Behind the Science
Why it works.
Not just that it works.
Every protocol we prescribe is backed by peer-reviewed clinical research. This page explains the mechanisms — exactly how each compound works, why the timing matters, and what the data shows. We don't do gimmicks.
01 — Medication Protocol
Tirzepatide
A dual GIP and GLP-1 receptor agonist. The most clinically significant advance in pharmaceutical weight management in decades — not because of the drug alone, but because of how we pair it with everything else.
The Mechanism
Tirzepatide · Twice weekly subcutaneous injection
Tirzepatide activates two receptors simultaneously: GLP-1 (glucagon-like peptide-1) and GIP (glucose-dependent insulinotropic polypeptide). Most people have only heard of GLP-1 from Ozempic and Wegovy — tirzepatide adds a second receptor that works through a distinct pathway, producing synergistic effects that neither receptor achieves alone.
GLP-1 activation slows gastric emptying, reduces appetite through hypothalamic signaling, improves insulin secretion, and decreases glucagon. GIP activation adds enhanced fat metabolism and improves pancreatic beta-cell function. Together, they reset the appetite set-point at the neurological level.
-
Appetite suppressionSignals to the hypothalamus that energy stores are sufficient — reducing hunger hormones (ghrelin) and increasing satiety hormones (PYY, CCK)
-
Gastric motility reductionSlows stomach emptying, extending the satiety window after eating and blunting post-meal blood glucose spikes
-
Insulin sensitivityImproves peripheral insulin signaling, reducing the metabolic dysfunction that drives fat storage and cravings
-
Fat metabolismGIP receptor activation directly promotes adipose lipolysis — breaking down stored fat for fuel
The Data
SURMOUNT-1 Trial · Phase 3 · N=2,539
The SURMOUNT-1 trial (Jastreboff et al., NEJM 2022) is among the most significant weight-loss trials ever published. Adults with obesity (no diabetes) were randomized to tirzepatide or placebo over 72 weeks. The results were unprecedented.
-
22.5% mean body weight reductionAt the highest dose (15mg), participants lost more than 1 in 5 pounds of their total body weight — a result previously only achievable with bariatric surgery
-
91% achieved ≥5% weight lossThe threshold at which clinically meaningful metabolic improvements are observed — reduced blood pressure, improved lipid panels, reduced insulin resistance
-
57% achieved ≥20% weight lossOutcomes that overlap with surgical intervention outcomes, without surgical risk
"Tirzepatide resulted in a mean reduction in body weight of 22.5% — a degree of weight reduction previously observed only with bariatric surgery."Jastreboff AM et al. Tirzepatide Once Weekly for the Treatment of Obesity. New England Journal of Medicine. 2022;387(3):205–216.
02 — Cellular Optimization
NAD+
Nicotinamide adenine dinucleotide. Every living cell depends on it for energy production, DNA repair, and metabolic regulation. Subcutaneous delivery, fasted each morning — timing is not incidental. It's by design.
What NAD+ Does
NAD+ · Subcutaneous injection · Fasted morning · 5 days/week
NAD+ is a coenzyme found in every cell of the body. It plays a central role in the electron transport chain — the process by which cells convert nutrients into usable energy (ATP). Without adequate NAD+, mitochondrial efficiency drops, cellular stress increases, and the body's ability to regulate metabolism deteriorates.
NAD+ levels decline naturally with age and with metabolic dysfunction. Restoring them through supplementation has emerged as one of the most promising areas in longevity and metabolic medicine.
-
Mitochondrial efficiencyNAD+ is the primary electron carrier in cellular respiration — more NAD+ means more efficient ATP production and less metabolic waste
-
Sirtuin activationNAD+-dependent sirtuins (SIRT1, SIRT3) regulate gene expression, inflammation, and metabolic adaptation — key drivers of the anti-aging response
-
DNA repair activationPARP enzymes — which repair damaged DNA — are NAD+-dependent. Chronic low NAD+ accelerates cellular aging
-
Why fasted?Fasting activates AMPK and increases NAD+ bioavailability. Injecting during the fasted window — before the eating window opens at 12PM — amplifies both the metabolic and cellular repair effects
Delivery Matters
Bioavailability vs. Oral Supplementation
Oral NAD+ precursors (NMN, NR) undergo significant first-pass metabolism. The conversion pathway from precursor to usable NAD+ in tissues is inefficient and variable between individuals. Subcutaneous injection delivers NAD+ directly into systemic circulation, bypassing hepatic metabolism and achieving substantially higher and more predictable tissue concentrations.
This is not a preference — it's a pharmacological reality. If you want meaningful cellular NAD+ repletion, injection is the only reliable route.
-
Higher bioavailabilitySubcutaneous delivery bypasses gut absorption variability and hepatic first-pass metabolism
-
Consistent dosingPredictable plasma levels make it possible to optimize timing with the fasting window and exercise protocol for maximum synergy
-
Metabolic synergyNAD+ injected in the fasted state pairs with Zone 2 cardio to maximize fat oxidation — when glycogen is low, the body preferentially burns fat with greater mitochondrial efficiency
03 — Hormonal Optimization
Sermorelin
A growth hormone releasing hormone (GHRH) analog. It tells your pituitary gland to release growth hormone naturally — the way your body was designed to do it — not synthetic replacement that bypasses the feedback loop entirely.
The Mechanism
Sermorelin · Subcutaneous injection · Bedtime · 5 days/week
Sermorelin is a synthetic analog of the first 29 amino acids of human growth hormone releasing hormone (GHRH). It binds to GHRH receptors on the pituitary gland and stimulates the natural, pulsatile release of endogenous growth hormone — as opposed to exogenous HGH injection, which delivers synthetic GH directly and suppresses the body's own production over time.
