Recently I interviewed Dr. Neil Paulvin, as we chatted about low dose naltrexone and peptides. If you would prefer to listen the interview you can access it by Clicking Here [1].
With me, I have Dr. Neil Paulvin, who is an innovative physician in the study of functional medicine, integrative sports medicine, regenerative medicine, osteopathic manipulation, and craniosacral therapy. He works with patients not only to treat but to find the root causes of autoimmune issues, thyroid and hormone imbalances, digestive and gut disorders, as well as a number of inflammatory-based conditions, uniquely combining osteopathic manipulation and functional medicine to fast-track healing, recovery, and biomechanics to progress athleticism. Thank you so much for joining us, Dr. Paulvin.
Dr. Neil Paulvin: Thanks, great to be here. Should be fun.
Dr. Eric: Look forward to chatting with you about low-dose naltrexone (LDN) as well as peptides. Before we do this, can you give a little bit of background? How did you get started maybe doing functional medicine and prescribing LDN to some patients as well as peptides?
Dr. Neil: Sure. I got into a lot of this initially because I was dealing with a lot of chronic illness patients, Lyme, fibromyalgia, autoimmune issues. There wasn’t a lot of traditional medicine that always worked that didn’t have a lot of side effects associated with it. I went down the rabbit hole of some more alternative treatment that had some good data behind it. That’s how I found out about LDN, which has been studied in a lot of conditions as well as peptides, which I learned over the last two or three years have incredible benefits for multiple conditions.
Dr. Eric: Why don’t you start out by, for those who are not familiar with LDN, explaining what that is?
Dr. Neil: Sure. LDN is a derivative or breakdown product. It’s a medicine that has been used for years in patients with opioid abuse or alcohol use disorder. That is usually a much higher dose, 250mg. They found even at those doses, there were some other benefits that come along, like with so many other medicines, found by accident, serendipity. What they found was that those medicines would potentially help with immune issues, weight loss, and inflammation. They didn’t want the side effects that those higher doses could achieve. Doctors went lower and lower and lower to find out where that happy place was, where we could “microdose” it but still get the benefits that naltrexone can provide. It can be given via pill or dropper. There are some nose sprays, but mostly common in a pill form, and taken at bedtime. That is when it works the best. Via the mechanism that it works. That’s where it comes from.
The one thing that people need to know is you can’t take it if you are on some type of narcotic medication like Percocet or oxycodone because it will put you into withdrawal. That is the one downside. Otherwise, minimal side effects. It works over a broad swath of conditions.
Dr. Eric: Can I ask how long you have been using it in your practice approximately?
Dr. Neil: Good question. Probably close to 10 years or so. 8-10 years.
Dr. Eric: Wow. You have been using it for quite a while then.
Dosing. As you mentioned, you start with low doses. How low do you start? 1mg or .5mg?
Dr. Neil: The preface for all of this is low dose is kind of an art. It’s not that everybody takes the exact same dose. We start at a low dose, anywhere between .25mg-1.5mg usually. A little bit lower in patients who have autoimmune issues, especially things like Hashimoto’s because as part of resetting the immune system, it can affect the thyroid hormone. You may need to change their medications around. You don’t want them crashing or going hyper on you, one or the other. You want to take some baby steps with it.
If you are doing it for pain or weight loss, you usually are a bit more aggressive with it because there aren’t as many side effects. That is usually the sweet spot in terms of where we start the dosing at.
Dr. Eric: Do you gradually increase the dosing with everybody? If they start on 1mg, and they are doing okay, would you keep them on that?
Dr. Neil: It depends on the symptoms. Usually, I will keep pushing for a little bit to find out where they will get the max benefit with minimal side effects. Very few people I just keep on the maintenance dose, less than 5%.
Dr. Eric: Okay. How frequently would you on average increase the dose? Would it be something like every two weeks, or every month or two?
Dr. Neil: It’s usually 1-2 weeks. Depends on the patient. Patients who are more sensitive or we are more worried about, you would go slower, every 2-3 weeks. Patients who you are progressing quickly and don’t have side effects, you’d do every week to 10 days.
Dr. Eric: Okay. What is the highest dose that would really be considered LDN still?
