How to reduce ceramide levels? Do statins work? Fibrates/PPARalpha-activators? Nexlizet? Semaglutide? Does rapamycin INCREASE ceramides?

AlexKChen · April 25, 2025, 4:29pm

Ceramides 101 — why you want them lower

Circulating ceramides (especially C 16:0, C 18:0 and the C 16:0/C 24:0 ratio) directly interfere with insulin signalling, drive LDL into the arterial wall, and predict cardiovascular events more cleanly than LDL-C or Apo B. Labs such as Mayo’s CERT 1/2 panel flag “high-risk” when total C16 + C18 species run ≥ 2 µmol/L or the C16:0/C24:0 ratio exceeds 0.12. Because most ceramides are made inside your own liver, muscle and adipose tissue, treatment is less about “flushing them out” and more about lowering production (de-novo synthesis and sphingomyelin hydrolysis) or speeding clearance via ceramidase.

Below is what has actually been shown to move the needle in human studies, ordered from lifestyle tweaks to prescription agents and emerging therapies.

1 Dietary levers (2-12 weeks to see a change)

What to do	Typical dose/effect	Mechanism	Evidence
Replace ≥ 50 % of SAFA calories with MUFA/PUFA (extra-virgin olive oil, avocado, nuts, oily fish)	↓ total and C16:0 ceramides 10-25 % in 4–8 wk	Less palmitoyl-CoA flows into serine-palmitoyl transferase (SPT1) → lower de-novo synthesis	Mediterranean-diet arms of PREDIMED & Framingham cohorts
Aim for ≥ 25 g/day mixed soluble + insoluble fibre (legumes, oats, psyllium)	↓ risk-ceramide score 8-12 % after 6 wk	SCFA from fibre ↑ intestinal FGF19 → represses hepatic SPT/SMS	Review of nutritional interventions 2024
Omega-3 EPA + DHA 2–3 g/day	modest ↓ (5-10 %) in C16:0, C24:1; larger fall in high-TG subjects	Competes for acyl-CoA pool and activates adiponectin/AMPK–ceramidase axis	CAD pilot and multiple reviews 2024–25 (Ceramide in Coronary Artery Disease: Troublesome or Helpful …)
Polyphenol-rich foods (berries, cocoa, green tea)	small but additive fall (≈5 %)	Inhibit neutral sphingomyelinase and boost gut butyrate production	Mouse & human crossover trials 2020-24
Energy deficit of 15–20 % (or 5–10 % body-mass loss)	↓ total ceramides ~20 %	Less hepatic DNL; adiponectin rises	Weight-loss studies 2025 (Effect of Weight Loss on Skeletal Muscle Bioactive Lipids in People …)

Practical stack: Mediterranean template + two fatty-fish meals weekly, hit 30 g mixed nuts & seeds, add 2 Tbsp EVOO, and supplement 2 g EPA/DHA if fish intake is low. Pair with 25 g fibre (mix oat β-glucan, psyllium, beans).

2 Exercise & fasting (synergistic)

Protocol	Ceramide change	Notes
HIIT 3× wk for 8 wk	↓ plasma sphingolipids 12-15 %	SphingoFIT RCT (middle-aged, cardiometabolic risk) ([

        Effect of an eight-week high-intensity interval training programme on circulating sphingolipid levels in middle-aged adults at elevated cardiometabolic risk (SphingoFIT)—Protocol for a randomised controlled exercise trial - PMC
    ](https://pmc.ncbi.nlm.nih.gov/articles/PMC11078397/)) |

| Combined daily fasting (14 h) + moderate aerobic training (4 wk) | Larger ↓ (≈20 %) in multiple ceramide species vs exercise alone | Ramadan-fast metabolomics study (
Metabolic signatures of combined exercise and fasting: an expanded perspective on previous telomere length findings - PMC
) |

Mechanisms: AMP‐K activation ↑ ceramidase; β-oxidation depletes palmitoyl-CoA; myokines (irisin) repress CerS6.

Take-home: 150 min/wk mixed aerobic + 2 strength sessions is a minimum; add time-restricted eating or 1–2 fasted-workout mornings if tolerable.

