What blood tests are people taking?, Any rapamycin specific ones?

[RapGuy]

Hi,

I’m just starting rapamycin and was wondering what people are doing out there with regard to blood testing. I’m planning to do quarterly blood testing to track my Levine phenotypic age, and other key blood variables. The best deal from a regular blood test cycle seems to be the Life Extension tests here:

https://www.lifeextension.com/lab-testing/itemlc381822/chemistry-panel-complete-blood-count-cbc-blood-test

and we also need the CRP test for the Levine Phenotypic calculations:

https://www.lifeextension.com/lab-testing/itemlc120766/c-reactive-protein-crp-cardiac-blood-test

I’ve also just read about the new blood sirolimus level tests available now from LEF for $95. It looks interesting - but not quite sure how we’d use it.

Are there any other test people use and find valuable when they are using rapamycin?

[RapAdmin]

Hi, and welcome to the site. Good questions…

I personally think its a really good idea to at least do fasting blood tests before you start rapamycin so that you have a baseline to look at later and compare your results over time.

The Complete blood chemistry panel from LEF is a good one - and one I’ve used a number of times. At $35 its a great value. I also do the CRP test - so I can do the Levine phenotypic calculations for biological age - and its been going well so far - with a 15 year lower biological age compared to chronological age. Sadly I didn’t test before I started rapamycin, so I have no idea if rapamycin has helped in that calculation.

By the way - for peoples benefit - here is the free spreadsheet (towards the bottom of this page at the following link) that I think Mike Lustgargeten pulled together so we don’t have to log onto special websites to calculate our Levine Phenotypic age.

Please - post your results here over time.

I try to get my basic CBC and CRP blood tests done every few months so I can track my progress.

The issue of the value of the sirolimus blood level test is a harder question. Its a blood test that is used commonly for serious disease patients using rapamycin (e.g. organ transplant, cancer, etc.) because they want to make sure that the level of the drug is high enough to be providing value. In our case we sort of want the opposite - we want to know that the trough level is low enough so that we aren’t inhibiting the mTORC2 complex, and therefore at risk of suffering from the negative side effects like immune system lowering.

In theory this blood test would help us, when done right at the end of the week (or two, if you’re on the two-week dosing schedule) just before you we take the next weekly dose of rapamycin, we can see if our blood sirolimus levels are low enough that we can be confident that we aren’t blocking mTORC2.

Dr. Green has suggested that we want to get our sirolimus blood levels down to 5 half-lives from when we took the last dose… which is a rather rough number. The half life for sirolimus in transplant patients is around 62 hours (+/- 16 hours or so) but I’ve seen a paper that suggests the blood sirolimus levels in healthy, younger, ethnically diverse patient groups is more like 80 hours (+/- 12 hours). So there is a wide variety we may have in the people here who are using rapamycin for anti-aging.

But, I’m not sure we (and I mean the medical community “we”) even know what a good lower target blood sirolimus level should be for healthy humans in an rapamycin anti-aging application.

Does anyone else have an idea or thoughts on this?

[RapAdmin]

Other Blood Tests that I see some people are getting done, or talking about getting done, while on rapamycin:

“If it were me, I would be measuring IGF1 levels as a crude proxy for mTOR”
" the idea behind measuring IGF1 is to make sure that you are not pushing mTOR so low that you are going to cause side effects like muscle and bone loss, or other types of wasting. You don’t want IGF1 to fall below the low end of normal."
It also gives you an idea for whether or not you are getting enough rapamycin to actually move the needle on mTOR. If you still have high IGF1 levels on weekly rapa then you might want to consider the possibility that some other drug or supplement you are taking is causing you to get a much lower effective dose of rapa than you realize (via say a CYP3A4 interaction).
I’m talking about basal IGF1. So I’d want to measure it, say, after a 12 hour fast— so I don’t see any spike from my last meal. And maybe measure it half way through a weekly cycle of rapa. Definitely not directly after taking the rapa, because you don’t want to see the short term negative spike.

