June 2023 Update: 1270 patients on Rapamycin.

1. Evaluation of off‑label rapamycin use to promote healthspan in 333 adults, Kaeberlein, Alan Green

This paper is the most important paper in the clinical treatment of Aging. Rapamycin is the most important anti-aging drug. There is a huge amount of speculation; but prior to this paper, no data. The proof of the pudding is in the eating. This paper is almost entirely about the experience of my patients.

In April 2017, I started the first rapamycin-based anti-aging medical practice in the world. In the first year, I had a small number of adventurous and extremely well-informed patients. This was by intent a sub rosa medical practice. There was no promotion. All there was was this website. If somebody did a huge amount of study in the field of Aging and rapamycin they might find my website. Everybody was told they must come to my office in Little Neck, N.Y.

People did come to Little Neck. A few people from N.Y. but mostly people came from almost every state. People came from over a dozen countries. People came to Little Neck, from places I didn't even know were places; like the Yukon, Wyoming, and Bonaire.

This is a one person medical practice . I have an Apple phone; but it doesn't ring. Everybody sends an e-mail to make an appointment nobody.

Gradually after 5 years; word started to slowly leak out. People stopped complaining about Aging. Aging was so slow it was not apparent on a yearly basis. Nobody developed dementia. Nobody had a heart attack.

In the beginning of 2022, I was contacted by Matt Kaeberlein. Matt and Tammi Kaeberlein came to visit me in Little Neck, NY. They wanted to send a questionnaire to my patients. Matt Kaeberline has been a leading Rapamycin researcher for 20 years. He has done excellent studies with mice and dogs. I agree to participate in the study. I furnished Matt with an email list of 900 patients. He sent them a questionnaire. Probably over 300 of my patients responded. All my patients are prescribed rapamycin once a week. Some take a little less interval and some a little longer. What is most important is NONE OF MY PATIENTS TAKE RAPAMYCIN DAILY.

Rapamycin was approved to be used DAILY in transplant medicine. A few clinical studies have been done by University associated researchers. In these studies, they always use rapamycin once a day. It doesn't appear to matter to them that rapamycin was approved to be a biological poison. It was approved to be used once a day and they use it once a day. All their studies are a TOTAL FAILURE.

In this study, 3 people used Rapamycin daily. In the data, I would have separated those 3 from everybody else. However, this was just 3; so not enough to screw up the overall results.

One extraordinary thing that was confirmed by this study was Rapamycin and Covid. In the Spring of 2020, when the world was in a Covid panic; I had 500 middle age patients who did a lot of world traveling. Based on my research, I advised all my patients to continue taking Rapamycin. This went against conventional thinking. My analysis was people got sick due to cytokine storm. Rapamycin stops overstimulation of the innate immune system. All my patients got Covid at the expected rate. None of my patients got very sick, none went to the hospital, none died, and none got Long Haul Covid.

The reason this study is so important is that this questionnaire reflects the result when middle-aged person take Rapamycin once a week instead of daily.

The results SPEAK FOR THEMSELVES. They are almost entirely my patients and the results are an excellent reflection of what my patients tell me every day.

The title of this paper is very misleading. What is MOST IMPORTANT is that people used rapamycin INTERMITTENTLY. If used daily, Rapamycin would have ZERO benefits and just a lot of harmful side effects.

June 6, 2023: Announcement: New Drop-Down Section "Patient Bulletin Board";

This will be patient comments, questions, and important new papers patients find. My patients are extremely well-informed. I learn a great deal from my patients. They frequently have very good finds and excellent ideas. The comments which they send to my email address will be "pasted" in the new drop-down section "Patient Bulleting Board". That section is now empty; but will slowly add to it. The e-mails sent to me having excellent general value; will be "pasted" on Bulletin Board. I will use the initials of the person sending the comment.

2. Baylor University Presentation

October 26, 2021 Baylor University
https://youtu.be/OZhOhu3HyNQ?t=1

On October 26, 2021, I was the guest speaker at Baylor University on Principles of Anti-Aging Medicine. It was a 50-minute presentation. The presentation is attached using a you-tube link.[Need to clean out the garbage which jumps into U-tube links) It includes a large number of slides which provide a very good summary. There were two parts of the presentation. The first part is a summary of rapamycin-based anti-aging medicine and the very large number of age-related diseases and conditions in which mTOR plays a major role in the pathogenesis. This includes a discussion how of how the reduction of mTOR with rapamycin prevents AD. The second part is a theoretical discussion of the new evidence that aging is programmed.

My opinion is that in the next 20 years, the emerging evidence that aging is programmed will completely change the understanding of aging and the practice of medicine. Programmed aging presents druggable targets in the fight against senescence. Primary care medicine will focus on prevention of age-related disease by slowing down aging by targeting the pro-aging programs.

3. The five most important works to understanding Aging and Evolution

I858, Darwin, Evolution through Natural Selection. Traits are selected because they are beneficial in the fight for survival.

1976, Richard Dawkins, The Selfish Gene. All living things are two parts, a disposable vehicle (our body) and the immortal genes which seek immortality.

2006 Mikhail Blagosklonny, Aging and Immortality. Aging and age-related disease are the same things. The driving force is mTOR (mechanistic Target of Rapamycin) and we can control mTOR with Rapamycin.

https://www.tandfonline.com/doi/pdf/10.4161/cc.5.18.3288

2011 Andre Martin, Change and Aging Senescence as an Adaptation. A computer program demonstrates the value of Aging. Animals with a short lifespans can drive immortal animals to extinction because they can evolve faster.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3174959/

2023 Borkum, The TCA Acid Cycle as the Central Regulator of Aging. mTOR regulates the rate of Aging by control of energy production by mitochondria through control of the TCA cycle.

https://onlinelibrary.wiley.com/doi/full/10.1002/adbi.202300095

It took 154 years and 5 men to understand the evolution of Aging. Now that we have all the pieces it seems remarkably simple. Evolution selects Aging as aging causes the death of older animals. The death of older animals allows the selfish gene to promote building better vehicles in their mindless quest for immortality. Death is promoted by mTOR, the master regulator. Death is promoted by Aging. A major regulator of Aging is turning off the power through the generation of ATP through TCA or Krebs cycle in mitochondria. It is as simple as running out of gas or pulling the plug. However, in terrestrial mammals Aging is slow; more like a dimmer switch. However, we can slow down Aging with Rapamycin; turn down mTOR. The problem is mTOR is not the only pro-Aging pathway. There are more ancient pro-aging pathways.

These 5 men all came from different fields. What they had in common is each can be called a very original genius. Darwin was an observational Biologist in the mid 19th Century. Dawkins was a theoretical Biologist. Blagosklonny is an M.D. who started with the study of cancer and moved into Aging. Martins was a computer programmer. Borkum is a Professor of Chemistry. Nobody started as an Aging specialist. Between these 5 giants, they transformed the Biology of Aging from junk science into real science. We who practice Ant-Aging Medicine; salute you.

4. Rare and Orphan diseases: mTOR and Rapamycin

Rapamycin is the most important drug in the history of medicine. Rapamycin has three major uses:

1. Slowing Aging

2. Prevention and amelioration of most age-related diseases.

3. The treatment of uncommon, Rare, and Orphan diseases. This is a completely untapped potential of Rapamycin. This requires patients with Rare diseases to study the basic science literature. Discovering that scientists have found that perturbations of the mTOR pathway are a major part of their disease. Deciding that they want to be Patient Number 1 regarding the treatment with Rapamycin. I am Patient Number 1 in the treatment of Apical Hypertrophic Cardiomyopathy with Rapamycin. That is why I am alive today. this gives me a special interest in the treatment of Rare diseases with Rapamycin.

5-6 percent of the population has rare and orphan diseases. These diseases are defined as having fewer than 200,000 people with the disease; out of a population of 330 million. There are about 6000 rare diseases. Some present in children and others first present in adults.

My practice only treats adults, not children.

Many rare diseases have mTOR as a major component of the disease. mTOR might act upstream as the primary defect. mTOR might act downstream as part of a final common pathway of damage to organs. mTOR is probably involved in half of the rare diseases.

Frequently very excellent researchers have analyzed the rare disease and found it is part of the mTOR pathway. They have not uncommonly ended their paper with the recommendation that Rapamycin should be investigated in the treatment of the disease. These recommendations almost invariably fall on deaf ears. Most medical institutions would find it very difficult to treat a rare disease with Rapamycin. They would not treat the disease with rapamycin unless it was part of a government-funded research project with approval of their IRB plus listed with the FDA as an official research project.

My office has many patients who are patient Number 1 for a rare disease for which there is no known treatment. I certainly do not treat ALL rare diseases. Only a rare disease in which basic research suggests that Rapamycin is the best treatment.

University-based medicine has another problem with treating rare diseases with rapamycin. They have no idea how to use rapamycin. If they tried to do a study; they would use daily rapamycin instead of weekly rapamycin and the study would be a total failure.

People with rare diseases are welcome to contact my office to determine if basic science suggests that the disease is part of the mTOR pathway. As with ALL patients, the initial visit must be in NY.

5. The TCA Cycle Controls Rate of Aging

https://onlinelibrary.wiley.com/doi/full/10.1002/adbi.202300095

"The Tricarboxylic Acid Cycle as a Central Regulator of the Rate of Aging: Implications for Metabolic Interventions. 2023. Borkum.

The 2006 Mikhail Blagosklonny paper, "Aging and Immortality" was an extraordinary breakthrough in understanding Aging. Aging and Age-related disease were driven by mTOR. mTOR promotes chronic inflammation and chronic inflammation was a major part of age-related disease. Inflammation was promoted by the innate immune system and macrophages. Rapamycin inhibited the innate immune system, Rapamycin stopped chronic inflammation, Rapamycin slowed age-related disease.

What was not clear was how mTOR slowed Aging itself. The answer had to wait 17 years for the Borkum paper.

Mitochondria are the most fundamental part of living things. Mitochondria from bacteria and the cell was the greatest merger in the history of Biology. Mitochondria are the power plant of the cell. Mitochondria generate energy through the Krebs cycle, also called tricarboxylic acid (TCA) cycle. The TCA cycle has 8 steps. Everybody had to memorize the Krebs cycle in college biochemistry.

The rate of the TCA cycle is regulated by enzymes. The enzymes regulate the amount of energy produced. If you don't generate enough energy, you die.

The rate of energy produced can speed up or slow down Aging. This makes the TCA cycle the central regulator of the rate of Aging.

mTOR is a key regulator of the activity level of some of the controlling enzyme regulators.

Caloric restriction and Rapamycin can both lower the levels of mTORC1.

Caloric restriction and rapamycin both slow the rate of Aging by changing the activity of enzymes that regulate the amount of energy produced y the TCA cycle.

If you have a Ph.D. in Biochemistry, this paper is not that hard to understand. If you don't have a Ph.D. in chemistry; you can hum along.

The bottom line is mTOR controls the rate of energy production in the TCA cycle. This controls the rate of Aging.

Rapamycin controls mTOR. so rapamycin can slow the rote of Aging by it's impact on mitochondria, the TCA cycle and energy production.

I will quote one line:

"Energy metabolism and aging are intimately connected. ATP levels decline linearly with age in animal models and in human calf and heart muscle. Bioenergetic failure is seen in certain senescent cells, certain animal models of Aging, and such human age-related diseases as Alzheimer's disease, osteoporosis, sarcopenia, heart failure, glaucoma, and COPD. Cellular functioning depends on intact energy generation functioning...

"Not surprisingly, then the most effective means of extending life and/or health-span--caloric restriction, fasting, ketogenic diet, and physical exercise --alter how energy is produced and utilized."

All this is through the mTOR pathway and the mTOR pathway is regulated by rapamycin.

This paper is the most important paper since 2006 as regards understanding the fundamental control of Aging.

This paper explains the metabolic pathway going through the TCA cycle which explains how rapamycin slows Aging.

6. June 2023: Summary Aging Theory and Treatment

1. TOR stands for Target of Rapamycin. "m" is added to stand for mechanistic. i.e.mTOR. mTOR has been conserved through two billion years of evolution. mTOR is in all cell with a nucleus in the animal and plant world. Every living thing on planet Earth, more complex than bacteria has mTOR as the command and control of the cell. This makes mTOR the most important molecule in the entire field of Biology and Medicine. mTOR is controlling everything happening in the Cell in both health and disease. mTOR was discovered in 1991. The 32 years since the discovery of mTOR has revolutionized our understanding of living things and disease. The world of medicine could be divided into the world before mTOR and the world after mTOR. Anybody in medicine not familiar with mTOR could be living in the 19th century.

mTOR in located in the cytoplasm of the cell next to the nucleus. it acts as the cell headquarters. Messages come in and messages go out. mTOR frequently acts by telling the nucleus what to do. the nucleus has the blueprints for how to build all the different proteins and other molecules.

2. Rapamycin is an antifungal drug made by a bacteria found in the soil of Easter Island. Rapamycin was made to stop the growth of a neighbor yeast in the soil of Easter Island. The substance that rapamycin was made to target in fungi was TOR; the control of growth in the fungus. why this was important is TOR was not just the control of growth in yeast; but in all cells.

TOR controls everything in the cell and rapamycin controls TOR. this makes Rapamycin the most important drug in all of medicine. The discovery of Rapamycin on Easter Island was the most important drug discovery in the history of medicine.

Scratch any age-related disease and you will find mTOR at the center of that disease. However, Rapamycin is not just in the center of almost age-related disease; Rapamycin is at the center of Aging itself.

to understand how TOR is at the center of Aging; one must understand Aging in terrestrial mammals. The first thing one must know to understand Aging is that in terrestrial mammals Aging is an intentionally well-controlled program with the purpose to cause a slow death; death by senescence, death by Aging.

For 153 years from Darwin 1858 to Martin 2011; people in the world of Aging had no idea what Aging was about. They totally did not understand the great benefit of Aging and that Aging was planned and controlled. Aging turns out to be a simple mathematical concept that allows animals to evolve

faster. It is not that Aging is good in itself; aging is good due to the bundle effect. Aging prunes old animals from the breeding pool. This allows NEW ANIMALS with new and better genes to produce better animals

Pruning older animals by death is adaptive. Aging is the mechanism chosen by mammals to prune or remove older animals. The death of the older animal, while bad for the animal that dies is good for their descendants over time. The death of the older animals facilitates the evolution of new traits. If you envision an animal as a disposable vehicle and an immortal genetic code; then the death of older animals destroys the disposable vehicle; but benefits the immortal genetic code over countless future generations.

2. Evolutionary theory is that for a trait to evolve by natural selection, that trait must be beneficial. Aging is beneficial. Those mammals that did not choose to age did not evolve rapidly and became extinct. The successful line of terrestrial mammals chose aging and senescent some 180 million years ago. Mammals have enjoyed extraordinary success and they owe their success to senescence which facilitated the evolution of the most wonderful traits. Reptiles have negligible senescence compared to terrestrial mammals. When you compare a 100-year-old crocodile to a 100-year-old human; the 100-year-old crocodile is a very robust animal. No doubt we would all like to age very slowly, like a crocodile; but crocodiles, as a species, have evolved very little in 200 million years.

3. PROGRAMMED AGING: Since the death of older animals was desired; genetically controlled programs evolved to bring about the aging and death of older animals. Aging is orchestrated, intentional, and planned for the purpose of causing death. Evolution incorporated a poison pill, a kind of time bomb, in our genes.

4 Anti-aging Medicine starts with understanding the elucidation of pro-aging pathways and then finding ways to block or ameliorate those pathways.

5. The SCHEME: Telomeres, mTOR, Senescent cells. The 3 main actors.

6. Telomeres: Telomeres are the caps at the end of chromosomes. With each cell division telomeres get shorter. If cells with short telomeres try to divide; they can become senescent cells.

7. Senescent cells are very harmful. They secrete toxic chemicals called SASP which promote frailty and age-related diseases and organ damage.

8. mTOR.

mTOR is very good in young animals when cells have healthy, long telomeres. mTOR promotes growth and development in young animals.

In older animals, with shorter telomeres, mTOR promotes the formation of senescent cells. mTOR is your best friend when you are young and your worse enemy when you are old.

9. The scheme:

Older animals have short telomeres. mTOR drives the formation of senescent cells. Senescent cells cause senescence and age-related disease.

10. The treatment:

Promote longer telomeres.

Block mTOR in older animals

Remove senescent cells.

12. Medications:

Rapamycin: The cornerstone of anti-aging medicine; highly specific drug for reduction of mTOR (target-of-rapamycin).

Dasatinib: A powerful antileukemia drug used to remove senescent cells with very favorable pre-clinical studies.

Ashwagandha (supplement) has a possible weak effect and could be beneficial to increase length telomeres. However, short telomeres is still waiting for an effective treatment.

13. The Major obstacle to anti-aging medicine:

The field which calls itself "Biology of Aging" has promoted the belief that aging was not adaptive, there were no genes or pathways controlling aging; but rather aging in animals was the same as "aging" in inanimate objects; like the deterioration of an old car. This false idea has blocked aging research, blocked understanding of aging and blocked physicians from considering anti-aging as something possible. Promotion of anti-aging requires throwing out all the classical ideas about aging that have dominated the field for the past 150 years.

7. Darwin and Evolutionary Theory

Darwin's 1858 paper, Origin of Species by Natural Selection is the most important paper in understanding Biology and also Aging in the past 200 years. Nothing else really comes close. Understanding everything starts with the basic understanding that all trait was selected because they helped survival. Some traits we admire and some we don't. Kindness, honesty, generosity, and empathy all help a society. Lying, stealing, lack of empathy or remorse, and cowardice can help individuals survive. But I digress.

Some very successful animals like Insects, and terrestrial Mammals have a relatively short lifespan compared to non-senescent animals like jellyfish, artic clams, reptiles, and fish.

In view of the great success of senescent animals, insects are over 80 percent of all known species and terrestrial mammals rule the Earth; it was reasonable to assume that a short lifespan might have a benefit.

Humans as a species are extremely impressed with their own brain. This is especially true with many people with a Ph.D. Socrates said he was smarter than other men; because Socrates knew he didn't know anything. Socrates was put to death because he asked too many questions and believed too few answers.

98% of those in the field of Aging believe EVOLUTIONARY THEORY. This theory as applied to Aging means evolution does not apply to Aging. Evolutionary theory has been the prevailing theory since probably 1900. Today, evolutionary theory is engraved in stone.

Evolutionary theory is classic Aristotle's deductive reasoning:

1. Aging is harmful because it causes the individual to suffer senescence leading to death.

2. Only beneficial or adaptive traits can be selected by Evolution.

3. Conclusion: Traits that promote Aging and death can never be selected by evolution.

"Evolutionary theory" makes Aging different from everything else in biology. They claim Aging merely follows the ordinary rules of physics and chemistry which apply to inanimate objects and materials. They say cars don't need a blueprint to tell them how to age and break down and neither do humans. The explanation for Aging is evolution, or nature, or perhaps even God is negligent. Evolution made of big mistake in failing to eliminate Aging.

My response is: humans make mistakes, evolution is a mathematical process; it can't make mistakes. It is all numbers over millions of generations. Successful organisms survive, and the less successful go extinct.

Evolutionary theory is totally wrong. It has blocked understanding Aging for 150 years. All theories of Aging which are based on evolutionary theory are wrong. What was wrong with evolutionary theory was the original premise that "Aging is harmful"

It is all about who's Ox is being gored. Aging was bad for the individual that was subject to Aging and death. However, from the perspective of the gene striving for immortality, aging was great. Aging, is just simple math. Aging allowed the selfish gene to evolve faster and build better vehicles to promote the survival of the Gene.

Richard Dawkins, 1976, The Selfish Gene provides a totally new way to see the meaning of life, evolution and Aging. See Section 2, "Aging is the Handmaiden of Evolution" for a continuation of this discusion.

8. My Story, Patient Number 1, Turns 80. 2/25/2023

January 2016 at age 72, I started treatment on a regime of 6 mg of Sirolimus, once a week for apical hypertrophic cardiomyopathy. This is a very rare autosomal dominant heart disease for which there is no known medical treatment.

I was in an early stage of heart failure with shortness of breath on walking up hills. After 3 months of weekly rapamycin, I had an excellent clinical response. I continued treatment and by the end of one year, I realized that weekly rapamycin had not only improved my heart condition; but also my prostate symptoms, periodontal gingivitis, overweight and a general feeling of being old. When I hailed my 73 birthday, I felt fabulous. I have now been on continuous treatment for the past 6 years. At age 79, I have no complaints. For a more detailed description see My Story, Section IX.

Based on my experience, I decided to open a rapamycin-based medical practice. Patient Number TWO was April 2017. The number of patients has gradually increased. The current number of patients treated with weekly rapamycin is now past 1250.

The practice is based upon the theory developed by Mikhail Blagosklonny that mTOR is driving aging. The cornerstone of the practice is the reduction of mTOR to ameliorate aging and prevent age-related disease. The foremost age-related disease in humans is the cognitive decline and AD. Prevention of AD in ApoE4 carriers is a major focus of my practice.

See Sections 12 for Blagosklonny Literature.

See Section 3 for discussion of AD.

In 2017, Rapamycin was the cornerstone of treatment. Rapamycin remains the cornerstone of treatment; but have now included Dasatinib to remove senescent cells when indicated.

9. DNA says human maximum lifespan is 38 years

New Report: "New study shows an animal's lifespan is written in the DNA. For humans, it is 38 years". (12/12/19) [Paper a year old; but I just saw it and it has huge significance; ASG 1/23/22]

When looked at complete genome of large number other other vertebrates, the DNA methylation lifetime predictor says maximum human lifespan should be 38 years.

"A genomic predictor of lifespan in vertebrates, Mayne, Scientific Reports. 2019

They looked at epigenetic changes in DNA methylation(DNAm). "DNAm of cytosine-phosphate-guanosine (CpG) sites. DNAm of CpG sites, involves a covalent modification of cytosine to form 5-methylcytosine. This has potential to regulate gene expression, including genes critical for longevity, without altering the underlying sequence."

Summary: "Aging is associated with epigenetic changes involving DNA methylation. Furthermore, an analysis of mammals showed that the density of CpG sites in gene promoters, which are targets for DNA methylation, is correlated with lifespan. Using 252 whole genomes and databases of animal lifespan and promotor sequences, we show a pattern across vertebrates. We also derive a predictive clock based on CpG density...The lifespan clock accurately predicts LIFESPAN in VERTEBRATES."

Results: Early humans, Neanderthals, Denisovans 38 years.

Rougheye fish 205

Bowhead whale 211.

Chimp 40 years.

Humans: 38 years.

According to our DNA, the maximum lifespan of humans should be 38 years.

[Note in tennis, Oldest Grand Slam winner in recent times, Roger Federer age 35, Wimbledon.]

It is very chilling to read that based upon DNA epigenetic clock, humans would be expected to have a maximum lifespan of 38 years.

I would suggest that humans have modified the program and turned dying into senescence. I think the DNA study explains why humans have a very long period of senescence.