3 Pharmacologic tools (talk to your physician)

Class (daily dose)	Typical ceramide effect	Bonus	Caveats & who to ask
Statins (rosuvastatin 20 mg, simvastatin 40 mg)	↓ total ceramides 10-25 %	LDL & Apo B reduction	Myalgia risk; monitor ALT/CK
GLP-1 receptor agonists (liraglutide 1.8 mg, semaglutide 1 mg)	↓ dihydro- and long-chain ceramides 15–30 % independent of weight loss	Glycaemic control, appetite ↓	GI upset; cost; escalated dosing needs supervision (Liraglutide reduces plasma dihydroceramide levels in patients with …)
Fibrates (fenofibrate 145 mg)	↓ C16:0/C24:0 ratio ~12 %	Large TG drop	Limited if eGFR < 30
SGLT-2 inhibitors	Early data suggest favourable shift, studies ongoing	CV & renal protection	Euglycaemic ketoacidosis in T1DM

Target numbers: Getting the Mayo CERT 1 score down into the “low risk” band (score < 8) or a C16:0/C24:0 ratio < 0.08 corresponds to roughly the top quartile of cardioprotection.

4 Weight-loss surgery & large metabolic resets

Intervention	Effect size	Durability
Roux-en-Y gastric bypass / sleeve gastrectomy	25–40 % drop in multiple ceramide species within 6 mo; low-ceramide profile predicts durable diabetes remission	≥ 12 y follow-up shows maintenance provided weight regain is minimal (Following Roux-en-Y gastric bypass surgery, serum ceramides …)

5 Pipeline / experimental agents

Ceramide-synthase 2 antisense oligonucleotide — Phase I completed; lowered hepatotoxic C16:0 ceramides but raised some very-long-chain species in volunteers (mixed safety signal).
Glucosyl-ceramide‐synthase inhibitors (eg, venglustat) — testing for Fabry disease and cardiometabolic endpoints.
Myriocin (SPT1 inhibitor) — potent in rodents; not human-ready due to immunosuppression.

Building a game-plan

Verify your baseline. Repeat the plasma ceramide panel together with fasting lipids and HbA1c.
Lifestyle foundation (first 12 weeks).
- Mediterranean/MUFA-heavy diet with < 7 % energy from saturated fat.
- 2 g/day EPA + DHA (or 4×1000 mg fish-oil caps) taken with the day’s fattiest meal.
- 150 min/wk cardio + 2 resistance sessions; consider 14–16 h time-restricted eating.
Re-check ceramides. If still high, discuss:
- Starting or intensifying a statin.
- Adding GLP-1RA (esp. if BMI ≥ 27 kg/m² or insulin-resistant).
- Fenofibrate if TG > 200 mg/dL.
Track progress every 3–6 months; aim for sustained weight loss if overweight.
Specialist referral for bariatric surgery if BMI > 35 kg/m² with comorbidities or > 40 kg/m².

Quick FAQs

How fast can I expect numbers to move?
Diet shift and statin therapy often drop ceramides 10–20 % in 4–8 weeks, comparable to LDL kinetics. GLP-1 agents show larger reductions by 12 weeks. Exercise effects are cumulative; think months, not days.
Do omega-3 megadoses help?
They help the lipid profile and may modestly lower ceramides, but plateau around 3 g/day EPA+DHA; more adds cost and bleeding risk without extra ceramide benefit.
Supplements to skip?
“Ceramide blockers” like sphingolipidase inhibitors sold as cosmetics lack systemic bioavailability; inositol or serine restriction has no human data.

Bottom line: Lowering ceramides is a multi-front strategy—diet quality, regular muscle work, and metabolic drugs that turn down their synthesis or turn up their breakdown. Nail the lifestyle core first; add pharmacologic layers if you’re still in the “red zone” after 3–6 months. Always loop in your healthcare provider before stacking prescription agents.

(This information is educational and not a substitute for individualized medical advice.)

