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Longevity Supplements Under the Microscope · The Science of Skin

• 0:08
  SPEAKER_02: Hello and welcome to the Science of Skin Podcast.
• 0:10
  SPEAKER_02: My name is Dr.
• 0:11
  SPEAKER_02: Ted Lane.
• 0:11
  SPEAKER_02: I'm a board certified dermatologist in Austin, Texas.
• 0:14
  SPEAKER_02: And I've got my partner in crime, Dr.
• 0:16
  SPEAKER_02: Patty Ferris out of New Orleans.
• 0:18
  SPEAKER_02: How you doing, Patty?
• 0:19
  SPEAKER_00: I'm good.
• 0:20
  SPEAKER_00: How are you doing today?
• 0:21
  SPEAKER_02: Great.
• 0:22
  SPEAKER_02: Uh and you know, listen, we're gonna talk about longevity a bit today.
• 0:26
  SPEAKER_02: Some of the most common questions that we get regarding supplements and off-label uses of medications.
• 0:32
  SPEAKER_02: But before we begin, I just want to remind everybody if you have questions after today's episode, if you have thoughts on new episode topics, give us a shout.
• 0:42
  SPEAKER_02: Send us an email at questions at science of skinsummit.com.
• 0:46
  SPEAKER_02: That's questions at science of skinsummit.com.
• 0:49
  SPEAKER_02: And for all of you listening, thank you for your support.
• 0:52
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• 0:54
  SPEAKER_02: Subscribe.
• 0:55
  SPEAKER_02: And we found that the growth of this podcast really occurs by word of mouth.
• 0:59
  SPEAKER_02: So please tell your friends, your professional colleagues about what we're trying to do here at the Science of Skin podcast.
• 1:06
  SPEAKER_02: We certainly appreciate your support.
• 1:08
  SPEAKER_02: But Patty, let's jump into it.
• 1:11
  SPEAKER_02: Longevity certainly is such a hot topic.
• 1:14
  SPEAKER_02: We're building a whole meeting around skin longevity.
• 1:17
  SPEAKER_02: But you know, even though we're trying to focus on the skin, you can't take skin longevity in a silo, right?
• 1:22
  SPEAKER_02: The skin is a reflection of what's happening internally and or it affects what's happening internally.
• 1:27
  SPEAKER_02: Absolutely.
• 1:28
  SPEAKER_02: So I think it's a good idea for us, Patty, just to jump into some of the more common, you know, supplements, medications, those kinds of things that people take because there's so much misinformation out there.
• 1:38
  SPEAKER_00: Unbelievable amount of misinformation.
• 1:41
  SPEAKER_00: And people take these things, they take a leap of faith where there's really very little data to support some of them.
• 1:48
  SPEAKER_00: I think the first thing maybe to say, Ted, is you know, the average lifespan in the U.S.
• 1:53
  SPEAKER_00: is just under 80.
• 1:54
  SPEAKER_00: So that's not too bad a run.
• 1:57
  SPEAKER_00: But your average health span is only 67 years.
• 2:00
  SPEAKER_00: So there's like a 13, almost a 13-year gap between when you start being sick and when you die.
• 2:07
  SPEAKER_00: And so this whole movement of longevity, I look at it as we're not just trying to make people live longer.
• 2:13
  SPEAKER_00: We want them to live better and live healthier and have that health span get way closer to our US average lifespan.
• 2:21
  SPEAKER_00: And I think you and I both know, and almost every physician out there would agree with us, that exercise and diet are really the key to longevity and health.
• 2:30
  SPEAKER_00: But people want shortcuts and they want, in addition to, even if they're doing the good lifestyle, you know, modifications, eating healthy and doing that exercise that we know is so important, they do want additional boosts.
• 2:43
  SPEAKER_00: And this is where supplements come in.
• 2:45
  SPEAKER_00: And I think during the COVID epidemic, supplements got wildly popular because people were scared and they were trying to protect themselves and they were taking all kinds of things, and probably you and I included.