IGF-1 Blood Test by Life Extension Foundation

In general, I think the spikes in mTOR don’t matter that much. Even people in their mid 20’s have a big spike in mTOR after meals. The difference between a 25yo and a 75yo is that the 75yo will have a much higher 12hr fasted (basal) level of mTOR than a 25yo. Brian Kennedy has pointed out that in many old people, the fasted mTOR is so high that it is almost the same as the peak from their spikes. It’s really that basal mTOR that I’m interested in, so I would always want to try to measure the IGF1 away from the spikes

Inflammation markers (hsCRP). Naive to memory markers (CD45RA/CD45RO). Formation of new T-Cells (T-Cell Receptor Excision Circles (TREC) Analysis), although these one might be difficult to measure

Fasting insulin, from which you can compute HOMA-IR score (Insulin Resistance). I learned this from Dr Green. It’s a good metric to track.

ApoB. According to Peter Attia, it’s the single most useful metric for cholesterol.

APOE gene test - APOE gene provides instructions for making a protein called apolipoprotein E - work out how likely you are to get the Alzheimer’s disease.

If it were me, I would get my IGF1 levels checked to make sure that they were not falling below the lower end of normal. I would also get a DEXA scan to make sure that I was not causing any damage to my bones.
Too much CR or fasting can weaken bones and teeth. Rapamycin mimics CR/fasting. The key here word is “too much”. I mean overdoing it. And I imagine that the risk is even higher if you combine CR+fasting+rapamycin.

[Ozone8]

For the 62-hour half-life figure, if Alan Green’s 5X recommendation was followed it would mean taking a rapamycin dose only every 13-14 days. That is almost twice the usual once per week frequency that everyone seems to quote.

During a cycle I usually take approx. 7 mg every 8-9 days. No problem with mouth sores, etc. But since some are now using a higher dose (10-20 mg) I might try that at 14-day intervals.

[Ozone8]

What about WBC and Absolute Neutrophil counts?

Hasn’t Dr. Green mentioned subcutaneous bacterial infections as a possible side effect of rapamycin usage?

My recent CBC showed a WBC of only 2.4 . While I’ve always been on the low end, that was a surprise.

[RapAdmin]

@Ozone8

But since some are now using a higher dose (10-20 mg) I might try that at 14-day intervals.

Yes - I’ve tried this for a month this summer - two cycles - with no problems. I’m considering going back to it.

I think we need to create a good spreadsheet on google sheets or something that would allow us to type in our weight and dosage of sirolimus (or everolimus) and get a graphic view of what the blood sirolimus curve looks like - at least a rough range of high and low - so we have a better feel for how long the sirolimus is sticking around for, so we can better optimize our dosages.

The best way would be the trough blood test done the day prior to your next dose, and I encourage people to look into that and share their data. But perhaps we can rough something out mathematically and then people can understand how aggressive they are potentially being with their dosing strategy.

[RapAdmin]

@Ozone8

What about WBC and Absolute Neutrophil counts?

Hasn’t Dr. Green mentioned subcutaneous bacterial infections as a possible side effect of rapamycin usage?

Yes - definitely WBC and Neutrophils - they are part of the standard CBC that many of us do - example below: After two years on rapamycin, my WBC is 5.6

https://www.lifeextension.com/lab-testing/itemlc381822/chemistry-panel-complete-blood-count-cbc-blood-test

On the issue of bacterial infections - yes, Dr. Green has written a lot about it - but I’ve talked to some rapamycin researchers and they suspect he’s making an error there. Here is the note I put in the side effects page where I had originally mentioned Dr. Green’s warnings about bacterial infections:

[Note: There is some very significant disagreement about Dr. Green’s above statement, by other medical professionals I’ve talked to with experience with rapamycin. Bacterial infections, and use of antibiotics to treat them, is extremely common in the USA. I found it very hard to get good numbers on the typical percent of a population in the US that get bacterial infections each year, but this document from PEW Trusts suggests that antibiotics in the US are prescribed at a rate of 838 for every 1,000 people (measured in 2015) - which suggests upwards of 84% of Americans (or at least their prescribing doctors) think they have a bacterial infection each year severe enough to require antibiotics. Dr. Green has suggested only 5% to 10% of his patients get bacterial infections in any year, which suggests a much lower than average rate of infection than normal for rapamycin users. Moreover, it is not something that the users of rapamycin that participate in forums suggest is a common issue. So, take this with a grain of salt until more data is provided by Dr. Green.]