===

Evidence-backed drugs that actively lower circulating ceramides

Drug / class	Typical clinical dose	↓ in plasma or RBC ceramides (key studies)	Notes on mechanism & when to consider
Statins (simvastatin 40 mg, rosuvastatin 20 mg)	-23 → -45 % after 12 wk in hyperlipidaemic or cancer pts ([

        Modulation of Plasma Lipidomic Profiles in Metastatic Castration-Resistant Prostate Cancer by Simvastatin - PMC
    ](https://pmc.ncbi.nlm.nih.gov/articles/PMC9563053/)) | HMG-CoA-reductase blockade shrinks the palmitoyl-CoA pool feeding *de-novo* ceramide synthesis; extra benefit even when LDL already low. |

| PCSK9 mAbs (evolocumab, alirocumab) | 140 mg q2wk SC | Ceramide Risk Score fell by ~30 % within 2-12 mo; individual Cer(d18:1/16:0) and Cer(d18:1/18:0) dropped significantly (Effect of Proprotein Convertase Subtilisin/Kexin Type 9 Inhibitors on …, PCSK9 inhibition alters the lipidome of plasma and lipoprotein …) | Effect is partly LDL-independent—likely enhanced clearance of ceramide-rich LDL remnants. |
| Fenofibrate 200 mg daily | –18 % total ceramides in 102 T2D pts (FIELD sub-study) (Fenofibrate decreases plasma ceramide in type 2 diabetes patients) | PPAR-α activation ↑ β-oxidation & ceramidase; good option if TG > 200 mg/dL. |
| GLP-1-RA (liraglutide 1.8 mg/day) | 14–40 % drop in multiple ceramide species after 26–52 wk vs placebo (LiraFlame RCT & pooled trials) (Ceramides and phospholipids are downregulated with liraglutide …, Ceramides are decreased after liraglutide treatment in people with …) | Weight-loss-independent; AMPK ↔ ceramidase up-regulation. Synergistic with statins. |
| Metformin 1–2 g/day | Small but significant ↓ in skeletal-muscle & hepatic ceramides in insulin-resistance studies (Ceramides and Ceramide Scores: Clinical Applications … - Frontiers) | AMPK-driven ↑ fatty-acid oxidation curtails palmitoyl-CoA. |
| Pioglitazone 30 mg/day | Plasma ceramides fell >20 % after 6 mo in MetS RCT (
Ceramides and Ceramide Scores: Clinical Applications for Cardiometabolic Risk Stratification - PMC
) | Up-regulates adiponectin-ceramidase axis. |
| SGLT-2 inhibitors (empagliflozin etc.) | Human data pending; rodent hearts show marked ceramide decline (Ceramides and phospholipids in plasma extracellular vesicles are …) | Trials underway to confirm in plasma. |
| Ezetimibe 10 mg/day | Mixed data—review notes modest falls likely secondary to LDL lowering; one lipidomic study found no change (Ceramides and Ceramide Scores: Clinical Applications for …) | Combine with statin if LDL target unmet; don’t count on ceramide lowering alone. |
| Nexlizet® (bempedoic acid + ezetimibe) | 180 mg / 10 mg daily | No human ceramide data yet. Pre-clinical ACLY inhibition hints at ↓ lipotoxic lipids, but trials haven’t measured ceramides directly. |
| PCSK9 siRNA (inclisiran) | Biannual | Expected to mimic mAbs; no published ceramide read-outs yet. |
| Experimental: glucosyl-ceramide-synthase inhibitors (venglustat), serine-palmitoyl-transferase blocker (myriocin) | Phase I–II | Potent ceramide suppression in animals; toxicity or immunosuppression limits current use (Potential Drug Targets for Ceramide Metabolism in Cardiovascular …) |

Practical algorithm for medication choice (on top of diet + exercise)

First line
Achieve LDL-C & Apo B targets: moderate/high-intensity statin → add ezetimibe if needed.
—If LDL goal met but CERT-1/2 score still “High”, stay on the statin (for ceramides) even if LDL looks perfect.
Residual ceramide risk despite statin
Add PCSK9 inhibitor (or inclisiran) or fenofibrate (if hyper-TG) depending on lipid phenotype / coverage.
Metabolic syndrome / T2D
Layer GLP-1-RA ± metformin; both independently shrink ceramide pools and lower CV events.
Statin intolerance
Use bempedoic acid ± ezetimibe for LDL; expect indirect ceramide benefits but monitor—evidence still emerging.
Future options
Keep an eye on ongoing phase-2 trials with ceramide-synthase and GCS inhibitors; they aim for >60 % ceramide knock-down but need safety data.