After age 38, We are living on borrowed time.

In my opinion, this study suggests that age 40 is a good time to start anti-aging treatment.

10. The economics of a private medial practice

For an average physician to make $175,000 a year they must see 22 patients a day. Assume 6 hours a day of work for a physician seeing patients. Seeing a patient is hard work. It requires a very high level of attention and concentration. That is 16.4 minutes a patient. Another study said 15.7 minutes per patient. This is 5.3 minutes for the patient to talk. 5.2 minutes for the physician to talk. 1 minute no talking. That leaves about 5 minutes for making notes on the computer. Throw in a few minutes for looking at lab reports and the staff is going to be signaling that this visit is going overtime and there is a room full of patients and more on the way.

To see 22 patients in a day usually requires a minimum of two staff; a front office person and a back office person. The back office person is usually licensed. There might be a need for a 3rd person for all the billing and paperwork. This requires a large medical office. Add in insurance and the overhead is $250,000 to $300,000 a year.

My office schedule allows 90 minutes between scheduled returning patients and 3 hours for new patients; 11 am, 2 pm, and 4:30 pm.

A typical new office visit is 2 hours. 3 hours are allowed between scheduled visits to allow for a complex case. Some cases are very simple. 2 hours allows time to discuss how rapamycin works. Some cases are very complex. One needs time to sort things out. time to consult with Dr. Google on the Internet. It is remarkable what you can figure out if have all the time you need to look things up on the internet. I take 5-10 minutes making notes in an old fashion paper file and writing prescriptions. Every case is different, but 3 hours are available.

The philosophy of my practice is to have a very low overhead so that every patient gets all the time they need. To accomplish this goal; I have no in-office staff. Nobody answers the telephone. Everything is by e-mail. I answer all my own e-mails.

I take no insurance, no Medicare. My practice is anti-aging and insurance doesn't cover anti-aging. If I billed insurance for "anti-aging" they might call that wire fraud as they don't consider Aging a treatable thing.

My medical style is a cross between Sherlock Holmes, Dr. Marcus Welby, and Jack Reacher. I like my patients. I am happy to meet them. They are an extraordinary group. They are intentionally going outside of traditional medicine. As a group, they are remarkably intelligent and very well-informed.

Also, I believe that with the internet and my mTOR-centric approach, I can figure out most disease processes. I think I can treat most conditions, once I understand the disease process. I have a very optimistic approach.

I have never seen a patient in which the disease was "all in their head". To me, that is the most rare thing in all of medicine. What is very common, is for patients to have diseases that don't show up on an MRI or blood tests. They are real diseases; they are just not well understood.

Nobody comes to my office because I am in their network. Everybody is paying for a consultation with their own money. Everybody sitting across the desk from me I consider to be the most important person in the world. They have frequently come a long way. I try to give everybody their money's worth

Many of the people I see have a very common problem; they are ApoE4 carriers are don't want to be at risk of dementia or they are very healthy and just want to slow down Aging. However when people have time to talk; it frequently turns out that they have a very complex story. A few patients have a rare disease and some become patient Number 1 for that disease using an "off-label approach. If a disease has no know medical treatment; that is a good place to start.

My opinion is 5 minutes for the patient to talk is not the right way to practice medicine.

11.Table of contents

Home Page: 15 Sections

Drop down: 5 sections

12. CAVEAT

The theory and praxis of my system is not CONVENTIONAL MEDICINE. It is not based upon GENERALLY ACCEPTED BELIEFS in the world of MEDICINE or the world of AGING. It is based upon the theory that aging in humans is programmed and mTOR is a major part of the pro-aging program.

While my treatment is science-based; it is based to a very large degree upon pre-clinical animal studies, not human clinical studies. While almost all treatments are prescription generic drugs which have been in clinical use for many years; the drugs are re-purposed for anti-aging. The treatment is specifically not based upon FDA approved controlled human clinical trials.

Furthermore, the very thing which this office purports to treat, PROGRAMMED AGING, driven by mTOR, is not recognized as an actual thing that exists by conventional medicine.

The following are the specific cardinal concepts NOT ACCEPTED by conventional medicine:

1. Aging in humans is programmed.

2. mTOR is driving programmed aging.

3. Aging is the fundamental cause of most Age-related disease.

4. Aging is a treatable condition.

5. Physicians should treat aging to increase health span in older people.

Therefore, all prospective patients are advised to use due diligence to make a proper informed consent to treatment.

This is "off-label" medicine.

2. Aging is the Handmaiden of Evolution

1. Theory of Aging in Humans

Aging in terrestrial mammals is very different from other vertebrates such as fish, reptiles and amphibians which all have negligible senescence. Humans have a very high degree of senescence compared to even most terrestrial mammals regarding the percent of lifespan spend in the stage of senescence. To understand senescence in terrestrial mammals one must go back 180 million years to the development of mammals. Fish had negligible senescence and gave rise to amphibians with negligible senescence which gave rise to mammals. 180 million years ago and for the first 120 million years of existence of mammals, the earth was dominated by reptiles, in particular dinosaurs. Mammals were under heavy evolutionary pressure to adapt to a challenging environment. The answer found by terrestrial mammals was programmed aging. The purpose of programmed aging was to increase adaptation in the evolution of new and improved genetic controlled traits. Mammals developed an elegant mathematical program in which life span is maintained at a relatively short, but just long enough to try out new traits and also reproduce. An essential part of the program includes pruning or removal of old animals which don't have the new traits. This also makes room for the new generation to have space to thrive without competing with older bigger more robust members. You can see proof that this works in computer programs and also in the fact that after the extinction of the dinosaurs, 66 mya, mammals had extraordinary success in taking over the land.

The consequence of the program which led to such great success of terrestrial mammals is humans have a programmed life span of about 38 years. We can manage to outlive our programmed lifespan of 38 years; but not without decades of increasing senescence. However, programmed aging requires genetic programs to drive aging. Anti-aging medicine is about the identification of druggable targets and then treatment to reduce the action of these programs driving aging.

At present mTOR and senescent cells are the main known drivers of programmed aging. mTOR stands for "target of rapamycin".

My office represents a new medical specialty. The treatment of Programmed Aging. The cornerstone of treating Programmed Aging is Rapamycin.

2. Modern Non-Programmed Aging Theories of Aging: Breaking Bad

I would consign all non-programmed aging theories to the junkyard of history. People who would like to read a very good discussion are referred to Theodore Goldsmith's book "The Evolution of Aging, chapter 7, 2014.

The best explanation of the evolution of Aging comes from Albert Einstein concept of time as the fourth dimension. In terms of evolution, the question is would this trait be adaptive over 10,000 generations.

In 1950 aging was an "unsolved problem of biology". According to Goldsmith, in 1950 there was nearly universal acceptance in the scientific community of the orthodox theory of Darwin's mechanics. For a trait to evolve, it must be beneficial. The problem was Darwin's evolutionary mechanics did not include time as the fourth dimension. The question was what is the benefit of death. it hurts the individual that dies. Therefore, it was considered impossible for "death genes" to evolve.

A patient of mine, a retired Marine Major explains how this same concept works in the Army. If an office is bypassed two times for promotion; he must resign. He is still a perfectly good officer. His resignation does not benefit him; but it benefits the Army as it makes room for new officers.

Why this works in Aging comes from the Richard Dawkins classic, "The Selfish Gene." Biologic organisms require four parts: a disposable vehicle, a genetic code, a dream and a plan. The dream is always the same and the plan is always the same. The desire to be immortal and the plan is to use the disposable vehicle to carry out the dream to propagation the immortal genetic program.

A example of how this works can be seen in a very sophisticated living organism; the Covid virus. The vehicle is an outer layer and some spikes, there is a genetic program, the is the dream to be immortal and the plan to infect millions of humans. To do this it keeps changing and because it changes so fast it has killed over 800,00 Americans and counting. The secret of success in the battle for survival is change and the faster you can change, the better your chances to adapt.

The basic understanding of biologic organisms, begins July 1, 1858, with the joint presentation by Charles Darwin and Alfred Russel Wallace, Theory of Evolution by Natural Selection. In the 1860s the great Alfred Russel Wallace expanded this concept to aging by suggesting that individuals are programmed to die so that they do not compete with their offspring.

In 1882 these ideas were supported by the influential German biologist August Weismann; but by the 1920s the idea of programmed aging was dismissed as a "perverse extension of the theory of natural selection".

in the 1950s, with the total acceptance that by the scientific world of the "modern theory of non-programmed aging; aging theory went down a rabbit hole. Aging theory down a rabbit hole has been an unmitigated catastrophe for humans. The life of humans after age 55 is dominated by aging and age-related diseases.

The foundation of the current aging theory is aging has no adaptive value. Therefore, no genes can evolve to promote aging. There can be no genes that evolved to promote aging, and therefore, anti-aging medicine is impossible.

In considering this subject the following should be kept in mind. 100 million years ago there were 3 types of terrestrial vertebrates: Reptiles, Amphibians, and Mammals. The reptiles and amphibians had negligible senescence; the mammals had evolved senescence after evolving from negligible senescence amphibians. 66 million years ago a meteor wiped out the dinosaurs and 75% of life on Earth. In the next 10 million years, senescent mammals became the dominant terrestrial vertebrate. The theory that the relatively short lifespan of mammals was a benefit in adapting to a changing world does not appear to have been considered when concluding that senescence has no adaptive value.

The following two papers, one by Travis, 2004, and the other by Martins, 2011, explode classical aging dogma.

The question of whether there are genes in humans which promote aging is the most important question in the world of Medicine. If there are genes that promote aging; then there are targets to slow aging.

3. "But Why would Nature Program Aging? Answer: "We age because the world changes" Martins

"Change and Aging Senescence as An Adaptation", Andre C.R. Martins, San Paulo, Brazil, 2011. [Link]

In a 2013 paper, "Aging in not programmed", Blagosklonny asks: "But why would nature program Aging ?" In this paper, Martins, using a computer model provides the computer generated answer: "We age because the world changes"

To answer this question Martins devises a computer model to represent evolution in a changing world. In the model there are two initially identical species and they compete for supremacy in a spatial grid. The only difference is one species is an Ager and dies at a specified age, while the other species has no programmed age of death, a Non-Ager. Only a single individual can occupy a square. If two individuals randomly land in the same square they compete, one survives and one dies. The more fit individual has the better chance to win by the formula (P= a/a+b). P is the probability that a will win and "a" and "b is the fitness. [Example P= 3/3+6) ; P = 33%;, when 3 and 6 are the fitness of a and b.]

The parameters are "f" the acquired fitness, "d" different negative numbers representing environmental change, M a fixed small number, either positive or negative, representing mutation and "b" which represents viscosity in the model and distance in the real world. After a fixed number of steps, representing fixed lifespan the Agers die. At each step there is a birth and fitness declines by an amount related to "d and "M".

The result is sometimes the Agers drive the non-Agers to extinction and sometimes the non-Agers drive the Agers to extinction. Who wins depends on the lifespan of the Agers and the size of "d" and also influence by "b". Overall the non-Agers can win early by greater numbers due to the Agers dying of fixed life span. However, if Agers can survive long enough to become sufficiently more fit; then they can drive the non-Agers to extinction. It is run on a two dimensional grid, 100 x 100, a typical time run is 1000 generations.

Note that without mutations, the non-Agers will always win, usually in about 200 generations. With mutations, if the Agers have the right life-span, not too short or too long, the Agers will usually win.

Two factors allow the Agers to win: mutations and environmental change. The mutations help the Agers to better adapt to the environmental change due to shorter life span.

Note: To get the results needs 1000 generations and 1000s of individuals on a computer program. Determining the outcome requires a computer program crunching the numbers.

Abstract:

"Understanding why we age is a long-lived open problem in evolutionary biology. Aging is prejudicial to the individual, and evolutionary forces should prevent it, but many species show signs of senescence as individuals age. Here, I will propose a model for aging based on assumptions that are compatible with evolutionary theory: 1) competition is between individuals; 2) there is some degree of locality, so quite often competition will be between parents and their progeny; 3) optimal conditions are not stationary, and mutations help each species to keep competitive. When conditions change, a senescent species CAN DRIVE IMMORTAL COMPETITORS TO EXTINCTION. This counter-intuitive result arises from the pruning caused by the death of elder individuals. When there is change and mutation, each generation is slightly better adapted to the new conditions, but some older individuals survive by chance. Senescence can eliminate THOSE FROM THE GENETIC POOL...It is not the individual that is selected but its lineage. While senescence damages the individuals and has an evolutionary cost, IT HAS A BENEFIT OF ITS OWN. iT ALLOWS EACH LINEAGE TO ADAPT FASTER TO CHANGING CONDITIONS. WE AGE BECAUSE THE WORLD CHANGES."

Discussion:

Death by senescence has an important evolutionary price for a species that adopts it. When there is no change Non-Agers win. When there is mutation, agers have a better chance at surviving as they adapt faster. By introducing gradual change in the environment, we have seen that extinction of the non-agers is a robust result, observed for a large range of parameter values. SENESCENCE CAN BE CHOSEN BY EVOLUTIONARY DYNAMICS AS THE BEST ANSWER TO CHANGE. AGING PRODUCES A PRUNING EFFECT ON THE SPECIES, ELIMINATING OLDER, SLIGHTLY LESS (GENETICALLY) ADAPTED INDIVIDUALS WHO HAD MANAGED TO SURVIVE BY CHANCE."

Better fitness has a better chance of survival...When this is associated with ransom mutations and environmental change, an aging species can have an advantage to compensate for the deaths by old age, and, in the long run, drive the non-aging species to extinction.

Note: Aging and senescence is only best under some conditions. Under different circumstances, non-aging is better. That is why there are some aging species and some non-aging species. This presents as short lifespans and senescence and long-lifespans and negligible senescence. What was wrong about classical aging theory is they thought one size fits all and that aging was NEVER good.

4. Travis, 2004; Evolution of Death Genes; A Computer Program Reveals How Programmed Aging Evolves.

"The evolution of programmed death in a spatially structured population"; Travis, 2004; [Ref] .

"Evolving dispersal and age at death", Dytham, Travis, 2006.

The author used a computer program using the patch occupancy model to investigate the evolutionary ecology of programmed organism death.

Results: In a population with global dispersal, evolution selects for individuals with an ever-increasing life span. In a population with local dispersal, individuals are genetically programmed to die.

In a local dispersal population, programmed death follows KIN SELECTION THEORY.

In order for a programmed death to develop, there must be decreasing fecundity with increasing age.

In the real world, animals that swim in the ocean or that fly can disperse far easier than terrestrial animals. Fish and birds have greater longevity as a group than terrestrial animals. The explanation provided in this study comes from Kin Selection theory.

Summary: Decline in fecundity with age is required for death genes to evolve. When a decline in fecundity with age is present, the following happens in a computer model:

"In an individual-based spatial model in which programmed age of death is allowed to evolve; in a freely mixing population with global dispersal, evolution selects for individuals with ever-increasing life span. However, in a spatially structured population with localized dispersal, a programmed age of death evolves. The exact age of death that evolves depends critically on the scale of dispersal. Within this model, individuals are genetically programmed to die, even though they are still able to reproduce. These results suggest that death can be adaptive and offer an explanation for the evolution of "death genes".

This model explains why in the real world there is a high degree of senescence in land mammals and frequently negligible senescence in ocean animals.

Note: Terrestrial mammals like humans have all the requirements for programmed death to develop: decreased fecundity with age and local distribution.

5. Theory of Aging: Results of Martins and Travis Computer Programs and Blagosklonny Hyperfunction.

The computer programs based theory starts with rejecting all theories that are based upon the proposition that senescence and aging can't be an evolved adaptive trait. That means rejecting all classical theories of aging.

The Travis-Martins-Blagosklonny theory of aging have the following tenets:

1. Martins: A biologic organism that ages and has a fixed lifespan can adapt faster due to mutations. This is advantageous in a changing world, to which they are not well adapted. A biologic organism that does not age and has a relatively long lifespan will be slower to adapt. Adaptation is by a change in genes which then bring about modifications in the organism.

2. Travis: If an organism has decrease in fecundity with age then:

(a) If the organism has global distribution, the organism will continue to evolve a longer lifespan.

(b) If the organism has local distribution, the organism will evolve a fixed moderate life span. The age of lifespan which evolves depends on the amount of distribution, fecundity, interaction with kin, etc.

3. Blagosklonny: mTOR causes hyperfunction in older animals which drive senescence. The same mTOR program is beneficial in growing animals and conserved for 2 billion years..

Biologic organisms find it much easier to repurpose existing molecules than invent new molecules.

6. The Disposable Vehicle and the Immortal Genetic Program

The book, "The Selfish Gene, published 1976, by Richard Dawkins, is a very important book to understand evolution, natural selection and aging. It is also good for understanding Kin Selection Theory.

The basic idea is a biologic organism is two parts: a disposable device and an immortal genetic program. The part that matters to me, as a doctor, is the disposable vehicle. The disposable vehicle is the person. The part that matters to evolution is the immortal genetic program.

To understand aging, the entire focus should be on the immortal genetic program. The death of the disposable vehicle, the actual body and the life of the biologic organism means nothing. Classical aging theory can not understand aging as their focus was on the disposable vehicle.

In the computer program by Martins, the entire focus is on the improvement of the genetic program, which is looked at is fitness. In the computer program by Travis, it is Kin Selection which drives the computer program.

In the Richard Dawkins book, Kin Selection theory drives rational social behavior. His ideas which apply to social behavior apply equally to the evolution of aging.

You have a 50% interest in your children and your brothers and sisters. You have a 25% interest in your grandchildren and the children of your brothers and sisters. From a biologic view, that is your immediate family and your concern with their welfare is directly related to their fecundity. The loss of one niece or nephew is a much greater loss than an elderly brother or sister past child bearing age.

Biologic Fitness = Your fitness (number of offspring you produce + Fitness of Kin (total number of offspring they produce). You merely have to calculate your genetic interest in them.

A biologic organism is just a device for passing on the immortal genetic programs they were entrusted with. You are given the gift of life and the payment due is that you do everything you can to promote the genes.

When it comes to your death, evolution will calculate the chance you will pass on more genes, and how your death is beneficial or not beneficial to passing on the immortal genes.

Evolution functions like a Life Insurance company. The insurance company sells you a life insurance policy at 20 years old with a very good idea of when you will die. Evolution gives you a policy at the time of conception. If evolution doesn't think you living very long is a good idea for passing on the genes they gave you or developing new and better genes, then they include in your genetic program a poison pill, a time bomb which at a certain age turns on the death program.

7. Travis Results applied to Effect of Extrinsic Mortality on senescence in guppies, opossums.

In the Travis model of Programmed Death, they studied the effect of stochastic death (Figure 3B) on programmed age of death. As the rate of stochastic death increased from low (10% probability) to high (40% probability) the programmed age of death increased from low 10 to moderate 30. This made complete sense in the study as all other things remaining constant, increased stochastic death (corresponding to increased death from predators in the wild) would result in lower population density favoring a longer life span.

However, this is the exact opposite of what was predicted by classical aging theory. According to Medawar's theory, higher extrinsic death from predators will result in shorter lifespan and increased senescence as why would organisms waste efforts on repair and fitness if just more likely to be fit at the time of death.

The following excellent study "Effect of extrinsic mortality of senescence in guppies"; Reznick, 2004; had results exactly the same as predicted by Tavis study and the exact opposite of what classical aging theory predicts.

They studied guppies from high mortality and low mortality regions of rivers in Trinidad. The fish in the low mortality region were protected by waterfalls and predators could not reach this area. In the low predator region, the guppies had a 20-30 times better chance of surviving 6 months. All guppies regardless of size were equally at risk high of predation.

When guppies were removed from both areas and bred for two generations in a lab to reduce the stress; the guppies from the high predation area had 35% longer lifespan and 40% longer reproductive span. The authors conclude: "Our results do not comply with the classical Medawar-Williams theory regarding senescence, in terms of survival, fecundity or reproductive value.

In another paper, "Retarded senescence in an insular population of Virginia opossums", Austad, 1993; studied opossums on the mainland and opossums on an insular island population removed from predators for 4-5000 years. The island females had a longer lifespan and decreased fecundity. The conclusion was, "All these results are consistent with evolutionary senescence theory."

The Travis study would provide a totally different interpretation of the Austad data. Opossums are subjected to a very high rate of predation on the mainland. Dogs easily kill opossums. Therefore, on the mainland, opossums would be expected to have a very low rate of dispersal. The price for dispersal would be very high. However, on the island, the opossums are free to disperse as there are no predators. Therefore, wider dispersal would result in an increase in lifespan. Austad did not consider the effect of predators on dispersal because dispersal has nothing to do with classical aging theory.

8. Martins and Travis Results applied to Evolution and Aging in Vertebrates

A recent paper: "Senescence as a trade-off between land colonisation and longevity: critical review and analysis of a hypothesis"; Bilinski, 2020; did an extremely good review of the literature from 1950 to 2020 concerning life expectancy, the existence of senescence in major animal groups. All their conclusion are based upon classical aging theory and I disagree with all their conclusions, but their data is very good. As regards their conclusions; in my view, they have reversed cause and effect.

450 million years ago JAWED FISH -

440 mya, Ordovician extinction, 85% species extinct.

430 mya, Ray-finned fish, lobe-finned fish.

The ray-finned fish are the modern bony fish, they comprise 50% of all vertebrates.

LOBE-FINNED FISH developed into Amphibians. 370 mya

Amphibians give rise to synapsids and sauropsids, 320 myo

250 mya Permian-Triassic extinction; The Great dying, 96% marine life, 70% terrestrial life extinct

230 mya Synapsids--> Mammals

230 mya Sauropsids --> Reptiles --> Dinosaurs

200 mya Triassic-Jurassic extinction, 80%

100 mya Dinosaurs--> Birds.

66 mya K-Pg extinction; 75% species including dinosaurs become extinct

Fish have Negligible Senescence

Amphibians have Negligible Senescence

Reptiles have Negligible Senescence

Mammals have Senescence

Birds have Senescence.

The most successful terrestrial vertebrates are mammals and birds Mammals and Birds evolved independently from Negligible senescence to senescent animals. The successful adaptation to land by mammals and birds required very many adaptations and was a great triumph of the power of evolution.

THE EVOLUTION THEORY OF MARTINS AND TRAVIS SUGGESTS THAT PROGRAMMED AGING PROVIDED THE SHORTER LIFESPANS THAT ALLOWED MAMMALS AND BIRDS TO EVOLVE THE ADAPTATIONS TO BE SUCCESSFUL ON LAND.

The Bilinski paper reverses my interpretation of cause and effect and says the adaptations to be successful on land required senescence.

The facts show there were non-senescent animals. The fish remained non-senescent and had great success. The mammals and birds evolved senescence from non-senescence and then had great success as land animals. The Martins computer program is a very strong argument that mammals and birds WON due to the benefit of senescence to adapt faster.

