For the non-medical professionals in the crowd (like myself) who need to look up these things:
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What supplements do you think are particularly worrisome for lead/heavy metal contaminants?
It varies so much and can be in many different supplements. Toxic heavy metals at significantly excessive amounts above the limits are just one of many concerns. I just gave one example that is incredibly easy to discern (and fairly common) without one having to already learn knowledge on the pharma and supplement industry (my dad is an expert at it).
Even generic medications aren’t guaranteed 100% to be completely safe with USP grade although it’s not to the point where it’s as bad as the overall supplement industry - some of these Indian manufacturing options can have excessive levels of carcinogens ie nitrosamines such that there are voluntary recalls or recall with lawsuits for outright systemic fraudulent documentation. Generic Drug Manufacturer Ranbaxy Pleads Guilty and Agrees to Pay $500 Million to Resolve False Claims Allegations, cGMP Violations and False Statements to the FDA | OPA | Department of Justice
So if I’m taking anything long-term, especially if the meds were intended for developing or third-world countries, I am very wary. Even for the ones ending up for the US or other developed countries with slightly better laws, I am wary about anything non-brand name (“authorized generics” can be acceptable) even if the risk is relatively low, and it’s generally not cost-effective to switch from generics to brand name in most situations - the generics side is just based on my low risk tolerance.
Of course, it’s far less common than the issues regarding supplements - unless you figure out how to get insurance to cover the brand name (which I often can - especially for certain psych meds with documentation and pre-auths especially with my “Cadiliac health plan” - @DrM might be able to chime in better as it’s more common in psychiatry to actually happen) it’s probably not worth it in most cases, but it can be for supplements since almost all of them aren’t USP grade or at least close to equivalent.
The FDA barely even has any oversight on international manufacturers and they still do pre-announced inspections (instead of the abandoned surprise inspections done in 2014-2016 partly due the frauds getting so bad, especially starting with the 1984 Hatch-Waman Act which changed incentives towards cutting a lot more corners) with a dearth of staff qualified to do so. When I see enough bogus third party testing reports on the supplement side or especially the wide majority has lack thereof, along with the rates of testing by relatively legitimate enough third-party testers ie ConsumerLab and supplement-induced liver issues far higher than USP grade meds in certain comparable cases - it’s more than enough to be concerned.
You can read about the FDA accountability issues on international generic manufacturers here at a very recent GAO report:
“GAO’s concerns about FDA’s ability to oversee the increasingly global drug supply chain led it to designate the issue as a high-risk area in 2009.”
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To get brand names prescribed, the doctor must be persistent, it takes quite a bit of your and the front office time to respond to every denial that managed care gives. My experience is that they wear down if you keep trying, often you eventually prevail.
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Unfortunately, that is the case for most insurers - the better the stock price the worse they are in general it seems…but I guess the bright side is if one can get the right type of “Cadillac plan” (my SO is an engineer in big tech where it’s easy for them to negotiate on the best possible plans - but it still varies somewhat) as an example - they covered Concerta XR for me easily instead of generic methylphenidate ER. No back and forth - simple pre auth approved - and not just psych meds. I heard a lot of insurance cos make it so hard from my psych for brand name meds - and it’s hard for patients to tell which ones are gonna play hardball.
Btw I’ve tried the generic before a few times blinded (may not have been perfectly blinded on a true standard, since my SO helped me choose a day “pseudo-randomly”) - was such a noticeable difference in effect and duration, multiple times. I think the generics had to drop the bioequivalence claims at some point?
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I have just developed shingles. I also have a suspicion this is from Rapamycin. I took a small break from Rapa (as I ran out), and just recently started up again around 3 weeks ago. Now I have shingles. I have no recollection of getting this except since my childhood. Nothing too serious, I’m not even totally sure it was because of Rapa, just thought it was worth noting.
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The half-moon shape at the base of your fingernail is known as a lunula. Lunulae cover the bottom of your nail, just above
Apparently a common denominator of people who are suffering from long Covid is that they no longer have lunula on their fingers (just their thumbs). I’ve never had Covid and certainly don’t have long Covid, but it gave me occasion to look at my fingers for the first time. And I have none!
It could be a sign of anemia or other issues. I don’t think I have that either. So I wondered if other people taking rapamycin have lunulae?
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Funny… I know that I use to have half moons on my fingernails… now none… not even on my thumbs. All gone.