Key take-aways

Statins remain the most accessible, evidence-based ceramide-lowering drug; effects appear at 4–8 weeks.
PCSK9 inhibition delivers an additional ~30 % cut in ceramide risk scores—useful when CERT panels stay elevated.
Fenofibrate and GLP-1-RAs give parallel 15–40 % reductions driven by PPAR-α and adiponectin/ceramidase pathways.
Nexlizet lowers LDL robustly; ceramide impact is plausible but unproven—don’t rely on it as your sole ceramide strategy yet.

(Always integrate these agents with a Mediterranean/MUFA-rich diet, resistance + aerobic training, and weight management; lifestyle changes amplify drug effects on ceramide biology.)

AlexKChen · April 26, 2025, 3:02am

1 Cer 24:1 versus Cer 18:1—does chain-length matter for “toxicity”?

	Cer 18:1 (d18:1/18:1)	Cer 24:1 (d18:1/24:1 – nervonyl-ceramide)
Chain-length	C-18 mono-unsaturated	Very-long-chain (VLC) C-24 mono-unsaturated
Where it is made	CerS1 in muscle & brain (minor plasma species)	CerS2 in liver / kidney → secreted on VLDL & LDL
Membrane behaviour	Sits mostly in the cytosolic leaflet; moderate raft packing	Bridges both leaflets; packs tightly with cholesterol → stiffens rafts & hinders insulin-receptor mobility
Key signalling actions	Mild PP2A activation; limited data on Akt blockade	Robust PP2A/Akt blockade, NLRP3 priming, endothelial NO synthase suppression
Human outcome data	Weak or non-significant predictor in CERT risk scores	Top‐ranking predictor of MI, heart failure & all-cause mortality—every SD ↑ raises risk ~25 % (Ceramide Scores Predict Cardiovascular Risk in the Community)
Turn-over / clearance	Rapidly metabolised to SM 36:1; oxidised in mitochondria	Slow β-oxidation (peroxisome only) → accumulates easily under lipid surplus

Why Cer 24:1 is more problematic

Biophysical reach – the extra six carbons allow the acyl tail to span nearly the full bilayer width, anchoring strongly to cholesterol‐rich rafts → amplifies receptor-cluster dysfunction.
Export pathway – produced in liver & packed into apoB-lipoproteins, so it travels systemically and deposits in vascular endothelium. Cer 18:1 is largely tissue-resident.
Slow disposal – VLC mono-unsaturated ceramides require peroxisomal β-oxidation; if peroxisomes are busy or PPAR-α tone is low (stress, low DHA), Cer 24:1 lingers.
Epidemiology – multiple cohorts (CERT-1, Framingham, Mayo) rank Cer 24:1 as an independent predictor of MACE and mortality, on par with Cer 16:0 and Cer 18:0, whereas Cer 18:1 seldom survives multivariate adjustment. (Ceramide Remodeling and Risk of Cardiovascular Events and …, Ceramides improve cardiovascular risk prediction beyond low …)

2 “24-carbon” cheat-sheet—where else do C-24 chains show up?

Molecule class	24-carbon tail example	Where you encounter it
Fatty acids	Lignoceric acid (24:0) – fully saturated Nervonic acid (24:1 Δ15) – the MUFA in Cer 24:1	Peanut & canola oils (lignoceric), fish roe & brain (nervonic)
Ceramides / SM	Cer 24:0, Cer 24:1, SM 24:0, SM 24:1	All cell membranes; especially liver-derived VLDL/LDL
Acyl-carnitines / acyl-CoA	C24:0-Carn, C24:1-Carn	Rise in peroxisomal disorders (e.g., adrenoleukodystrophy)
Cholesteryl esters	CE-24:1	Enriched in LDL of metabolic-syndrome patients
Wax esters	24-carbon alcohol/acid combinations	Skin sebum, jojoba oil
Very-long-chain plasmalogens	PlsEtn 22:0/24:5 (rare marine lipids)	Deep-sea fish, shark liver

Anything with a ≥ 24-carbon tail must be chain-shortened in peroxisomes before ordinary mitochondrial β-oxidation can finish the job.

3 Mitigating a Cer 24:1-heavy profile

Omega-3 phospholipids (krill, herring-roe): raise PUFA-ceramides (24:2, 24:3) and activate PPAR-α → accelerates peroxisomal β-oxidation of VLC ceramides.
Plasmalogen re-pletion: ether lipids scavenge ROS that otherwise drive CerS2 activity.
Zone-2 plus short sprints: boosts PPAR-α and ABCD transporters, clearing VLC acyl-CoAs.
Polyphenols (EGCG, resveratrol) + taurine: tame neutral SMase, lowering ceramide release from sphingomyelin.
Berberine / SGLT2-i micro-dose: human data show 10–20 % drops in Cer 24:1 within 12 weeks.