• 2:57
  SPEAKER_01: Yeah.
• 2:58
  SPEAKER_00: Everybody got jumped on the bandwagon.
• 3:00
  SPEAKER_00: But that's when supplement use really went up.
• 3:03
  SPEAKER_00: And I mean, tell me what, like, what are you hearing about in your practice uh in terms of supplements?
• 3:08
  SPEAKER_02: Yeah, I mean, everybody has it's it's amazing to me for inflammatory diseases, including acne and rosacea, how much people are now turning to how do I treat this naturally?
• 3:20
  SPEAKER_02: How do I kind of go at this from the inside out?
• 3:23
  SPEAKER_02: You know, tell me about zinc, tell me about biotin, um, tell me about niacinami.
• 3:29
  SPEAKER_02: It's it's really amazing that that people are now starting to think about how to treat inflammation using nature uh instead of medicinal purposes, medicinal opportunities, and and I which is not there's nothing wrong with that.
• 3:43
  SPEAKER_02: My goodness, T traditional Chinese medicine has been all about that for thousands and thousands of years, so we know that there's something to it.
• 3:51
  SPEAKER_02: It's just uh I get a little bit worried when people rely only on that because we have such great opportunities from the pharmaceutical industry to treat inflammation as well.
• 4:01
  SPEAKER_00: Well, I think you hit on one that's wildly popular, and that's the NAD supplements, the precursor molecules, of which niacinamide is one of them that we in dermatology actually do use for the prevention of non-melanoma skin cancer.
• 4:16
  SPEAKER_00: But I think when it comes to looking at it for the longevity space, it get the data gets a little soft.
• 4:24
  SPEAKER_00: And the first thing is that there was a very recent study in the last few weeks that came out that showed that older patients don't even have low NAD levels.
• 4:32
  SPEAKER_00: And this has been debated before.
• 4:34
  SPEAKER_00: So the whole premise of taking it is gee, I must need more NAD because I've got to make more ATP and have more energies, and my mitochondria will function better.
• 4:43
  SPEAKER_00: But it's even controversial whether we need more NAD.
• 4:47
  SPEAKER_00: Now we know that exercise boosts NAD, right?
• 4:50
  SPEAKER_00: And you can get NAD from your diet.
• 4:52
  SPEAKER_00: Um, but people want to take NAD supplements, so they go to niacinamide or NMN, or they go to nicotinamide ribicide.
• 5:01
  SPEAKER_01: NR.
• 5:02
  SPEAKER_00: And yeah, NR.
• 5:04
  SPEAKER_00: And the data again gets a little bit soft on these.
• 5:07
  SPEAKER_00: We know that these are converted to NAD, so there's no question about the pharmacokinetics of these supplements, but do they really affect your biology?
• 5:17
  SPEAKER_00: Do they affect mitochondrial function?
• 5:19
  SPEAKER_00: Do they really make a difference?
• 5:21
  SPEAKER_00: And when we look at some of the systematic reviews and meta-analyses, there was one of nicotinamide ribicide.
• 5:27
  SPEAKER_00: It was 25 randomized human crop controlled human trials, not all controlled trials, because most of these supplement studies, by the way, are not controlled.
• 5:36
  SPEAKER_00: That's problem number one.
• 5:38
  SPEAKER_00: But even looking at the randomized trials that are available, 25 of them, the authors of this systematic review basically said that they think collectively oral nicotinamide ribicide supplement really displayed few clinically relevant effects, and that we really shouldn't promote it for longevity and for health benefits, at least at this point in time.
• 6:01
  SPEAKER_00: They also, you know, state that it has been used to treat certain disease states, and we know in dermatology that we have used them in disease states, inflammatory diseases.
• 6:13
  SPEAKER_00: But the data is just very soft when it comes to just general health benefits.
• 6:18
  SPEAKER_00: And the same is true of another larger systematic review on all the NAD supplements.
