#1

A few lab results…

Rapamycin after 48 hours

After my issue with the compounding pharmacy (see Biohacking rapamycin’s bioavailability), my MD wrote me a new script for a generic Sirolimus. I posted a photo on the linked thread.

I’ve started at 14 mg once per week, 2 mg over what I took prior to the compounding pharmacy mess.

I should have everything on track, but the experience piqued my skepticism, so I had a test done.

Because of access to the blood draw and scheduling I had blood taken 48 hours after my weekly dosing (of 14 mg). Not looking for maximum or minimum levels. I just want to make certain I get reasonable levels.

Results → Sirolimus, Lc/ms/ms (mcg/L) = 4.6

Does this give me the blood levels I should expect taking US sourced generic Sirolimus 48 hours after dosing?

Probably a month or more before the rapamycin kicks in again, but I had the following tested as well:

hs CRP: 0.6 mg/L

Apolipoprotein A1: 146 mg/dL
Apolipoprotein B: 146 mg/dL

This give me a ratio of 1.00 which seems concerning.

Cholesterol

  • Total: 282
  • HDL: 58
  • LDL: 201
  • VLDL: 22

Yet, I have no coronary calcium and a clear carotid artery.

I’d appreciate some interpretation of the results and suggestions.

Thanks in advance.

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#2

I would schedule an appointment with your physician based on your APoB alone.

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#3

Do you have lipid/cholesterol numbers at a more reasonable Rapa dose? 6 mg? Do you have data when you’re not on any Rapa?

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#4

Do you have lipid/cholesterol numbers at a more reasonable Rapa dose? 6 mg? Do you have data when you’re not on any Rapa?

Hi KarlT

Not certain why you’d suggest 14 mg once a week as unreasonable. Dr. Green takes significantly more. I don’t hack the dosage with grapefruit juice.

I have always had high total and LDL cholesterol, even in my twenties.

Since starting rapamycin, my total and LDL cholesterol have decreased. Total dropped from, a pre-rapamycin high of 340. HDL has stayed in the same range.

This said, I also started taking 1 teaspoon per day of organic Ceylon cinnamon around the same time I started rapamycin, which could have also affected the cholesterol levels.

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#5

I would recommend you start taking a statin and perhaps ezetimibe immediately. Mice don’t die of heart disease but it’s the biggest killers in us humans.

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#6

I reviewed my labs and two genetic markers with my doctor.

I have a genetic marker correlated to high LDL.
This said, I apparently don’t have the “sticky” kind hence no coronary calcium deposits.

As I also have low/normal hs CRP and low/normal blood pressure, my doctor didn’t think I needed to take statins.

I need to go back to Peter Attia’s website and study the question of whether I should take statins anyway.

I have another genetic marker that suggests I can benefit from low dose aspirin without side affects. The doctor recommended I take it as well.

Separately she said I could take CoQ10 and increase my intake of Omega 3.

We’ll additionally schedule a stress test (I haven’t had one in 15 years) and monitor things going forward.

Interestingly, she had access to a coronary risk program into which she entered my test results, age, etc. Does anyone know of such a program or website?

Feeling a bit better.

This still leaves me with my first question:

Results → Sirolimus, Lc/ms/ms (mcg/L) = 4.6

Does this give me the blood levels I should expect taking US sourced generic Sirolimus 48 hours after dosing?

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#7

Yes - that dosing seems correct for the dosing you took and the timing, 48 hours after dosing. Here (below) is the typical graph from a test they did with healthy volunteers. (this is dosing measured by people’s surface area, so you need to do a little work to translate that to mg/kg which might be easier for you to compare to your own dosing and weight.

Screen Shot 2021-10-06 at 10.49.26 PM
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Of course - that just means you have effective sirolimus. We don’t really know much in terms of what the optimal dosing in healthy humans is for longevity purposes. More reading you may want to do on how and why to take the blood/sirolimus test (you may also want to do a trough blood test just before your next dose). How to get a Rapamycin (sirolimus) Blood Level Test

More Reading:

Pharmacokenetics and Safety of a Single Dose of Rapamycin (sirolimus) in Healthy Males
10.1097@00007691-200010000-00006-3.pdf (163.8 KB)

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#8

RapAdmin

Many thanks.