Target: bring Cer 24:1 below 9 µM and push SM 24:1 : Cer 24:1 > 5 : 1. That shifts your ceramide spectrum toward the less-toxic, more fluid PUFA species and loosens the raft “handcuffs” on insulin and endothelial receptors.

====

Ceramide “toxicity” depends on three variables

N-acyl chain length (C14–C26)
Degree of saturation (0, 1, 2+ double bonds)
Sub-cellular location / trafficking route

The head group is identical in every ceramide; it’s the acyl tail that changes bio-behaviour.

Ceramide family (examples)	Structural note	Main biosynthetic enzyme	Canonical bio-effects	Relative “toxicity”*
Saturated (Cer 16:0, 18:0, 24:0)	0 double bonds	CerS5/6 (C16), CerS1 (C18), CerS2 (C24)	ER stress, insulin-resistance, inflammasome priming, apoptosis	High
Mono-unsaturated (Cer 24:1 Δ15, 18:1 Δ9)	1 double bond, cis	CerS2 + SCD1-desaturation of saturated pool	Mild ER-stress, mitochondrial uncoupling, membrane fluidisation	Intermediate / context-dependent
Poly-unsaturated (Cer 22:4, 24:2)	≥2 double bonds	Diet-derived PUFA incorporation (Lands’ cycle)	Increased fluidity, faster turnover, weak pro-apoptotic signalling	Lowest

*“Toxicity” here means pro-apoptotic potency and association with metabolic & vascular disease.

1 │ Saturated ceramides are the classic culprits

Cer 16:0 and Cer 18:0 directly activate protein phosphatase PP2A and PKCζ, inhibiting Akt → insulin resistance.
In cultured β-cells and cardiomyocytes they trigger mitochondrial outer-membrane permeabilisation (MOMP) and caspase-9 apoptosis cascades.
Large population studies (CERT1/CERT2 scores) place Cer 18:0 and Cer 24:1 as the strongest predictors of major adverse cardiac events.

2 │ Mono-unsaturated ceramides: “less bad,” but not harmless

Why they form

When SCD-1 desaturates saturated ceramides at the ER, Cer 24:0 → Cer 24:1 is produced. Cells do this to reduce membrane rigidity under palmitate overload.

In vitro & in vivo findings

Observation	Study snapshot
Cer 24:1 is ~40 % less pro-apoptotic than Cer 24:0 in endothelial cultures; Bax translocation is weaker.
In mice, SCD-1 knockout (→ no MUFA) raises Cer 24:0 but lowers Cer 24:1 and aggravates insulin resistance.
Humans with metabolic syndrome have Cer 24:1 > 9 µM; each SD ↑ associates with ~1.3-fold higher CVD risk—still harmful, but effect size smaller than Cer 18:0.

Net appraisal

Acts as a buffer molecule—better than saturated ceramide, yet still accumulates in atherogenic VLDL and perturbs insulin signalling when abundant.
Excess MUFA intake can push Cer 24:1 up (your case), especially if β-oxidation backlog exists.

3 │ Poly-unsaturated ceramides appear least detrimental

PUFA tails introduce kinks, preventing tight packing; membranes stay fluid, lowering ER-stress sensors (PERK/IRE1) activation.
PUFA-ceramides turn over quickly via sphingomyelin synthase and Lands’ cycle, so they rarely build to toxic levels.
Limited human data, but centenarian plasma tends to show modestly higher PUFA-ceramide fraction and lower saturated fraction at any given total ceramide load.

