WADA; 2026. Accessed July 24, 2026. https://www.wada-ama.org
42. US Anti-Doping Agency. BPC-157: a prohibited peptide. Accessed July 24, 2026. https://www.usada.org
43. FDA committee votes in favor of compounding several peptides. Time. July 23, 2026. Accessed July 24, 2026. https://time.com
44. FDA advisory committee backs controversial peptides. Regulatory Affairs Professionals Society (RAPS). 2026. Accessed July 24, 2026. https://www.raps.org
45. FDA panel okays peptides for compounding, including BPC-157 and KPV. STAT News. July 23, 2026. Accessed July 24, 2026. https://www.statnews.com
46. FDA panel recommends easing peptide restrictions over agency scientists' objections. NBC News. 2026. Accessed July 24, 2026. https://www.nbcnews.com
47. Associated Press. Financial ties reported among FDA peptide advisory panel members. 2026. Accessed July 24, 2026.
48. Leerink Partners. Equity research note: PCAC peptide vote and the telehealth compounding market. 2026.
49. Examine.com. BPC-157 research breakdown. Accessed July 24, 2026. https://examine.com/supplements/bpc-157/
50. Jarry J. Body protection compound: no proof required. McGill Office for Science and Society. Accessed July 24, 2026. https://www.mcgill.ca/oss

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A previously healthy 21-year-old shows up with seven months of headaches and 30-plus pounds of weight gain he can’t explain. He’s eating the same and training more, and the scale climbs anyway. We hand the case to Dr. Austin Baraki cold and work it in real time: the exam, the labs, the MRI, and two diagnoses that turn a headache workup into the clearest proof we’ve got that body weight is set by the brain, not by character. This is the capstone of our weight series (willpower, calories, protein), and it ends on the drug that, this year, did something for these patients that nothing had done before.

Timestamps
00:00:00 Cold open: the man who couldn’t stop gaining weight
00:01:49 Meet the case (and the rules of the game)
00:02:36 The presentation: 21, headaches, unexplained weight gain
00:03:57 Austin’s one-liner and how a clinician builds a differential
00:05:10 Secondary headaches: what raises the red flag
00:13:12 The exam: vitals, and the eye findings that matter
00:14:37 The labs, one number at a time
00:16:08 Raised pressure and a visual-field clue (bitemporal hemianopia)
00:20:45 The MRI
00:21:54 First diagnosis: craniopharyngioma
00:25:32 The name: a tumor built from tooth tissue
00:25:50 Surgery, and what it costs
00:27:43 The new mystery: gaining weight faster than ever
00:33:41 Second diagnosis: acquired hypothalamic obesity
00:39:17 How your brain sets your weight: the POMC brake and the AgRP accelerator
00:42:07 What about leptin?
00:45:46 Monogenic vs common obesity
00:50:30 Why GLP-1 drugs still worked: the brainstem backdoor
00:52:11 Responders and non-responders
00:55:40 Setmelanotide: a drug for the broken circuit
00:56:53 TRANSCEND, and the new FDA approval
00:58:55 What it costs
01:01:32 Why we care about body fat at all: the garage
01:04:36 Flux: which fat is actually dangerous
01:09:15 Close

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1. Brijmohan A, et al. Acquired hypothalamic obesity following craniopharyngioma resection in a young adult [case report]. 2025. PMCID: PMC12268545; PMID: 40677794. 

2. Miller JL, et al; TRANSCEND investigators. Setmelanotide in acquired hypothalamic obesity: a phase 3 randomized trial. N Engl J Med. 2026. 

3. Rhythm Pharmaceuticals. FDA approves IMCIVREE (setmelanotide) for acquired hypothalamic obesity. News release. March 19, 2026.

4. US Food and Drug Administration. FDA approves first treatment for weight management for people with certain rare genetic conditions (setmelanotide). 2020.

5. Montague CT, Farooqi IS, Whitehead JP, et al. Congenital leptin deficiency is associated with severe early-onset obesity in humans. Nature. 1997;387(6636):903-908.

6. Farooqi IS, Jebb SA, Langmack G, et al. Effects of recombinant leptin therapy in a child with congenital leptin deficiency. N Engl J Med. 1999;341(12):879-884.

7. Krude H, Biebermann H, Luck W, et al. Severe early-onset obesity, adrenal insufficiency and red hair pigmentation caused by POMC mutations in humans. Nat Genet. 1998;19(2):155-157.

8. Farooqi IS, Keogh JM, Yeo GS, et al. Clinical spectrum of obesity and mutations in the melanocortin 4 receptor gene. N Engl J Med. 2003;348(12):1085-1095.

9. Clément K, Vaisse C, Lahlou N, et al. A mutation in the human leptin receptor gene causes obesity and pituitary dysfunction. Nature. 1998;392(6674):398-401.

10. Fabbrini E, Tamboli RA, Magkos F, et al. Surgical removal of omental fat does not improve insulin sensitivity and cardiovascular risk factors in obese adults. Gastroenterology. 2010;139(2):448-455.