9. Results from the Travis-Martins Model of Aging applied to Real World Findings

The fundamental idea of the Travis-Martins model is aging is an adaptive trait that animals can adopt or not adopt based upon their circumstances.

The shortest recorded vertebrate lifespan is found in Coral reef pygmy fish. The total lifespan is 8 weeks, 3 weeks as larvae, 2 weeks to mature and 3 weeks to reproduce. Females can only produce 3 clutches in a lifetime, a little over 400 eggs. Males guard eggs until hatching.

The Rough eye Rockfish can live to over 200 years and 200 year old females can produce a million eggs in a year. The shortest lived species of Rockfish, Sebastes minor, lifespan is 11 years. In the same species lifespan ranges from 11 years to over 200 years. The longest living fish is the Greenland shark which has lifespan of 450 years. The Greenland shark and Rough eye Rockfish have no decrease in fecundity with age.

The bat and the rat are about the same size. The rat has local distribution; but the bat can fly and has wide distribution. Some bat species live up to 40 years and rat lives about 3 years. Most bats forage individually after insects or fruit. However, paper, Gager, 2016, "Group size, survival and surprising short lifespan in socially foraging bats. Median survival of females was very short with 1.8 years and maximum longevity of 5.6 years.

Mammals generally are senescent. However the Bowhead whale with global distribution lives over 200 years. The Hairless mole rat has negligible senescence. They are eusocial animals living in large groups. Only the Queen breeds and she has no decrease in fecundity with age. The workers don't breed at all; but just help. None have a decrease in fecundity with age.

Passerine birds have lifespan of around 30 years. Pelagic or sea birds live long than land Passerine birds. The sea birds can have wider distribution. The longest living animal is the Ocean Quahog clam. They live on the ocean bed.

When viewing senescence as adaptive and programmed; then extreme longevity makes sense as extremely long-lived animals are not programmed to have a fixed lifespan. Animals choose senescence and fixed lifespan or negligible senescence with no fixed life span.

To age or not to age; that is the question.

10. On a Challenging Planet; the Imperative is to Avoid Extinction

Earth is a very challenging planet for living things. 98% of species that ever lived have become extinct. There have been 5 mass extinctions since 440 million years ago. The Ordovician extinction 440 mya wiped out 85% of species. Late Devonian extinction 360 mya, 75% species extinct. Permian Triassic extinction 253 mya, called the great dying, extinction of 96% marine life and 70% terrestrial life. Triassic-Jurassic extinction 200 mya, 80 % of species extinct. The K-Pg extinction, 66 mya, known as the day the dinosaurs died, extinction of 75% of species. There have been times when Earth very hot and times when ice covered most of the planet Times when food sources were wiped out and periods of intense volcanoes. Predators and prey can evolve and there is the threat of disease.

In view of these mass extinctions, it is peculiar that aging theory is all about how animals should focus on longer lifespan as opposed to how animals should try to avoid extinction. The best way to meet the challenges is to evolve new traits to adapt. Understanding the best way to evolve new traits involves mathematical reasoning.

A mouse has a gestation period of 19-21 days. A female mouse gets pregnant about 5 to 10 times each year and can give birth to a litter of 3-14 pups.

If you think of evolution in terms of what happens with 50,000 individuals in 10,000 generations as regards best ability to evolve traits and you have very good mathematical intuition; you start to see the value of a short lifespan versus a long lifespan.

One reason to remove older individuals is they have already bred and introduced their genes into the evolving gene pool. The old individuals are removed to make room for the new generation which may have favorable mutations.

Note that none of this is being done for the benefit of an individual mouse who is programmed to have a short life. It is being done for "the greater good".

An estimate is that there are 20 Billion mice in the world. ( 9 billion humans)

A totally different plan; used for many fish is negligible senescence. Chronologically old fish are frequently more valuable because they have grown big enough to avoid predators. For a Rough eye Rockfish, a good plan is just keep growing, become more fertile the older you get, and lay a million eggs a year when over 200 years old.

An estimate is there are 3500 Billion fish in ocean. In the ocean, the best plan is negligible senescence; but for terrestrial animals, senescence is generally best. The best evidence is that negligible senescent fish dominant the water and senescent mammals and senescent birds dominate land

11. On the Cusp of Golden Era of Anti-Aging Medicine

We are at the dawn of the age of anti-aging medicine. The foundation is the growing recognition that aging is programmed. The pro-aging program creates targets for pharmaceutical intervention. The leading suspect for programmed aging is mTOR and senescent cells. Aging is the underlying cause of most age-related diseases. Targeting aging decreases the risk of age-related disease. Treating aging also treats the normative changes of aging, especially the brain and the heart.

Humans, a terrestrial mammal, evolved senescence, a treatable condition.

3. Cancer, ASHD, Brain Aging, Alzheimer Disease

Slow Aging, Prevent Disease

The goal of Programmed Aging Medicine is to slow aging, target pre-disease and thus prevent late disease. Here we will look at the 3 major age related diseases plus a condition called normative brain aging. They are without doubt very different age-related diseases; however, they are all mTOR driven diseases and can be prevented with rapamycin. Of these four conditions; prevention of normative brain aging and cognitive decline may be the most compelling reason to use rapamycin. Even without rapamycin one might live to old age without cancer, atherosclerotc heart disease or Alzheimer's disease; but cognitive decline due to brain vascular deterioration is a "normative change"; so for some people, prevention of cognitive decline may be the most compelling reason for using rapamycin.

Cancer Prevention

"Prevention of cancer by inhibiting aging", 2008, Blagosklonny has an excellent discussion regarding (a) evidence that rapamycin prevents cancer and (b) the mechanism. (9)

A. Evidence rapamycin prevents cancer:

1. Retrospective-analysis of human data; de novo tumors:

"Retrospective analysis in renal transplant patients has revealed that rapamycin (sirolimus) decreased the frequency of new tumors, [89-94]. In a multicenter study by Mathew at two years after renal transplant, patients receiving rapamycin as base therapy had no malignancies compared with 5% incidence among those receiving cyclosporine."

"In the study that involved 33,000 patients, the incidence rates of patients for any de novo malignancies were 0.6% with rapamycin (rapalogs) and 1.81% with cyclosporine/tacrolimus (not rapalog). There were no de novo solid tumors in patients receiving rapamycin. In contrast 1% of patients receiving cyclosporine had developed de novo solid tumors. Importantly, rapamycin decreased cancer incidence even without the withdrawal of cyclosporine. This indicates that rapamycin decreases cancer incidence."

Rapamycin prevents cancer in very many mouse studies.

Human study: In Phase II study breast cancer, rapalog plus Letrozole was better at preventing breast cancer recurrence than Letrozole alone.

Caloric restriction, which acts through inhibition of TOR, known to reduce cancer incidence.

Metformin, which reduced TOR throught AMPK pathway, shown to reduce cancer incidence in diabetic patients.

"Cancer is Age-related disease:"

"The incidence of cancer is lowest at age 20 and then increases exponentially, doubling every eight years." "Cancer disproportionately strikes individuals of ages 65 and older. median ages of cancer patients at death for major tumors ranges from 71 to 77 years. median age prostate cancer is 79 years."

"Why common cancer is an age-related disease:"

Mutations accumulate with age.
Aging, per se renders an organism cancer-prone as aging process promotes cancer.

Tumor Regression in Young Animals:

In certain animal models, tumors preferentially grow in old animals. Hepatic tumor cells transplanted into liver of young animals regressed, while grow in old animals.

Tumor cells injected into lungs of old animals grow but not in young animals.

Latent versus Clinical Cancer:

"After age 50 years, both incidence and mortality rates from prostate cancer increase at a nearly exponential rate. Autopsy study data from many countries demonstate that 15% to 30% of men older than 50 years have histological evidence of latent prostate cancer. The presence of latent cancer increases with age so that by age 80 approximately 60% to 70% of men have evidence of histological cancinoma at autopsy. Yet, wth similar incidence of histological cancer, clinical cancer is 10-20 times less frequent in Japan than in the USA and prostate cancer mortality is low in Japan." Thus prevention of cancer progression (from latent to clinical) is very important.

Senescent Stroma may Promote Cancer:

"Stromal cells affect cancer growth. In some experiments, cancer-associated stroma, but not normal stroma, promoted cancer growth. Carcinoma-associated fibroblast can direct tumor progression of and initiated prostate epithelial cell changes in the tissue milieu, such as those that accompany normal aging, may determine the ability of a genetically aberrant cell to produce a tumor."

"By altering the tissue microenviornment, senescent cells may contribute to the rise in cancer that occurs with age..senescent stromal cells can stimulate neighboring premalignant or dormant cells to form tumors. Senescent cells produce enzymes, growth factors and inflammatory cytokines. Human fibroblasts that have undergone senescence increase the growth of co-transplanted cancer cells in mice. These senescent cells seem to promote cancer growth both by direct mitogenic effects and by indirect effect via tissue damage. Senescent fibroblasts promote tumor growth. Stromal fibroblasts adjacent to human ovarian cancer cells are senescent.

"Aging of stromal-derived human breast fibroblasts can contribute to breast cancer progression due to secretion cytokines including MMP...Senescent cells secrete MMP, which are major mediators of basement membranes degradation, angiogenesis, tumor invasion and metastasis. Thus senescent human fibroblasts increase the early growth of tumors via MMP secretion. Noteworthy, TOR induces MMP synthesis, which is inhibited by rapamycin.

Summary:

Rapamycin does not prevent the mutations and DNA damage which causes cancers. Rapamycin in low dose used for anti-aging does not have a strong direct effect on cancer cells. Rapamycin slows aging. Slows the formation of senescent cells. Slows the formation of the permissive enviornment which promotes cancer growth.

Rapamycin prevents latent cancers from becoming clinical cancers. By slowing aging, rapamycin has a very powerful effect on delay of clinical cancer.

9. Blagosklonny, Prevention of cancer by inhibiting aging, Cancer Biol Ther. 2008 Oct;7(10):1520-4. Epub 2008 Oct 21.

Atherosclerotic Heart Disease

There is very large body of evidence that shows long-term caloric restriction is highly effective in reducing risk for atherosclerosis in humans. There also is abundance of evidence that caloric restriction works through reducing the TOR pathway. In heart transplant recipients rapamycin prevents coronary artery disease. In various animal models, rapamycin prevents progression of atherosclerosis. This section looks at the mechanism by which reducing the TOR pathway with rapamycin prevents atherosclerosis.

In the paper "Prospective Treatment of Age-related diseases by slowing down Aging" (10) atherosclerosis is used as model for how TOR drives age-related diseases.

Step 1: Cellular Geroconversion from resting cell to Senescent cell. "When cell cycle is blocked, active growth promoting pathways as TOR cause irreversible conversion to cellular senescence characterized by cellular hypertrophy, hyperfunction, hypersecretory and pro-inflammatory phenotype. Rapamycin decelerates or suppresses geroconversion.

Atherosclerosis depends on hyperfunctions of local cells: endothelial cells, smooth muscle cells (SMCs) and macrophages. The development of atherosclerotic plaque involves endothelial activation, hypertrophy and hyperpasia of SMCs, monocyte migration, macrophage activation, uptake of lipids by activated cells, accumulation of fat and formation of foam cells. In one study rapamycin was shown to inhibit monocyte/macrophage migration and their accumulation in carotid lesions in cholesterol fed rabbits. (10)

The best study to demonstrate the mechanism of atherosclerosis is:

Senescent intimal foam cells are deleterious at all stages of atherosclerosis". (11)

In this study they demonstrated that atherosclerotic lesions contain senescent cells. They identified 3 types of senescent cells:

a. Macrophage/monocytes

b. Endothelial cells

c. Vascular smooth muscle cells.

In early lesions senescent foamy macophages accumulate in the subendothelial space at the onset of atherosclerosis, where they drive pathology by increasing the expression of key atherogenic and inflammatory cytokines and chemokines.

In advanced lesions, senescent cells promote features of plaque instability, including elastic fiber degradation and fibrous cap thinning, by heightening metalloprotease (MMP) production.

"Together, these results demonstrate that senescent cells are key drivers of atheroma formation and maturation."

Fig 1: Senescent cells drive formation of atherosclerotic plaque.

Fig 2: Intimal senescent foamy macrophages form during early atherogenesis and foster production of proatherogenic factors.

Fig 3: Removal senescent cells reverses proatherogenic microenvironment

Fig 4: Senescent cells promote plaque instability by elevating metalloprotease (MMP) production.

"Advanced plaques contain three distinct senescent cell types that not only drive lesion maturation through inflammation and monocyte chemotaxis but also promote extracellular matrix degradation. Clearing senescent cells from lesion inhibits both plaque growth and maladaptive plaque remodeling processes associated with plaque rupture, including fibrous cap thinning and elastic fiber degeneration. Furthermore, senescent cells in lesions show heightened expression of key SASP factors and effectors of inflammation. These data suggest that senescent cells can directly influence core proatherogenic processes through specific secreted factors."(11)

This paper directly shows the key role of senescent cells in the pathogenesis of atherosclerosis. At this point in time, senolytics to remove these senescent cells are slowly becoming clinically available. Rapamycin decreases the production three fold of all types of senescent cells by inhibiting TOR.

10. Blagosklonny, Prospective Treatment of Age-Related Diseases by Slowing Aging. Am J Pathol. 2012 Oct;181(4):1142-6..

11. Childs, Senescent intimal foam cells are deleterious at all stages of atherosclerosis. Science. 2016 Oct 28;354(6311):472-477.

Prevention of Normative Brain Aging

Normative brain aging refers to the mental decline which is considered the norm for older persons. This includes cognitive decline, impairment of memory and leaning ability; not quite dementia; just becoming a little bit stupid. An extraordianary study published November 2019, by the Veronica Galvan group in San Antonio, Texas, shows rapamycin has the extraordinary ability to prevent this normative brain aging in elderly rats. Rats started at 19 months (equivalent to middle age) and maintained on low dose rapamycin to 34-months old (maximum age for rats) were free of any evidence of age-related vascular deterioration and were as "smart" as 16 month old adult rats as regards memory and learning ability.

Results:

1. Rapamycin restores cortical microvascular density. Untreated old rats had reduced microvascular density in cortex and hippocampus. Rapamycin treated 34 month old rats had microvascular density indistinguishable from young 16 month old mice.

2. Rapamycin restores cerebral blood flow. The old rats had decreased cerebral blood flow that was global, cortical and hippocampal. The rapamycin treated 34 month old rats had blood flow same as 16 month old rats.

3. Rapamycin prevents loss of pre-synaptic density. Presynaptic density is a measure of neuronal integrity. It is required for learning and memory.

4. Rapamycin preserves functional hyperemia. When area of brain is stimulated to perform specific function, that area lights up with increased blood supply. This is a complex mechanism called neurovascular coupling. This is lost during aging; but preserved in old rats on rapamycin.

5. Rapamycin preserves hippocampal learning and memory. The net result of all the above is loss of learning abilty and memory in old rats; however, this was preserved to levels indistinguishable from young rats in rapamycin treated 34 month old rats.

Cerebrovascular dysfunction and cognitive decline are highly prevalent and considered the norm in aging. This study showed these changes can be prevented with low dose rapamycin. This is of extreme importance in and of itself. However, these vascular changes are the precursors for dementia and can be considered the early pre-disease state of Alzheimer's disease.

12. Van Skike, mTOR drives cerebrovascular, synaptic, and cognitive dysfunction in normative aging, Aging Cell. 2019, Nov 6.

Alzheimer's Disease

In 2019, there was a very excellent paper by Matt Kaeberlein and Veronica Galvan. (4) Matt Kaeberlein was noted above and Veronica Galvan is one of the world's leading research scientists in prevention of Alzheimer's disease (AD) with rapamycin. In 2010, she was first to demonstrate that rapamycin could prevent AD in a transgenetic mouse model of AD. The paper includes one paragraph which summarized the body of research of the past 10 years regarding rapamycin and prevention of AD. I suggest that anybody interested in this topic download this open access paper and review references 13-24.

"In addition to its robust effects at attenuation normative aging, rapamycin has also been shown to have beneficial effects in several different mouse models of AD that exhibit amyloidosis alone, or amyloidosis plus tauopathy, or primary tauopathy. Indeed, the breath and depth of positive preclinical data for rapamycin are perhaps greater than for any other potential AD therapy at this time. Such beneficial effects of rapamycin include:

Reducing amyloid B deposition,
Reducing pathogenic tau phosphorylation and abundance of misfolded tau species including neurofibrillary tangles,
Restoring cerebral blood flow and cerebrovascular density,
Preserving blood-brain barrier integrity,
Preventing human tau-induced neuronal loss, and
Improving cognitive function.

Beneficial outcomes have been seen in several different mouse models of AD including:

a. 3X transgenic mice [3 human AD genes]

b. P3015 mice

c. hAPP mice

d. transgenic 2576 mice

e. APP/PS1 mice

f. ApoE4 transgenic mice [Mice with human ApoE4 gene]

g. A viral vector-based mouse model of AD in which tau P301L is expressed in layer II of the lateral entorhinal cortex of the mouse brain.

Improvement after rapamycin treatment have been observed in these animal models when initiated either before the onset of disease symptoms or after symptoms and pathology are already present.

In addition to studies with rapamycin, genetic inhibition of mTOR rescued memory deficits, improved cognitive function and decreased tau and AB deposits.

The rapamycin derivative temsirolimus also improved special learning and memory and prevented apoptosis [cell death] in the hippocampus of AD mouse models."

This extraordinary paragraph summarized 10 years of very compelling evidence.

Everybody has the ApoE gene. 20% of persons have the ApoE4 allele, while 75% have ApoE3.

The ApoE4 allele increased the risk of AD 3 fold and lowers the median age of onset from 85 for non-ApoE4 carriers to to age 75 for those with 1 E4 allele. I suggest that anybody with a family history of AD, especially if onset 80 years or younger have genetic testing for presence of ApoE4 allele. (23&Me does test)

My linked website, www.Alzheimer-prevention.com is directed at ApoE4 carriers who need protection against risk of AD.

My opinion, based upon the very extensive literature, is that rapamycin will provide excellent protection for both ApoE4 carriers and non-carriers prior to the onset of symptoms (the pre-disease stage).

The above paper suggests rapamycin treatment for early onset AD diagnosed as MCI (mild cognitive impairment stage).(4)

As is true for almost all the age-related diseases, rapamycin is best for pre-disease. However, for persons with the AD in the MCI stage; Dasatinib is the best hope to stop or slow progression.

Bartzokis 2011, Alzheimer's Disease as response to age-related myelin breakdown.

Less than 1% of AD cases is due to early onset genetic dominant AD.
The major brunt of AD falls upon the 20% of population who have the APOE4 gene. This 20% of the population gets the substantial majority of AD cases prior to age 80. This includes the 2-3% of double ApoE4 carriers who have a median age of onset of about 69 years old. For ApoE4 carriers, AD is commonly a middle age disease. For non-ApoE4 carriers, AD is usually an old age disease.
The 3 major risk factors for AD are:1. Human2. Age 3. ApoE4 carrier.
If you have immediate relatives who had AD prior to age 80; you are at higher risk of having ApoE4 allele. However, unless you have 4 grandparents who all hailed their 90th birthday in excellent cognitive shape; you don't know your ApoE4 status for sure.
Genetic testing for ApoE4 allele is done by 23&Me and a few other places. Any group advising against genetic testing for ApoE4 is a group opposed to the prevention of AD. The prevention of AD in APOE4 carriers is the major focus of my practice. AD is ae classic age-related disease. Rapamycin is the cornerstone of treatment for the prevention of AD.

The rest of the pharmacologic treatment plan includes:1. Dasatinib and Quercetin to remove senescent cells.2. Theracurmin as Curcumin to remove Iron.3. DHA to support myelin.

AD is NOT due to amyloid. Rather the increase in amyloid with age is the downstream by-product of the upstream disease process. Amyloid is the EFFECT NOT THE CAUSE.

The incidence of AD doubles every 5 years starting at age 65. By age 100, the incidence is 40% per year. When the incidence of a "disease" reaches 40% a year; that is no longer a "disease" That is the "normal" physiological aging process.
Humans are the only animal that gets AD. Humans are also the only animal with a "super-computer" as a new "device" linked to the old vertebrate brain. Understanding AD starts with understanding the human brain.

AD can be viewed as an UPSTREAM disease and a DOWNSTREAM DISEASE.
The Upstream disease process is due to the age-related inability to repair and maintain the cerebral microvascular system and MYELIN. The human brain is 2% of the body by weight and receives 25% of blood supply; so the extraordinary importance of cerebral microcirculation is obvious. Myelin is the secret sauce of the human brain. One can not understand the uniqueness of the human brain or AD; without understanding the pattern of myelination of the human brain.
The downstream disease is dominated by senescent cells.

For an extraordinary EXCELLENT explanation of the upstream disease pathogenesis of AD see: "Alzheimer's disease as homeostatic responses to age-related myelin breakdown; " George Bartzokis, 2011. [Ref]

Rapamycin can help prevent the upstream disease process in the following ways: (1) Rapamycin prevents deterioration of the cerebral microcirculation which results in both ischemia and breakdown of the blood-brain barrier (BBB). Both ischemia and breakdown of BBB result in damage to Oligodendroglia. The role of the Oligodendroglia in maintaining myelin and maintaining the health of axons is paramount. (2) The breakdown of myelin causes the release of IRON. The Iron acts as a catalyst in interaction with increased amyloid to cause clumping of amyloid-beta into oligomers. The innate immune system then reacts to the oligomers of amyloid-beta causing inflammation. Rapamycin lowers the activity of the innate immune system and decreases inflammation. (3) Rapamycin can have an anti-aging effect on Oligodendrocytes.
Rapamycin can help prevent the downstream disease process as follows: (1) Inflammation results in the development of senescent cells; which include senescent Oligodendrocytes, senescent Microglia, and senescent Astrocytes. These senescent cells with elevated mTOR then cause increased phosphorylation of TAU. The process results in the formation of senescent neurons bearing neurofibrillary tangles. The senescent neurons with neurofibrillary tangles then cause the death of other neurons. The mechanism of spread and destruction is familiar to anybody who has seen a horror movie about a zombie apocalypse. (2) Rapamycin is helpful in the prevention of the development of senescent cells.
The treatment of senescent cells is Dasatinib + Quercetin.
The major treatment to prevent the upstream disease process is Rapamycin. The major treatment for the downstream disease process is Dasatinib.

The Usual Suspects, MMP

In the discussion of the above three disease there are the usual suspects. The main suspect is always mTOR, the master of cell functions. The second suspect is always senescent cells, which are increased with elevated mTOR. The third suspect is a particular enzyme. This is Matrix metalloproteinase (MMP), which is an enzyme that breaks down proteins such as collagen which acts as a major building block in tissues. mTOR increases MMP and rapamycin blocks the production of MMP.

In cancer, MMP degrades the basement membranes and promotes tumor invasion.

In ASHD, MMP destroys the collagen support for the fibrous cap which causes the plaque to become unstable, break down, bleed and result in occlusion of blood vessels and myocardial infarction.