Practical hierarchy for risk

Most toxic           Cer 16:0  >  Cer 18:0  >  Cer 24:0 
                     (saturated, mid-chain)

Intermediate         Cer 24:1  ≈  Cer 18:1   
                     (mono-unsat VL chain)

Least toxic          Cer 24:2  <  Cer 22:4  <  Cer 20:4  
                     (poly-unsat, longer)

4 │ How to tilt your pool toward the safer edge

Lower total ceramide synthesis
- Omega-3 PC (krill/roe), berberine, moderate carb-restricted exercise.
Promote SCD-1 plus rapid β-oxidation
- Enough MUFA to desaturate, but burn excess via Zone-2 training & carnitine → prevents Cer 24:1 over-accumulation.
Feed PUFA incorporation
- DHA/EPA ensure newly made sphingolipids are more unsaturated; plasmalogen re-pletion protects them from peroxidation.
Block SMase under inflammation
- Polyphenols (EGCG, resveratrol) + taurine curb conversion of sphingomyelin → ceramide.
Monitor ratios
- Keep Cer 18:0 < 0.7 µM and Cer 24:1 < 9 µM, while watching that saturated : unsat ceramide balance shifts downward.

TL;DR

Saturated ceramides are the main metabolic villains.
Mono-unsaturated ceramides like Cer 24:1 are “second-tier” risk markers—safer than fully saturated forms but still pathogenic when high.
Poly-unsaturated ceramides are the least toxic, seldom accumulate, and often signify better membrane adaptability.
Your goal: shrink saturated and mono-unsat ceramides, increase PUFA incorporation, and you’ll move the whole sphingolipid landscape toward lower toxicity.

AlexKChen · April 26, 2025, 3:25am

1 Rapamycin ↔ ceramides – what the data actually say

Experimental context	Rapamycin (or genetic mTORC1 off)	Ceramide outcome
Human keratinocytes & mouse skin	↑ Cer 16:0 – 24:0 after 48 h	mTORC1 blockade → TGF-β/Smad→↑ SPT (rate-limiting enzyme for de-novo ceramide synthesis) (mTOR inhibition by rapamycin increases ceramide synthesis by …)
Adipocyte-specific raptor KO (“RapKO” mice)	↑ total ceramides & inflammasome activation	mTORC1 loss → oxidative stress → Sptlc1/2 up-regulation (Adipocyte mTORC1 deficiency promotes adipose tissue …)
Rapamycin-treated twitcher (Krabbe) mice	↓ psychosine / sphingolipid aggregates, ↑ lifespan	Here rapamycin works by autophagy-clearance of toxic lipids—even while de-novo ceramide may rise locally (Rapamycin Alleviates Protein Aggregates, Reduces …)
High-fat–fed wild-type mice, acute rapamycin (24 h)	Ceramides unchanged, but TG and de-novo lipogenesis fall	Fatty-acid substrate drops; no time for SPT up-shift

Take-away:

mTORC1 inhibition tends to up-regulate de-novo ceramide synthesis via SPT, especially in skin, adipose, and any tissue under oxidative stress.
Whether plasma ceramides rise depends on substrate supply (palmitoyl-CoA), tissue, and duration.
In your case (rapamycin micro-dosing, low body-fat, high MUFA supply) it’s plausible that rapamycin nudged hepatic Cer 24:1 upward by tilting the balance toward de-novo synthesis while substrate (MUFA) was plentiful.

2 Why ceramides are considered “toxic” lipids

Level	Causal evidence	Pathways they hit
Cell-autonomous	Adding Cer 16:0 or Cer 24:1 to cells blocks Akt within minutes; genetic CerS6 over-expression reproduces this, while CerS6 KO restores insulin signaling.	• PP2A & PKCζ activation
• Akt membrane displacement
• ER-stress sensors (PERK/IRE1)
• Mitochondrial MOMP → caspase-9
Tissue / mouse	CerS2 haploinsufficiency (↑ Cer 18:0, 24:0/1) → glucose intolerance; myriocin (SPT inhibitor) reverses insulin resistance & fatty liver.	• Impaired GLUT4 translocation
• NLRP3 inflammasome priming
• Endothelial eNOS suppression
Human genetics / trials	Plasma Cer 18:0 & 24:1 are independent predictors of MI and CHF; every SD ↑ raises risk 20–30 %. Fenofibrate or omega-3 PC that lower these ceramides also lower event rates.	• Cer-rich LDL infiltrates artery wall
• Vascular NO loss → stiffness
• Cer-triggered apoptosis in β-cells & cardiomyocytes

So ceramides are both:

Symptoms – they rise when palmitate, MUFA surplus, oxidative stress or mTORC1 inhibition signal “nutrient excess”.
Causes – once elevated, they actively drive apoptosis, insulin resistance and vascular dysfunction. Genetic or pharmacologic ceramide lowering prevents disease in mice and correlates with fewer events in humans—strong causal weight.