• 6:23
  SPEAKER_00: They looked at NR and NMN, and this was 28 randomized controlled trials.
• 6:28
  SPEAKER_00: And it was kind of an interesting study, Ted, because they actually looked at animal studies.
• 6:32
  SPEAKER_00: So they looked at the early studies, the animal studies, and then they kind of looked again at a certain cohort, 33 human studies, and they sort of found the same thing that the last paper found.
• 6:45
  SPEAKER_00: Basically, there was a huge gap between what happened in the animals and what happened in the human clinical trials.
• 6:51
  SPEAKER_00: And the human clinical trials didn't show very many benefits, and it wasn't consistent.
• 6:57
  SPEAKER_00: So this is the problem.
• 6:58
  SPEAKER_00: You have lots of people studying these things.
• 7:01
  SPEAKER_00: We're probably not doing long enough studies, quite frankly.
• 7:04
  SPEAKER_00: We're not doing scientifically rigorous enough studies on these things.
• 7:08
  SPEAKER_00: And so I think that as physicians, we have to sort of couch these maybe as adjunct therapies to lifestyle modifications and things like that, so that people don't we don't overpromise and underdeliver, let's put it that way.
• 7:24
  SPEAKER_02: You know, it was that that uh NAD study that you were referring to.
• 7:27
  SPEAKER_02: There was a New York Times article that kind of editorialized it.
• 7:31
  SPEAKER_02: And uh I always love reading the readers' comments uh uh from those kinds of articles because it was so interesting.
• 7:38
  SPEAKER_02: It was such a split between some people who would be like, you idiots, don't take anything, just exercise to follow a good diet.
• 7:44
  SPEAKER_02: I've been doing that for 50 years, and I, you know, and I'm healthy and I'm 90.
• 7:48
  SPEAKER_02: Exactly.
• 7:49
  SPEAKER_02: And then there's the other ones who are like, don't call me an idiot.
• 7:51
  SPEAKER_02: I'm 90 years old, I've been taking NMN for 20 years, and I could have never felt better.
• 7:56
  SPEAKER_02: And so there's such this anecdotal bias that people have.
• 7:59
  SPEAKER_02: So true.
• 8:00
  SPEAKER_02: Um that that we it's just really hard to to uh overcome from the medical establishment because you've got these true believers in these supplements, and whether or not there's data at the population or at a large study level doesn't really matter to them.
• 8:16
  SPEAKER_02: It's how they feel when they take it, which maybe is all that's really necessary, you know.
• 8:21
  SPEAKER_02: But it it's from someone looking at it who, you know, we're trying to decide whether we recommend this to our patients or not, it's really difficult to translate this animal data to humans because it just more often than not does not translate.
• 8:35
  SPEAKER_02: Mouse data just so often does not translate.
• 8:38
  SPEAKER_02: Mice die of cancer at a much higher rate than humans.
• 8:42
  SPEAKER_02: Their genetic instability is just much higher than humans.
• 8:45
  SPEAKER_02: And so we often see a response in mice that doesn't translate to humans.
• 8:51
  SPEAKER_02: So just be really careful when you're trying to take something based on animal data.
• 8:58
  SPEAKER_02: And that's pretty much why we're trying to do this science of skin longevity summit is to focus on the inhuman data and what is available to us right now and what we can through evidence-based medicine incorporate into our practices because you know there is some and we really need to focus on that.
• 9:15
  SPEAKER_00: Yeah, there there is some data.
• 9:16
  SPEAKER_00: I mean, you we talk about IVNAD.
• 9:20
  SPEAKER_00: A lot of people are taking IVNAD, the med spots are you know using it like crazy, but again, no good data in humans, no controlled trial whatsoever.
• 9:30
  SPEAKER_02: So you know, yeah, and I was just thinking, Patty, there there is another supplement, Urolythan A, that we should talk about because that actually, in my view, does have some pretty good inhuman trials and supports its use.