Dr. Neil: That keeps going up and up. There are no rules now on it. Other doctors hit low double digits. You want to make sure you are working with someone who is experienced at handling it, and they are doing it for the right reasons. There is prescription medication out there called Contrave, which is LDN, 8.5mg, twice a day. That’s 17mg a day. For the weight loss, you are pushing higher. I am all about what I call the delta. If I put someone on 7mg, are they going to get a much bigger benefit from me putting them on 12-13mg? Usually, it’s not a huge difference. You will get more side effects than benefit usually. My top is right around double digits, like 10mg. A couple patients might be higher, but that’s not common, at least for me.
Dr. Eric: How about a typical autoimmune patient? I know it will vary. Would they at times exceed 5mg?
Dr. Neil: Not usually. If it’s just an autoimmune patient, usually lower is better. With them, it’s such a domino effect of so many other things going on that I don’t see much benefit beyond that, unless I am trying to treat something else.
Dr. Eric: The reason I ask is because I have been used to, over the years, when other practitioners have recommended LDN, probably the max dose would be 4.5-5mg. Recently, I had a patient who was taking 7.5mg, which was the highest I’ve seen for one of my patients. I hear you saying that in some cases, maybe not autoimmune, but other cases, they might take in double digits. You mentioned the 8.5mg twice a day in that certain situation. It sounds like autoimmunity, you tend to keep them on the lower end.
Dr. Neil: Yeah. We tend to keep them on the lower end to limit side effects. We also have the buffer where we know we’re giving it 6-10x the dose. There are not many issues with it. Now that the prescription meds are out there, and that’s given without many side effects, we have a pretty broad swath to go for.
Dr. Eric: Have you seen any difference with different types of autoimmune conditions? I am guessing you probably see a good amount of Hashimoto’s patients. Do you see similar effects with people with rheumatoid arthritis (RA) or multiple sclerosis (MS)? Are there some autoimmune conditions where it doesn’t seem to be as effective?
Dr. Neil: No. Everybody is different. Some people could have inflammation. Some people may have a mast cell issue. Some people may have brain fog or cognitive issues. Everybody is different. It is very hard to compare A to B. I have seen improvement throughout the spectrum in all of my autoimmune patients. I have adopted what I branded the Safety Deposit Box method, meaning you have to turn all the keys at one time on all of these patients. It’s not just about regulating the immune system, but you also have to deal with inflammation or cognitive issues. It works better that way and keeps you on lower doses of certain medications. It’s definitely worked in pretty much all of them.
Luckily, Hashimoto’s usually has less systemic complaints than MS or RA does. RA is much more noticeable. At least half of my Hashimoto’s patients don’t even know they have it until I tell them. Most patients with RA or MS unfortunately know there is something going on. Those symptoms are usually unfortunately more life-altering than Hashimoto’s, at least from what I have seen. I have patients all over the world who come to see me for these things. Hashimoto’s is usually by itself a little bit simpler to treat than MS. That is the broad category. It can help any of them, and they will all usually see some improvement.
Dr. Eric: I’m glad you mentioned that you don’t just give LDN. It sounds like you do a lot more. If the person has a leaky gut or other gut issues, or if they have cognitive issues. You pretty much do what a functional medicine practitioner is supposed to do, which is try to address the triggers and underlying imbalances.
Dr. Neil: Exactly. We are looking at their labs, hormones, lifestyle, sleep, exercise. We’re doing all of those things. It’s definitely not just one thing in most patients. It’s doing a bunch of different things, working from the ground up. Start at the foundation, and they have one or two things, then you take it step by step. If you try to do 100 different things, it doesn’t work.
Dr. Eric: Do you put pretty much all your autoimmune patients on LDN? Does it depend on the person?
Dr. Neil: I would say a majority are on it, just because I find that it works. What I like to do is find things that work on a lot of their complaints. It will help their immune system, their pain. We know it can help heal the gut. It does so many things with minimal side effects. I love it because it checks all those boxes.
Some people don’t like the side effects. Some people are on narcotic pain medications and can’t take it. Ketamine has become more prevalent in my area, so that makes it a bit of a contraindication. Most patients who can use it do.
Dr. Eric: You said some people don’t like the side effects. From what I understand, there are not a lot of side effects. One of them is sleep issues. If they are taking it at night, they may have to take it during the day. Can you talk about any side effects people should be aware of?
Dr. Neil: The main three are problems with sleeping the first day or two. That is because of the way it affects the cytokines in the brain and the other hormones it works on. It may affect sleep. But some patients say, “I slept the best I’ve ever slept.”