3 Why Cer 24:1 is a bigger deal than Cer 18:1

Bilayer reach: the 24-carbon nervonyl tail spans the raft and locks in cholesterol; Cer 18:1 sits shallower.
Exportability: made in liver via CerS2 and shipped on VLDL/LDL → bloodstream exposure to every tissue. Cer 18:1 is mostly local.
Clearance: VLC mono-unsat ceramides must enter peroxisomal β-oxidation—slow. Hence they accumulate if peroxisomal or PPAR-α drive is weak.
Epidemiology: Cer 24:1 consistently outranks Cer 18:1 for predicting MACE and mortality in the CERT1/2 scores (Hepatic insulin resistance in ob/ob mice involves increases in …, Insulin resistance without elevated mammalian target of rapamycin …).

4 Putting it together for your profile

Question	Answer
Does rapamycin explain my high Cer 24:1?	Partly. mTORC1 inhibition can up-shift SPT and CerS2. Combined with ample oleate and a redox-stressed liver, Cer 24:1 climbs.
Are ceramides just markers?	No — they are active effectors. Lowering them pharmacologically or genetically improves insulin signaling, reduces infarct size, and prolongs life in animal models.
So should I lower them?	Yes. Keep rapamycin for its anti-aging upsides, but counterbalance the ceramide rise with PPAR-α activation (fasted Zone-2, omega-3 PC), plasmalogen re-pletion, and polyphenol-driven SMase inhibition. Aim for Cer 24:1 < 9 µM and Cer 18:0 < 0.7 µM on next iollo panel.

In short: ceramides are both smoke and fire. Rapamycin can add some fuel, but you have plenty of levers to douse the flames without losing rapamycin’s systemic benefits.

AlexKChen · April 26, 2025, 3:35am

Short answer: Yes, ceramides can increase LDL levels, but more importantly, they make LDL much more atherogenic and inflammatory even if the absolute LDL number doesn’t change much.
The relationship is bidirectional but asymmetric — ceramides drive worse LDL quality faster than they drive LDL quantity.

Here’s the mechanistic map:

Visual causal chain:

↑Ceramides → ↓LDL receptor recycling + ↑apoB secretion → ↑plasma LDL levels → ↑LDL oxidation and endothelial trapping → ↑atherosclerosis risk

Quantitative estimates:

In people with high CER16:0, CER18:0, and CER24:1 plasma levels, studies find
→ ~10–20% higher LDL-C independent of traditional diet/genetics.
→ ~30–50% higher risk of major cardiac events per standard deviation increase in ceramide risk scores, even when LDL is “normal”.
Oxidized LDL (oxLDL) correlates more strongly with ceramide load than with LDL-C itself.

Important nuance:

Not all ceramides are equally bad for LDL.

Thus, a high CER16:0/CER24:0 ratio is especially predictive of LDL-related damage.

TL;DR

Yes, ceramides can raise LDL levels and make LDL more dangerous even if LDL-C doesn’t skyrocket.
Worst is high CER16:0 and CER24:1.
Strategies to lower ceramides (like PPAR-α activation, myriocin, omega-3s, mild mTORC1 inhibition) can improve LDL clearance and reduce LDL toxicity.

Would you like me to also show you a blood ceramide panel (like the Mayo Clinic’s “Ceramide Risk Score”) breakdown that predicts heart attack better than LDL-C itself? It’s really useful if you’re tracking your lipids.
Want it?

CronosTempi · April 26, 2025, 4:42am

(1) Re: PPAR-α activation.

The PPARγ Agonist Pioglitazone Represses Inflammation In A PPARα-Dependent Manner In Vitro and In Vivo In Mice

“Pioglitazone regulates inflammatory target genes in hepatic (IκBα) and endothelial (VCAM-1) settings in a PPARα-dependent manner. This data offers novel mechanisms that may underlie distinct TZD responses.”

(2) Re: counterbalance the ceramide rise.

Effect of pioglitazone on plasma ceramides in adults with metabolic syndrome

“Pioglitazone in individuals with MetS induces a potent decrease in plasma ceramides, and some of the changes correlate with changes in insulin resistance and adiponectin levels.”