In Alzheimer's disease, MMP breaks down the blood brain barrier and causes damage to the cerebral microcirculation; a critical early step in the pathogenesis of AD.

These are very different diseases, but at the cellular and molecular level; you find the same usual suspects.

4. New Site: Senescent Cells, Aging, and Senolytics

Senescent Cells and Aging

Aging kills by age-related disease. Aging and age related disease are merely different manifestations of the same disease process. If not for aging; there would not be age-related disease.

At the center of Aging is elevated mTOR and senescent cells.

The purpose of this new website is to provide an in depth examination of the part played by senescent cells in Aging and age-related disease. The website also undertakes a detailed examination of senolytics, which are drugs which remove senescent cells.

There is now a sufficient body of evidence to justify the introduction of SENOLYTICS into clinical medicine.

https://senolyticstreatment.com/

5. New Products, Topical Rapamycin And Others

New Section: November 26, 2020

Topical rapamycin is an excellent new product for aging human skin.

It is expected that topical rapamycin will both help ameliorate the ubiquitous skin aging seen in adults and also decrease skin diseases associated with aging such as skin cancer.

This paper is featured here for two reasons:

Topical rapamycin is a new product now offered to my patients.
This paper provides an excellent discussion of the mechanism of how rapamycin slows aging; which applies not just to the skin; but has a general application.

Topical rapamycin reduces markers of senescence and aging in human skin: an exploratory, prospective, randomized trial.

~Chung, Dec 2019.

Abstract: Aging is a major risk factor for the majority of human diseases, and the development of interventions to reduce the intrinsic rate of aging is expected to reduce the risk for age-related diseases, including cardiovascular disease, cancer, and dementia. In the skin, aging manifests itself in photodamage and dermal atrophy, with underlying tissue reduction and impaired barrier function. To determine whether rapamycin, an FDA-approved drug targeting the mechanistic target of rapamycin (mTOR) complex, can reduce senescence and markers of aging human skin, an exploratory, placebo-controlled, interventional trial was conducted in a clinical dermatology setting. Participants were greater than 40 years of age with evidence of age-related photoaging and dermal volume loss...

A significant reduction in p16INK4A protein levels (a marker of senescent cells) and an increase in collagen VII protein levels were observed among participants at the end of the study. Clinical improvement in skin appearance was noted in multiple participants, and immunohistochemical analysis revealed improvement in histological appearance of skin. Topical rapamycin reduced the expression of p16INK4A protein consistent with a reduction in cellular senescence. This change was accompanied by relative improvement in clinical appearance of the skin and histological markers of aging and by an increase in collagen VII, which is critical to the integrity of the basement membrane. These results indicate that rapamycin treatment is a potential anti-aging therapy with efficacy in humans.

Introduction: "Inhibition of the mTOR pathway using rapamycin...is one of the most promising anti-aging pathways...Our laboratory was the first to describe mTOR activation as a feature of senescent human cells, and mTOR activation has recently been described as a feature of aging tissues and cells, suggesting that activation of the pathway is a component of age-related dysfunction in multiple setting and may underlie age-related functional decline. In addition, the mTOR pathway is a direct target of the IGF-1 signaling pathway, which is a major driver of aging....

Senescent cells contribute to age-related decline by influencing the microenvironment and through the production of inflammatory cytokines. We and other have demonstrated that rapamycin can delay or prevent senescence in human cells."

[AG note: This is excellent discussion of how aging is driven by interaction of senescent cells and mTOR pathway and how blocked by rapamycin]

"In the skin, senescent cells measured by increased expression of the p16INK4A protein have been found to correlate with markers of aging such as elastic fiber morphology and wrinkling of the skin Dermal atrophy, a significant problem in the elderly, can lead to skin fragility, impaired wound healing, and an increased rate of infections and complications following injury. Photoaging, manifested by fine wrinkles, dyspigmentation, and dull appearing skin, is nearly ubiquitous in adults older than 50 years."

"In order to address the hypothesis that rapamycin treatment can ameliorate age-related disorder and dysfunction in human tissue through a reduction in senescence, we examined the impact of a topical formulation of rapamycin on markers of senescence and aging in human skin, using a placebo controlled, exploratory trial design"

Methods: A topical rapamycin cream (0.001%) was applied to back of one hand every 24 to 48 hours in evening for 8 months. Results were evaluated by clinical assessment and by immunohistochemistry following skin biopsy.

Results:

Topical rapamycin treatment reduced expression of senescence regulator p16INK4A.
Rapamycin improves cytokeratin 5/6 distribution with more tightly associated with basal layer.
Topical rapamycin increases collagen VII in the basement membrane.
Clinical improvement: Of the 13 subjects, (completing study) all except 2 showed improvement in clinical signs of cutaneous aging. The most notable improvement was a decrease in the prominence of veins and tendons, a hallmark of age-related volume loss of the hands. Fine wrinkling was also improved, consistent with the increase in collagen VII. The dyspigmentation and dull appearance associated with photoaging was also consistently improved. These changes were evident approximately 4 months following the initiation of treatment, and continued improvement was noted upon subsequent visits.

Discussion: "This study demonstrates a clear impact of rapamycin treatment on both the molecular signature associated with senescence and the clinical signs of aging in the skin. The data support the idea that a reduction in the burden of senescent cells underlies these improvements...We favor the concept that rapamycin reduces entry into senescence."

There was a reduction of p16INK4A, a marker of senescent cells. "We anticipate that rapamycin treatment reduces inflammatory cytokines in the skin."

"One quantifiable aspect of skin biology that is improved by the rapamycin treatment is the incorporation of collagen VII into the basement membrane, which represents a functional measure of skin quality that is improved upon treatment with rapamycin. Collagen VII is essential for a functional skin barrier , and the levels of collagen VII decrease with age and specifically beneath wrinkles."

"In summary, we present the first evidence that rapamycin treatment improves function and reduces marker of aging in human tissues"

AG note: This study can be seen on two levels:

First: Clinical evidence that topical rapamycin is a very good anti-skin aging preparation.

Second: An excellent explanation and demonstration of how rapamycin slows down aging with the skin being a good aging model because easy to study.

Topical rapamycin in this study was 0.001%. This is very small concentration and quite remarkable that this very small concentration had a significant anti-aging effect. Concentrations up to 100 times greater are also available by prescription from various compounding pharmacies. These stronger preparations are used for various lesions such as angiofibromas, etc. [One very enterprising patient made his own topical rapamycin preparation and used on flat warts (Verruca plan) with excellent results. The .001 % preparation in this study had no systemic absorption and no side effects were reported.

Topical rapamycin should be available as an OTC product at drug stores. Unfortunately, topicl rapamycin is only available by prescription.

The direction are add 1 capsule, 3 mg sirolimus, to 3.5 0z of Aquaphor Ointment. 3.5 Oz is 99 gm or 99,000 mg. When add 3 mg to jar of 99,000 mg preparation is .003%. I use a much stronger preparation (15 capsules in 3.5 Oz to make a 0.045% ointment for age related and solar related lesions on my scalp with good effect. Since the powder is red, can see that it is well dispersed in the white ointment

Topical Rapamycin is a very good product to improve the appearance and function of aging skin.

Rapamycin has an anti-aging effect on the skin, because rapamycin has an anti-aging effect on every organ of the human body. The skin was just a very accessible human organ to study. Rapamycin has an anti-aging effect on the brain, heart, muscle, joints, bone, kidney, immune system, and eyes demonstrated in human or animal studies. The mechanism shown is this study is the basic anti-aging mechanism. mTOR and senescent cells are driving aging and rapamycin slows down this process and slows aging.

Another paper of great interest is:

"Rapamycin for the aging skin" by Mikhail Blagosklonny 2019.

The paper starts:

"In 2007, I filed a patent application claiming that topical rapamycin (e.g. in the form of a cream or ointment) could be used to prevent and treat skin aging"..."The patent was not granted."

Topical rapamycin might be the best topical preparation; but without a patent, there is no commercial interest.

A paper that provides a glimpse into the real potential of topical rapamycin is:

"mTOR in inflammatory skin disease: review of the literature". Cacciapuoti

DOI: 10.15761/JTS.1000317

"Cold Sores" (HERPES LABIALIS)

Update: 2/4/2021: Topical Rapamycin and oral Herpes virus (cold sore)

Herpesvirus uses mTOR to attack human cells. See paper: "Constitutive mTORC1 activation by a herpesvirus Akt surrogate stimulates mRNA translation and viral replication", Chuluunbaatar, 2010, NYU.

"Classic Kaposi's sarcoma treated with topical rapamycin"; Diaz-Ley, 2014, Spain.

Kaposi's sarcoma is an angioproliferative disorder caused by human herpesvirus 8 (HHV-8). They healed KS lesion with 16 weeks topical Rapamycin. They used 0.5% in petrolatum base. I would suggest 0.05% in petrolatum base for Herpes Simplex-1 (HSV-1) "cold sores". [Apply once a day at very earliest start)

Note: Anybody using topical rapamycin for Herpes cold sores has bragging rights for being PATIENT NUMBER 1

Glutathione Maintenance, NAC + Glycine Supplementation

A recent paper from Baylor College of Medicine, Houston, March 2021 represents the first great breakthrough in the treatment of aging itself. In 1956 Harman presented his free radical theory of aging. Just 67 years later, that theory has borne fruit. Mitochondria are little batteries that generate chemical energy that provide the energy for life. During the process, mitochondria generate toxic reactive oxygen species (ROS) which cause harmful oxidative stress to mitochondria. The major antioxidant mitochondia depend on for protection against the damaging effects of oxidative stress is GLUTATHIONE. The problem is in older persons, Glutathione levels are at too low a level for protection. This results in mitochondrial dysfunction. Glutathione is composed of three amino acids: glutamic acid, cysteine, and glycine. In older persons the levels of cysteine and glycine are too low to form sufficient Glutathione (GSH). The solution to the problem is very simple. Just supply an adequate amount of CYSTEINE AND GLYCINE for the cell to correct glutathione deficiency. The lead researcher, Rajagopal Sekhar, who first published a similar study in 2011; did just that and the results were EXTRAORDINARY. The dose for a 70 kilo man was 9 gram of cystine and 7 grams of glycine (about the amount of these two amino acids in 1.5 pounds of steak). The results on mitochondrial function, oxidative stress, inflammation, insulin resistance, walking speed, grip strength, cognitive function and other markers of aging dysfunction were remarkable. In a prior study excellent results were seen at 2 weeks. In this study persons were tested at 12 and 24 weeks. By 24 weeks, older persons were showing similar results to young persons in critical areas. Upon stopping treatment, all benefits were gradually lost.
What was different is this study: BOTH Glycine and cysteine (as N-acetyl cysteine (NAC) were administered and in much higher doses.
"Glycine and N-acetylcysteine (GlyNAC) supplementation in older adults improves glutathione deficiency, oxidative stree, mitochondrial dysfunction, inflammation, insulin resistance, endothelial dysfunction, genotoxicity, muscle strength, and cognition: Results of a pilot clinical trial"; Kumar, Sekhar, 2021. [Ref] Dose:Glycine .1 grams/kiloNAC .13 grams/kilo How to take: Dose divided into 3-4 times a day to prevent GI distress from too much NAC.Glycine: Available in 2.2 pound bag. Glycine has a sweet taste and will dissolve very well in hot liquids like coffee, tea, etc.
NAC contains sulfur and smells like rotten eggs. Must take in capsule form, 600 mg or 1000 mg.
The bad news is that is a lot of NAC capsules to swallow. The good news is can throw away all other supplements.
Prior to treatment measure your grip strength. Then measure at 4 weeks, 12 weeks, 24 weeks. Grip strength is best measure of mitochondrial function. (this assumes no increase in muscle mass)

6. Covid and Rapamycin

From causes of aging to death from COVID-19

Abstract

COVID-19 is not deadly early in life, but mortality increases exponentially with age, which is the strongest predictor of mortality. Mortality is higher in men than in women, because men age faster, and it is especially high in patients with age-related diseases, such as diabetes and hypertension, because these diseases are manifestations of aging and a measure of biological age. At its deepest level, aging (a program-like continuation of developmental growth) is driven by inappropriately high cellular functioning. The hyperfunction theory of quasi-programmed aging explains why COVID-19 vulnerability (lethality) is an age-dependent syndrome, linking it to other age-related diseases. It also explains inflammaging and immunosenescence, hyperinflammation, hyperthrombosis, and cytokine storms, all of which are associated with COVID-19 vulnerability. Anti-aging interventions, such as rapamycin, may slow aging and age-related diseases, potentially decreasing COVID-19 vulnerability.

Abstract

November, 2021, 20 Months of COVID Experience

In March 2020, it was very clear COVID was going to be a very deadly disease. As we approach Thanksgiving 2021, the USA death toll approaches 800,000.

However, for people taking Rapamycin, COVID turned out to be just a novel viral infection. As a 77 y/o with a cardiomyopathy, I was very concerned in March 2020. I had COVID in October 2020 and it was nothing more than a mild viral syndrome lasting a few days. My experience seems to be very consistent with my patients.

Rapamycin has a very dramatic effect decreasing the activity of the innate immune system. It also has effect on T-cells. This had combined effect to block intense cytokine reaction and ameliorates reaction to COVID. The above paper by Blagosklonny is excellent discussion. In short, Rapamycin seems to give middle-aged persons a young person like reaction to COVID.

At this point, everybody is advised to follow CDC recommendations regarding Covid vaccination.

7. TOR-Driven Aging and Rapamycin

"He not busy being born is busy dying"

"It's Alright Ma", Bob Dylan, 1965

The Blagosklonny theory of TOR-drive aging, [1] is that TOR driven aging is a continuation of TOR driven growth. In the older animal, cells can be blocked from being born [cell cycle, mitosis] and these cell then become senescent cells which promote aging and dying. TOR [Target-of-Rapamycin] was discovered in 1991 and soon turned out to be one of the greatest discovery in the history of medicine. With the discovery of TOR, scientists had found the holy grail of cellular biology.

In an extraordinary leap of genius, Blagosklonny explained how the cell and the organism went from TOR-driven growth to TOR-driven aging. Furthermore, TOR driven aging was the same as TOR-driven age-related disease. All that was needed to slow down aging, slow down development of age-related disease and prolong health and life span was the pharmacologic inhibition of TOR and nobody had to wait for such a magical drug to be discovered; it was a generic drug in clinical practice since 1999 and available at your local drug store.

All that is necessary to fully understand the Blagosklonny theory of how to slow down aging and prevent age-related disease is the ability look at aging de novo, free from the barnacles of two thousand years of misconceptions.

1. Blagosklonny, Aging and Immortality Quasi--Programmed Senescence and its Pharmacologic Inhibition, Cell Cycle. 2006 Sep;5(18):2087-102.

The dawn of the Age of TOR

In 1991, Michael Hall is studying the control mechanism of growth in yeast. He discovers that an obscure anti-fungal agent called rapamycin can stop growth. Hall concludes that there is something in the yeast cell that is blocked by rapamycin. He calls that substance in the yeast cell, Target of Rapamycin or TOR. Michael Hall had just discovered the holy grail of cellular biology.

The discovery of TOR in the yeast cell was made possible by the discovery of Rapamycin in the soil of mysterious Easter Island in 1965. Easter Island is primarily barren volcanic rock. Apparently, one strain of soil bacteria, eyeing the neighboring yeast one day, decided that the tiny island was just not big enough for both of them. The bacteria targeted the command and control center of the yeast cell which make the yeast stop growing. The bacteria had targeted what Michael Hall was to call TOR.

TOR has been conserved through two billion years of evolution. It is the command and control center of every cell, both plant and animal on planet Earth.

It did not take long for the leading scientists to figure out that what had been discovered was the key to understanding how the cell worked. They had the Control of the cell and they had the Key to the control. The 28 years since the discovery of TOR has ushered in a new Golden Age of discovery in the world of cellular biology and cellular medicine. Scientists have discovered hundred of proteins which are part of various signaling chains that instruct cells how to operate. This world within the cell is a world of extraordinary complexity. Prior to the discovery of TOR, the cell was a Black Box. Twenty eight years after discovery of TOR cell molecular pathways in both health and disease are well defined and better defined every day. For me, this definition of how the cell operates at the molecular level is bigger than everything that went before in 2000 years of medicine.

Disease starts at the cellular level. Understanding a disease is understanding the cellular pathways that have gone awry. Most disease can be seen as a failure to maintain homeostasis at the cellular level. By the time a disease becomes manifest at the tissue and organ level, it is a very advanced disease.

The discovery of TOR and the extraordinary advances that followed have cracked the code of health and disease at the molecular level.

Aging comes a cropper

From ancient Greece to Modern times, Aging had remained inscrutable and invincible; until now. Prior to the discovery of TOR in 1991, it was impossible to understanding Aging as TOR is at the center of aging. In 2006, 15 years after the discovery of TOR, in the seminal paper "Aging and Immortality, Quasi-Programmed Senescence and Its Pharmacologic Inhibition", Mikhail Blagosklonny publishes one of the great original theories in science. It is a radical and entirely new theory of aging. The paper not only explains the dynamics of aging; but also how to slow aging with a clinically available prescription medication.(1).

The key concept is that aging is not an abstract thing; TOR-driven aging is the same thing as diseases of aging. The theory is reminiscent of Einstein's E= MC squared. Aging and diseases of aging are the same matter.

13 years after the "Aging and Immortality" paper I have a clinical medical practice, now with over 380 patients, using rapamycin to slowing aging in the exact same manner proposed in the 2006 Blagosklonny paper.

Blagosklonny theory, TOR-driven Aging

The Blagosklonny theory of aging is presented in a large number of papers from 2006 through 2019. Many of these papers are summarized below under the heading "Blagosklonny Literature". In this section, I try to summarize the key concepts from the 2006 paper noted above and the 2009 paper: "TOR-driven aging, Speeding car without brakes." (2)

Aging is not programmed.
Aging is a continuation of growth and development program that is not turned off. The term quasi-program just means the aimless continuation of the developmental program; but has no further biological purpose and can be harmful.
TOR promotes growth of cells even when cell cycle (mitosis) is blocked. TOR causes the production of SENESCENT CELLS.
Senescent cells are hyperfunctional and damage tissues and promote diseases of aging.
Aging presents as hyperfunction, hyperplasia, cell hypertrophy.
By analogy, aging can be viewed as a speeding car that lacks brakes and can not slow down when the road requires going slowly and then crashes.
The TOR growth pathway is universal from yeast and worms to humans and plants. TOR is activated by nutrients, Insulin, growth factors. TOR drives growth and aging is a unintended continuation of growth.
"Like crashes at the end of the road, these diseases are late manifestations of aging. From the TOR perspective, death from aging and from diseases of aging has the same meaning, because diseases of aging are just manifestations of aging, like smoke is a manifestation of fire."
According to classic gerontology, non-repaired molecular damage causes aging. In contrast, TOR-driven aging causes damage (diseases of aging).
From the classic perspective, nothing can be done to inhibit aging. From the TOR perspective, the pharmacologic brake (rapamycin) will slow down human aging.

2. Blagosklonny, TOR-driven aging Speeding car without brakes, Cell Cycle. 2009 Dec 15;8(24):4055-9.

The Proof is in the Pudding

The following sections will move from theory to the laboratory proof:

Rapamycin Prolongs Lifespan
Rapamycin prevents age-related diseases.
Rapamycin slows production of senescent cells and removal of senescent cells ameliorates disease.
Rapamycin slows the Epigenetic clock.

8. Rapamycin/TOR Anti-aging Medicine

Rapamycin Prolongs Life Span

From Mikhail Blagosklonny:

The three major criteria for potential anti-aging drugs are:

A drug that prolongs life span in model organisms preferably mammals.
A drug that prevents or delays several age-related diseases in mammals.
A drug that suppresses cellular geroconversion from quiescence to senescent. [This statement means suppresses the formation of senescent cells. [3]

These criteria overlap each other. If an intervention extends life span, it must delay age-related diseases. Animals die from age-related diseases. For example, caloric restriction (CR) delays all diseases of aging and extends life span. One may say that CR extends life span by delaying disease. One may say that CR delays diseases by slowing down aging, Both interpretations are correct. CR deactivates the nutrient-sensing pathway, know as TOR (Target of Rapamycin). [2]

Rapamycin is essentially CR in a pill. They each target the exact same pathway, TOR.

Of all the known chemical substances in the universe, a Rapamycin has emerged as the most robust in extending lifespan. Rapamycin has extended the lifespan of every living thing tested in the laboratory: yeast, worms, flies, and even middle-aged mice. In a recent 2014 paper, it was reported rapamycin extended the median lifespan 23% in male mice and 26% in female mice.

From Matt Kaeberlein: "The drug rapamycin is currently the most effective and reproducible pharmacological approach for directly targeting the aging process to increase life span and health span in laboratory animals. Rapamycin positively impacts most hallmarks of aging and it has been shown to increase lifespan in each major invertebrate model organism and in rodents. Rapamycin increases life span by 10 to 30% in multiple strains of mice." [4]

Blagosklonny and Kaeberlein are the two foremost experts on the theory and practice of rapamycin.

3. Blagosklonny, From rapalogs to anti-aging formula, Oncotarget. 2017 May 30; 8(22): 35492–35507.

4. Kaeberlein, Rapamycin and Alzheimer's disease: Time for a clinical trial?, Sci Transl Med. 2019 Jan 23;11(476).

Rapamycin Prevents Age-Related Disease

From Blagosklonny: "Rapalogs prevent age-related diseases in mice as well as in other mammals including non-human primates and humans. As examples: rapamycin prevents atherosclerosis, neurodegeneration and retinopathy and cardiomyopathy in rodents. Rapalogs prevent cancer in mice and humans. Rapamycin decreases obesity in mice and humans. As predicted, rapalogs rejuvenate immunity, improve immune response in mice and humans." [3]

From Kaeberlein: "Not only does rapamycin treatment increase life span but it also delays, or even reverses, nearly every age-related disease or decline in function in which tested in mice, rats and companion dogs, including cancer, cardiac dysfunction, kidney disease, obesity, cognitive decline, peridontal disease, macular degeneration, muscle loss, stem cell function, and immune senescence" [4]

The above statements regarding Life span extension and prevention of age-related disease might seem fanciful, overimaginative and unrealistic. However, the quotes come from a 2017 and a 2019 paper prepared by the worlds leading authorities. Furthermore, a review of these two papers will show multiple references to support and document each and every statement.

Not mentioned in above was a very large body of evidence that rapamycin is the leading drug to prevent Alzheimer's disease. Alzheimer's disease is discussed in following section.

Rapamycin also prevents insulin resistance, metabolic syndrome, osteoarthritis, osteoporosis and age related chronic lung disease.

Rapamycin Slows Formation of Senescent Cells

Criteria (3) above for potential anti-aging drug was suppressing formation of senescent cells.

In a 2018 paper Blagosklonny states, "It has been calculated than rapamycin slows geroconversion by approximately 3-fold". This means rapamycin slows formation of senescent cells three-fold. [5]

The Blagosklony theory of aging is that aging is hyperfunctional.