There is occasionally some nausea. If you dose it the right way, I very rarely see that.
The other one I’ve gotten a decent amount of times, probably 1-3%, is you get dreams like you are on some type of psychedelic. That tends to go away over the first day or two as the brain adapts to it. I have had one patient have to stop it just because the dreams didn’t go away. That’s out of thousands of patients on it.
Dr. Eric: How about headaches? Are they a common symptom of LDN? I think I have had a couple patients who said headaches. I can’t say it’s common, even though I can’t also say that I have a lot of patients on LDN since I don’t personally prescribe it.
Dr. Neil: I’ve seen it. It’s not- Chicken or the egg is not the right expression. Is that from the medicine? Is that something else? I don’t know. I’ve had less than two handfuls of patients have that symptom. If you look at the side effectsof anything, you can get one person who gets this, but I don’t really see it.
Dr. Eric: The big one is sleep, but not everybody experiences sleep issues. Some people take it, and they actually sleep better.
Dr. Neil: The other one I have seen occasionally, and I know it’s reported in groups, and it’s usually because of other reasons, is weight gain, even though it’s used for weight loss. What is happening in those patients is it’s regulating the hormones and immune system. The other doctors are not getting on top of the hormone part, so there is some weight gain associated with it. That’s the other side effect I have seen sometimes, but that’s it.
Dr. Eric: For your Hashimoto’s patients, I know you mentioned earlier where they might be able to lower their dose because the effects of LDN on the immune system. Do you have people who are able to completely get off of thyroid hormone replacement by taking LDN?
Dr. Neil: The answer would be yes, I guess. In a lot of cases, I am not as aggressive with the thyroid medicine initially unless their numbers are horrible. The majority of patients that I see, their antibodies are worse than the thyroid hormone is. If you look at their thyroid numbers specifically, they are not bad. I tend not to have them on thyroid hormone.
If there is a double there, where they are both on LDN and thyroid hormones, it’s a mixed effect. Maybe 25% come off their meds. Is there something else going on? The patients that are just Hashimoto’s can sometimes come off the medicines because it’s not a hormone problem specifically, it’s an autoimmune issue. If we fix the autoimmune issue, they can regulate themselves.
Dr. Eric: I know that LDN can also help with Graves’ just like it can with other autoimmune conditions. Have you seen other Graves’ patients who are on LDN?
Dr. Neil: I have a couple. It’s kind of its own beast. I tend to be more delicate with that because you can crash really quickly or have a thyroid crisis with it. It depends. Are they on some type of prescription med that will help them calm down their thyroid storm, or symptoms they are having? I use it, but I go really small doses with them. I also make sure that if they are seeing an endocrinologist, that their endocrinologist knows what they’re doing because otherwise, that could get sticky. It’s the one thing I have seen the least success with, but it does help. I use other tools in my toolbox more than LDN, at least initially.
Dr. Eric: When someone is on LDN, can most people eventually get off of it? Is the goal for you to work on other areas and then for them to get off the LDN like six months or a year later? Is that something where it’s part of your wellness plan? On average, I know it differs.
Dr. Neil: In the big picture, what happens? I would say it’s almost 50/50. Patients are like, “I feel so much better on it. I have no side effects. It’s not expensive. I might as well stay on it.” It’s 50/50 for a patient to come off of it.
I have patients usually on it for 3-6 months. I tell them from the get-go that they should expect to be on it for six months; otherwise, there is no point in doing it. I literally have a ton of patients who I see them every six months. They are feeling great, so why make them get rid of it? Now there are some other studies coming out on LDN in terms of anti-aging and longevity and other things. It will probably switch more to that as the studies come out.
Dr. Eric: I think I heard you say earlier Lyme disease. Do you give it to Lyme patients? Or did you say you work with Lyme patients? Is LDN something you would recommend for someone with Lyme or bartonella?
Dr. Neil: Yeah, Lyme is an autoimmune issue. It helps with pain and brain fog and resets the microglia, which any patient with Lyme who has cognitive issues works with. I use a lot of it with Lyme. I use it with any type of chronic illness patient, just because it hits so many broad stroke things. It makes it so useful. With Lyme patients, it’s part of an overall program. I have Hashimoto’s patients who are just on LDN, and they get better. Most Lyme patients, it’s not going to work that way.
