October 9, 2026 
3 min read
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William "Wes" Alden, MD, PhD | Clinical Education Series
Compounded Peptides and the Rules That Govern Them
By William “Wes” Alden, MD, PhD
Longevity discussions easily slide into expensive testing and unproven treatments. A usable plan for ordinary practice starts with the steps that have the strongest evidence for longer healthspan, adds a smaller set of tools with moderate support, and treats the most speculative ideas with open caution.
First tier: the foundations
Control blood pressure, LDL cholesterol, and blood sugar according to standard guidelines. Stop smoking and keep alcohol modest. Combine aerobic exercise with strength training. Fix sleep problems, including apnea when it is present. Stay socially connected and treat significant depression or anxiety. Correct hearing and vision losses. Follow age-appropriate cancer screening and vaccination schedules. These measures have population-level data and form the base of any serious plan.
Second tier: solid metabolic tools
For the right patients this level includes GLP-1 or dual agonists when diabetes or obesity with cardiac risk is present, prescription omega-3 therapy when triglycerides or the REDUCE-IT criteria apply, and systematic treatment of insulin resistance. A few supplements with defined roles (CoQ10 in selected situations, vitamin D when levels are low) can be considered. Oral NAD precursors and certain specialty lipids may be discussed as options with early human data, not as proven longevity drugs.
Third tier: still investigational
Most regenerative peptides, mitochondria-derived peptides, senolytic compounds, and aggressive NAD infusion protocols live here. The mechanisms can be interesting. Outcome evidence in healthy aging humans is weak or absent. These ideas should never crowd out the first two tiers, and any conversation about them needs plain language about limited proof and regulatory status.
How to talk about it
Patients appreciate honesty. A workable stance sounds like this: we have strong evidence for the foundational measures, moderate evidence for certain metabolic tools in specific situations, and incomplete data for the newer experimental approaches. We will put most of our effort into the first two groups and only revisit the third as better evidence appears.
Closing view
Practical longevity work is less about finding one breakthrough molecule and more about steadily doing the things already known to help. An internist who anchors the plan in vascular risk control, metabolic health, sleep, movement, and social connection, and who judges peptides, NAD strategies, and specialty lipids by the same evidence standard used for everything else, gives patients both scientific honesty and real support.
William “Wes” Alden, MD, PhD, is a physician-scientist and internist. His career has included academic medicine, federal clinical research, community practice, and medical philanthropy. He works in the Greater New Orleans area, including Metairie, New Orleans, and the Northshore communities of Mandeville and Covington. His interests include metabolic health, integrative approaches, neurodegenerative conditions, and practical whole-person care. He emphasizes honest evidence and clear communication with patients and families.
This article is for general education and reflects Dr. Alden’s professional perspective. It is not medical advice and does not create a doctor-patient relationship. Results vary from person to person. Many peptides, NAD products, and specialty lipids mentioned here are not FDA-approved for anti-aging, cognitive enhancement, or most of the wellness uses sometimes promoted. Material labeled for research use only should never be given to people. Please consult a qualified clinician about your own situation before starting any evaluation or treatment.