From Blagosklonny: "Killing senescent cells is beneficial because senescent cells are hyperfunctional. The hypersecretory phenotype or Senescence-Associated Secretory Pheontype (SASP) is the best known example of universal hyperfunction. Most hyperfunctions are tissue-specific. For example, senescent beta cells overproduce insulin and this activate TOR in hepatocytes, adipocytes, and other cells, causing their hyperfunction, which in turn leads to metabolic syndrome (obesity, hypertension, hyperlidemia, and hyperglycemia) and is also a risk factor for cancer. SASP, hyperinsulinemia, obesity, hypertension, hyperlipidemia and hyperglycemia are all examples of absolute hyperfunction (an increase in functionality)." [6]

"Killing senescent cells is beneficial because senescent cells are hyperfunctional." [6]

"Senolytics are drugs that extend life span and delay some age-related diseases by killing senescent cells. Targeting senescent cells have been shown in animal models to prevent age-related pathologies such as emphysema, lung fibrosis, atherosclerosis, osteoporosis, osteoarthritis, renal disease, intervetebral disc pathology, hepatic steatosis (fatty liver) and other age-related conditions." [6]

The above list of age-related disease shows why preventing the formation of senescent cells is so important. Senescent cells are extremely harmful and the harm causes by senescent cells can be lowered by preventing their formation in the first place (rapamycin) or killing senescent cells by drugs called senolytics.

These three sections show how rapamycin fulfills the criteria for potential anti-aging drugs.

Nothing in the entire universe of drugs comes close to rapamycin and other rapalogs in fulfilling these three criteria of potential anti-aging drugs.

5. Blagosklonny, Does rapamycin slow down time?, Oncotarget. 2018 Jul 13; 9(54): 30210–30212.

6. Blagosklonny, Paradoxes of senolytics,. Aging (Albany NY). 2018 Dec; 10(12): 4289–4293.

Aging is easily treatable

A recent paper by Blagosklonny has the provocative title: "Disease or not, aging is easily treatable". The first sentence is: "For decades, one of the most debated questions in gerontology was whether aging is a disease or the norm."(7)

In my opinion, this entire debate is obsolete, archaic and medieval. Galen, a philosopher in ancient Greece put forth the idea that aging was not a disease, because everybody got aging and therefore aging was natural. Galen also originated the miasma theory which held that diseases such as cholera and epidemics like the Black Death were due to "bad air." In the second half of 19th century the germ theory of infectious disease exploded Galen's miasma theory. It is also time for Galen's theory of aging to be consigned to the "ash heap of history"

The answer provided by Blagosklonny is: "It does not matter because aging is already treated using a combination of several clinically-available drugs, including rapamycin...For treatment purposes, aging is a deadly disease (or more generally, predisease), despite being a normal continuation of normal organismal growth. It must and, importantly, can be successfully treated thereby delaying classic age-related diseases such as cancer, cardiovascular and metabolic diseases, and neurodegeneration." (7)

In my practice, I have treated over 380 patients (Oct 2019) and the one question nobody ever asked was whether aging was a disease or was natural.

Aging should be considered a "term of art". In my practice aging can have TWO meanings:

A. "Aging is the sum of all age-related disease." This means aging is the sum of pre-disease and clinical disease.

B. Aging is also used as being short for TOR-driven aging as in the title: "TOR -driven aging, Speeding car without brakes" (Blagosklonny, 2009 [2]

Aging mechanisms which is not TOR-driven aging is put in category "post aging syndrome.

Aging must be connected to pre-disease or clinical disease. Aging is not an abstract concept. Aging is pathology.

"In pre-disease, abnormalities have not reached the arbitrary diagnostic criteria of the disease. So, aging consists of progression from (pre)-pre-disease (early aging) to disease (late aging associated with functional decline). Aging is NOT a risk factor for these diseases, as aging consists of these diseases: aging and disease are inseparable. [7]

In this paper, Blagosklonny has a very instructive diagram: GROWTH-->AGING. Initially aging is Hyper-functions in the pre-pre-disease and the Pre-disease stages, then aging ends in loss of function and Death.

Caption: Relationship between aging and disease, "When growth is completed. growth-promoting pathways increase cellular and systemic functions and thus drive aging. This is a pre-pre-disease stage, slowly progressing to a pre-disease stage. Eventually, alterations reach clinical disease definitions, associated with organ damage, loss of function (functional decline), rapid deterioration and death."

NORMATIVE AGING

The concept of "normative aging" is where the Blagosklonny concept of aging splits entirely from conventionally thinking. In conventional thinking normative changes, that which is the norm, is not a disease at all. In the Blagosklonny concept of aging, NORMATIVE AGING is the quintessential disease of aging. Unrelated humans share 99.5% genetic similarity. Therefore, it makes complete sense that something as fundamental as TOR-driven aging should effect everybody. Those changes that effect everybody are the bed rock of the disease. In an extremely important paper discussed below under the topic of normative brain aging; it was shown that rapamycin prevents deterioration of cognitive and vascular decline in the aging rat brain. That paper is the complete vindication of the concept of TOR-driven aging and prevention of pre-disease.

Healthspan. This term refers to the subclinical disease period. "In theory, a treatment that slows aging increases both healthspan (subclinical period) and lifespan. The goal of both anti-aging therapies and preventive medicine is to extend healthspan (by preventing disease), and thus extending total lifespan.

Preventive Medicine vs Anti-aging medicine

The goal of preventive medicine is to present disease by treating pre-disease. This is the same goal as anti-aging medicine. The difference between classic preventive medicine and anti-aging medicine is the cornerstone of anti-aging medicine is slowing aging.

When you start with preventive medicine and add rapamycin to slow aging, you have transformed preventive medicine into anti-aging medicine.

Conclusion: "Anti-aging drugs such as rapamycin delay age-relate diseases. In order to extend life span, an anti-aging drug must delay age-related disease...

"And this approach is actually being used now to treat aging at Alan Green's clinic in Little Neck, NY."(7)

7. Blagosklonny, Disease or not, aging is easily treatable, Aging (Albany NY). 2018 Nov; 10(11): 3067–3078..

Epigenetic Clock Shows Rapamycin Slows Aging

Recent paper by Steve Horvath shows rapamycin suppresses the progression of aging as shown by the Horvath epigenetic clock. (8)

The Horvath clock is a major achievement in aging research. The Horvath DNA methylation epigenetic clock is an objective way to measure biologic age independently of time.

In this study Horvath showed that rapamycin reduced biologic aging of growing skin cells in culture. Rapamycin is now the first drug and so far the only drug shown to slow epigenetic aging.

Rapamycin reduced cellular proliferation rate, reduced somatic cell differentiation, REDUCED NUMBER OF SENESCENT CELLS and preserved proliferative capacity, however these specific effects were separate and distinct from slowing of the epigenetic clock.

The paper concluded: "In summary, the observations above represent the first biologic connection between epigenetic ageing and rapamycin.

These results for human cells add to the evidence that extension of life, at least by rapamycin, is indeed accompanied by retardation of ageing.

These observations also suggest that the life-extending property of rapamycin may be a resultant of its multiple actions which include, but not necessarily limited to SUPPRESSION OF CELLULAR SENESCENCE AND EPIGENETIC AGING, WITH THE POSSIBILITY OF AUGMENTATION OF CELLULAR PROLIFERATION POTENTIAL." [8]

This paper is huge. Prior to this paper the evidence that Rapamycin slows aging was the indirect evidence of extension of mouse and other lifespans.

This study is direct evidence on human cells of rapamycin slowing aging.

8. Horvath. Rapamycin retards epigenetic ageing of keratinocyts independently of its effects on replicative senescence, proliferation and differentiation, Aging (Albany NY). 2019 May 31; 11(10): 3238–3249.

Rapamycin/TOR Anti-aging Medicine

TOR has two components, TOR1 and TOR2. Rapamycin has only one action, it blocks TOR. TOR1 is very sensitive to a single dose of rapamycin and TOR2 is very resistant. Therefore, intermittent use as weekly rapamycin can be used to block TOR1 and not block TOR2.

Rapamycin anti-aging preventive medicine is a combination of Anti-aging Medicine and Preventive Medicine as regards prevention of age-related disease.

Both seek to prevent disease and thus extend health span and prolong life span. Both treat pre-disease to prevent clinical disease. The difference is Preventive medicine uses classic methods to prevent specific age-related diseases. Anti-aging medicine seeks to slow down aging and thus delay all age-related disease. The cornerstone of slowing aging that this office uses is rapamycin. The target is TOR1. The basic concept is TOR1 is driving age-related disease.

The special expertise of this office is knowing how to use rapamycin to lower TOR1; but not lower TOR2

There are no published studies on how to use rapamycin to lower TOR1 and not TOR2 and get a satisfactory result. Knowing how to properly use rapamycin as an anti-aging drug is based upon experience and the art of medicine.

At this time (Sept 2019), the office has been treating patients with intermittent rapamycin for over 2 1/2 years and has treated over 350 patients. I have also taken rapamycin myself for close to 4 years.

The medical literature lists many side-effects from use of rapamycin. Many experts say that rapamycin has too many side-effects to be used for anti-aging medicine. It is true that rapamycin is a potent prescription drug and as is true for all prescription drugs; people who do not know what they are doing should not use or prescribe them. Rapamycin is not for the uninitiated or for those health care providers who lack sufficient expertise required to use rapamycin in a knowing manner.

COME FOR THE FUTURE, STAY FOR THE PRESENT

The ever expanding evidence in the scientific literature is that rapamycin slows aging, extends life span and delays and decreases risk of a large number of age-related diseases.

What is not clear from the literature is the effect in the present, not the future. Ameliorating pre-pre disease and pre-disease can have a dramatic impact on quality of life in three to six month from onset of treatment. One of most noticeable effects is on the brain. Overall mood and feeling of well-being is frequently improved.

Many patients report their brain is sharper, functions better, and processes information better.
Cardiac symptoms of fatigue and shortness of breath with exercise may be significantly improved. This is especially evident if hike or jog or walking up hills.
Muscles stay strong.
Skin looks younger.
Rapamycin is also the premier weight loss drug. One can get back to the waist size one had when they were twenty-something.
Chronic kidney disease improves. Stage 3 chronic kidney disease, as measured by GFR (glomerular filtration rate) can improve to stage 2 and stage 2 to normal.
Mild osteoarthritis can improve.
Prostate lower urinary tract symptoms such as urgency, frequency and nocturia are frequently improved.

Rapamycin treatment is not about waiting till you are 100 years old and noting all the diseases you dodged; or about a clinical study that follows people for 10 years and does calculations about "Odds ratio" [OR].

For many of my patients, slowing aging is about feeling better now [in the present] with life span extension and disease prevention something in the distant future rapamycin provides to boot.

However, not all patients have pre-clinical disease. Many have serious disease in the present.

In basic science, rapamycin has emerged as the silver bullet for the treatment of a large number of age-related diseases. However, rapamycin is a generic drug. In the United States, we are not Communists and nobody is expected to spend millions of dollars on clinical studies for which they can not receive any monetary benefit. Therefore, no human clinical studies are anticipated for rapamycin. However, the basic science research suggests that rapamycin is the greatest new drug to emerge since Penicillin, some ninety years ago. This office seeks to accommodate those persons who seek protection from age-related disease in their own lifetime. For this purpose, this office relies heavily upon animal models and basic research.. The premise underlying treatment is that those of us who need geroprotection now, would most likely be dead before appropriate clinical trials are initiated, completed, evaluated and the results incorporated into clinical practice.

This office practices Rapamycin Medicine. Rapamycin Medicine is the application of the theory and research of Mikhail Blagosklonny to clinical medicine. The Blagosklonny theory of aging and age-related disease is presented below in the following section, Blagosklonny Literature. In short, the theory is elevated TOR causes TOR driven aging and TOR driven aging causes age-related disease. Age-related disease and death is a late manifestation of the damage caused on a cellular and molecular level by elevated TOR.

Rapamycin Medicine is the "off-label" use of rapamycin for prevention and amelioration of these diseases.

This website attempts to present a very large amount of science-based information based upon quoted scientific papers. Almost all papers quoted are "open-label" and readers are encouraged to download and study all references.

CAVEAT: While I have been on weekly rapamycin for close to 4 years and I am very pleased with the results, and Mikhail Blagosklonny predicts rapamycin will become the standard of care in our lifetime for anti-aging protection; nevertheless, to the best of my knowledge, NO OTHER PHYSICIAN IN THE UNITED STATES HAS A SIMILAR PRACTICE USING WEEKLY RAPAMYCIN AS THE CORNERSTONE OF AN ANTI-AGING/ PREVENTIVE MEDICINE PROGRAM as regards age-related disease. Furthermore, the majority of physicians do not believe there is a common underlying cause for diseases of aging or that lowering TOR can prevent such disease.

Use of weekly Rapamycin as the cornerstone of an anti-aging formula has not been proven by human clinical trials. Such treatment is not recognized by the FDA. There is not the safety of many physicians having used a similar weekly rapamycin treatment for many years.

Consequently, a careful analysis is necessary to make a proper informed decision regarding use of weekly rapamycin.

Disease A:

Cancer
Atherosclerotic heart Disease
Age-associated Cardiomyopathy
Obesity
Fatty Liver Disease (NAFLD)
Osteoarthritis
Diabetes type 2, Insulin resistance
Hypertension
Hearing Loss

Disease B:

BPH (Benign prostatic hyperplasia)
Osteoporosis
Age-related Macular degeneration
COPD (Chronic lung disease)
Chronic renal disease

Neurodegeneration:

Alzheimer's disease (Prevention)
Parkinson's disease
Tauopathy

In the drop-down section the evidence is primarily from basic science and animal studies.

Disease A has more evidence and studies than Disease B

APOE4 carriers should consult linked website Alzheimer-prevention.com

9. My Story, Patient Number 1, January 2016 to Age 80, February 25, 2023.

I have been a physician for over 50 years, having received my MD degree in 1967 when I graduated from SUNY Downstate Medical Center. I also earned a BA degree from George Washington University and a JD degree from Hofstra Law School. I am Board certified in Anatomic, Clinical and Forensic Pathology. I believe in fact-based science.

When I was young, I attended college on a tennis scholarship. When I was 40, I a ran a marathon in just under 4 hours. By age 70 my main physical activity was reduced to walking my two Shiba Innu dogs in the park. By age 72, the small hills had become big hills. I switched to walking on a flat path. You don't need to be a weather man I know which way the wind blows. I concluded I was dying and I was dying of Aging.

I knew absolutely nothing about aging. The first thing I discovered is the British and Canadian spell it Ageing and the American spell it Aging. I was dying and I knew the accepted American way to spell Aging. But if I was dying from something, I wanted to know more than just how to spell it.

What I discovered was the most extraordinary and improbable story that anything I had ever encountered in my lifetime. In fiction, I dislike fantasy stories that defy reason and reality. For me, fiction is OK; but fantasy gets rejected. As soon as I decide, that something is totally crazy; I find a different author. But the Rapamycin story was not fiction.

On one of the most remote places on planet earth, Eastern Island , people appeared to spend almost all their time resources and energy in creating huge stone strange statues called Moai some 1000 years ago. Then the Spanish arrive at this dot in the South Pacific on the most holy day of the year and the called this little dot, Easter Island. There are 5 counties in NYC, and Easter Island is the same size as Staten Island, which is only bigger than Manhattan, 67 square miles

Now the story starts to get really weird and goes into complete fantasy land. On this very weird little Island, 2000 miles from nowhere in the middle of the South Pacific ocean live a soil bacteria called Steptomyces hygroscopicus, its own species in the genus Streptomyces. This species, S. hygroscopicus specializes in making anti-fungal antibodies. They make Validamycin, which nobody has ever heard of. They also make an anti-fungal antibody called, Rapamycin. S. hygroscopicus is a common worldwide soil bacteria, but only on Easter Island do they make Rapamycin

Rapamycin is the most important drug discovered in the world of bacteria. Penicillin was very important and discovered in 1928; but penicillin is a fungus, not a bacteria. Penicillin gave rise to the Age of Antibiotics. However, Rapamycin is far and away the most important drug made by bacteria and the prize goes to S. hydroscopicus, from Easter Island. A credit to their species. There are very few species in this world that can claim such a great distinction. That the particular variety that makes Rapamycin only comes from Easter Island is extraordinary.

a clever soil bacteria decided to use chemical warfare against a bothersome neighbor; so the clever bacteria made a biologic poison to target the pesky yeast.The molecular target of the poison was the command and control of the yeast cell. The substance the bacteria targeted turned out to be the command and control of not only the yeast cell; but of every cell of every organism on planet earth, a substance so extraordinary it has been conserved through 2 billion years of evolution.

In 1965 an expedition to that island brought home a soil sample. In the soil sample from Easter Island Rapamycin was discovered and noted to be an anti-fungal agent. In 1991, rapamycin led to the discovery of TOR, Target of Rapamycin. The discovery of TOR increased our understanding of cellular biology and disease by about 10 fold.

In 2006 Mikhail Blagosklonny, put all the pieces together and explained aging. TOR promoted growth and development; but when growth and development stopped; TOR activity continued; but now cells were not busy being born, they were busy dying (conversion to senescent cells). The Blagosklonny answer: reduce activity of TOR and you slow down aging. Blagosklonny created an anti-aging formula (Koschei formula) and rapamycin was the cornerstone of that formula. Based upon "empirical medicine principles", I decided rapamycin 6 mg once a week would be an aggressive treatment and 3 mg once every 10 days would be a conservative treatment. I choose the aggressive treatment. January 2016, I began the rapamycin-based Koschei formula. I considered it a "Hail Mary pass"; a play made in desperation, with only a small chance of success and time running out on the clock.

Four months later, I felt like Archimedes must have felt when he took to the streets of Greece crying "Eureka". Suddenly, I no longer felt old. I felt like a person in good health. I could walk 5 miles without being tired, cycle my bike up hills without a hint of angina, I had no shortness of breath on moderate exertion. I lost 20 pounds, my waist-line went from 38 inches to 33. Creatinine went from elevated to normal and fasting blood sugar went down.

Update, January 2018

It's now over 2 years later, and I feel great. I've had no significant side-effects from rapamycin I believe two things Blagosklonny has said; (a) weekly rapamycin is safer than aspirin and (b) Rapamycin is the most important new drug since antibiotics. Based upon my personal experience with rapamycin and my study of basic research involving rapamycin and age-related diseases, I decided to begin this medical practice.

Update, August 2019

I recently had a cardiology evaluation with an echocardiogram. I discovered, much to my great surprise, that I was NOT suffering from "aging" in 2015 when had marked failing health. I was suffering from heart failure due to a very serious inherited autosomal dominant CARDIOMYOPATHY, specifically "apical hypertrophic cardiomyopathy". If I had seen a cardiologist I would have been told that there was no treatment except a heart transplant when I reach end stage heart failure. While my diagnosis was wrong, the treatment was right. I had an excellent clinical response with rapamycin as described above. At my current age of 76, 6 years after onset of first symptoms and after 3 1/2 years of rapamycin weekly treatment, I am doing very well. I feel great, walk 5 miles a day, weigh 145 pounds and feel totally asymptomatic. Technically, I was not treating aging; but rather unknowingly treating a very specific genetic disease. However, although, the heart condition was inherited, elevated TOR played a major role in progression of the disease and lowering TOR provided excellent symptomatic improvement.

But aging is driven by TOR and the hypertrophic cardiomyopathy also appears to be driven by TOR. Although I clearly had the genetic disorder all my life, it presented as a pre-disease at age 55 with atrial fibrillation and 18 years later at age 73 with early heart failure.

Whether I was suffering from an inherited disease or an age-related disease or an inherited disease that presents with aging may be a distinction without a difference.

The one thing I am rather sure about is that without Mikhail Blagosklonny and rapamycin, I would probably not be alive today.

Update, November 2019

Tried Dasatinib and Quercetin, 100 mg Dasatinib and 1000 mg of Quercetin daily for 3 days. My impression is side-effects were similar to a flu shot and quite mild. Cost of treatment was $30.00. Datasinib obtained with prescription sent to a Kentucky compounding pharmacy.

10. Bacterial Infections (FEVER) Require Antibiotics

Risk bacterial infection

Five years and 760 patients have revealed that the single major risk of weekly Rapamycin is INCREASED RISK OF BACTERIAL INFECTION. Rapamycin decreases the activity of INNATE IMMUNE SYSTEM. This is the first line of defense against bacterial infection. In the past, bacterial infections have been the NUMBER ONE KILLER of mankind. The BLACK DEATH. plague, of the middle ages, was causes by a bacterial infection.
Antibiotics are the greatest contribution to medicine of the past 100 years. Antibiotics are extraordinary good for bacterial infections. The very worst thing you can take for a bacterial infection is ADVIL, or any other NSAID. Physicians may treat a Baby with Tylenol for fever because babies commonly have viral infections and may run very high fevers. If you are an OLDER ADULT, you do not treat a fever with Advil etc. Advil lowers your immune reaction and masks the disease symptoms.
Dental procedures and tooth decay are a common cause of bacterial sepsis in older adults. Sepsis is very dangerous. Sepsis may causes fever and systemic symptoms; but NO LOCALIZED DISEASE.
If you are taking Rapamycin and develop a FEVER or any other signs and symptoms suspicious for bacterial infections; take the following steps:1. Start antibiotics, Z-pak, in first few hours of onset of fever.2. Discontinue Rapamycin until you have no fever and no signs of infection.3. Seek medical attention if fever or other signs of bacterial infection persists more than a few days.
Older people are at increased risk of bacterial infection. Rapamycin increases this risk. DO NOT TAKE RAPAMYCIN UNLESS YOU HAVE IMMEDIATE ACCESS TO Z-PAK OR OTHER ANTIBIOTIC.
There is NO FREE LINCH. Rapamycin decreases activity of innate immune system which is very good for most age-related disease; but not good for bacterial infection.

Major side effect: Neutrophil Dysfunction

After almost 3 years of experience with weekly rapamycin, it has emerged that the major side is increased risk of extracellular bacterial infections. These bacterial infections are mostly skin and subcutaneous tissues. The risk is both increased frequency of bacterial infection and increased severity of bacterial infection

Some animal studies showed rapamycin caused increased risk of death from pulmonary bacterial infection.

On the other hand, the function of the immune system, involving lymphocytes and antibody production is improved. In a recent study involving humans (Mannick, 2018) the risk of viral infections presenting as URI (upper respiratory infection was decreased.

The increased risk of infection from invading bacteria involves the innate immune system, which includes Neutrophils (also called polys) and macrophages (which engulf bacteria). Decreasing activity of mTORC1 hinders the function of the innate immune system, especially NEUTROPHILS.

