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enthusiasm dramatically outpaces science FDA Category 2 classifications for peptides like Semax reflect absence of FDA-standard evidence, not documented harmsRussian clinical experience suggests reasonable safety, but long-term effects by Western standards remain uncharacterized Established interventionsexercise, Mediterranean diet, sleep optimization, cardiovascular risk management, cognitive engagementhave far more consistent evidence than any peptide for dementia risk reduction For Research Prioritization Compounds meriting continued investigation: GLP-1 Agonists: Prevention trials in preclinical/presymptomatic populations, testing compounds with better brain penetration (dulaglutide, lixisenatide) SS-31/Elamipretide: Cognitive outcomes in mitochondrial disease populations, potential expansion to brain aging indications P21: Phase I human trials to establish safety, pharmacokinetics, and proof-of-mechanism for CNTF-pathway neurogenesis Klotho: Watch for Phase 1 results from Jocasta Neuroscience (expected 2027-2028)

Potential role of microbiome in Chronic Fatigue Syndrome/Myalgic Encephalomyelits (CFS/ME)

People return to activity when pain decreases, yet the tissue may not have regained structural integrity