[rapa_experimenter]

On the issue of bacterial infections - yes, Dr. Green has written a lot about it - but I’ve talked to some rapamycin researchers and they suspect he’s making an error there.

That’s really interesting - and makes sense. Looking at average incidence of bacterial infections in non-rapa versus rapa cohorts. Thanks for sharing!

Whilst this is slight off topic versus the OP, I’d just like to segue for a second into another potential mistake made by Dr Green (we’re all human after all).

On his site he advocates for supplementation of Glycine & NAC for restoring youthful glutathione production. This is based on research by a Rajagopal V Sekhar in Houston Texas (link). Based on that research, Dr Green suggests dosage of:

• Glycine 0.1 grams/kilo
• NAC 0.13 grams/kilo

However, when I did my own calculation of the doses, from the paper, it should be 0.1 grams/kilo for both. The extra 0.03 of NAC isn’t much - but for a 70KG human, that’s 2.1 grams extra per day you’re buying + ingesting, without much reason.

I emailed the paper’s author, Dr Sekhar, and he confirmed the dose used in the research 0.1 grams/kilo. However, he suggests the research is still too early to be advocating for it.

Anyhow, I emailed Dr Green to let him know, and he replied about something irrelevant and didn’t update the recommendation on the website. shrug

So yeah, we all make mistakes sometimes.

[EnrQay]

LabQuest through walkinlab.com has similar pricing. The blood panel + CRP_hs is what I am planning to get quarterly to track my Levine age. I doubt the sirolimus test is important: Dr. Blagosklonny’s goal is to take the most he can without side effects since he believes there is a correlation between dose and life span.

[Paros]

If on a two week cycle of rapamycin, when, during those two weeks would you have the IGF-1 test done?

[RapAdmin]

That person’s idea of testing IGF-1 as a proxy for MTOR is just an idea. I don’t know if anyone has done this yet - so it needs more research. I’m not sure of its validity - though there is lots of data and papers that suggest there is overlap in the IGF-1 and MTOR pathways.

I’m sorry I can’t be of much help on this idea. I would recommend you talk with your doctor, or perhaps other people with more experience and in-depth understanding of the relationship and correlation of MTOR and IGF-1 can join this conversation and contribute some thoughts…

Perhaps some papers that can start the research and discussion:

Conservative Growth Hormone/IGF-1 and mTOR Signaling Pathways as a Target for Aging and Cancer Prevention: Do We Really Have an Antiaging Drug

Tissue-Specific Responses of IGF-1/Insulin and mTOR Signaling in Calorie...

Targeting both IGF-1R and mTOR synergistically inhibits growth of renal cell...

[EnrQay]

@RapGuy

new blood sirolimus level tests available now from LEF for $95

Do you know where can I find this test? I couldn’t find it at lifeextension.com…is that LEF?

[RapAdmin]

Just look midway down on the first post and you can see this text with their phone number:

Recently the Life Extension Foundation Lab services has started offering a low cost blood test for blood sirolimus levels via Labcorp. testing services. They sent this email to me recently:

After re-evaluating current pricing for test 716712, we are able to offer it at a price of $95 going forward. Please call us if you would like to place an order. Thank you for your support and interest in our lab testing services. Life Extension Customer Support, (800) 678-8989.

From:

What are the Rapamycin Dosing Schedules for Anti-Aging?