Dr. Eric: Before we move on to peptides, is there anything else that I should have asked you about LDN? Is there anything else you want to say that you think is urgent for people to know?
Dr. Neil: The main thing I would say is understanding that most patients are going to ask when they will notice benefits. It’s 4-6 weeks for most patients. Some of the data will say three months.
The other thing I want people to know is I am pretty aggressive with it and comfortable with it. I have been dealing with it for many years now. If you are on steroids long-term, not just acutely or on some type of autoimmune medication, like Methotrexate or Remicade, you do want to let the doctors prescribing it know about it because some people who want to be aware of that will want to stop it or at least will talk to me and ask, “What’s the deal? I’ll monitor that, and you monitor this. We’ll go from there.” It used to be a lot more restrictive on what you want to use it for, but now we keep pushing the boundaries to see that there is not a huge issue.
Dr. Eric: Thanks for sharing that about LDN. Let’s move on to peptides. Can you explain what peptides are and when you use them in your practice?
Dr. Neil: Let me try to summarize it in a paragraph here. It’s really hard. Peptides are small groups of amino acids. They exert their effect at a specific hormone, a specific enzyme system, a specific location, which makes them very efficient because it’s more specific than taking an Ibuprofen. They can be used now for almost anything. We use them now for anything from brain fog to erectile dysfunction to fatigue to rotator cuff tendonitis. They have a broad scope of what you can use them for. Now they are pretty much available in any form, everything from hair gel to injection to IV to creams to nose sprays. It used to be injection or nothing a couple years ago.
Dr. Eric: How do you typically administer them? Do you administer them in both ways, or is it usually mostly oral or injection?
Dr. Neil: it depends on what they’re talking and what they’re taking it for. Some of them are only available in injection or orally. If there is multiple choices, we usually recommend injection, as it’s more absorbable but passes the gut. There is a group of them that are available both orally and injection-wise. We will help people do the injection if they feel comfortable doing that. Two, three years ago, most patients didn’t love doing injections. Now, patients are like, “I inject myself all the time. I feel comfortable doing it here, here, here.” The field has definitely changed in terms of patients self-administering meds, which wasn’t common a couple years ago.
Dr. Eric: You answered one of the questions I was going to ask you, which is do you administer the injections in your office, or do they self-inject? It sounds like maybe initially they go to your office, and you show them how to inject them. Then from that point on, they can do it on their own.
Dr. Neil: I have maybe two patients who come to the office and get injected. I have patients all over the world, so it doesn’t make sense for them to come here. It’s not that hard; it’s just an insulin syringe. So most patients will inject themselves. We have a couple that are needle-phobic. There are other forms, like creams or pills. You can pivot now. Otherwise, I have patients injecting 3, 4, 5 a day. It’s gone the other way from what it used to be.
Dr. Eric: They are fairly safe, I assume? Are there any side effects that people should be aware of?
Dr. Neil: That is the elephant in the room at this point, not in the sense that some are known to be safer than others. If you took LDN or prescription medications or supplements, there are some good studies out there. There aren’t as many studies on peptides long-term.
The ones that we get a little bit concerned about because there is the theory of cancer are the ones that boost growth hormone, even though there is no specific study that shows it. We know that any time growth hormone gets increased, there is a chance for increasing risk for any type of cancer you may have. We will discuss that with the patient. We will often do a max of three months at a time with those peptides, which is called a cycle. You are not doing almost any of the peptides in perpetuity to limit that risk.
There are also ones that work on the thymus. It’s never been proven. It used to be prescription medication. We do it for three months. That is called thymogenalpha-1, which doesn’t exist anymore because it hasn’t been approved by the FDA, not because of side effects, but because of false promises. People were promising the world with it, and it wasn’t true.
This is another issue. People on social media tend to say that things can do things they can’t, so they get everybody in trouble. The bad kid in school. There is also one called TBC and TB-500, which is for inflammation mostly. That is mostly a Reddit thing. It’s amazing watching the Reddit groups and Facebook groups. Some people find some study done on some rare animal that showed one thing, which has nothing to do with humans, and they will put it out there. There is the supposition that it may happen. There is no human data or mouse data, which is a step below that we tend to look at, that it may cause cancer. It’s out there, and people will find that one Reddit group, and they will show it to me.