The innate immune system sometimes causes "friendly fire" due to incorrect identification of something as enemy bacteria. A number of age-related diseases, including atherosclerosis and coronary artery disease are related to this malfunction function of the innate immune system. This results in chronic inflammation, although there are no invading bacteria and no pathogens. One on the ways in which weekly rapamycin therapy ameliorates some age-related disease is by reducing "friendly fire" from the innate immune system.

The cells which compose the innate immune system are controlled by mTORC1. Decreasing mTORC1 activity impairs the function of the innate immune system, including Neutrophils. However, decreasing activity of mTORC1 is the major target of weekly rapamycin therapy.

Since the innate immune system including Neutrophils is the first line of defense against invading bacteria and yeast; decreasing mTORC1 thereby INCREASES the risk of infection from invading bacteria and yeast.

Consequently, In the skin and subcutaneous tissues, any onset of redness, pain, swelling, the cardinal signs of inflammation, should be considered as highly suspicious for bacterial infection.

Whle on rapamycin, anything suspicious for bacterial infection, should be considered as SERIOUS. Bacterial infection is especially serious to persons on rapamycin as there may be a decrease in the function of Neutrophils. ALL BACTERIAL INFECTIONS INVOLVING PERSONS ON RAPAMYCIN SHOULD BE TREATED WITH ANTIBIOTICS. In addition, rapamycin should be stopped until infection is totally eradicated.

The most serious infection is PNEUMONIA. Any onset of fever (100.0) should be aggressively treated with antibiotics. If had a "cold" followed by fever, treat with antibiotics. If fever persists go to E.R. for possible pneumonia.

resTORbio, Inc. Fails clinical trial

resTORbio announced Phase 3 Protector 1 Trial to show protection against Clinically Symptomatic Respiratory Illness did not meet primary endpoint. The study was to show protection against respiratory illness in individuals 65 years of age and older during 16 weeks of winter cold and flu season. Odds placebo 0.44; odds RTB 0.46.

ASG Comment: In 65 year old persons, reducing mTOR1 is expected to improve acquired immune function which would be expected to increase protection against VIRAL INFECTIONS. However, reduction of mTOR1 also impairs function of innate immune system making one more susceptible to BACTERIAL INFECTIONS.

In winter people are susceptible to both viral infections and bacterial infections. Therefore, clinical study failed. Note that this was a 16 weeks study. A study showing that reduction of mTOR1 prevents Alzheimer's disease would take far more time and expense.

I see this as a good result for mTOR1 reduction. The most serious side effect of mTOR1 reduction is increased risk of bacterial infection. In this study, the increased protection against viral infections off set the increased risk of bacterial infections. Bacterial infections can be treated with antibiotics. Therefore, people were no worse off as regards risk of clinically symptomatic respiratory illness.

Rapamycin and Gout

Rapamycin increases the risk of Gout. Rapamycin decreases innate immune system. One effect of this is to decrease the action of macrophages. Macrophages remove urate acid crystals which provoke gout attacks. Allopuriinol can be used to reduce Uric acid and prevent Gout if have episodes of Gout while taking rapamycin.

The mTOR and Alcohol Connection

It is widely know that moderate alcohol drinkers live longer that teetolers. However, the mechanism was not understood until revealed by David Foster. Alcohol is involved with the mTOR pathway. mTOR, raptor and phosphatidic acid (PA) are combined to build mTORC1 while mTOR, rictor and phosphatidic acid (PA) are combined to build mTORC2.

Alcohol interacts with PA and reduces its availability.

The net results is a small amount of alcohol lowers mTOR1; while a large amount of alcohol lowers both mTOR1 and mTOR2.

For this reason, moderate alcohol consumption has an anti-aging health benefit; but heavy alcohol consumption has negative health consequences.

Alcohol is far from an ideal anti-aging drug because the safety margin between good and bad effects is fairly narrow. However, for people who do drink, it is good to be aware that moderate drinking may lower mTOR1 and be good; but too much will lower mTOR2 and be harmful.

The health benefits of moderate alcohol consumption of reduced cancer risk, reduced risk of cardiovascular disease and reduced mortality is through reduced mTORC1.

Foster, DA ,"Reduced mortality and moderate alcohol consumption: The phospholipase mTOR connection. Cell Cycle. 2010 Apr 1;9(7):1291-4.

UNDER CONSTRUCTION

8. Study to treat Polycystic Kidney disease with Sirolimus a FAILURE

In 2010 a study to treat polycystic kidney disease with Sirolimus was a total failure.

The study was a complete failure because they used Sirolimus DAILY. If they used it weekly they would have had excellent results. The point is that whenever anybody does a study with rapamycin and the study is a complete failure; note how it was given. Clinical research studies use rapamycin daily as that is how approved to be used and oral daily works in mice. Studies with daily use in humans do not have a net reduction of mTORC1 and always fail and just cause a lot of side effects. On the other hand, weekly or intermittent rapamycin is safe and has excellent results.

The question is why don't people doing research use rapamycin weekly if weekly works very well in clinical practice. The explanation is: Water runs down hill. Information flows from Academic medicine to clinical practice. It is a one-way street.

"Sirolimus and Kidney Growth in Autosomal Dominant Polycystic Kidney Disease", Serra, 2010, New England Journal Medicine.

The conclusion was in adults with polycystic chronic kidney disease, 18 months with sirolimus did not halt polycystic growth.

The devil is in the details. They used 1.5 mg daily. The conclusion should have been:

DAILY USE did not halt the disease. The researchers did not want to say the problem was that they did not know what they were doing. It is much easier to say the drug doesn't work than they wasted millions of dollars because they screwed up.

13 years later and after the treatment of 1250 patients, I looked at the study and knew exactly why it was a complete failure.

1.5 mg daily was not enough inhibition of mTORC1.

1.5 mg daily was enough to reduce mTORC2. The reduction of mTORC2 caused liver dysfunction which increased INSULIN RESISTANCE. The increase in insulin resistance increased INSULIN. The increase in insulin increased mTORC1. THE NET RESULTS WAS 1.5 MG DAILY OF SIROLIMUS does not reduce mTORC1 and therefore does not stop the growth of kidney cysts. All a dose of 1.5 cm sirolimus daily dose is cause a lot of side effects, no health benefits, and would be expected to shorten life span.

Einstein said the definition of Insanity is doing the same thing over again and expecting a different result.

Rapamycin, (Sirolimus) is now hot. We may expect a few studies using Sirolimus.

In almost all these studies, they will usually use 1-2 mg daily. ALL THESE STUDIES WILL BE A TOTAL FAILURE.

The important thing is that when people look at the results; they understand that the study was a failure; NOT because Sirolimus, is not an excellent drug to prevent almost all age-related; but due to DAILY USE.

Rapamycin was approved in 1999 to be a biological poison to stop the proper function of T-cells and thereby prevent kidney rejection in transplant patients. This was excellent.

The problem is in THINKING that since it was approved to be used once a day to prevent kidney rejection; THEN IT MUST BE USED ONCE A DAY FOR EVERYTHING. Researchers like to color inside the lines. In research, it s OK to try to use Sirolimus, off-label, for a study; BUT MUST BE USED IN THE APROVED MANNER, ONCE A DAY.

Every one of my 1250 patients takes rapamycin weekly and gets excellent results. I am not treating transplant patients. I don't care that Sirolimus was approved to be used daily. I know that daily use is toxic and produces no benefits.

In the next few years, there will be a few studies published in which rapamycin was used daily to stop the progression of a disease and the results will be a failure The important thing to take away from these studies is that the problem was not Rapamycin; the problem was the person running the study had no idea how to use Sirolimus .

11. Junk News Story: "Rapamycin increases AD-associated plaques in mice"

A recent news story, June 7, 2022, has caused concern in many patients and requires explanation.

Researchers used a mouse model of AD called 5XFAD. This model overproduces massive amounts of amyloid. The mouse has 5 defective genes from autosomal dominant familial AD. Rapamycin decreases the activity of the innate immune system which includes macrophages and microglia. Therefore, rapamycin naturally decreases the clearance of amyloid in this mouse model. Rapamycin is not good for this mouse.

99.9% of AD cases do not have these defective genes.

This 5XFAD mouse model is not applicable to most humans and in particular humans at increased risk due to being APOE4 carriers.

In my opinion, the finding in this study is only applicable to the 0.1% of AD cases that are familial autosomal dominant.

In mouse studies in which the human APOE4 gene replaces the mouse APOE gene, rapamycin is very effective in preventing AD. Wild-type rats are a good model for the human cerebral microvascular system and rapamycin is very effective in preventing age-related decline.

I would characterize this study as "Garbage in, garbage out". The garbage in is that the 5xFAd mouse model is not a good model for the 99.9% of cases that are not autosomal dominant familial AD. This model has no cerebral vascular component of the disease, no tau tangle formation; but just massive amyloid overload.

In ordinary human AD, amyloid is the downstream byproduct of the upstream disease process. The upstream disease process is not initiated by amyloid.

Bottom line: Bad model, Bad result.

11. Senescent Cells, Senolytics, Dasatinib, Aging

Dasatinib + Quercetin Added to Anti-aging Formula

In 2006, Mikhail Blagosklonny revolutionized the understanding of Aging with the seminal paper, "Aging and Immortality". The paper introduced the concept of hyperfunction, epitomized by senesecent cells and considered senescent cells as a driving force in aging. One of the major reasons it was theorized by Blagosklonny that rapamycin was an effective anti-aging drug was because rapamycin reduced the formation of senescent cells 3 fold and opposed the secretion of SASP (a mixture of about 50 very active chemicals) by senesent cells. So central to aging and age-related diseases are senescent cells that aging could be renamed "senescent cell disease".

In 2006, Dasatinib, sold under the brand name Sprycel, was approved for medical use in the United States for the treatment of chronic myelogenous leukemia (CML) and acute lymphoblastic leukemia (ALL).

In the ensuing 13 years, an extraordinary body of basic research developed regarding the fundamental cause of aging and the role of senescent cells. In 2018 paper, Blagosklonny noted that drugs targeting senescent cells, called senolytics, had been shown in animal models to prevent such varied age-related pathologies as emphysema, lung fibrosis, atherosclerosis, osteoporosis, osteoarthris, renal disease, intervertebral disc pathology, hepatic steatosis (fatty liver) ... and the list just keeps on growing.

Dasatinib used with Quercetin (a natural plant product) has been shown to be very effective as a senolytic in animal studies. Recently D & Q was shown to increase mouse lifespan and in two human studies published in 2019 was show to be both safe and effective. [discussed below]

The recommended protocol regarding age-related pathology is intermittent use consisting of 100 mg of Dasatinib for 3 days. The list price of Dasatinib at a regular pharmacy (CVS as example) is $16,000 for #30, 50 mg tabs or @ $500 a single 50 mg tablet or $ 3000 for a 3 day .

course.

I have recently located a U.S. compounding pharmacy that makes Dasatinib available at a few percent of the above list price. Current treatment with Dasatinib is now very affordable.

I have recently completed my third, 3 day treatment with 100 mg of Dasatinib plus Q and found the side-effects very mild and consistent with the description in literature for a 3 day treatment.

In the major September 2019 paper which presented the preliminary study in humans, Dr. Kirkland, one of the leading researchers in field of senolytics and Dasatinib, concluded:

"WE CAUTION AGAINST THE USE OF SENOLYTIC AGENTS OUTSIDE THE CONTEXT OF CLINICAL TRIALS UNTIL MORE IS KNOWN ABOUT THEIR EFFECTS AND SIDE EFFECTS."

We demur.

It is noted that much of this research conducted by Dr Kirkland is funded by Bristol-Myers Squibb which has the license to sell Dasatinib under the brand name Sprycel. The drug company is prohibited by FDA regulations from promoting the off-label use of Dasatinib. Furthermore, Dr. Kirkland could be seen as an agent of the drug company and also prohibited from promoting off-label use.

This office fully understands that Science must proceed in a very slow and deliberate manner. If the entire Baby Boomer generation is dead before the required clinical trials are completed prior to label expansio; that is not something that Science can be concerned about. But it is something this office is concerned about. The position of this office is we have a non-delegable duty to our patients to use our own best judgment regarding treatment and after consideration of all pertinent research, we have concluded that including the off-label use of Dasatinib in our anti-aging formula is in the best interests of our pat

Dasatinib Decreases Senecent Cells in Humans

This was first study to show Dasatinib would decrease senescent cells in humans. Dasatinib in dose of 100 mg plus Quercetin 1000 mg was given orally to individuals with diabetic kidney disease for 3 days and 11 days later the senescent cell burden was measured. The 3 day treatment was well tolerated.

Results:

1. Senescent cells in subcutaneous adipose tissue were reduced: 35%, 17%, 62% depending on marker used for senescent cells.

2. Macrophages, which are anchored to senescent adipose cells were released and reduced 28%. Senescent cells and macrophages contribute to formation of "crown-like structures" characteristic of adipose tissue in diabetes and obesity were reduced 86%.

3. Healthy adipocyte progenitors were increased 8%.

4. Senescent epidermal cells were reduced 20% as measured by length and 31% by marker.

5. Circulating SASP factors IL-1a, -2,-6, -9 and Matrix Metalloproteinasea (MMP) -2, -9 and -12 were significantly lower.

Discussion and Significance:

D + Q have elimination half lives of 4 and 11 hours. This study showed that 3 day course of treatment, "Hit-and-run" reduced senescent cell burden 11 days following last dose. Senescent cells take weeks to over a month to form and acquire a SASP; meaning that senolytic agents like dasatinib can be administered in a "hit and run" fashion. Most potential side effects can be avoided through intermittent administration for 3 days. In chronic leukemia the dose of 100 mg a day has been administered continuously for years. Most SASP factors tested were significantly reduced. In another trial in humans there was decrease of 53 out of 66 SASP factors with Dasatinib.

This study showed a 3 day course of D+Q was well tolerated and 11 days later showed significant reduction in senescent cell burden in humans.

Dasatinib in Idiopathic Pulmonary fibrosis, first-in-human pilot study

In this first-in-human pilot study published February 2019, Dasatinib was shown to alleviate physical dysfunction in IPF and increased 6-minute walking speed. Here we take close look at the protocol and the side effects:

The dosing was a 3 week course of intermittent dosing, 100 mg of Dasatinib for 3 days plus quercetin 1250 mg a day followed by 4 day gap and repeated for 3 consecutive weeks.

Side effects: Generally mild to moderate. 1 serious adverse event after study consisting of bacterial pneumonia superimposed on pulmonary fibrosis. No fatal adverse events. All 14 persons complete study.

Most frequent adverse events were respiratory symptoms (cough, shortness of breath, runny nose,) Gastrointestinal discomfort or heartburn; headache; feeling tired/weak or feeling generally unwell.

It should be noted that this was 3 dosing intervals of 3 days each; not the single 3 day dosing interval reported in above study.

My own impression of 3 day course was similar to above. I had runny nose, heartburn, feeling tired and unwell; but all symptoms mild. Not the sort of thing I would like 3 weeks in a row; but once every 2-4 weeks for single 3 day course would seem OK.

Dasatinib Improves Health and Lifespan in Old Mice

In 2018 study, Dasatinib plus Quercetin was given orally to 24-27 month old mice (equivalent to 75 year old humans) bi-weekly (every 2 weeks) for 3 consecutive days until death. The D+Q mice had 36% higher median post-treatment lifespan and lower mortality hazard 65%. The physical function in last 2 months of life in D+Q mice was not lower compared to last two months of life of shorter living control mice. (frailty-like symptoms)

20 month old wild-type mice were treated with D+Q intermittently bi-weekly for 4 months (3 day consecutive treatment). Compared to control mice, the D+Q mice had higher maximal walking speed, hanging endurance, grip strength, treadmill endurance and daily activity. (less frailty) Expression of SASP components were also reduced in visceral adipose tissue for D+Q treated mice. Of note, D+Q biweekly or monthly had identical results.

Evidence for a causal role for senescent cells in physical dysfunction was shown to satisfies a modified set of Koch's postulates:

1.Transplanting small number of senescent cells is sufficient to induce physical dysfunction in young (6-month old) mice.

2. Aging (17-month old) exacerbated effects of senescent cell transplant. Transplanted senescent cells decreased survival.

3. Eliminating senescent cells with D+Q both prevents and alleviates physical dysfunction induced by senescent cell transplant.

4. Transplanted senescent cells caused formation of more senescent cells then numbers actually transplanted.

Conclusion was "study provides proof-of-concept that senescent cells can cause physical dysfunction and decreased survival even in young mice, while senolytics can enhance health and lifespan in old mice."

Dasatinib + Quercetin studies

Brain:

"Senolytic therapy alleviates AB-associated oligodendrocyte progenitor cell senescence and cognitive deficits in an Alzheimer's disease model", 2019, Zhang.

Direct exposure of OPCs (oligodendrocyte progenitor cells) to beta-amyloid plaques trigger senescence in OPC which then promote pathogenesis of AD. D+Q cocktail reduce senescent OPCs and reduce neuroinflammation, lessen AB load and ameliorate cognitive deficits in AD mouse model. Study suggest role of senolytic therapy with D+Q in prevention and treatment of AD.

"Tau protein aggregation is associated with cellular senescence in the brain", Musi, 2018.

"Tau protein accumulation is most common pathology among degenerative brain diseases, including Alzheimer's disease and ...over 20 others." Tau-containing neurofibrillary tangles (NFT) accumulation is closest correlate with cognitive decline and cell loss. NFT display a senescence-like phenotype. Tautransgenic mice with late-stage pathologu were treated with D+Q cocktail to remove senescent cells. There was a reduction in total NFT density, neuron loss and ventricular enlargement (brain atrophy). Treatment with D+Q at biweekly intervals for 3 months produced a 35% reduction in NFT burden and reduced neurodegeneration. "Overall, our data provide evidence that cellular senescence may be an underlying pathogenic process common among tauopathies."

12. Blagosklonny Literature

“Slowing Down Aging"

"Prospective Treatment of Age-Related Disease by Slowing Down Aging, " 2012, in this very short paper Blagosklonny summarizes what I call "Blagosklonny Medicine". The main subject headings are: "mTOR and Geroconversion", "From Gerogenic Cells to Diseases using Atherosclerosis as an Example", "Cancer", Rapamycin for Diverse Disease", "Inhibition of mTOR Extends Life Span", "Caloric Restriction". Here we quote a portion of the Cancer section:

"Despite the common misconceptions that rapamycin may cause cancer, it has been known for a decade that rapamycin prevents cancers in renal transplant recipients. At 2 years after renal transplantation, patients receiving rapamycin (sirolimus) as a base therapy do not develop any malignancies. In addition rapamycin prevented tumors and cured pre-existing tumors...Rapamycin is also extremely effective in the prevention of cancer in animal models. The cancer preventive effects of rapamycin may be the result of its anti-aging effect. In fact, caloric restriction that decelerates aging delays cancer. Caloric restriction may slow aging by inhibiting mTOR."

Quasi-Programmed Senescence

My prediction is 50 years from today, the Blagosklonny theory of TOR-driven aging will form the foundation of primary medical care for older person, the prevention of age-related disease. I consider these to be the major papers.

"Aging and Immortality, Quasi-Programmed Senescence and Its Pharmacologic Inhibition", 2006, marks the dawn of anti-aging medicine. The paper presents a radical new theory of aging and a pharmacologic manner to inhibit aging and age-related disease. Its significance for medical treatment is of the same order of importance as the introduction of the germ theory of infectious disease some 150 years earlier. However, the germ theory of disease had to wait 70 years until 1928, for the discovery of Penicillin by Alexander Fleming to have an effective antibiotic; the Blagosklonny theory of aging came with an effective treatment already available as a prescription drug.

Dr. Michael Hall, noted in Acknowledgements, discovered TOR in 1991 and gave it is prophetic name, Target of Rapamycin.

Abstract:

"While ruling out programmed aging, evolutionary theory predicts a quasi-program for aging, a continuation of the developmental program that is not turned off, is constantly on, becoming hyper-functional and damaging, causing diseases of aging. Could it be switched off pharmacologically? This would require identification of a molecular target involved in cell senescence, organism aging and diseases of aging. Notably, cell senescence is associated with activation of the TOR nutrient and mitogen-sensing pathway, which promotes cell growth, even though cell cycle is blocked.

Is TOR involved in organism aging? In fact, in yeast (where the cell is the organism), caloric restriction, rapamycin and mutations that inhibit TOR all slow down aging. In animals from worms to mammals caloric restrictions, life-extending agents, and numerous mutations that increase longevity all converge on the TOR pathway. And in humans, cell hypertrophy, hyperfunction and hyperplasia, typically associated with activation of TOR, contribute to diseases of aging.

Theoretical and clinical considerations suggest that rapamycin may be effective against atherosclerosis, hypertension and hyper-coagulation (thus preventing myocardial infarction and stroke), osteoporosis, cancer, autoimmune disease, and arthritis, obesity, diabetes, macula-degeneration, Alzheimer's and Parkinson's diseases.

Finally, I discuss that extended life span will reveal new causes for aging (e.g., ROS, "wear and tear", Hayflick limit, stem cell exhaustion) that play a limited role now, when quasi-programmed senescence kills us first."

TOR-driven aging, Speeding Car without Brakes

In the 2009 paper by above title, Blagosklonny discusses the traditional theory of aging and the TOR theory. The traditional belief is that aging is due to "accumulation of molecular damage". According to this theory, aging is a decline, a loss of function, damage caused by wear-and-tear; nothing can be done to stop aging and furthermore, age-related disease all have separate and specific causes distinct from aging.

Blagosklonny uses a speeding car without brakes to analogize his theory of aging and disease of aging. In youth a car is moving at the highest speed on the highway, 80 mph. This is a very dangerous highway due to predators and the program is to drive at top speed. TOR is the program that runs the computer that drives the engine. At a certain point, adulthood, Blagosklonny says a 20 mph section of road is reached. [This is from Blagosklonny's anti-aging viewpoint; to me the wild animal needs to be a super-star athlete to survive and any slowing down will just hasten death from predators.] At any rate, very few animals reach the 20 mph section of road due to external causes of death; furthermore, the car has no brakes and there is no way to slow down from 80 mph. Blagosklonny concludes, "natural selection does not favor brakes." It is only in modern humans and domestic animals, when external causes of death are removed that aging becomes an issue.

The Blagosklonnny theory is that aging is a continuation of growth on a cellular and molecular level. Aging is being driven by TOR just like growth was driven by TOR. Only aging is not programmed but is quasi-program (program-like). "Quasi-program of aging is an aimless continuation of the developmental program that was not switched off. Unlike a program, a quasi-program has no biological purpose and may be harmful. The analogy to the car is that the car crashes (dies) because it doesn't slow down in the 20 mph zone. Speed causes the crash; just like aging causes diseases of aging. In this model, aging and diseases of aging have the same cause, hyperactive TOR, the equivalent of driving 80 mph instead of 20 mph when reaching the 20 mph section of road.