The distinction is critical. Sermorelin preserves the body's natural feedback loop. The pituitary still regulates GH release — sermorelin simply amplifies the signal. This means safer, more physiologic GH elevation without the risks associated with exogenous HGH therapy.
-
Natural GH preservationStimulates endogenous production rather than replacing it — the pituitary remains active and the hypothalamic-pituitary axis stays intact
-
Body composition improvementGrowth hormone promotes lipolysis (fat breakdown) and lean muscle preservation — especially important during caloric restriction on tirzepatide
-
Recovery accelerationGH is the primary driver of tissue repair and collagen synthesis — critical for patients doing resistance training 3x per week
-
Why bedtime?75–80% of daily growth hormone secretion occurs during slow-wave sleep (N3). Injecting sermorelin at bedtime aligns with this natural pulse — amplifying the body's largest GH release window without disrupting the circadian rhythm
The Difference
Sermorelin vs. Exogenous HGH
Synthetic human growth hormone (rHGH) delivers GH directly, bypassing the pituitary entirely. Over time, this suppresses the body's own production through negative feedback — the pituitary detects elevated GH levels and shuts down its own release of GHRH and GH. Dependence develops.
Sermorelin works upstream. It works with the body's existing regulatory system, not around it. When you stop sermorelin, your pituitary function returns to baseline. When you stop exogenous HGH, you may have permanently impaired your pituitary's ability to produce GH on its own.
-
Physiologic dosingGH is released in pulses, the way the body naturally intended. Sermorelin amplifies pulses. HGH injections create a flat, supraphysiologic rise
-
Preserved feedback loopThe hypothalamic-pituitary axis continues to regulate GH — somatostatin still provides inhibitory feedback, preventing excess
-
Compound benefit with resistance trainingStrength training on Mon/Wed/Fri creates a GH demand signal. Sermorelin amplifies the recovery response every night
04 — Protocol Design
Why the timing
is the treatment
The Renew protocol is not three medications in isolation. It's a system built around your body's hormonal and metabolic rhythms. Every element is timed to compound the effects of the others.
AM
Fasted NAD+ Injection Daily Sun–Thu
Administered during the fasted window (before 12PM eating window opens). Fasting activates AMPK signaling, which increases cellular NAD+ demand and bioavailability. Pairing NAD+ with fasted Zone 2 cardio maximizes fat oxidation — low glycogen forces mitochondria to preferentially burn fatty acids, and NAD+ improves mitochondrial efficiency during that process.
AM
Zone 2 Cardio, Fasted 20–45 min · Sun–Thu
Zone 2 (60–70% max heart rate) is the fat oxidation zone. At this intensity, the body relies primarily on fatty acid oxidation rather than glycolysis — maximum fat burning, minimal muscle catabolism. Fasted Zone 2 is scientifically shown to improve mitochondrial density and metabolic flexibility. Done after NAD+, the combination produces synergistic fat-burning effects that fed cardio cannot replicate.
PM
Eating Window Opens 12PM – 7PM
Intermittent fasting (time-restricted eating) extends the morning fat-burning state and improves insulin sensitivity throughout the day. The 7-hour eating window is sufficient for adequate protein and caloric intake while keeping insulin suppressed during the morning protocol hours. Protein target: 0.7–1g per pound of lean body mass to preserve muscle during weight loss.
Weekly
Resistance Training 3× per week
GLP-1 agonists like tirzepatide can cause muscle loss alongside fat loss if resistance training is not part of the protocol. Studies show that up to 40% of weight lost without resistance training can be lean muscle mass — metabolically catastrophic. Resistance training creates a mechanical signal for muscle protein synthesis, which combined with adequate protein intake and sermorelin-enhanced recovery, preserves and builds lean tissue while tirzepatide drives fat loss.
PM
Eating Window Closes No food after 7PM
Critical for sermorelin efficacy. Growth hormone release is suppressed by insulin. If you eat close to bedtime, insulin levels remain elevated during the critical early deep-sleep window when most GH is released. Stopping eating at 7PM ensures insulin is low by 10–11PM when sleep and sermorelin injection both trigger the GH pulse.
PM
Sermorelin Injection + Sleep Bedtime · Sun–Thu
Administered immediately before sleep. The pituitary releases 75–80% of daily GH during slow-wave sleep. Sermorelin amplifies this pulse — perfectly timed with the body's natural circadian GH secretion rhythm. Post-exercise (from morning or afternoon resistance training), GH demand is already elevated. Sermorelin turns that signal into maximized recovery: muscle repair, collagen synthesis, fat mobilization, and deep sleep quality improvement.
05 — Supplement Protocol
Evidence-based supplements.
Nothing else.
The Renew supplement protocol contains only compounds with well-established mechanisms and clinical evidence. No proprietary blends, no marketing claims — each one earns its place.
Why Renew
This is not a shortcut.
It's a system.
The protocol works because all of its pieces are designed to work together — not because any single medication does. Most clinics prescribe the medication. We prescribe the whole system.
Prescribed, not dispensed
Every patient is evaluated by a licensed ARNP. Dosing is personalized to your labs, body composition, and health history — not dispensed from a protocol sheet. Joshua I. Morgan, ARNP oversees every patient directly.
Real science, cited
Every compound we prescribe has peer-reviewed clinical evidence behind it. We explain what it does and why. If we can't defend the mechanism, we don't prescribe it. No peptides without data. No supplements without evidence.
The full protocol
Medication without the exercise and nutrition protocol produces inferior results. We give you all of it — the timing, the why, the what-to-eat window, the exercise prescription — because that's how the results actually happen.
Get Started
Ready to begin?
Month 1 includes your full consultation, labs billed to insurance, protocol setup, and your first two-month medication kit. $899 to start, $399/month after that.
Book a Consultation View Services