Does rapamycin cause that? On rapamycin for 2.5 years… or is it something else?
Obviously gone before I caught covid for the first time last month.
Since I trim my nails frequently… I did think since being on Rapamycin…my fingernails and toenails are healthier… great color. They actually might be a bit thinner…upon closer inspection. They seem to grow faster. Trimming… weekly.
What does no lunula means? Link: No half-moon on nails: What does it mean?
And one more reason - you are taking rapamycin.
I have been taking rapamycin for over a year and I have zero lunulae. I really don’t know when they disappeared, but I do remember having them in the past.
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Solutions to canker sores? Yes. Colgate Total (cetylpyridinium Chloride mouthwash).
Rince at night, sore gone by morning. Works every time.
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I have taken rapamycin twice. I do intend taking it next week. I dont know whether my lunulae are changed. You will see i have grooves on my thumbs to measure nail growth.
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Interesting… Please - new adopters of rapamycin, I encourage you to track / check this (take a photo) before starting rapamycin and then again over time - 3 months, 6 months). I have no idea if this is a “thing” with rapamycin.
I just looked and I only have the on the Lunula on my thumbs, not on my fingers at all. I “think” I used to have them on my fingers at some point in the past, but forget when. I’m not the kind of person that looks at my fingernails very often.
I’ve been taking rapamycin for over 3 years now, but I’m currently on a 3 month+ pause due to participation in a clinical trial.
Will track to see if anything changes after I restart rapamycin next month.
I seem to remember Peter Attia commenting at some point that his nails grow more slowly when he’s taking rapamycin. Has anyone else noticed this?
I did find this in the research literature:
mTOR(mammalian target of rapamycin) inhibitors
In view of the role of mTOR signalling downstream of EGFR, MAPK, and PI3K pathway, its side effect profile closely resembles that of EGFR inhibitors and MEK inhibitors which includes nail plate thinning, onychodystrophy, brittle nails, distal onycholysis, diffuse yellow nail discoloration (xanthochromia), and periungual lesions.[49,50] A study has shown incidence of 22% for periungual lesions with mTOR inhibitors.[51]
Source: Nail Changes With Chemotherapeutic Agents and Targeted Therapies - PMC
Interesting… also came across this in the Rapamycin / Sirolimus Side effects:
Incidence not known
- Abnormal wound healing
- headache
- hives or itching
- large, hive-like swelling on the face, eyelids, lips, tongue, throat, hands, legs, feet, or sex organs
5. nails loose or detached - puffiness or swelling of the eyelids or around the eyes, face, lips, or tongue
- swelling of the arms or legs
8. yellow nails lacking a cuticle
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Still have them, though the pinky finger lunula is almost gone.
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This is really fascinating. This generally is not a good sign. Lose of lunula is sometimes associated with disease.
“Some people cannot see a half-moon, or lunula, on the nail while a missing half-moon may suggest a person has a vitamin deficiency or a serious medical condition.”
https://onlinelibrary.wiley.com/doi/full/10.1002/ccr3.3471
“Thorough nails examination should be an integral part of exhaustive physical examination in uremic patients since nail disorders, as absent lunula, can serve as a marker of chronic kidney disease in the absence of more alarming signs.”
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Now that winter is here, I have noticed an odd reaction to rapamycin. On the day I take rapamycin, and maybe 2 or 3 days after, I am easily chilled and have to wear extra clothing indoors to keep myself warm.
I keep my house temperature constant year around. I have ignored it in the past and thought it might be a coincidence.
The last test showed my hemoglobin and hematocrit levels to be low and my doctor put me on an iron supplement to try and raise the levels.
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Similar response here, being cold, at higher doses (3mg+grapefruit), though for me it’s the first day primarily and then it’s gone. (Though I notice a number of side-effects fade with weekly repetition at the same dose, so we’ll see how it goes over time.)
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Hi RapAdmin, I realize this is an old post but would you mind posting a link to Brian Kennedy’s talk? I didn’t realize he had moved on from the Buck Inst.
I agree with you, Sol. It seems I was having more side effects at lower dosages than I am at very high dosages. The only side effect that has continued constantly is the euphoric fatigue. The inability to fall asleep on dosing days is gone too…
I hope the benefits don’t fade as well.
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The one I was originally talking about seems to have been pulled off Youtube or made private… but here is one that seems to cover the same area:
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Thanks for the link! Singapore… wow quite a move!