On the molecular level TOR is a growth program. Growth is hypertrophy (increase in size) and hyperplasia (increase in number, mitosis, cell division). In the older animal, many cells are blocked from mitosis by anti-cancer programs. When a cell is directed by TOR to undergo mitosis; but mitosis is blocked by anti-cancer program; that cell becomes a senescent cell. the senecent cell is still able to grow, which is not blocked, and the cell takes on hyperfunction. On the molecular level, hyperfunction of senescent cells is the essence of aging.

A study of aging shows that before reaching the "end of the road" aging is hyperfunction. "In humans, aging is associated with hyperglycemia and high insulin, increased visceral fat, hyper-immunity, pro-inflammatory states, hyper-coagulation, hypertrophy, hyperplasia, growth of atherosclerotic plaques, proliferating cancer cells. Hyper-active and hypertrophic smooth muscle cell contribute to high blood pressure. Hyperactive osteoclasts cause osteoporosis. Hyper is the key word to describe the onset of aging."

Diseases are like the crashes at the end of the road. The sudden heart attack is the end result of atherosclerosis which has been going on for decades. From the TOR perspective "diseases of aging are just manifestations of aging, like smoke is a manifestation of fire."

To add to the complexity, with age in many ways the speeding car appears to slow down. In some ways it slows to 50 mph and to some "anti-aging specialists" this appears to be the cause of aging and the treatment is hormone supplements to get the car back to 80 mph.

From the TOR perspective, whether the car is going 80 mph or 50 mph it should be going 20 mph. The treatment is to slow the car down. The car has no brakes; but rapamycin is a pharmacologic brake.

The answer of modern medicine is "aging tolerance" Aging tolerance is all the excellent and very expensive modern treatments of diseases of aging.

Blgosklonny concludes: "Medical interventions increase aging tolerance, thus extending average life span despite chronic disease. Yet braking (slowing down) the aging process itself will prevent or delay diseases themselves. And since a continuation of TOR-driven developmental growth drives the aging process...[this] could be inhibited pharmacologically, thus preventing aging and diseases of aging."

Koschei the immortal and the anti-aging drugs

In this classic paper, Blagosklonny first presents the idea of an anti-aging formula. This formula was expanded in the 2017 paper discussed below and forms the basis of the treatment plan used by this office.

The paper has excellent discussion of How Rapamycin Prevents Obesity

1. Rapamycin increases lipolysis, releasing fatty acids from fat tissue.

2. Rapamycin prevents entry of lipoproteins into the tissues.

3. Rapamycin decreases insulin secretion, therefore, preventing insulin-induced obesity.

4. Rapamycin prevents adipocyte differentiation.

Prevention of cancer by inhibiting Aging. This paper is discussed above.

TOR-centric view on insulin resistance and diabetic complications: perspective for endocrinologists and gerontologists.

This paper presents a radical new concept for understanding diabetic complications such as blindness, cardiovascular disease, kidney disease.

Glucose and insulin activate the mTOR pathway.

Overactivation of mTOR pathway causes insulin resistance.

mTOR is involved in diabetic complications.

mTOR is involved in aging and age-related disease.

This paper forms the basis of one of main tenets of anti-aging medicine: the promotion of insulin sensitivity which then lowers mTOR.

"From Rapalogs to Anti-aging Formula" 2017

Abstract: "Inhibitors of mTOR, including clinically available rapalogs sch as rapaymcin (Sirolimus) and Everolimus are gerosuppressants, which suppress cellular senescence.Rapamycin slows aging and extends life span in a variety of species from worm to mammals. Rapalogs can prevent age-related diseases, including cancer, atherosclerosis,obesity, neurodegeneration and retinopathy and potentially rejuvenate stem cells, immunity and metabolism. Here, I further suggest how rapamycin can be combined with metformin, inhibitors of angiotensin II signaling (Losartan, Lisinopril), statins (simvastatin, atorvastatin [Lipitor]..., aspirn and a PDE5 inhibitor (Cialis). Rational combinations of these drugs with physical exercise and an anti-aging diet (Koschei formula) can maximize their anti-aging effects and decrease side effects".

"Well-tolerated doses with minimal side effects can be deducted based upon clinical use of rapalogs. So optimal anti-aging doses/schedules can be suggested. given that rapamycin consistently extends maximal lifespan in mice, rapamycin will likely allow mankind to beat current record of human longevity, which is 122 years."

"mTOR: from growth to aging"

"It was theoretically predicted that stimulation of mitogenic/growth pathways in arrested or quiescent cells must lead to senescence..Cellular senescece is futile growth, a continuation of cellular growth when actual growth is restricte. Growth-stimulation of arrested cell causes their hypertrophy and hyperfunctions (for example, hypersecretory phenotype or SASP in senescent fibroblasts)."

"This can be applied to organismal aging. When developmental growth is completed, then mTOR and some other signaling pathways drives organismal aging. These pathways stimulate cellular functions, leading to hyperfunctions (for example, hypertension). Secondary, hyperfunctions can lead to loss of function. Hyperfunction theory links growth, aging and age-related diseases. Suppression of aging prevents or delays age-related diseases."

Age-related diseases are manifestations of advanced aging

"Age-related pathologies and conitions include atherosclerosis, hypertension, osteoporosis, obesity, insulin-resistance and type II diabetes, cancer, macular degeneration, Parkinson and alzheimer's diseases as well as menopause in women, and many changes in appearance that are not called diseases (baldness, for example) and presbyopia. Stroke, myocardialinfarction, heart fibrillation, broken hip, renal and other organs failure are consequences of age-related pathology."

In brief, age-related iseases are both manifestations of advanced aging nd causes of death. Aging is the sum of age-related diseases and symptoms from wrinkles and presbyopia to stroke and cancer metastasis.

Since aging is not programmed, these diseases develop at different speeds..In brief, animals die from ag-related diseases, which are manifestations of advanced aging.

If a drug delays ALL age-related diseases, it is a classic anti-aging drug becuse it will extend life span by delaying causes of death."

Criteria for potential anti-aging drugs

A drug that prolongs life span in model organisms preferably in mammals.
A drug that prevents or delays several age-related diseases in mammals.
A drug that suppresses cellular geroconversion from quiescence to senescence.

Rapalogs

Rapamycin prolongs life span im mice at doses that have no noticeable side effects.
Rapalogs prevent age-related diseases in mice as well as in other mammals including non-human primates and humans. As examples rapamycin prevents atherosclerosis, neurodegeneration and retinopathy and cardiopathy in rodents.
Rapalogs prevent cancer in mice and humans.
Rapamycin decreases obesity in mice and humans.
Rapalogs rejunenate immunity, improve immune response in aging mice and humans.
Rapalogs suppress cellular geroconversion from quiescence to senescence.
Rapamycin suppresses aging, age-related pathologies in model organisms: the yeast, the fly and the worm.

[Note: suppress aging in these organism is very significant as these organism do not get cancer; the effect is at the fundamental level of aging]

"According to all criteria, rapalogs are anti-aging drugs. Importantly, rapalogs have minimal side effects."

1. Aging and Immortality, 2006 (above Ref 1)

2. TOR-driven aging, Speeding car without brakes (above Ref 2)

3. Koschei the immortal and anti-aging formula

4. Prevention of cancer by inhibiting aging (above Ref 9)

5. TOR-centric view of insulin resistance and diabetic complications

6. Prospectve Treatment of Age-related Diseases by Slowing Down Aging (above Ref 10)

7. Rejuvenating immunity: "anti-aging today" eight years later

8. From rapalogs to anti-aging formula (above Ref 3)

2018 Papers:

9. Disease of not, aging is easily treatable (above Ref 7)

10. Does rapamycin slow down time? (above Ref 5)

11. Paradoxes of senolytics (above Ref 6)

Rejuvenating immunity

In "Rejuvenating immunity: "anti-aging drug today" eight years later" 2015; the focus is the December 2014, Mannick paper, "mTOR inhibition improves immune function in the elderly". [discused in two sections discussing below]. The Abstract states, "The year 2014 ended with celebration: Everolimus, a rapamycin analog, was shown to improve immunity in old humans, heralding "a turning point" in research."

"INTRODUCTION: "Until recently, aging was believed to be a functional decline caused by accumulation of random molecular damage, which cannot be prevented. Breaking this dogma, hyperfunction theory described aging as a continuation of growth, driven by signaling pathways such as TOR. TOR-centric model predicts that rapamycin (and other rapalogs) can be used in humans to treat aging and prevent diseases, In PROPER DOSES AND SCHEDULES, rapamycin and other rapalogs not only can but also must extend healthy life-span in humans.

This theory was ridiculed by opponents and anonymous peer-reviewers. Yet, it was predicted in 2008 that "five years from now, current opponents will take the TOR-centric model for granted" And this prediction has been fulfilled."

"By 2010, many predictions of the TOR-centric model have been tested and confirmed. In 2010, one prediction remained: "rapamycin will become the cornerstone of anti-aging therapy in our lifetime". Until December 2014, all gerontological papers on rapamycin stated that current rapalogs are just proof of principle and will not be used due to side effects. Even further, use of anti-aging drugs in our lifetime was called science fiction. For unclear reasons, scientists emphasized that rapamycin and current rapalogs will not be used in aging humans due to imaginary side effects."

For me, the key phrase is "proper doses and schedules". The side-effects weren't imaginary; the problem was a failure of imagination. The failure to imagine what would happen if rapamycin was taken once a week, or once every two weeks and the belief that rapamycin must be taken everyday and have same side-effects as seen in transplant medicine. This was the extreme importance of the Mannick study; demonstration that 5 mg once a week improved immunity with no significant side effects.

In this paper, Blagosklonny discusses, "Post-Aging syndrome". This is idea that today most people die from TOR-driven aging; but when TOR-driven aging is defeated, many new causes of death from aging will be revealed.

13. Immune Function, Mannick Study

a Rapamycin Side Effects

This section represents what I believe to be just about the total extent of knowledge regarding side-effects from long-term use of weekly rapamycin. The reason for the potential enormous difference between daily side-effects and weekly side-effects is directly related to the half-life of rapamycin. The FDA section on rapamycin says elimination half life is 62+/- 16 hours. Daily dose is every .4 half-lives and weekly is every 2.7 half-lives.Taking a drug once every 0.4 half lives or once every 2.7 half lives can have a profound impact on effects and side-effects. In the paper, "mTOR inhibition improves immune function in the elderly, Joan Mannick, December 2014, writes "adverse events are related to pre-dose (trough) concentrations". Trough concentrations are high after .4 half lives and low after 2.7 half-lives. Transplant medicine needs to prevent low trough concentrations to prevent acute rejection; but anti-aging medicine wants low trough concentrations to prevent side-effects.

SIDE-EFFECTS RAPAMYCIN WEEKLY 6 MG FOR 14 MONTHS:

                                             2015-Nov    2016-Aug    2016-Dec      2017-Mar 2017- Aug    2018- March
Glucose                                      89                73                 84                  86                98                 98
HgA1c                                                              6                  6.2                 5.9               6.2               5.6
Insulin                        -                -               -                                               6.3              4.1                4.6
Creatinine                                1.20H            0.9                0.92               0.94            1.20H           1.09
Cholesterol                               114               102               140               173              171               147
HDL                                                               54             54             52            56           60                  60
LDL                                                                42             37             78         103           97                  74
TG                                                                  89             55             49           68          70                   57
Hemoglobin                                                13L            12.1L       12.5L      12.3L     13.0 L        13.0 L
Hematocrit                                                  39.5           37.4L       37.7L      36.2L     39.2           38.8
WBC                                                              6.1             6.3           2.6L         4.9         5.0             5.0
Lymphocytes                                            1129            901          660L        706L      890            1105

1/1/16: 172 pounds; 3/22/17: 150 pounds.

Waist/hip ratio start: 38/38 inches; waist/hip ratio 1 year: 33/36 inches.

Lipitor 80 mg start 10/15 for angina; Stop Lipitor 9/16 causing Gout.

Analysis: Glucose metabolism: rapamycin caused mild glucose intolerance. Insulin level 3/17 was normal and showed insulin sensitivity. Combination of glucose intolerance and insulin sensitivity is benign and not pre-diabetic.

Renal: Decrease in creatinine from elevated to normal was extraordinary.

Lipids: Dramatic results from Lipitor regarding LDL with low of 37 and increase to 103 with stopping lipitor. No apparent effect from rapamycin.

Blood: Rapamycin increased mild anemia of 13 gm Hemoglobin before to 12.3 gm. Indices normal. Mild anemia is real side-effect. Decrease in absolute lymphocytes.

Overall: glucose intolerance, insulin sensitivity, improved renal function, mild anemia, decrease lymphocytes.

Clinical: No mouth sores in 14 months, (apthous stomatitis). No untoward clinical side-effects.

Subjective impression: Miraculous improvement in health; feeling old to feeling young.

This is a case report of ONE person, me, taking weekly rapamycin; for 14 months. Until a larger study is reported, I think this is the best source of information regarding expected side-effects from weekly rapamycin.

UPDATE: MARCH 2018.

Now on weekly rapamycin, 6 mg a week for just over 2 years.

Weight 156 pounds. No dieting.

Glucose metabolism seems excellent with Insulin 4.6. Insulin lower August 4.1 probably reflects high level physical activity in Summer and very little physical activity in winter.

Only meds: Rapamycin, Lisinopril.

Lipids good: HDL 60, LDL 74.

(Low Lipids August 2016 on Lipitor stopped due to side-effect from Lipitor.)

Initial mild anemia at 1 year now returned to baseline.

WBC 5.0 low normal associated with longevity.

Creatinine at 2 years at normal level, was initially elevated. Jump creatinine August 2017 probably due to hypotension and dehydration from blood pressure meds.

The above laboratory results suggest that all the "experts" who say can't take rapamycin long-term to prevent diseases of aging are MISINFORMED. There is extreme difference between DAILY VERSUS WEEKLY.

My experience is that weekly rapamycin has an acceptable safety profile in contrast to daily rapamycin which I consider toxic.

HOMA Score

Homa score is calculated from glucose and insulin levels and shows insulin resistance. [See HOMA IR resistance calculator on line]

Rapamycin treatment started Jan 2016

HOMA score:

3/17 1.3

8/17 1.1

3/18 1.1

Healthy range: 0.5-1.4

Above 1.9 early insulin resistance

Above 2.9 significant insulin resistance

{Note: without insulin level can not calculate degree of insulin resistance and without knowing insulin resistance, don't know anything about glucose homeostasis.]

mTOR inhibition Improves Immune Function

"mTOR inhibition improves immune function in the elderly", a Novartis sponsored paper by Joan Mannick, December 2014, was a watershed moment in clinical anti-aging medicine. It was the first and ONLY study involving humans and a rapalog used in a manner relevant to anti-aging medicine. In a March, 2015 paper, "Rejuvenating Immunity..."Blagosklonny quotes Nir Barzilai, "it sets the stage for using this drug to target aging, to improve everything about aging...turning point in research".

2009 was a big year for rapamycin. In the Harrison experiment, rapamycin was shown to significantly extend the lifespan of middle-age mice and Rapamycin became an FDA approved drug for use to prevent organ rejection in transplant medicine. The problem was rapamycin became the Dr. Jekyll and Mr. Hyde of medicine. In animal studies rapamycin looks like the best drug in the world; it ameliorates atherosclerosis and prevents development of Alzheimer's disease in mice and everything imaginable in between in regard to amelioraton of age-related disease. However, in transplant medicine involving humans, just about everything rapamycin does is bad; unless you think knocking out the immune system is good. The paradox was how could rapamycin be so good in animal studies in the laboratory and so bad for humans in transplant medicine.

For the answer, one must go back 500 years to Paracelsus, the father of Toxicology. Born in the year 1493, he expounded the concept of dose response, "Solely the dose determines that a thing is not a poison," In the 500 years since Paracelsus, the importance of dose was lost.

In the Mannick study, they used a different interval and gave Everolimus once a week instead of every 12 hours as everolimus is used in transplant medicine and lo and behold, Everolimus improved immune function instead of knocking out immune function. This study involved 218 elderly volunteers over age 65. They were divided into 4 groups. One group took 0.5 mg once a day, one group 5 mg once a week, one group 20 mg once a week, and a control group. They took Everolimus for 6 weeks, stopped for 2 weeks and then were given a flu shot. The Everolimus treated group had a 20% enhancement response to the flu shot. Novartis has a drug which was approved to enhance immune response which had a 20% level of enhancement; so 20% enhancement is clinically significant and good enough for FDA approval.

The explanation of the mystery is as follows: Mannick states, "many of the adverse events are related to the pre-dose (trough) concentration". Mannick meant this to refer to "side-effects"; but on the molecular level, the little molecules do not know the difference between an effect, a side-effect and an adverse event.

A little arithmetic makes it all clear. The average dose of Everolimus in transplant medicine is 1 mg every 12 hours. The half-life of Everolimus is 30 hours. I calculated the following table to show the trough level in total milligrams of Everolimus remaining before the next dose when reach steady state.

Dose Half-lives Trough level in stead-state

1 mg every 12 hours 0.4 4.8 mg

0.5 mg every 24 hours 0.8 0.8 mg

5 mg every 168 hours 5.6 0.1 mg

20 mg every 168 hours 5.6 0.4 mg

The chart explains the mystery. The trough level when Everolimus used in transplant medicine is 50 times higher than when given 5 mg once a week. That 50 fold difference in trough level is highly significant. Everolimus is a poison when give 1 mg every 12 hours; but Everolimus is not a poison when give 5 mg once a week. Rapamycin is a poison when given 2 mg or 5 mg once a day; but not a poison at 3 mg or 6 mg once a week. Rapamycin was designed to be a poison. Its use in transplant medicine is consistent with the original purpose; poison the TOR control system. But by changing the interval between doses, rapamycin is a medication that can ameliorate disease; not knock-out the immune system.

Conclusions from Mannick study

1. The effects of rapamycin as used in transplant medicine should not be extrapolated to use of rapamycin in anti-aging medicine. The two uses have different aims and extreme differences in trough level which causes entirely different effects.

2. Animal studies can be very relevant to anti-aging medicine. In discussion, Mannick states that in a study of elderly mice, treatment with rapamycin for 6 weeks enhanced the response to influenza vaccination; therefore they tried it in human study and got the same results. Animals studies; but not results fom transplant medicine, correctly predicted the outcome of the study.

3. A rapalog can be used in elderly humans to improve immune response. Mannick notes immunosenescence is a decline in immune function that occurs in the elderly, leading to an increased susceptibility in infection and decreased response to vaccination as compared to younger adults. Adults 65 years and older account for 90% of influenza related deaths. In this study, Everolimus enhanced immune response to flu shot by 20%. In humans and mice, Rapalogs improved immune response in fundamental ways on the cellular level. Everolimus reduced the percent of CD4 and CD8 T lymphocytes expressing programmed death-1 (PD-1) receptor, which inhibits T cell signaling and is more highly expressed with age. Mannick also noted that "in elderly mice 6 weeks treatment with rapamycin rejuvenated HSC (hematopoietic stem cells) function, leading to increased production of naive lymphocytes and improved response to vaccination.

4. Proper anti-aging dose need not cause toxicity to be effective. The "sine qua non" of rapalog toxicity is the canker sore, also called aphthous ulcer. In the study the 5 mg a week dose was no less effective than 20 mg weekly. The following is chart of incidence of canker sores in 4 groups:

0.5 mg daily 5 mg weekly 20 mg weekly Placebo

Mouth ulcer 6 (11%) 2 (4%) 9 (17%) 3 (5%)

Note: The 5 mg weekly dose, which had excellent results, also had less incidence of canker sores than the control. This dose also had a much lower trough levels than .5 mg daily and 20 mg weekly.

Low Dose Sirolimus study

"The efficacy and safety of low-dose sirolimus for treatment of lymphangioleiomyomatosis" [LAM], Andoa, 2012, is the only paper reporting a series of patients on low dose Sirolimus. The study included 15 patients, average age 40, duration of treatment 17 months. They were under treatment for LAD, a rare condition caused by elevation of mTOR due to defect in gene that control TSC complex, which inhibits mTOR.

In renal transplant patients with dose of 2 mg daily mean trough level is 8.5 ng/mL and with 5 mg a day mean trough level is 17 ng/mL.

In this study 11 patients took 1 mg a day and 4 patients took 2 mg a day. The mean trough level was 2.16 ng/mL. In addition, they didn't take any other potent medications. Therefore, their reported adverse events are closer to what would be expected on sirolimus therapy for disease of aging prevention with intermittent dose aimed at low trough level. Following chart was reported:

Adverse events related to Sirolimus therapy

Total Grade 1-2 Grade 3

Upper respiratory infection 5 5 0

Fungal Infection 1 0 1

Hypercholesterolemia 0 0 0

Diarrhea 6 6 0

Stomach discomfort 2 2 0

Stomatitis 9 (60%) 8 1

Discussion of Adverse events: One patient developed an Aspergillus infection in the third year of mTOR inhibition treatment, in which severe parenchymal damage due to underlying disease had created a cavity.

"The most common adverse events related to low-dose sirolimus were stomatitis (canker sore) (9 patients), gastrointestinal episodes (8 patients) including diarrhea and stomach discomfort (2 patients) and upper respiratory infection, usually not severe, except one patient with Aspergillus infection in cavity-like area of lung. Stomatitis was usually not severe. Elevated cholesterol was not observed.

This was total adverse events reported in 15 patients with mean of 17 months. As shown by Mannick study, fewer adverse events can be expected on weekly therapy than low-dose daily therapy. In particular in Mannick study fewer mouth sores were reported in 5 mg a week group than in control. Although this was only 6 weeks, mouth sores and various adverse events are more common in first few weeks of treatment.

High Weekly dose of 6 mg once a week has lower trough than 1 mg daily. My experience has much less mouth sores. Some patients do have stomach discomfort and diarrhea.

Suppression mTORC1 and not mTORC2 about the half-life of Sirolimus

The rapamycin half-life for humans is 62 hours. The rapamycin half life for mice is 6.4 hours.

In 2007 Granville paper (Ref 5 Cancer) "A Highly Effective Rapamycin Schedule" they used rapamycin to reduce size and number of tobacco carcinogen-induced mouse lung tumors. They found 3 injections a week of 1.5 mg/kg was extremely effective and better than every day for 5 days a week. They determined 4.5 mg/week was better than 7.5 mg/week. As discussed in Cancer section, prevention of cancer requires the same mechanism as extension of lifespan and prevention of other age-related diseases.

In mice, every other day is once every 7.5 half lives.

In humans a daily dose is once every 0.4 half lives.

In humans, a weekly dose is once every 2.7 half lives.

An excellent paper, "The Enigma of Rapamycin Dosage", Mukhopadhyay, 2016, sheds much light.

For an anti-aging effect must reduce mTOR1; but not mTOR2.

Rapamycin as used as an immunosuppressant is NOT an anti-aging drug and shortens lifespan.

Formed mTOR1 is very sensitive to rapamycin in contrast to formed mTOR2 which is very resistance to rapamycin.

The mTOR1 complex consists of mTOR +Raptor +PA (phosphatidic acid.

The mTOR2 complex consists of mTOR+ RIctor + PA.

