How Long Does It Take For PPS To Work?

Pentosan Polysulfate Sodium (PPS) is an FDA-approved drug in the United States under the brand name ELMIRON. ELMIRON is an oral medication indicated for treating bladder pain and discomfort associated with interstitial cystitis.

As usual, the Boulder Longevity Institute gets ahead of the crowd by finding a way PPS can be used in the U.S. as a beneficial regenerative medication. While not effective orally outside of its use as a bladder pain relief drug, PPS can be beneficial in the treatment of arthritis when administered via injection.

BLI partners with a compounding pharmacy to get PPS to patients now. The drug, in phase III trials approved by the FDA, will go to market in the coming years as Zilosul. 

As we know, arthritis is an inflammatory process at its core. Sure, the inflammation can be instigated by injury but we can say with confidence that addressing the inappropriate inflammatory response as quickly as possible leads to markedly better outcomes.

PPS works to address the entire inflammatory process in ways that typical treatments for arthritis pain – anti-inflammatories, steroids, joint replacements – do not. Pentosan works through various mechanisms like pain control, halting the progression of degeneration, and encouraging an environment for regeneration. 

Once a better environment for regeneration has been completed, stem cells or platelet cells can be introduced into a space where they can thrive. 

So how long does it take to work? Well, Dr. Yurth of Boulder Longevity Institute believes it depends on the extent of arthritis. Studies show pain control in 6-8 weeks with one to two injections per week. However, this is not the case for every user.

The more damage, or the further along the arthritic process, the longer PPS takes to fully engage in the work of improvement. With that said, there are those who see quick pain relief that is typically experiencing the impact PPS has on the inflammatory process.

While a relatively new use for pentosan, BLI has been using it long enough to note that 80 – 90 percent of clients see improvement over time. Patience is key, as it can take six months or so to really see regenerative impacts in the more damaged knee. 

Dr. Yurth has seen the value of pentosan firsthand, as she has been taking it for years and notes marked improvement in her chronic knee issues. Whether for chronic arthritic knees or an acute injury, pentosan is a game changer in the fight against damage brought by inflammation.

Depending on your clinical presentation, you may have to be patient. However, in the end, the benefits of pentosan polysulfate sodium are well worth the wait.

The Importance of Supplement Cycling

Most of us have understood the importance of taking a daily vitamin since childhood. Any Flintstone kids still growing out there? Taking some basic supplements on a daily, long-term basis makes sense. 

Dr. Elizabeth Yurth of the Boulder Longevity Institute points out that Vitamin D, B-Complex vitamins, or general multivitamins are logical additions to your daily supplement routine. What about the more aggressive supplements like spermidine, NAD, or antioxidants?

Using a process of supplement cycling (time on – time off specific vitamins and supplements) can help the body reap the benefits without doing unintentional damage. Certain supplements can be overwhelming when taken regularly over long time periods. 

The overwhelm can be physical, including burdening the liver as it works to filter the body of unwanted chemicals. There can be a financial toll associated with overconsuming supplements, as most of them would not be considered inexpensive. Finally, trying to keep up with supplement dosages, timing, and ingredient interactions can be downright stressful.

Human bodies are indescribably complex. The interaction of pathways, messengers, and metabolism can all be impacted by supplements. A short period of intake of certain supplements may not overwhelm these systems but over time could have negative impacts. 

Dr. Yurth offers a couple of examples, of the hundreds she can think of, describing how supplements could have unintended consequences. She notes that many supplements are tested over short periods of time, leaving us in the dark of how they impact our bodies with extended intake. 

We constantly hear about how oxidative stress is overwhelming our bodies. Social media has convinced us that throwing antioxidants at the supposed problem will tamp down the oxidative stress, and be beneficial in the long term. While many of us are inundated with this stress occurring in the body, the thought process that antioxidants are a cure all is problematic.

The problem with this approach is that not all oxidative stress is a bad thing. This stress can encourage mitochondria to respond appropriately, improving damaged cells on their own. This is a prime example of how the complicated systems in our bodies can be thrown off balance by what we think is best. Balance (homeostasis) is key.

5-HTP is another example of how less might be more. We know 5-HTP is a good supplement that positively impacts sleep, encourages true rest, and reduces stress through the increase in serotonin and melatonin it induces. What happens if we intake 5-HTP for extended periods?