• 9:44
  SPEAKER_00: Um, it's interesting, Ted, because we'd see we saw it at the AAD, right?
• 9:49
  SPEAKER_00: It's going in the skin care.
• 9:50
  SPEAKER_02: Yeah, we did.
• 9:51
  SPEAKER_00: Urolithin A.
• 9:53
  SPEAKER_00: It's so interesting.
• 9:54
  SPEAKER_00: So urolithin A is an interesting molecule because it's actually like a postbiotic.
• 9:59
  SPEAKER_00: It's a metabolite that is produced by gut bacteria when you eat certain fruits, like pomegranate.
• 10:06
  SPEAKER_00: There's uh polyphenols called elagitanins, and they get broken down by the gut bacteria and release this compound urolithin A.
• 10:14
  SPEAKER_00: And it's a very potent compound.
• 10:16
  SPEAKER_00: It affects mitochondrial function, induces mitopagy, improves mitochondrial function, also acts as a really good anti-inflammatory.
• 10:24
  SPEAKER_00: And clinical trials have shown that it helps with muscular function and exercise in older patients.
• 10:30
  SPEAKER_00: So there was a systematic review meta-analysis on urolithin A, and they looked at five randomized controlled trials, and it encompassed 250 subjects, so it's a pretty big cohort of patients.
• 10:41
  SPEAKER_00: But they were short studies, like some of the studies are 28 days, some of the studies are four months.
• 10:45
  SPEAKER_00: And if you look at the dosing TED, it goes from 10 milligrams to a thousand milligrams.
• 10:50
  SPEAKER_00: So, how many milligrams are you supposed to take?
• 10:53
  SPEAKER_00: I think 500 is the sweet spot, but I don't actually really know.
• 10:57
  SPEAKER_00: So, what they basically found here was that there was a good anti-inflammatory effect.
• 11:02
  SPEAKER_00: So they confirmed that uh through this meta-analysis.
• 11:05
  SPEAKER_00: It did upregulate some of the mitochondrial genes and markers of autophagy, and it did not, interestingly enough, seem to affect mitochondrial ATP production.
• 11:15
  SPEAKER_00: So, you know, again, there's these conflicting sides to these things.
• 11:20
  SPEAKER_00: Nonetheless, this particular supplement's getting very popular, and we're seeing it, as I mentioned, coming into topical skincare products where it's being positioned kind of as a longevity ingredient.
• 11:32
  SPEAKER_02: Yeah.
• 11:34
  SPEAKER_02: We should probably say that a lot of those studies, and and as I mentioned, I do take your lithin A supplements, but but the studies were industry funded for the large to a large extent.
• 11:44
  SPEAKER_00: I think four of the five in the meta-analysis were funded by industry.
• 11:47
  SPEAKER_02: Yeah.
• 11:48
  SPEAKER_00: And again, I want to say this just because it's an industry study doesn't mean it's a disingenuous study.
• 11:53
  SPEAKER_00: I mean, we have to pay attention to that, but look at all the pharma studies, they're all industry-sponsored studies.
• 11:59
  SPEAKER_00: So we can't throw every study out of the bus on the bus, you know.
• 12:03
  SPEAKER_02: No, we can't.
• 12:03
  SPEAKER_00: I I I run a lot of those studies and I can tell you, even though it's industry funded, we yeah, because industry has a vested interest in testing things, and supplement companies have a vested interest in testing their supplements.
• 12:14
  SPEAKER_01: Right.
• 12:15
  SPEAKER_00: So I mean, we have the same thing.
• 12:17
  SPEAKER_00: Well, you I know you take urolithin A, but are you on the creatine train like me?
• 12:21
  SPEAKER_01: I am.
• 12:22
  SPEAKER_01: Yep, we both are.
• 12:23
  SPEAKER_01: We're on the creatine train.
• 12:24
  SPEAKER_01: Yeah.
• 12:25
  SPEAKER_01: How much do you take?