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#9

This is most likely the 10-year risk calculator that cardios typically use. Peter Attia is not a fan of it, arguing that we should be calculating 30-year risk if we are interested in longevity. The argument goes that if we were smokers, we should keep smoking until 10-year risk for lung cancer reaches a certain threshold

Some of what you are seeing could be related to the timing of the test after dosing with rapa. I recently got my lipids tested 7 days after and 4 days after dosing (7 mg). My ApoB was 27% higher 4 days compared to 7 days after (75 and 59 mg/dl, respectively). I also got Lp(a) tested both times, and Lp(a) was about 13% lower at 7 days compared to 4 days (193 and 170 nmol/L, respectively), which was interesting because I thought it wasn’t supposed to change much. I still have high Lp(a), so I plan to go to a cardiologist next week and hope to get put on a statin to lower ApoB. But, they may not do it because I’m still at a very low risk due to my numbers and age.

Anyway, you might see significantly lower ApoB if you test 7+ days after your dose. But, if it’s chronically elevated due to rapa, I’m not sure that’s good.

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#10

Since I started rapamycin at relatively high doses my lipids shot way up compared to levels before taking rapamycin. Over time, I have been convinced by “Dr. Lipid”, https://twitter.com/Drlipid, and others that keeping lipids within the recognized “normal” range is beneficial. Many cardiologists think lower is better.

After attempting to lower my lipids using Lipitor (atorvastatin) and not wanting to up the dosage, I tried several supplements that are supposed to help lower lipids, but they did not help that much. So after 18 months of rapamycin, I lowered my dosage to 5mg weekly taken with EVOO.

On 5/30/23 I added Pantethine (Coenzyme A Precursor) to my daily stack. This was suggested by John Hemming, but I believe he takes it for other reasons.

So for this test period, I have been taking 40mg of Lipitor after supper and 600 mg of Pantethine. first thing in the morning on an empty stomach.

Wow, I didn’t think this combo would lower my lipid levels so much.

No other supplement combined with Lipitor has had this much effect.

My blood glucose levels are still borderline.

Since I have been on average to higher levels of rapamycin doses for 18 months, I think I will self-experiment with taking a “maintenance” level of rapamycin. LaraPo has been taking 1mg daily if I recall correctly, and one week off. I will try 1mg daily for 5 days then 9 days off.

I am taking berberine, citrus bergamot, cinnamon, and chromium at twice the recommended doses, but they don’t seem very effective. I also take metformin with my rapamycin, but not on days I am not taking rapamycin.

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#11

Have you tried taking ezetimibe together with atorvastatin?

#12

Since my lipid markers are quite low I will stop taking a statin (again) and substitute
ezetimibe if I need it. I have some on order.

#13

I’m not sure whether you’ve said how old you are. If you are 80, I would be comforted by zero CAC score. If you were 55 or less, then you are among the 75% who also have a zero CAC score. But if you have a genetic predisposition to high LDL, I would find a different doctor.

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#14

So what do you think successfully lowered your cholesterol? The statin or the Coq A supplement?

#15

I think in my case the pantethine seemed to work synergistically with the Lipitor.

As I mentioned I am going to discontinue Lipitor and see if the pantethine alone will keep my lipids in the low normal range. For the immediate future at least I am going to get my bloodwork done monthly.
Here is one older paper. Pantethine seems to have many benefits.

https://www.researchgate.net/profile/Laszlo-Vecsei/publication/26746811_Current_medical_aspects_of_pantethine_Treatment_strategies/links/59422ac80f7e9b1d452df8b7/Current-medical-aspects-of-pantethine-Treatment-strategies.pdf

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#16

What brand of Pantethine and what dosage did you use ?

#17

“NOW Supplements, Pantethine (Coenzyme A Precursor) 600 mg, Double Strength, Cardiovascular Health*, 60 Softgels”
I take one 600mg gel capsule in the morning.

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#18

Thanks for posting. Do you mind sharing how much you weight (to calculate the rapamycin dose you took per kg body weight)?

#19

Olafurpall - Great question. 192 lbs

zazim -

71 years old
Requested a script for Crestor and will have further discussions about ezetimibe (to start)

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#20

Another thread here said Dr. Green was taking 20 mg every two weeks, not weekly.