The pitfalls of pumping peptides

“There’s a new religion sweeping through the northern suburbs of Johannesburg. It’s not CrossFit, cold plunging, or intermittent fasting. It’s peptides. And if you’re not on at least three of them, are you even trying?” These words, written by filmmaker and producer Adam Thal in a recent tongue-in-cheek social media post, encapsulate the growing preoccupation with peptides. 

Ozempic, Mounjaro, and other GLP-1 receptor agonists may be household names when it comes to the growing obsession with weight loss injectables, but they’re just one aspect of the peptide craze. Aside from weight loss, peptides offer anti-ageing benefits and muscle growth. But to be effective ‒ and safe – their use needs to be monitored by medical professionals. 

There are many well-known, registered prescription medicines that contain peptides, including insulin, somatotropin (the human growth hormone), and more recently, the GLP-1 group of medications, says aesthetic and anti-ageing doctor Dr Talia Notelovitz. Yet a growing number of peptides being used are not approved for clinical use by governing bodies like the South African Health Products Regulatory Authority (SAHPRA) and the Food and Drug Administration (FDA) in the United States. 

While some community members we approached work in the industry, or say they’ve benefitted from peptide use, they refused to go on record due to the absence of FDA and SAHPRA approval. 

But what exactly are peptides? “Amino acids are the building blocks of proteins and when they are connected in short chains they are called peptides,” explains Notelovitz. “In the body, these occur naturally and act as signals to modulate cellular processes like collagen synthesis, the formation of new blood vessels, the activation of healing pathways, or the release of hormones.” They can also be found naturally in protein-containing foods and supplements. 

“Synthetically manufactured peptides modulate the effects of naturally occurring peptides and have an incredible potential in both wellness and medical spheres,” she says. “There is evidence in laboratory and animal studies that various peptides can have multiple benefits, including weight loss, improved tissue healing, skin quality, body composition, memory, and immune function.” Largely injectable, these peptides are becoming more widely available. 

“Yet, many years of research are required before a medicine is registered for a therapeutic goal and released for use by the general public,” Notelovitz says. This includes laboratory studies, animal and human studies, and then larger clinical trials. “The purpose of the studies is to determine the efficacy, safety, potential side effects, contraindications, and correct dosing.” 

In examining peptide prevalence, registered clinical dietitian and founder of wellness hub, Sunrise by HMDietetics, Hilit Milner points out that today, nutritional and medical information and products are readily available. “Social media and technology have created a culture where health information gets spread very quickly, often without enough context, regulation, or medical oversight,” she says. “The lines between trends and true nutritional or medical relevance have started becoming blurred.” 

While peptides have been around for many years, their use and intensive research around them have dramatically increased in the last few years, including in South Africa, Milner says. “This, together with the fact that we live in a world where we want results and solutions, has pushed peptides into the spotlight.” 

Milner stresses the efficacy of peptides when used under professional guidance. “I see, both in research and in practice, many benefits to peptide usage, and they truly are compounds that, if used correctly, can have many physiological benefits. However, they need to be approved by a medical board, backed by clinical trials, and given under close medical or dietetic supervision.” 

So, how are peptides available in advance of clinical trials and approval by governing bodies? Compounding pharmacies provide medication that is still in the research phase to patients who need them for specific medical indications, broadening access, Notelovitz says. 

“With the current focus on wellness, longevity, and beauty, these products were rapidly adopted and promoted by social media influencers as a must-have for beauty, fitness, and longevity,” she says. 

This has given rise to a trend of “obtaining peptide preparations from unverified and unregulated sources via the internet, a gym instructor, or beautician”, which is unsafe and potentially dangerous. It is fuelled by the harmful misconception that because they occur naturally in the body, peptides are automatically safe. “Without regulation, the vial could be contaminated by bacteria or other substances, contain an incorrect dose or even a totally different substance.” Only peptides manufactured from a registered compounding pharmacy ‒ and given under medical supervision ‒ should be considered, Notelovitz says. 

Milner says she has observed increasing numbers of people using peptides without understanding their bodies. “Many people aren’t being properly assessed nutritionally, medically, or metabolically beforehand, and are often not monitored appropriately during treatment, even when peptides are prescribed by their doctor. In some cases, individuals are using products of uncertain quality or sourcing, which can carry significant risks.” 

Notelovitz stresses that peptides aren’t miracle cures and cannot replace standard medical treatments. Milner agrees. “In fact, some patients are non-responders to certain peptides due to genetics, histamine overload, or high cortisol levels,” she says. They also cannot rely on the peptides alone for the desired effect; healthy habits are still vital. For example, she says, with GLP-1s, if you’re not on top of your dietary intake, you may be doing more harm than good. “A medication cannot replace the role of proper nourishment.” 

Milner says peptide use should never be considered in isolation. “Peptides should rather be viewed as one possible tool within a much broader health strategy that includes nutrition, lifestyle, behavioural support, and understanding the individual as a whole. Two people can follow the same diet or use the same medication and experience very different outcomes, depending on genetics, lifestyle, stress levels, sleep quality, and gut and metabolic health.” 

The fact that many peptides are still in their research phase compounds possible risks, says Notelovitz. “We don’t as yet have sufficient evidence from studies on humans to exclude the possibility that negative effects could emerge, particularly in the long term. Both doctor and patient need to be aware of benefit versus potential risk due to the lack of clinical trials.” 

“As more data regarding effectiveness and safety emerges and regulations change ‒ which we expect in the near future ‒ we may be able to utilise peptides without the ethical dilemmas we face at this stage.” 

While an exciting advance, the use of peptides should never be taken lightly or used without a full medical assessment and supervision, she says.