I’ve been taking rapamycin starting in January, once a week, first 3mg, then 4mg, then 5mg, and now twice 6mg. From here on, I will continue taking rapamycin once a week 6mg, until late March, early April, when I will undergo a battery of tests, including rapamycin levels in my blood. I will look at the results of these tests, and review my health journal wherein I daily carefully note all health related events and procedures. At that point, I will re-evaluate whether to continue with the 6mg/week, or escalate - in any case, I would probably not escalate beyond 10mg/week. If I do escalate, obviously, I will continue to carefully monitor and test frequently.
I do not feel the empagliflozin is much of a gamble for a healthy person with healthy habits. Extensive studies in non-diabetics and those with normal kidney function have shown that these are remarkably safe drugs on the whole. Of course, there are some risks, such as urogenitary infections, but it really seems pretty context dependent, and fairly minimal in healthy subjects. Meanwhile, the benefits seem fairly robust. It seems to me the risk reward ratio makes these drugs a very attractive intervention regardless of your health status.
With regard to rapamycin, obviously the picture is much more murky. It represents much more of a gamble. On the positive side, it appears that rapa is relatively a very safe drug. The human trials are thin on the ground, but those that exist, focus primarily on the safety - like the recent PEARL trial. There are some side effects, but none seem very oneorous, and more importantly seem to resolve upon cessation of treatment - again, this means that even if you experience negative effects, you can safely bail out without damage. The problem with rapamycin is that we don’t have very good measures or biomarkers with which we can track any prospective benefits of rapamycin - how do we know it’s doing anything positive for our health or longevity? All we have is anecdotal evidence, which is of course hardly satisfying. Basically - we don’t know. It therefore represents a gamble. Another problem that is somewhat related, is that we really don’t have a satisfactory handle on optimal dosing and frequence protocols.
So how to think of the rapamycin gamble? On the pro side:
1)It appears quite safe
2)The side effects are manageable
3)It has delivered health and/or longevity benefits all along the evolutionary tree, and it appears the mechanism is preserved - worms, mice, dogs/cats(?), marmosets. What are the odds that suddenly the gravy train stops with humans? Not zero, but not terribly high, seems to me.
Cons:
1)There can be side effects, sometimes bad enough that the intervention does need to be stopped
2)It can potentially disrupt glucose and lipid levels, necessitating the addition of drugs to control these, leading to polypharmacy
3)It can potentially present challenges if one expects surgery, exposure to high bacterial counts, perhaps unknown DDI (drug drug interactions).
4)It might not provide any tangible benefits in humans or in particular individuals
So if I look at the balance of pros vs cons, it strikes me as a reasonable gamble. What is persuasive to me, is the relatively small downside to taking rapamycin. The benefits may be speculative, but with minimal downside, it’s a “GO” for me. Obviously, that is an individual calculus, that each of us would have to make for themselves.
If I were in the same age group as your sons (I am much older - 66), I personally would not hesitate to take both an SGLT2i like empagliflozin and rapamycin. But that’s me, and my risk/reward calculus!