Rapamycin competes with PA.

Nano-molar doses of Rapamycin can dislocate PA from mTORC1 and partially dislodge Raptor and thus cause inactivation of mTORC1.

mTOR-Rictor+PA is very stable and only micro-molar doses of rapamycin could dislocate Rictor and inactivate mTORC2.

mTORC2 deteriorates over time and more mTORC2 must be synthesized.

Rapamycin in nano-molar doses can bind to newly synthesized mTOR before it binds to Rictor and thus prevent formation of mTORC2.

Therefore must allow sufficient time for rapamycin to be reduced to low enough level so that doesn't prevent synthesis of new mTOR2.

This requires sufficient time between doses, based on half-life of rapamycin to not block formation of new mTORC2.

However, when rapamycin is used as immunosuppressant must maintain high nadir dose of rapamycin to prevent formation of new mTORC2; therefore use daily dose, 0.4 half lives.

When rapamycin used as anti-aging drug must not inhibit mTORC2 and therefore must have low nadir level before new dose and therefore use weekly dose, once every 2.7 half lives.

14. Koschei Anti-Aging Formula

Rapamycin

In "Koschei the Immortal and Anti-aging Drugs", 2014, Blogosklonny, sets forth an anti-aging formula. Rapamycin is the cornerstone of that formula. Rapamycin was approved in 2009 for use in transplant medicine. For that purpose it has been used in over a million people with good results with foreign organ retention for many years. Rapamycin is generally well tolerated with only mild to moderate side-effects. I stipulate that the dose and manner of use of Rapamycin in transplant medicine is hazardous to your health and certainly that manner of use is in no way suitable for anti-aging medicine.

In transplant medicine they start with somebody with a normal level of mTOR function and use rapamycin to knock mTOR activity down to almost zero level of activity. Then they keep mTOR at this very low level. The goal is to totally disrupt normal mTOR function and signaling. This complete disruption of normal mTOR function causes a severe disruption of lymphocyte function. The net result is you can put a foreign organ into a person and not get an immediate violent rejection and infarction of the transplanted organ. This is how the body is supposed to react. However, as long as mTOR is kept continuously depressed, the immune system will not function properly and orchestrate rejection of the foreign organ. This is great medicine and saves lives. The extraordinary thing is the "experts" who ascribe the same side-effects seen in transplant medicine to the effects they claim would be seen if rapamycin was used in anti-aging medicine.

It was well known in medicine 500 years ago that whether a drug is poison or safe is a matter of dose. Indeed, consuming 4 liters of water quickly is fatal 50% of time [LD 50] due to sudden hyponatremia and brain swelling and edema. Nobody says water is too dangerous to drink.

In anti-aging medicine, Blagosklonny recommends intermittent or pulse treatment and also suggested weakly dosage.Rapamycin has a half-life of @ 62 hours. That means daily use is once every 0.4 half-lives while weekly use is once every 2.7 half lives. For that reason, only data regarding using rapamycin once a week is applicable to side-effects expected from once a week use and side-effects from daily use are not applicable.

In my practice, I consider the proper anti-aging dose of rapamycin to be 2-6 mg, and the proper interval 1-3 weeks. So the most conservative anti-aging dose would be 2 mg once every 3 weeks.

I would certainly welcome formal research studies on the best dose and best interval and I expect to see those results in about 50 years from now.

Caloric Restriction

Caloric restriction is major component of Koschei formula. Caloric restriction has been known to extend life span in numerous species from worms to mice for 100 years. Caloric restriction prevents age-related diseases including cancer and atherosclerotic heart disease. Interestingly, caloric restriction ameliorates sarcopenia. While caloric restriction increases insulin sensitivity, severe caloric restriction produces a glucose intolerance picture which is benign in significance. A 2015 study in mice showed mechanism of action of caloric restriction was inhibition or TOR and increase in SIRT1. Thus caloric restriction is different from rapamycin alone which only inhibits TOR.

In a very important study in humans, there was 25% caloric restriction in one group and 12.5% caloric restriction in another group combined with 12.5% increase in energy use through exercise. Compared to control group the caloric restriction group and the caloric restriction group plus exercise had similar results. There was a 20 pound weight loss, mostly body fat. Fasting glucose remained about the same; but fasting insulin levels went down 33%. Adiponectin showed 17% increase. SIRT1 level increase 3 fold. There was indication of decease in oxygen free radicals in muscle by 22%. Most important was the effect on mitochondria. Mitochondria increased in number and became more efficient. The increased efficiency of mitochondria was shown by reduced basal energy use at rest and less production of free radicals.

The best natural experiment showing what caloric restriction can do to a human population is the traditional Okinawan diet in the years 1950 to 1995. These people were farmers who worked very hard and as a matter of culture consumed less food. Studies calculated that they took in 8% less calories than their requirements. They had a remarkable decrease in age-related disease. Compared with Americans, men had 17% incidence of coronary heart disease and women 8%. Men had 50% incidence of colon cancer and women 30%. Men had 14% incidence of prostate cancer and women 9% incidence of breast cancer. As regards average life span, it was 5 years longer than Americans. The oldest 1% lived to 105 compared to 101 for oldest 1% of Americans. For the last 20 years, Okinawans have switched to a more traditional Japanese caloric intake and they no longer show any health benefits.

The Okinawan experience shows that an 8% caloric restriction less than required can achieve excellent results.

Most people notice that after a period of time on a caloric restriction diet they stop losing weight. They then get discouraged and go off the diet. In the Koschei formula, the purpose of a diet is not to lose weight; but rather maintain weight on less calories. It is not the weight loss; but the caloric restriction itself which results in the health benefits.

Physical Activity

Physical activity is a very important part of the Koschei formula. Blagosklonny states, "chronic physical exercise inhibits mTOR and increases insulin sensitivity."

For an excellent study on the cellular mechanisms and signaling pathways through which physical activity decreases insulin resistance, see 2008 paper by Erin Glynn entitled, "A chronic increase in physical activity inhibits the fed-state mTOR/S6K1 signaling and reduced IRS-1 serine phosphorylation in rat skeletal muscle." The very short explanation is physical activity causes activation of AMPK energy sensing pathway, which leads to a decrease in insulin resistance in skeletal muscle. Muscle is the major regulator of insulin resistance as skeletal muscle is responsible for up to 75% of insulin dependent glucose disposal in humans.

In the book, "Autobiography of Geronimo", it was stated that Apaches could travel 70 miles a day on foot. There are ultra-marathon runners who train for runs of 50-100 miles. If they ever see a doctor, it is about running related injuries as they have very low level of age-related disease. The major negative effect of civilization on human health is that civilization caused a decrease use of leg muscles. Humans are by nature, the greatest long-distance runners of the animal world.

The question is: "what is the minimum level of physical activity needed"? The minimum requirement seems to be burning 1000 calories a week; the equivalent to walking 10 miles. One study showed that moderate physical activity is associated with 50% reduction in cardiovascular disease in over-65s. Another study had shown that moderate physical activity of walking 4 hours a week had a 54% reduction in cardiovascular mortality and a high level which was described as jogging 3 hours a week, had a 66% reduction.Note that the difference between moderate and high was small; but the difference between moderate and low activity was dramatic.The conclusion of the study was that older adults who are physically active have a lower risk of coronary heart disease, stroke, and death from cardiovascular disease.

The main point is that physical activity, like walking or jogging, causes a decrease in insulin resistance in leg muscles. A decrease in insulin resistance causes a decrease in insulin levels which causes a decrease in mTOR.

Metformin

Metformin is part of our anti-aging formula. In a 2014 UK paper metformin monotherapy had a 15% longer survival than non-diabetic control subjects. Survival of diabetic patients not on Metformin had a survival 23% lower than non-diabetic subjects, which reflects expected results.

In a NIA (National Institute of Aging) 2016 study, metformin used alone had a modest increase in life spanbut only in male mice.When metformin was combined with rapamycin there was a very dramatic increase in one of two strains of mice. Male and female mice had a 24% increase in median life span and 10% and 17% increase in maximum life span. This was an impressive increase over rapamycin alone.

Metformin has been shown to reduce cancer in a great majority of animal studies and many human studies, especially liver and pancreas. Metformin acts through very interesting pathways which include activation of LKB1 (a tumor suppressor) and then stimulation of AMPK pathway which inhibits TOR.

For such an excellent drug, the question is why Metformin doesn't get more attention. A leading researcher on Metformin, explained, "The problem with Metformin is it's cheap, it's widely available, it has a great safety profile, and anyone can use it."

Metformin is also excellent to combine with rapamycin as the two agents have many opposite side effects, which can cancel each other's negative side effects.

Angiotensin II disruption

Angiotensin II disruption is an extremely important part of the anti-aging formula. In clinical medicine today, there are two ways to disrupt angiotensin II, angiotensin-converting enzyme inhibitors (ACEIs, [Lisinopril, enalapril] and angiotensin II receptor blackers (ARBs, (Losartan, Candesartan). [We only use those that cross the blood-brain barrier]. These drugs are the most popular drugs used for the therapy for hypertension and are used by millions for that purpose. However, angiotensin II is involved in far more than just hypertension.

Two great parallel systems on the cellular level are the TOR system and the angiotensin system. The TOR system is 2 billion years old and the angiotensin system is 500 million years old. The evolution of the angiotensin system was essential for the development of a circulatory system, which was required for animals to get bigger than a few millimeters, the distance for effective diffusion.

There are two main theories of aging. The hyperactive TOR theory first presented in 2006, and the ROS theory (reactive oxygen species) first presented in 1956. The hyperactive TOR theory is about early aging and diseases of aging related to hyperactive TOR, and the ROS theory relates more to late aging. [see first section Blagosklonny Medicine] The current major focus of the ROS theory is on mitochondria, the major source of oxygen free radicals. Angiotensin is intimately involved with mitochondria and oxygen free radicals. While TOR is strictly organic chemistry, in the angiotensin system, the most important components are small molecules, superoxide and Nitric oxide.

Disruption of angiotensin II, prolongs lifespan of mammals. In hypertensive rats, treatment with angiotensin II inhibition with ACEIs or ARBs ameliorated the harmful vascular effects of hypertension and doubled the rats lifespan. In a study of normal rats without hypertension, Enalapril, an ACEi prolonged lifespan by 21.4% and Losartan, an ARB, increased lifespan 12.5%.

In an extremely important study by Begnigni, 2009, "Disruption of the Ang II type 1 receptor promotes longevity in mice", they created homozygous mice with knock-out of the Ang type 1 receptor. The knock-out mice lived a remarkable 26% longer than the controls. The knock-out mice showed protection from atherosclerosis and vascular damage. The knock-out mice also showed reduced age-induced mitochondrial loss. The conclusion was that reduction in oxidative stress ameliorated mitochondrial loss. They also showed an increase in genes for Nampt and SIRT3. Caloric restriction also has this effect, but not rapamycin, which only extends lifespan by inhibition of TOR. This study showed that knock-out Ang II receptor increased lifespan dramatically, but it seemed through a separate system than inhibition of TOR. Caloric restriction appears to have one foot in each system.

In a separate study of genes associated with extreme human longevity, Begnigni showed that genes with variations in angiotensin II receptor, which decreased function, were associated with extreme longevity.

Another study in humans showed treatment with angiotensin II inhibitors reduced risk of cancer, hazard ratio of 0.66.

For an understanding of the extraordinary roles of angiotensin II on age-related disease, I recommend reading, "Angiotensin II revisited: new roles in inflammation, immunology and aging", by Ariela Benigni, 2010. For the role of angiotensin II regarding mitochondria, I recommend "Renin-angiotensin system inhibitors protect against age-related changes in rat liver mitochondrial DNA content and gene expression", Elena de Cavanagh, 2008.

Aspirin and Statins

Aspirin is the only "anti-aging" drug recommended by the US Preventive Task force. The recommendation is for men 45-79 and women 55-79 to prevent cardiovascular disease and colorectal cancer. They did not specify 81 mg or 325 mg. I recommend 81 mg to decrease risk of upper gastrointestinal bleed.

I agree with evidence showing aspirin has a very beneficial effect on health of endothelial cells. The effect is mediated through both inhibition of platelets and decrease in chronic inflammation of endothelial cells. Part of the protective effect of Aspirin on endothelial cells is through blocking an inhibitor of NO synthase and increasing production of Nitric oxide. The increase in Nitric oxide causes a decrease in vasoconstriction and is similar to pathway of Ang II inhibitors who's main action is to increase Nitric Oxide.

I also agree with data that aspirin decreases risk of colon cancer.

One important study (Wan, 2013), established aspirin as a true anti-aging drug. The study was "Aspirin extends the lifespan of C.elegans via AMPK and DAF-16/FOXO in dietary restriction pathway." In this study aspirin was shown to activate LKB1. LKB1 is a very important tumor suppressor. LKBI then activates AMPK which in addition to many other beneficial effects also inhibits mTOR. This puts aspirin in same pathway as metformin with activation of LKB1 and AMPK. In contrast to Rapamycin, which has a single action; the direct inhibition of mTOR; Aspirin and Metformin are indirect inhibitors of mTOR and also involved in many other pathways.

Statins are included in our anti-aging formula. In addition to usual reasons for using statin; rapamycin can cause elevation of lipids. This elevation is a result of beneficial effect in that rapamycin prevents lipids from entering tissues and rapamycin has a robust anti-atherogenic effect regardless of elevated lipids. However, lowering serum lipids with statins through decreased production in liver is beneficial and synergistic with the rapamycin effect of removing lipids from atheroma.

In the 2013 Cochrane report, which reviewed 19 trials involving 60,000 patients with mean age 57, statins reduced all cause mortality (OR 0.86). In a VA study, all cause mortality was also decreased (OR 0.54) and the conclusion was "statins showed a highly significant negative association with death."

15. Toxins In Our Foods (A.G.E.s)

Introduction to A.G.E.s

Toxins in our most common and most loved foods, called Advanced Glycation End Products, acronyn A.G.E.s, have emerged in the past 20 years as something of great importance. However, A.G.E.s and their dangers and origins remain unknown to most health care professionals and most people. These toxins are not directly related to mTOR or treatment with rapamycin. They are toxins that work downstream to action of mTOR and rapamycin. The connection is Preventive Medicine. For people taking rapamycin to try to maintain good health; it does not seem like a good idea to be simultaneously poisoned by high levels of toxins in our diet. Especially, since these toxins can be reduced to safe level with no cost, no risk, no caloric restriction, no medication. All that is required is information about the risk and a practical guide showing how to lower A.G.E.s. in our diet.

How It All Began

Dr. Helen Vlassara arrived at Rockerfeller University, a leading world center for medical research in NYC, in the summer of 1974 as a newly minted medical school graduate. Over the next 20 years her group studied diabetes. Over the next 20 years her group became more and more impressed with the role of A.G.E.s in the pathogenesis of all diabetic complications, including those involving the eye, brain, heart, kidney, nerves, circulatory system. They noted that diabetes resembled accelerated aging. They considered A.G.E.s a strictly endogenous problem, produced in the body.

A.G.E.s had been described by a French chemist Louis Maillard in 1912 as a complex chemical reaction between amino acids and sugars during cooking. They were then called "browning products" for the brown color they gave food as oven-baked bread. Everybody is very well acquainted with these brown substances as they impart the enticing aroma, flavor and taste to our favorite foods, including roast chicken, grilled steak, fried bacon, pizza from the oven and grilled burgers and fries.

"Look at all those A.G.E.s !!"

Until 1995 it was assumed that there was no connection between the delicious A.G.E.s in foods and the very bad A.G.E.s causing havoc in the body of diabetics. One day in 1995, Dr. Vlassara was the guest speaker at an international diabetes conference and was attending a spectacular banquet reception. As she looked out at the stunning display of food she exclaimed, "Look at all those A.G.E.s at a diabetes event !". Her colleague responded, "Why not, We don't absorb A.G.E.s from food."

However, by this time, Dr. Vlassara's lab had the newly developed the technical ability to measure A.G.E.s in blood. The next day the colleague cooked up a delicious meringue of egg whites and table sugar, loaded with A.G.E.s. The colleague gave a blood sample before and after eating the meringue. The results showed the the A.G.E.s in his blood skyrocketed within minutes after he ate the meal. Two years later they published the ground breaking paper; "Orally absorbed reactive glycation products (glycotoxins): an enviornmental risk factor in diabetic nephropathy", Koschinsky...Vlassara, 1997.

The science of the toxic effect of A.G.E.s in foods was off and running.

Firsthand look

Dr. Vlassara was at the center and leading researcher in the development of this story. She has published over a hundred scientific papers. In 2017, she published an excellent book on this subject; Dr. Vlassara A.G.E Less Diet. The book is highly authoritative and gives a first hand account of how field developed

Toxin in Our Foods

Most of the A.G.E.s in the body come from our diet, in particular, a relatively small number of very high A.G.E. foods. The toxins are produced by exposing animal products, meat, fish, dairy, to high dry heat as in broiling, grilling, frying and baking. The average NYC diet has 16,000 KU quantity of A.G.E.s. The body can handle about 5000-8000 A.G.E.s. Most people consume 2-3 times more A.G.E.s than their body can handle. The kidneys remove the A.G.E.s and when kidney function decreases with age and disease, the ability to handle A.G.E.s becomes much less. Excess A.G.E. accumulate in the body and cause havoc. The following sections will discuss the havoc caused by an excess of these toxins.

Caloric Restriction Is Not Caloric Restriction

Feeding mice 40% less standard mouse chow is called 40% caloric restriction. Standard mouse chow is commercially heat processed for longer shelf life and is very high in AGEs. Mouse chow provides mice with a higher relative AGE diet than typical standard Western diet. Therefore, feeding mice 40% less standard mouse chow is 40% less AGEs PLUS 40 percent less calories. As will see in later discussion, feeding mice same amount of chow with same calories; but with AGEs reduced 40% results in substantial improvement in lifespan and health span. In many studies, what is called 40% caloric restriction has superior results to oral rapamycin. In my opinion, the superior results of 40% caloric restriction over oral rapamycin is the combined synergistic effect of reduction in both AGEs and a separate effect from reduction in calories. It is also my opinion, that the combination of oral rapamycin combined with substantial reduction in AGEs can achieve all the benefits of caloric restriction.

CAVEAT

The theory and praxis of my system is not CONVENTIONAL MEDICINE. It is NOT based upon GENERALLY ACCEPTED BELIEFS in the world of medicine or the world of aging. It is based upon the theory that aging in humans is programmed and mTOR is a major part of the pro-aging program.. While the treatment is science-based; it is based to a very large degree upon pre-clinical animal studies; not human clinical studies. Almost all treatments are prescription generic drugs which have been in clinical use for twenty years or more; but the drugs are re-purposed for anti-aging. This is "off-label" medicine. Furthermore, the very thing this office purports to treat, TOR-DRIVEN AGING, is not recognized as a disease by conventional medicine.

Therefore, all prospective patients are advised to use due diligence and investigate opinions of many other experts before seeking treatment. DUE DILIGENCE is required to make a proper informed consent to treatment.

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The Medical Practice of Alan S. Green

The Medical Practice of Alan S. Green

June 2023 Update: 1270 patients on Rapamycin.

1. Evaluation of off‑label rapamycin use to promote healthspan in 333 adults, Kaeberlein, Alan Green

2. Baylor University Presentation

3. The five most important works to understanding Aging and Evolution

4. Rare and Orphan diseases: mTOR and Rapamycin

5. The TCA Cycle Controls Rate of Aging

6. June 2023: Summary Aging Theory and Treatment

7. Darwin and Evolutionary Theory

8. My Story, Patient Number 1, Turns 80. 2/25/2023

9. DNA says human maximum lifespan is 38 years

10. The economics of a private medial practice

11.Table of contents

12. CAVEAT

Announcement: May 4, 2023

2. Aging is the Handmaiden of Evolution

1. Theory of Aging in Humans

2. Modern Non-Programmed Aging Theories of Aging: Breaking Bad

3. "But Why would Nature Program Aging? Answer: "We age because the world changes" Martins

4. Travis, 2004; Evolution of Death Genes; A Computer Program Reveals How Programmed Aging Evolves.

5. Theory of Aging: Results of Martins and Travis Computer Programs and Blagosklonny Hyperfunction.

6. The Disposable Vehicle and the Immortal Genetic Program

7. Travis Results applied to Effect of Extrinsic Mortality on senescence in guppies, opossums.

8. Martins and Travis Results applied to Evolution and Aging in Vertebrates

9. Results from the Travis-Martins Model of Aging applied to Real World Findings

10. On a Challenging Planet; the Imperative is to Avoid Extinction

11. On the Cusp of Golden Era of Anti-Aging Medicine

3. Cancer, ASHD, Brain Aging, Alzheimer Disease

Slow Aging, Prevent Disease

Cancer Prevention

Atherosclerotic Heart Disease

Prevention of Normative Brain Aging

Alzheimer's Disease

Bartzokis 2011, Alzheimer's Disease as response to age-related myelin breakdown.

The Usual Suspects, MMP

4. New Site: Senescent Cells, Aging, and Senolytics

Senescent Cells and Aging

5. New Products, Topical Rapamycin And Others

New Section: November 26, 2020

Glutathione Maintenance, NAC + Glycine Supplementation

6. Covid and Rapamycin

Abstract

Abstract

November, 2021, 20 Months of COVID Experience

7. TOR-Driven Aging and Rapamycin

"He not busy being born is busy dying"

The dawn of the Age of TOR

Aging comes a cropper

Blagosklonny theory, TOR-driven Aging

The Proof is in the Pudding

8. Rapamycin/TOR Anti-aging Medicine

Rapamycin Prolongs Life Span

Rapamycin Prevents Age-Related Disease

Rapamycin Slows Formation of Senescent Cells

Aging is easily treatable

Epigenetic Clock Shows Rapamycin Slows Aging

Rapamycin/TOR Anti-aging Medicine

9. My Story, Patient Number 1, January 2016 to Age 80, February 25, 2023.

10. Bacterial Infections (FEVER) Require Antibiotics

Risk bacterial infection

Major side effect: Neutrophil Dysfunction

resTORbio, Inc. Fails clinical trial

Rapamycin and Gout

The mTOR and Alcohol Connection

UNDER CONSTRUCTION

8. Study to treat Polycystic Kidney disease with Sirolimus a FAILURE

11. Junk News Story: "Rapamycin increases AD-associated plaques in mice"

11. Senescent Cells, Senolytics, Dasatinib, Aging

Dasatinib + Quercetin Added to Anti-aging Formula

Dasatinib Decreases Senecent Cells in Humans

Dasatinib in Idiopathic Pulmonary fibrosis, first-in-human pilot study

Dasatinib Improves Health and Lifespan in Old Mice

Dasatinib + Quercetin studies

12. Blagosklonny Literature

“Slowing Down Aging"

Quasi-Programmed Senescence

TOR-driven aging, Speeding Car without Brakes

Koschei the immortal and the anti-aging drugs

"From Rapalogs to Anti-aging Formula" 2017