Tryptophan finds another route and drives down the kynurenine pathway. This throws the appropriate system out of balance, possibly leading to neurological damage, depression, and a reduction in sleep. This is the opposite outcome we would be hoping for and is instigated by too much 5-HTP.

The loss of vital homeostasis is a real threat when taking certain supplements for long durations. This is how cycling helps. Taking breaks via these cycles allows the balance to remain in place. Your liver gets a break and the body is allowed to reset. 

Dr. Yurth also points out how the body typically reacts to inputs like supplements or exercise. It adapts. Doing the same thing over and over leads to a plateau in results. Cycling supplements or changing exercise routines challenges the body to keep improving.

The assistance of someone like the specialists at Boulder Longevity Institute is certainly helpful. We have seen how challenging it can be to know what to take, how long, and how much. Getting the perspective of a professional is the best bet for those taking supplements other than the typical everyday vitamins. 

For those seeking a DIY approach, take your basic supplements regularly. For more aggressive supplements, consider 12 weeks on and 12 weeks off cycles to allow your body to rest, recuperate, and react appropriately.

The body needs homeostasis. Cycling supplements can protect the cells and maintain balance over time. Balance is key.

Peptides: The Next Step to Health Optimization

Peptides, The Next Step in Human Optimization

Peptides are short chains of amino acids found throughout our bodies in virtually every cell. They are responsible for signaling and communication in the body, aiding in nearly every core biological system from brain function to fat storage. They can also help with insulin control, manage sleep disorders, and promote overall longevity. However, much like our hormone levels decline with age, our naturally occurring peptides and amino acids decrease as we age. This decrease can lead to increased fat and muscle loss starting as early as your mid 20s or early 30s. Peptide therapy, similar to hormone therapy, can provide our bodies with those essential amino acids once again and kickstart the regeneration process.

There is such a wide range of peptides and functions, from wound healing to glucose management. Some of the more popular and well known peptides include BPC-157, thymic peptides, and GLP-1 agonists.  

BPC-157 can aid in healing and regeneration throughout the body, including wounds and tissue rejuvenation. It can be taken orally or through an injection. When taken orally, BPC-157 can aid in gut tissue and ulcer treatment, along with ulcerative colitis. When taken as an injection, BPC-157 is best for musculoskeletal injuries. This is achieved through the production of nitrous oxide and other crucial growth factors, which assist in making new blood vessels. It promotes the physiological processes that take place in the event of wound healing and tissue regeneration.

Similarly, thymic peptides encourage normal immune function and healing. Such peptides originate from our thymus gland, a small organ found near our upper chest. In our thymus gland, immune T cells are generated and trained to fight off infections and cancerous cells. However, the size of our thymus shrinks as we age, and as a result our naturally occurring thymic peptides decrease, leading to a decrease in overall immune function. Subsequently, supplying our bodies with thymic peptides aids in immune system health and healing. Common thymic peptides include Thymosin Alpha-1, Thymulin and Thymosin Beta-4. Thymosin Beta4 is often paired with BPC for collagen growth and healing as well.

GLP-1 agonists such as semaglutide are similar to those that our body makes. Although compounded and chemically synthesized, GLP-1 agonists like semaglutide act like the peptide that our bodies naturally make. While GLP-1 agonists were originally taken for glucose management, they are now administered for additional lifestyle maintenance and management purposes. For example, they can help with appetite control, body weight, blood pressure, plasma glucose, and plasma lipids. While these agonists are generally well tolerated, there may be some nausea early on as the body adjusts to the chemically synthesized peptides.

While all of these peptides are beneficial in theory, not all peptides are equal. Buying from a reputable source is important to your health and longevity. “Research-only” peptides you can buy off the internet are often compounded with fillers and lack sterility and purity testing. Getting your peptides prescribed by a a physician that sources their peptides from a FDA-approved compounding pharmacy ensures safety and efficacy.  Peptides need to be taken in the right order, amounts, and proportions, so working with certified professionals and physicians is recommended. Navigating peptides alone is like touring a museum without a tour guide, you are unlikely to get much out of it…and you might even stumble into an area marked off limits

Reasons to NOT Worry if You Run Out of Your Prescription

There can be an overwhelming dread when you realize you have run out of your prescription unexpectedly. Whether it be a hormone, peptides, or drugs like pentosan polysulfate sodium, you likely do not need to be worried. 

