#242

If you get prescription you can get it in several EU countries.

Sure. I would certainly add fiber first. Large dose of omega3. And further reduce saturated fat intake.

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#243

What about citrus bergamot, panthethine, berberine, niacin, etc?

When I wasn’t on statins, using berberine and canola oil… my apoB was 55 mg/dl.
Off statins and berberine, with olive oil… it was 74 mg/dl.

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#244

Other possible supplements:

Boswellia
Nigella sativa
Tart cherry
Pomella
Nobiletin
Hesperidin

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#245

Same lab? Same diet? Lifestyle?

I haven’t looked in depth into these. If you are going to go down the supplement road it can become expensive (panthethine alone costs around 40 EUR for months supply and reduces apoB less than adding omega3, which can be eaten as delicious and nutritious whole foods) and I don’t think they will be as effective as probably they affect same or similar pathways as drugs. Berberine affects PCSK9 pathway so this might be interesting, but you had objections that is mitochondrial poison and dirty drug. I researched a bit citrus bergamot and I was not convinced it has a very strong LDL-C (or apoB) lowering power. Really mixed results. Same with policosanol.

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#246

PCSK9i > rosuva/atorvastatin > other statins > bempedoic acid > ezetimibe = diet > lots of psyllium husk before a fatty meal > panthentine > omega 3 >> other supplements

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#247

I am an apoB reduction maximizer. If I have to use berberine, so be it.

Of course I will take statins, and probably ezetimibe as well. I want lower apoB though despite using them and bempedoic acid and PCSK9 inhibitors are a bit of a hassle to get.

Preferably a pill that also is preferably not dirty with a clean and understandable mechanism of action.

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#248

I suppose I am a cellular function maximiser. Hence I look for things that maximise cellular function. If my tests point to an increase in ApoB or LDL-C that I should worry about then I worry about it and potentially take action, but they don’t.

My big thing at the moment is not related to this particular dimension, hence I am not prioritising activity in this area.

I think if I get my vascular epithelial function at an adequate standard then I don’t need to target really low levels of either LDL-C or ApoB, but as with everyone else there is not massive certainty here.

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#249

Measuring cellular function is incredibly difficult and will not necessarily lead to the desired result. Even if, for example, a young adult in his early 20s suddenly stopped aging, he would still succumb to heart disease or stroke in his 80s or 90s.

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#250

EUdoctor? You can get bempedoic acid shipped from Germany. Price is around 85 EUR form monthly supply. And if you get PCSK9i prescription for Praluent you can probably pick it up locally for around 350 EUR 2x150mg (which you can split into two months).

#251

Even if, for example, a young adult in his early 20s suddenly stopped aging, he would still succumb to heart disease or stroke in his 80s or 90s.

I don’t think that is the case. I think part of the issue is a failure of epithelial function. However, in the end we as biohackers put our lives (rather than our money) where our mouth is.

I agree with you that measuring cellular function has difficulties. You can measure organ function with certain biomarkers and that is in many ways quite a direct result of cellular function.

I can even measure cellular function by the growth of new hair, or whether or not I am physically stronger. However, direct measurment is hard although methylation of DNA or acetylation of Histone levels may be useful.

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#252

I am so close to optimal apoB that I don’t know if I even have to go that route in the first place.

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#253

Do you really have to go all in with biohacking on one particular treatment?
I take various medications and supplements that have proven benefits in humans, primates and in the ITP mice. Some may have a slightly negative effect but the net benefit is still greater in the end.

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#254

There is no shame in admitting to being an Europoor. We cannot afford the same stuff Americans can.

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#255

I think we probably agree. There needs to be a balance across a number of directions. Obsessing about a single biomarker is not a good idea, but if you identify one that is out of kilter then it is worth considering whether to adjust protocols to bring it back into line.

About a year ago I was going a bit haywire on MCV, but that has now come back down about 5-8 femtolitres. More recently I had kicked up my BP from a metabolic shift, but that is now back down in good territory.

I still think functional tests are the key to monitoring success, but it is best not to just have one dimension to this.

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#256

Panthentine seems very promising:

Is it similar to bempedoic acid?

If I have no side effects or it doesn’t seems they will come, yeah.

I also am unsure how long EUDoctor will operate. I think long term. Once I found something that works I’ll stock up on medications/supplements for many years, then later CETP inhibitors etc come. I don’t know the EU laws on doctors and so on works. Why is EUDoctor the only one offering this service?

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#257

It’s interesting the different approaches people have. I’m a “cover all bases” maximizer. My (non-evidenced based) approach is:
Step 1 = Optimize an achievable and sustainable diet, exercise and lifestyle
Step 2 = Cover any deficiencies.
Step 3 = Amino Acids
Step 4 = Rapamycin!
Step 5 = Use Pharma and/or Supplements minimally to adjust biomarkers where desired (apoB, HBa1c, CRP?)
Step 6 = Trial Pharma and/or Supplements to guage for n=1 subjective benefit
Step 7 = What am I missing?

The trouble I see with going all in on one thing is that the side effects may not be apparent for a long time - at which point it may be too late to avoid permanent damage.

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#258

My keeping doses low, side effects are mitigated for the most part. My only “risky” medication is high dose rapamycin but at least I only take it monthly.

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#259

I’m thinking we need to watch for this issue by tracking a broad set of biomarkers to watch for potential issues and get an early warning. I don’t think we have this list yet, but something we may all want to work towards developing and tracking. Sort of a “Bryan Johnson” testing protocol but “Lite”, as we don’t all have $2 Million per year to spend.

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#260

Note that pantethine and pantothenic acid (vitamin B5) is not the same substance.
And it lowers apoB just marginally while reducing LDL-C more.

There are not many laws on telemedicine in Europe. Telemedicine is legal in Croatia as far as I am aware and he is completely legal. Doctors can prescribe off label medication at their own discretion but also responsibility and they have to have an informed consent from patient to avoid any legal responsibility. EUdoctor issues so called “white” (private) prescription that is out of pocket expense of the patient. Since EU directive on prescriptions issued in any EU country is valid in other EU country (with few exceptions) and this is it. I don’t use his service as my husband is a doctor but I am used to getting prescriptions filled in other countries as I travel a lot and sometimes it is much cheaper to buy certain medicine in another country. No questions asked.

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#261

Both are coa precursors pantheine not rate limited