Here are the common variables that people are considering when they start dosing rapamycin: 1. Starting Dose and Ramping Up the Dose: I started at 1mg per week, then each week increased by 1mg until I reached my target dose of 6mg/week. Most people, working with their doctor, seem to end up taking between 3mg and 10mg of rapamycin in a single weekly dose. (see recent poll results below) [DoseRapa] In my case, many months after I plateaued at 6m per week, I slowly increased to my current dose of 10mg/week. This has worked well for me, with only one time when I got a canker sore (which cleared up by itself after a few days). Other people ramp up more quickly - for example 3mg/week, then 6 mg a week… Generally I seem to see more side effects the faster the ramp up in dose. Dr Green…

[EnrQay]

LEF doesn’t seem to be offering the test right now, though I haven’t contacted them directly.

[RapAdmin]

You have to call them directly. We talked to them and got them to offer it at a low cost.

[EnrQay]

Thank you! I’ll do that. I not only want to check trough levels, but I also want to verify that I have the real stuff.

[RapAdmin]

When you say you want to verify “you have the real stuff” - why do you say that? what makes you suspicious that it might not be the real stuff?

If you are buying a the sirolimus from any of the top 8 or so manufacturers of sirolimus listed here, then it almost certainly has a significant dose of sirolimus. Sirolimus is a generic medication so the prices are low, and therefore the incentive is also very low for anyone to produce counterfeit versions of rapamycin - so I suspect that the risk is low that you are getting a counterfeit drug.

I suspect that the bigger risks are that the dose may be lower than the dose stated on the package - but in the lab tests I’ve seen (as at the bottom of this page) that hasn’t been evident. Just taking a blood sirolimus test won’t tell you if your product is giving you the correct dose, (though if you have tested with both a validated product - e.g. the name brand rapamune - and compare blood levels at the same time in multiple test - then it might give you a very rough idea of equivalency).

The other risk - and I tend to think that it is the larger risk - is for contaminants in the process, and therefore in the drug purchased. Just taking a blood sirolimus test won’t tell you if you have any contaminants from tainted drugs.

If you are using, as your source of the drug, powder purchased from China (which I see some people purchasing and discussing on different discussion forums) then I think the dosage, and the contaminants are higher potential risks - and ones that only lab testing can really address.

[EnrQay]

Mine were manufactured by Iosis Remedies in Solan, Himachal Pradesh, which is associated with Ikon Remedies. The package is labelled “Sirokem” sirolimus tablets. A web search makes it seem legit, but it is a new company and I have no real way of knowing. Thanks for the list of top manufacturers.

This happens to be the batch I have: https://www.reddit.com/r/Rapamycin/comments/qp2hrt/anyone_know_how_i_can_verify_this/ , but only gives me a little reassurance. As the commenter says, it’s like grading your own homework.

[RapAdmin]

I’ve never heard of that supplier. Generally you want to purchase pharmaceuticals from the largest, most established companies because they generally tend to have the best quality control processes in their manufacturing groups.

And - Ideally you want to purchase the product and have it lab tested (by a 3rd party, independent lab), or at least have seen tests of the product by third parties. We have a sample lab analysis done on Biocon and Zydus on this page at the bottom of this posting about getting quality testing on sirolimus - I encourage you to check it out.

Yes - the Certificate of Analysis is produced by the company selling the product - so if they are lying about the contents of the product, they’d likely lie about the COA also - so its not very helpful.

[Paul]

I enrolled in the Life Extension Vitality in Aging study so I get a LE’s complete male panel plus Omega 3 tests yearly. I also have my regular annual physical with many of the same tests in mid-year. Primary goal is tests for the Levine calculation. Fasting insulin and Vitamin D are always requested. I’ve also had TNF-alpha and IL6 tests done.
I had tests available for Levine calc before starting Rapamycin and my bio age and chrono age were equivalent at 66. Four months after starting rapa my bio age per the calc was 53. Primary improvements were in creatinine and RDW.