The majority of hormones, peptides, and drug treatments offer a build up effect in our system. This allows their impact to remain even without taking the prescription for a short time.

Additionally, the ideal benefit of these treatments is some semblance of a systemic improvement. Thus, the improved cellular function can tolerate short durations of change.

Ideally, keep an eye on your supplies. If a weekend or vacation is approaching, take stock of how much you have remaining and what you might need. 

In the event you do run out, remain calm. Your body will handle the downtime by using built-up impacts, improved cellular function, and may even benefit from a short break from treatments. Have your prescription refilled or addressed as soon as possible and rest easy knowing you will be okay.

Is this the year we finally take a new approach to treating joint & back pain?


In this recorded live lecture, Dr. Yurth shares the latest science and research on what’s causing your joint & back pain and how to treat it – not simply patch, replace, or fuse it. In this intimate hour-long session, you’ll learn why our traditional approach to joint & back pain is largely stuck in the Dark Ages, how to think about arthritis as a disease that we must address at the cellular level, and what science-backed methods are available to treat, and even reverse, your pain.


  • The technology used for hip and knee replacements looks virtually identical to that used 30 years ago.
  • Scoping a knee has become a largely obsolete practice in Europe due to its minimal, and sometimes harmful, effect in treatment of osteoarthritic knee pain.
  • Just like your brain doesn’t wear out from thinking too hard, your joints don’t wear out from continued use – arthritis is a degenerative disease state!

With her combined expertise in orthopedics and functional medicine, Dr. Yurth will share regenerative and cellular treatment options aimed at helping to address the root cause of your pain and how to not only alleviate issues, but actually regenerate and heal.

Play Video


As technologies continue to change and evolve, the treatment of joint replacement and osteoarthritis has remained stagnant. Osteoarthritis, a joint degradation that leads to cartilage death and thickening of the joint lining, is the third leading cause of disabling pain as we get older.

Arthritis is a disease that progresses with age. It is not stationary to one area. Instead, a complete cellular process takes place that affects our entire system, not just the painful joint.

Traditional treatments for joint pain have included injections such as steroids and hyaluronic acid that are injected into the site of pain. However, these tend to provide short-term relief. An article in 2019 found that steroids worsened disease progression. As for hyaluronic acid, 28% of patients had surgery within 7 months of receiving the injection.  

Surgery has been another method, as knee replacement surgery is one of the leading procedures done in the United States. A British medical journal analyzed all of the available orthopedic medical surgeries, including knee replacement, and found only one to be viable and useful, which was carpal tunnel release. A similar type of surgery, known as arthroscopic surgery, goes in and “cleans up” the area around the joint. However, it has been banned in other countries outside the US after being found to worsen conditions instead of healing. Though there is a time and place for surgery, it should be analyzed on a personal basis that takes into account the drawbacks and data – and not the initial “go-to” solution.

While traditional methods focus on a target area of the body, next generation regenerative medicine focuses on healing the cellular processes that lead to pain throughout the body. Within our bodies, inflammaging, mitochondrial dysfunction, and damaged senescent cells can all lead to pain. When in balance, all of these processes play a critical role in healing and supporting our immune system. For example, mitochondria produce ATP to aid in the healing process and autophagy helps to reduce the impact of damaged, senescent cells (think of taking out the trash). However, when our immune system is not in balance, mitochondria may accumulate too many reactive oxygen species, which lead to too many damaged proteins for autophagy to get rid of, leading to pain. Next generation treatments to help these processes include pharmaceuticals, hormone support, and peptide therapies.

Pharmaceuticals and hormonal support have a wide range of uses and types. One type of pharmaceutical includes repurposed drugs. This includes medications that are FDA approved for certain purposes but can aid in the healing of other conditions as well. For example, a compelling option includes PPS, or Pentosan Polysulfate, which is currently being used in other countries as a common treatment for osteoarthritis to reduce inflammatory cytokines and improve cartilage functions.