• 12:26
  SPEAKER_00: I take 10 milligrams because I keep thinking my, you know, I'm a little bit senior to many of our colleagues, and I feel like for my brain health, and I would love to prevent neurodegenerative diseases.
• 12:38
  SPEAKER_00: So I take 10 a day, 10 grams a day.
• 12:41
  SPEAKER_00: Is that a lot?
• 12:42
  SPEAKER_02: No, no, I think that's probably the top end from what I understand.
• 12:45
  SPEAKER_02: Um, I haven't done a lot of my own personal research into creatine.
• 12:49
  SPEAKER_02: So I take five to ten milligrams.
• 12:51
  SPEAKER_02: Um, you gotta drink a lot of water with it.
• 12:53
  SPEAKER_02: Um, and so sometimes, depending on how much I'm working that day.
• 12:58
  SPEAKER_02: Um, you get dehydrated.
• 13:01
  SPEAKER_02: Yeah, you gotta be careful there.
• 13:02
  SPEAKER_02: But um, yeah, creatine is is an interesting addition, been around forever.
• 13:06
  SPEAKER_02: We know that our our teenage boys love taking creatine with the protein powder.
• 13:11
  SPEAKER_00: They do, they do.
• 13:12
  SPEAKER_00: Uh it's it's wildly popular.
• 13:16
  SPEAKER_00: And I did, when I was researching it, found a very interesting positioning paper that came from the International Society of Sports Nutrition.
• 13:24
  SPEAKER_00: You may remember it because I quoted it in my American Academy of Dermatology talk.
• 13:29
  SPEAKER_00: And they really go through the benefits of creatine in in athletes and in even in kids who are playing sports.
• 13:36
  SPEAKER_00: And it really does seem to reduce muscle damage, it helps you recover from muscular injury, um, it helps with cramping and dehydration.
• 13:45
  SPEAKER_00: It may even be preventative for things like concussion and traumatic brain injury, which is so important, especially in young kids playing sports and professional athletes as well.
• 13:56
  SPEAKER_00: And they looked at a long-term, a group of um athletes who took it long-term, like I think it was about 21 months, and they didn't see any changes in kidney function, liver function, muscle markers, electrolytes, lipids, urinalysis, anything.
• 14:12
  SPEAKER_00: So that was sort of reassuring because I think a lot of people are concerned about the creatine-creatinine connection.
• 14:18
  SPEAKER_00: And I mean, I don't think you would give it to a patient who had kidney failure or any problems like that, but in a healthy cohort like they looked at here, it didn't seem to affect kidney function at all.
• 14:29
  SPEAKER_02: Yeah.
• 14:30
  SPEAKER_02: So this is a good study.
• 14:31
  SPEAKER_02: Yeah, tell us about the multivitamin study, Patty, because I thought that was so interesting.
• 14:35
  SPEAKER_02: Oh my gosh.
• 14:36
  SPEAKER_00: That was interesting.
• 14:37
  SPEAKER_00: And I, you know, Ted, I had heard about that online.
• 14:39
  SPEAKER_00: I kept seeing all these, you know, influencers talking about you need to take up Centrum Silver because of this Cosmos study.
• 14:47
  SPEAKER_00: So I went and pulled the Cosmos study, and it was a large randomized controlled trial of 2200, over 2,200 patients.
• 14:54
  SPEAKER_00: And they were either given cocoa or a multivitamin or a placebo, or there was a cohort that had got both the cocoa and the multivitamin.
• 15:04
  SPEAKER_00: But in the end, what they really found out was that the cocoa supplement did not probably produce any additional benefits.
• 15:12
  SPEAKER_00: And the multivitamin showed some modest significant improvement in cognitive function.
• 15:18
  SPEAKER_00: And this was after three years, so it may have benefits for that.
• 15:23
  SPEAKER_00: But when you look at the data where they were all talking about it's going to make you live longer after patients took it for two years, and this is a Centrum Silver Vitamin, they tested, Ted, five of the epigenetic clocks.