We are doing those for three months, and that’s it. Patients are aware of those side effects. That sounds scary, but there is no evidence with any of those peptides that it happens. I have prescribed them for years with thousands of doctors prescribing them, and there is not really a reported case of it. Unfortunately now a lot of people do the Dr. Google thing, and they find things. We have to explain to them, or they just move on, and we do other things.
That’s a long-winded answer. Most of the other ones are pretty safe with minimal side effects. The main thing we are concerned about is the reaction that you can have to anything. You can have a histamine reaction to something. You may feel a little nauseous when you get an injection, but that can happen with LDN, supplements, and prescriptions. That is usually the big question that we get. Somebody will see it on a podcast or a Reddit or Facebook group. The paradigm has flipped, where most patients are doing their own research, and they are coming to you and saying they want to do this or that, as opposed to asking what they should do. It’s been interesting over the last couple years.
Dr. Eric: Are peptides similar to LDN in that you’re not just giving the person peptides, but you’re also doing other things from a functional medicine perspective?
Dr. Neil: It depends. Are we doing functional medicine? I also do a lot of sports medicine, as you mentioned in the intro. If I have somebody who has a rotator cuff tear that hasn’t improved, I may just do the peptide and some physical therapy. If I am doing a peptide series in a Lyme patient, in that case, I am doing the whole package deal, not just one thing. It depends. What’s great about the peptides is they treat so many different things. If it’s a chronic illness patient, yes. If it’s somebody who just has hair loss, we’re not doing as much, which is what makes them really great.
Dr. Eric: That makes sense. Most people listening to this have a thyroid or autoimmune thyroid condition. What would be two or three of the top peptides you would give someone with Hashimoto’s or Graves’ or a non-autoimmune thyroid condition?
Dr. Neil: In terms of autoimmune, a Hashimoto’s patient, we are going to work on the immune system first. That will be thymulin, which is related to the thymosin that doesn’t exist anymore. Thymulin is its cousin that we use that works pretty well.
Beyond that, we’d use a peptide called BPC-157 since a lot of gut and immune issues overlap. Many autoimmune issues connect with gut infections. I’m sure you’ve dealt with that. That is probably our second goal with it.
We use a peptide called KPV, which will help heal the gut but also has been shown to help with mast cell issues, for patients who don’t do well with histamine. Sometimes that overlaps on all autoimmune conditions depending on what school of thought you are. More and more studies are coming out about the mast cell giants. There is a huge connection between the mast cell and the immune system and autoimmune issues.
Those are probably the two or three I tend to use if there are no other complaints. Then we will go from there if there are other overlying issues.
Dr. Eric: Just like I asked you with LDN, with peptides, is it something that people will continuously take on average? For someone with hair loss, for example, will someone only take it for three months or six months, and their hair grows back? For autoimmunity, is it temporary or more of a long-term thing?
Dr. Neil: Like I mentioned earlier, usually, we do what are two terms of a use for it. One is we are doing cycles, usually 3-4 months of any peptide. Then we also do stacks, which means we are combining more than one peptide together to get a better benefit than we would with each one individually.
We are also cycling through. For the first two months, I may do BPC and thymulin, and then I may stop that and switch to KPV for the next two or three months. In most cases, patients are not on peptides in perpetuity. They are taking breaks for the reasons I described. You can get in theory what we call tachyphylaxis, meaning you won’t respond as well in the fifth month as you are the first month. That benefit is slim.
They are not cheap. LDN, depending where you are, you can get for $40-$60. Some peptides could be $800-$900 a month. Unless you’re not seeing a big benefit, most patients are spending $800-$3,000 a month on medicine that isn’t helping them.
Usually, it’s two or three months. The only things that I will tend to do longer for is patients who have complaints, and we are trying to clean things up. The rotator cuff, you are treating to the end, and it’s a finite end. Some of these autoimmune things, you’re going on and off.
Dr. Eric: It sounds like LDN is more longer-term. Part of that is the cost, but also autoimmunity, it’s not something that will be resolved within two or three months, whereas peptides, a combination of the cost, and even besides the cost, you said it’s three or four-month cycles. You usually won’t have someone on peptides for six consecutive months or longer, but that wouldn’t be uncommon with LDN.
Dr. Neil: Also, in a functional kind of method, the one I use is sometimes If you have a little back pain, and you take Ibuprofen for a month every year just because it acts up when you are shoveling snow or raking leaves, if your shoulder pain comes back or your bloating comes back, you can hop back on for two or three months and then go on with your daily lifestyle regimen.