11. Klein S, Fontana L, Young VL, et al. Absence of an effect of liposuction on insulin action and risk factors for coronary heart disease. N Engl J Med. 2004;350(25):2549-2557.

12. Guyenet SJ. The Hungry Brain: Outsmarting the Instincts That Make Us Overeat. Flatiron Books; 2017. 

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Every couple of years a new headline warns that the protein you eat is quietly hurting you. This year the target is your kidneys. Before that it was cancer, then your bones, then the claim that your body can only use twenty or thirty grams of protein at a meal. In this episode, Dr. Jordan Feigenbaum goes through the actual studies behind each scare: the kidney trials, the 2014 IGF-1 and cancer paper that started the panic, the acid-ash bone hypothesis, and the per-meal "cap." Each fear starts from a real mechanism, and each one was run straight to a frightening conclusion the clinical outcomes never supported.

The take home is simple. For a healthy adult, protein is not the lever people think it is, and where a real signal exists (processed and red meat, or a kidney that is already diseased) it tracks the whole dietary pattern more than the protein number. The two things that actually decide your health here are whether you eat mostly real food and whether you train.

Timestamps
00:00 The protein scare cycle 
01:23 The four fears 
01:59 Kidneys: healthy kidneys under higher protein 
06:22 Kidney disease: does cutting protein help? 
09:38 Red meat and the dietary pattern, not protein 
12:00 Muscle, aging, and lifting on a restricted diet 
13:54 Cancer: IGF-1 and the 2014 study everyone cites 
16:22 The age reversal, and what travels with protein 
18:48 Bigger data, processed meat, and the IGF-1 tell 
22:15 Bones and the acid-ash myth 
25:13 The 30-gram cap 
27:17 What protein actually does, and how much you need 
32:20 The two questions that matter

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Studies
Levine et al. Cell Metabolism 2014. doi:10.1016/j.cmet.2014.02.006
Naghshi et al. BMJ 2020. doi:10.1136/bmj.m2412 
Devries et al. J Nutr 2018. doi:10.1093/jn/nxy197 
Antonio et al. J Nutr Metab 2016. doi:10.1155/2016/9104792 
Knight et al. Ann Intern Med 2003. doi:10.7326/0003-4819-138-6-200303180-00009 
Klahr et al. (MDRD). NEJM 1994. doi:10.1056/NEJM199403313301301
 Hahn, Hodson & Fouque. Cochrane 2020. doi:10.1002/14651858.CD001892.pub5 
Obeid, Hiremath & Topf. Kidney360 2022. doi:10.34067/KID.0001002022 
Lew et al. J Am Soc Nephrol 2017. doi:10.1681/ASN.2016030248
Castaneda et al. Ann Intern Med 2001. doi:10.7326/0003-4819-135-11-200112040-00008 
Bauer et al. (PROT-AGE). JAMDA 2013. doi:10.1016/j.jamda.2013.05.021
Fenton et al. Nutrition Journal 2011. doi:10.1186/1475-2891-10-41
Shams-White et al. Am J Clin Nutr 2017. doi:10.3945/ajcn.116.145110
Witard et al. Am J Clin Nutr 2013. doi:10.3945/ajcn.112.055517
 Macnaughton et al. Physiol Rep 2016. doi:10.14814/phy2.12893
Trommelen et al. Cell Reports Medicine 2023. doi:10.1016/j.xcrm.2023.101324 
Wycherley et al. Am J Clin Nutr 2012. doi:10.3945/ajcn.112.044321
 Moore et al. JAMA Intern Med 2016. doi:10.1001/jamainternmed.2016.1548 
Larsson et al. Cancer Med 2020. doi:10.1002/cam4.3345 
Brenner, Meyer & Hostetter. NEJM 1982. doi:10.1056/NEJM198209093071104 
Chan et al. PLoS One 2011. doi:10.1371/journal.pone.0020456
Berryman et al. Am J Clin Nutr 2018. doi:10.1093/ajcn/nqy088 
Morton et al. Br J Sports Med 2018. doi:10.1136/bjsports-2017-097608

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Is weight loss really just Calories in, Calories out? The equation is true, but "just count your Calories" is bad advice for most people, and almost every objection to it is pointing at something real. In part two of our energy balance series, Jordan Feigenbaum takes the biggest "it's not Calories, it's ___" claims (metabolism, thyroid, cortisol, PCOS, insulin, the type of food) and tests each against the best evidence. The verdict: none of them breaks the equation. Every one is a hand on a lever that moves Calories in or Calories out, not a hole in the math.

In this episode: why your metabolism does not crash at 40, how small real metabolic adaptation actually is after weight loss, why hypothyroid weight is mostly water, what the cortisol and PCOS (now PMOS) data show, how absorption and cooking move Calories only at the edges, why even dietitians miscount their own intake, and why the carbohydrate-insulin model fails three tests, including the GLP-1 drugs that raise insulin and still produce the biggest weight loss we have ever approved.