• 15:37
  SPEAKER_00: And you and I talk about these clocks all the time.
• 15:39
  SPEAKER_00: I you understand them far better than I do.
• 15:42
  SPEAKER_00: So you can explain those in a second.
• 15:44
  SPEAKER_00: But when they looked at five of these clocks, only two of them showed very modest slowing in their epigenetic aging based on two of the five clocks.
• 15:53
  SPEAKER_00: So I'm not sure why everybody was jumping up and down saying it's going to make you they were saying, making claims like you're two years younger or two.
• 16:02
  SPEAKER_00: There was a number they actually put to it.
• 16:05
  SPEAKER_00: But it seemed like a sort of an erroneous conclusion based on the fact that three of the five clocks didn't show any improvement at all.
• 16:12
  SPEAKER_00: Yeah.
• 16:13
  SPEAKER_00: Certainly not saying multivitamins are bad for you, but I don't I think they may be good for cognition in older patients, but I'm not sure they're gonna turn the clock, you know, I'm not sure they're the fountain of youth, as they've been touted on TikTok in the last six months.
• 16:27
  SPEAKER_02: Yeah, and and I uh I have kind of conflicting thoughts about multivitamins because as we've as I'm learning more and more about this precision medicine idea and and kind of fixing micronutrient deficiencies.
• 16:40
  SPEAKER_02: And you and I just read a paper about how precision medicine in patients with with early stage dementia was much more effective in delaying and or reversing the dementia than standard of care and those um drugs that are currently in development where there are published results.
• 16:58
  SPEAKER_02: And so you think, wow, precision medicine, there may be something to that that we haven't really taken advantage of.
• 17:03
  SPEAKER_02: Aren't we essentially fixing some micronutrient deficiencies with multivitamins?
• 17:08
  SPEAKER_02: And therefore, that kind of correlates with what we saw in the Cosmos trial, as you mentioned.
• 17:12
  SPEAKER_02: Now, regarding the epigenetic data, you know, it's it's essentially looking at methylation patterns on the epigenome and assess assessing those and how they correlate with with biologic versus chronological age.
• 17:25
  SPEAKER_02: Uh and there's multiple generations of epigenetic clocks.
• 17:28
  SPEAKER_02: The latest generation tend to be a little bit more rigorous and robust.
• 17:32
  SPEAKER_02: They take advantage of multiple tissue types.
• 17:34
  SPEAKER_02: And we found that multiple tissue types within an epigenetic clock makes it a much more robust um mechanism to allow us to understand the biological age.
• 17:46
  SPEAKER_02: Um so I I would have to look back and see which epigenetic clocks they were looking at and and whether if we started to use some of these next generation, if it would show a little bit more difference.
• 17:55
  SPEAKER_02: But you're right.
• 17:56
  SPEAKER_02: And then you've got all these proprietary epigenetic clocks as well.
• 17:59
  SPEAKER_00: And so companies are coming up with their own clocks.
• 18:02
  SPEAKER_00: You know, I think you make a really good point that needs to be maybe said again.
• 18:08
  SPEAKER_00: Most of the studies on antioxidant supplements, I'm thinking of the Suvamax study, which was a huge study they conducted in France, where they were looking at supplements that had multivitamins and minerals and antioxidants.
• 18:20
  SPEAKER_00: What they found was that if you have baseline normal levels, like you're eating well, they don't really help you.
• 18:27
  SPEAKER_00: So your comment is very poignant.
• 18:29
  SPEAKER_00: If you have micronutrient deficiencies, then taking a multivitamin or a supplement will help.
• 18:35
  SPEAKER_00: And so that really speaks, I think, also to precision medicine.
• 18:39
  SPEAKER_00: You know, like it's just not, you know, we don't want to throw throw everything on the wall and see what sticks.
• 18:46
  SPEAKER_00: Maybe we're not testing enough.