LDN is usually a longer-term medication. LDN is like Vitamin D or testosterone. It doesn’t save up. If you stop it, it’s gone, and you have to start all over again. The peptides are usually causing more of a result, and that may be more life lasting. I guess I can put it that way.
Dr. Eric: That makes sense with any medication. Typically, if you stop taking it, you will lose the benefits. Some things like antibiotics, you take for an infection for hopefully a short amount of time, although that can be a longer time for something like chronic Lyme. Thanks for explaining.
Is there anything that you didn’t mention on peptides that you think is important for the listeners to know?
Dr. Neil: I think we hit almost everything. Two or three things I would mention. First of all, be careful about ordering peptides. There are so many sites out there that are not regulated by anybody. They may be cheaper, but buyer beware. They are getting product that is out of the country. If you are getting it from a pharmacy, you know it’s regulated by a state or local government. They are being screened. You know what you’re getting. It has to have certification with it. That’s the first thing I would mention. Especially everything in the supplement community, things become the wild wild West. you want to get products from a quality source.
You want to work with someone who is experienced because there is a lot of nuance to a lot of this stuff. I have a lot of patients who come in and say, “I’m on these five peptides at this dose.” These doses make no sense. Whoever prescribed them had no idea what they were doing. For LDN, it’s pretty hard to mess up. Peptides have more of an art to them of knowing how to implement them.
The last thing I would say is when you talk to the doctor about them, make sure you answer these few questions. What is your goal with the peptides? They will have a dramatic effect. Make sure if you are willing to do only one or two, that the doctor knows. I have some patients who come on five or six different ones, and they feel horrible because they are on too many.
Make sure you understand the cost and you will be on them for multiple months. If the patient can’t afford them every month, they need to try something else. The peptides aren’t going to work for you in two weeks usually. It’s something you will usually do for two or three months. If you can’t embark on that journey, let me know now. I have 700 things in my toolbox. We may switch you to LDN, which is cheaper and can do a lot of the same things and get the benefits you want without you having to worry about a needle and stuff like that.
Dr. Eric: That was very helpful. Before we wrap things up, I have a question about craniosacral therapy. I know you do that in your practice. I have been fascinated by it. They have some techniques in chiropractic that are related to craniosacral. Who in your experience would be a good fit for craniosacral? This might be a broad category. If someone is having brain fog or cognitive symptoms in general, or is it more like specific conditions?
Dr. Neil: I’m trying to think how to answer that. When I started doing it 15-17 years ago, there was no LDN or peptides. There was no hyperbaric chambers or gut chambers or discussions about gut health. It wasn’t there. The paradigm has totally changed.
It definitely is a much slower and steadier progress. It’s not something where in most cases, you’re like, “Oh my god, this is better.” What it still has a really good niche to is someone who had a concussion, a head or neck injury, who have EDS. That is an A to B situation. If I hit my head on the car door, I was a little dizzy. I was treated, and I felt 100% better. It’s great for an injury situation.
In terms of brain fog or fatigue, it’s definitely a help, but it’s not going to be a home run usually for most patients. It’s a nice add-on. It’s gotten harder and harder to find good providers, at least in Manhattan, where I am. It’s something to look into. It’s much gentler. There is no medication involved. Something it’s really good for, because there are allergy issues where I am, are sinus issues. Those are really where it has a good niche for it.
Dr. Eric: That’s good to know. A lot of people do have sinus issues, so that’s great. Thank you for sharing this, Dr. Neil.
Where can people find out more about you? You have a practice in Manhattan, but you also work with people throughout the world. Can you share your website and anything else?
Dr. Neil: The simplest way to find out about me now is the website, DoctorPaulvin.com. I have a lot of information on there. We are redoing it to get some newer things on there. The YouTube channel is Dr. Paulvin, as is the Instagram channel. Those are the easiest ways. We have a newsletter. Depending how much of a deep dive you want, we have a lot of information on there. It may take a while. That is a good way to reach out to me in terms of what we do and if you have any questions about seeing me virtually or in the Manhattan office.
Dr. Eric: Thanks again, Dr. Paulvin. Appreciate you sharing your knowledge when it comes to LDN and peptides and a little bit on craniosacral.
Dr. Neil: Thanks for having me.