Do I need to ramp up again?

so I stopped dosing (8mg every sunday) as I had an EGD last week and have a colonoscopy this week. Can I go back to 8mg right away or should i ramp up again. it took me 8 long weeks when I started as I was dosing 1mg each week until 8mg. I really don’t want to take that long again if i don’t have to. I had no side effects on 8mg, not even a canker.


AIUI the reason for ramping is caution as to what dose may cause a problem. It may starting with 4 then 8 achieves that, but i dont know.

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I’m a little cautious I tend to go back down to 4mg then work my way back up.

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I was actually think 4mg myself, then 2mg more and then the final 2mg. that would only be 3 wks v.s. 8 wks like when i first started.


Not medical advice – but for myself … I’d go back to my 8 mg if I was robust and had no symptoms. There is no urgency obviously - but I’d be fine doing this - when we went on a trip, I missed a week and when I came back there was no ramping - I do 8 mg q8 days.

Now I’d nuance that with IF there is anything healing, such as they did a biopsy or a polypectomy … I’d wait 10 days post before dosing to make sure there is full healing an no complication. If no biopsy or polypectomy … I’d be jumping right back in … but that is what I’d do for myself, which isn’t necessarily how cautious I am when advising patients … but even then … if you just missed one dose … I’d tell my patients to just go back to full dose.

Just my approach on this … again, no medical advice for you as I don’t know your full situation.


Thx and not taken as medical advice. I did have biopsy done from the EGD, (a small inflamatory nodule) and I had H Pylori. And I usually have one or two small polyps on my colonoscopy’s. If I do again this time, I’ll just wait to start dosing again until sunday rolls around 2 weeks later which would be 14 days. I don’t think a few days more is any big deal…

why do you do 8mg every 8 days instead of say 7 days (which is what most people seem to be dosing at)

I’ve never ramped. I didn’t know about this site when I started and I just started taking what Alan Greene had put on his site as middle of the road. My doc didn’t have advice, I was his first Rapa patient.

I have around 48 hours of reasonable mtorc1 inhibition… above 3 ng/ml with this. So at my age … 56 I’m happy have 75% of the time in recovery.
Once I hit 60 I’ll likely head for 65% and even then will just increase the dose rather than decrease the interval.
Getting adequate days to workout is important.
I suspect I’ll end up on something like 12-13 mg every 10 days once 60 and will have 3.5 days of inhibition and 6.5 days of recovery


Huh. interesting. I am new to this and just started about 2-3 months ago. I am 65 and am taking 8mg every sunday. I wonder if i should space the dosing out a day or two or stay at 7 days. It sounds like you are using 8 days so that you are not having too many days in inhibition before you dose again…

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Different people have different views. I think my 21 day frequency is the least frequent, but I dont have a fallow period.

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John - are you doing a really big dose every 21 days, or a standard dose?

Given that we are in a no evidence zone on things - and I also know you are very well educated - I’m interested in your thought process as I do it my way based on a logic … don’t have proof.

I also do it based on safety, but also trying to have a therapeutic level for ~25-35% of the time and then below a threshold of 3 ng/mL the remainder.

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I have 6mg with a multiplier (Pomelo, Grapefruit and next time Pomegranate)

We now are certain that Rapamycin reduces the production of stem cells. I am pretty certain there will be other good reasons to keep mTOR functioning at least for part of the time in a normal situation (not in a transplant situation). Hence I would ideally wish to have it functioning normally for the majority of time. However, I am compromising because I think I wish to bias matters for now to autophagy.

At the moment apart from bad sleep (for a day or two) I am not getting negative side effects. I read bad sleep as being a side effect of autophagy.

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So you are essentially doing what I’m promoting with a longer cycle given that you’ll effectively have 5-7 days with >=3 ng/mL with that as you’ve essentially taken 20 mg … would be my guess without measuring, and you’re just cycling more slowly, but having in the 25-35% of the time with a level >=3 ng/mL and the rest in recovery.
For my neurocognitive decline patients I usually go for a level ~6-7 ng/mL at 20 hrs and map out metabolism, and most end up on a 14 day cycle when we do that, with the theory that a higher level will get more into the CNS.

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Are you following serum amyloid in your NCI patients on Rapa? I’ve noticed there is a labcorp test 505725:beta-amyloid-42-40-ratio-plasma. Would be interesting to graph the levels on Rapa over time in a patient with detectable amyloid Beta. I think Dr. Alan Green should be doing this as well in his ApoE4 patients taking Rapa. Presumably it goes steadily up once detected so a Rapa intervention might quickly show a change.

curious as to how much of the multiplier you take? 4oz, 6oz etc.?

I don’t weigh it. Last time I took about half a grapefruit.

Essentially. I am not sure how I can get it measured in the UK. However, it seems a reasonable approach given other people’s experience.

So I don’t have enough numbers yet – and I’m not treating any folks right now that actually have MCI or AD, I have individuals with ApoE status’s of concern who are trying to avoid getting there.

I will get there in my practice as I have folks with MCI and start testing and monitoring this.

The tests I plan to offer are:

Quest AD Detect - $399 does the “Beta-Amyloid 42/40 Ratio’ ABeta 42/40 Ratio way cheaper than PrecivityAD – was direct to consumer, but see a note it isn’t now. Here is the info on that.
An Aβ42/40 ratio ≥0.170 suggests a lower risk of having AD pathology compared to lower values and may prompt investigation of non-AD causes of MCI or dementia.
An Aβ42/40 ratio of 0.150 to 0.169 suggests an intermediate risk of having AD pathology, these limits lie within the margins of interassay precision (data on file). Follow-up testing (eg, PET, CSF biomarkers) may be warranted to investigate AD pathology as the cause of MCI or dementia, especially near the lower limit of this range.
An Aβ42/40 ratio <0.150 suggests a higher risk of having AD pathology compared to higher values and may suggest that follow-up testing (eg, PET, CSF biomarkers) is warranted to investigate AD pathology as the cause of MCI or dementia.

Cyrex Alzheimer’s Linx — $495 on RUPA, has Alpha-synuclean


sorry, I didn’t mean in weight I meant in fluid oz like 4oz of juice.

I ate some fruit which was juiced in my digestive system.