Part two of three: willpower, Calories in Calories out, then GLP-1 drugs. Next week: are GLP-1s cheating?
Timestamps
0:00 Is it really just calories in, calories out?
0:18 The willpower episode and the through-line
2:10 Thermodynamics: what sets both sides
2:41 Your metabolism is three things
4:05 Claim 1: my metabolism crashed
4:24 No cliff at 40: the doubly labeled water study
5:33 Real metabolic adaptation after weight loss
6:56 Why your food diary lies
7:49 Claim 2: it's my hormones
8:07 Thyroid: mostly water
9:36 Cortisol: explains about 1 percent
11:12 PCOS is now PMOS
13:06 Menopause
14:18 Claim 3: a calorie isn't a calorie
16:48 Absorption: nuts, cooking, eggs
19:44 Why calorie counting fails
21:12 Claim 4: it's not Calories, it's insulin
22:02 Testing the carbohydrate-insulin model
25:52 The GLP-1 drugs that should end it
28:34 The whole list, claim by claim
29:53 What to actually do
30:42 Next week: are GLP-1s cheating?

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Pontzer et al., Science 2021. https://doi.org/10.1126/science.abe5017

Muller et al., Am J Clin Nutr 2015. https://doi.org/10.3945/ajcn.115.109173

Lichtman et al., N Engl J Med 1992. https://doi.org/10.1056/NEJM199212313272701

Karmisholt et al., J Clin Endocrinol Metab 2011. https://doi.org/10.1210/jc.2010-1521

Lee et al., Endocr Pract 2014. https://doi.org/10.4158/EP14072.OR

van der Valk et al., Obes Rev 2022. https://doi.org/10.1111/obr.13376

Nikokavoura et al., Diabetes Metab Syndr Obes 2015. https://doi.org/10.2147/DMSO.S85134

Greendale et al., JCI Insight 2019. https://doi.org/10.1172/jci.insight.124865

Lejeune et al., Am J Clin Nutr 2006. https://doi.org/10.1093/ajcn/83.1.89

Bray et al., JAMA 2012. https://doi.org/10.1001/jama.2011.1918

Novotny et al., Am J Clin Nutr 2012. https://doi.org/10.3945/ajcn.112.035782

Baer et al., J Nutr 2016. https://doi.org/10.3945/jn.115.217372

Baer et al., Br J Nutr 2012. https://doi.org/10.1017/S0007114511002649

Evenepoel et al., J Nutr 1998. https://doi.org/10.1093/jn/128.10.1716

Hall et al., Cell Metabolism 2019. https://doi.org/10.1016/j.cmet.2019.05.008

Champagne et al., J Am Diet Assoc 2002. https://doi.org/10.1016/S0002-8223(02)90316-0

Hall et al., Cell Metabolism 2015. https://doi.org/10.1016/j.cmet.2015.07.021

Wilding et al., N Engl J Med 2021. https://doi.org/10.1056/NEJMoa2032183

Jastreboff et al., N Engl J Med 2022. https://doi.org/10.1056/NEJMoa2206038

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Obesity roughly tripled in about 60 years, and the genes didn't change in that time. So if body weight isn't a willpower problem, what is it? Dr. Jordan Feigenbaum and Dr. Austin Baraki walk through what actually sets your weight: the adoption and twin studies behind the genetics, the "defended range" your biology fights to hold, the food environment that does most of the eating for you, and where GLP-1 medications actually work. Along the way — why diets regain after you white-knuckle them, what The Biggest Loser six-year data show about resting metabolism, and four willpower myths worth retiring. 
Hosted by Dr. Jordan Feigenbaum and Dr. Austin Baraki, co-founders of Barbell Medicine.
Timestamps
00:00 Cold open: Danny Cahill and The Biggest Loser
01:03 What we mean by "willpower"
05:48 Obesity tripled in ~60 years: the one number
06:31 Adoption and twin studies: genes vs. household
09:37 Set point vs. the defended range
10:37 Gene–environment mismatch
14:03 In the clinic: a lifelong weight history
19:18 Losing weight vs. keeping it off
20:26 Appetite doesn't reset (Sumithran)
25:52 Metabolic adaptation and the Biggest Loser data
34:07 Part 2: eating on autopilot
35:10 Portion size runs the meal
39:12 What changed in the food supply
40:42 Same genes, new environment: Pima and immigrants
43:20 Why ultra-processed food is easy to overeat
50:28 Processing vs. calories: the Hall ward study
52:36 When the brain changes eating: gourmand syndrome
1:00:01 Why the willpower story stuck
1:01:08 Taft, Churchill, and the intelligence myth
1:02:43 Does intelligence predict weight? (sibling study)
1:11:16 Are GLP-1s cheating? What they actually do
1:15:10 Beyond the scale: muscle, health, nutrition
1:24:21 Myth-busting: lightning round
1:39:04 Three takeaways: what to actually do
1:41:00 Danny Cahill, revisited 
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