Peptide therapies also serve as an option to target cellular processes. Peptides are good for repair because they have specific coding for specific actions, including promoting longevity. One example of a peptide includes BPC-157, which is found in our gut, that promotes healing. AOD-9604, another type of peptide, paired with supplements such as hyaluronic acid (HA), can help complete cartilage regeneration.

Overall, arthritis is a disease that is not stationary to one part of the body, nor is it an inevitable result of “wear-and-tear” as we age. Instead, there is a complete cellular process taking place affecting our entire body, not just the joint. It is for this reason that next generation regeneration therapy such as pharmaceuticals and peptides should be considered as treatments to rebalance these cellular processes and reduce joint and osteoarthritis pain.

Unraveling the Myths of Hormone Replacement Therapy and Cancer

Unraveling the Myths of Hormone Replacement Therapy and Cancer

There is a good chance you have heard that hormone replacement therapy (HRT) or hormone therapy (HT) causes cancer. If you have a family medical history that includes cancer, you have almost certainly been told by a physician that HRT carries a high risk.

Unfortunately, this is a wildly dangerous myth being propagated by countless physicians based on a study from 2002, called the Women’s Health Initiative (WHI). What you should know right away is the study has been largely disproven. 


Unraveling the Information Regarding Hormone Replacement & Cancer Risk

When discussing hormone replacement therapy, it is not uncommon to hear someone voice the concern, “But don’t hormones cause cancer?”Unfortunately, despite multiple studies over many decades refuting this claim, this belief persists – in large part as a result of a single study published in 2002 called the Women’s Health Initiative. The published article suggested that post-menopausal women taking a combination of estrogen and progestin were at an increased risk for heart disease, stroke, cancer, and blood clots. However, what is often overlooked is this study’s finding that also showed that those taking estrogen alone showed no increased risk. Taken together, the study indicated that it was the progestin, a synthetic form of progesterone (as opposed to the natural hormone progesterone), which led to increased risks – not the estrogen.

The 2002 study became widespread, and with it, concerns about hormone replacement therapy (HRT). Over the following years, there was a drastic drop in HRT usage as a result of the WHI. In 1999-2000, the total use rate of HRT in the United States was 38.3%, and in 2003, Norway and Sweden saw a 70% drop in HRT use. 

After the widespread discontinuation of hormone therapy, some interesting trends emerged. The decrease in hormone replacement yielded opposite outcomes than originally expected. 2004 to 2005 saw an increase in age-adjusted osteoporosis, a condition well-documented as linked to age-related decline in hormones. . Additionally, breast cancer rates remained unchanged.

After observing the opposite outcomes of stopping hormone therapy, doctors and physicians decided to analyze more data and re-evaluate the 2002 study. Further investigation of the original study yielded inconsistencies and potential biases. Of those in the original 2002 study, 50% were smokers, 50% were fat or obese, and for some women 10-20 years into menopause, the damages had already occurred. Overall, the majority of the original subjects had increased symptomatology due to their current lifestyles, not due to hormone replacement therapy.

Evidence refuting the 2002 article was also compiled. A 2003 update to the 2002 study showed no such hormone-induced increase in breast cancer. Additionally, evidence of the delivery of the hormones was shown to affect risks. Oral estrogen, such as found in birth control, shows an increased risk of blood clots and venous thrombosis, with no change in mortality. However, oral estrogen is filtered through the liver, which causes the increased risk. Transdermal estrogen, the type used in bioidentical hormone therapy, bypasses the liver and therefore eliminates the risk associated with oral estrogen. Evidence suggests it may even reduce the risk of blood clots and venous thrombosis. Similarly, bioidentical progesterone, unlike the synthetic progestin, has been well researched and documented for its many health benefits from sleep to weight management and more. 

Sadly, even today, many physicians as well as the United States Preventive Services Task Force (USPSTF) advise against such therapies based on the original 2002 results. Overall, bioidentical hormone replacement therapy is a sex-specific therapy meant to aid in the reduction of breast cancer, bone fractures, cancer mortality, and more. While a single early 2002 study suggested an increased cancer and blood-clot risk, dozens more recent studies have refuted such claims. Hormone therapies are available as an aid to women and men in maintaining their physiological health without increased risks – and arguably are critical to healthy aging and overcoming the traditional decline associated with reduced hormone levels as we age.