• 18:48
  SPEAKER_00: Maybe we're not doing enough evaluation of patients before we start giving them certain things.
• 18:55
  SPEAKER_00: And, you know, we know because we test like a lot of vitamin D.
• 18:58
  SPEAKER_00: And we, you know, we do test a lot of things in dermatology, especially in our hair loss patients, is when I see us, you know, really looking and taking a deep dive under the hood and then supplementing back the things they need makes a huge difference.
• 19:12
  SPEAKER_02: Absolutely.
• 19:13
  SPEAKER_02: And perhaps the the normal range that we have from our labs is actually not the normal range for everyone.
• 19:19
  SPEAKER_02: And I think that's a whole nother part of individualized medicine that we need to think about.
• 19:23
  SPEAKER_02: Um, and and perhaps, you know, the more I've learned about precision medicine, the more I thought about neutrophil really.
• 19:29
  SPEAKER_02: And thought maybe this is how neutrophil is really working um by fixing these micronutrient deficiencies and and allowing our body to perform it's most efficient um for the the state that we're in.
• 19:42
  SPEAKER_02: I don't know, it's just a thought that came to mind recently as I was talking to a patient about all this, um and and why she wasn't responding to monoxyl, which we know 20 to 30 percent of patients don't, you know, why neutrophil is is also a good idea to take with monoxyl, in my view.
• 19:57
  SPEAKER_00: Uh well it it was the the the uh basis of how it was formulated was looking at the various micronutrients that were common in that patient population.
• 20:08
  SPEAKER_00: And so, you know, but again, it it it works like a charm for some.
• 20:14
  SPEAKER_00: There's no question about it.
• 20:16
  SPEAKER_00: You know, there's there's a huge cohort of patients who do very well on supplements.
• 20:21
  SPEAKER_00: And it also has other things in it, as you know, besides micronutrients that could benefit like soft palmetto, which is anti-androgen and ashwagandha and curcumin, you know, lots of antioxidants, took off or all, things like that.
• 20:36
  SPEAKER_00: So it's really it's a multivitamin type of platform for sure.
• 20:40
  SPEAKER_00: Right.
• 20:41
  SPEAKER_00: Yeah, super interesting.
• 20:43
  SPEAKER_00: I think we should finish up with rapamycin because take it away because you are the rapamycin king.
• 20:51
  unknown: Yeah, really.
• 20:51
  SPEAKER_02: Tell the truth.
• 20:52
  SPEAKER_00: Are you on rapamycin?
• 20:53
  SPEAKER_02: No, I am not.
• 20:54
  SPEAKER_00: Okay.
• 20:55
  SPEAKER_02: I'm not, but I'm this close.
• 20:58
  SPEAKER_02: Rapamycin is, you know, affects mTOR, uh, nutrient dysregulation and nutrient sensing.
• 21:04
  SPEAKER_02: Uh it's it's meant to increase autophagy and uh otherwise uh help our mitochondria as well.
• 21:12
  SPEAKER_02: So many benefits of possible theoretical benefits of affecting the mTOR pathway with rapamycin or or tac, you know, tacrolimus or everolimus, for example.
• 21:22
  SPEAKER_02: Um there are some studies, you know.
• 21:25
  SPEAKER_02: There's um certainly in in primates, there's some studies, in mice, there's some studies.
• 21:30
  SPEAKER_02: Um there was a essentially a questionnaire that was put out to patients who are on weekly or or off-label use of rapamycin for longevity purposes, and they tried to match that with a an age match control population.
• 21:44
  SPEAKER_02: So I think it was something like two or three hundred rapamycin users and one or two hundred age match controls.
• 21:51
  SPEAKER_02: Didn't seem to be any increase in adverse events with the rapamycin, except for oral ulcers, which is interesting, and and there's some Thought that if you are experiencing oral ulcers, you may actually be at a therapeutic kind of at the dose that you want to be.
• 22:07
  SPEAKER_02: So it's it's somewhat of a tell.
• 22:09
  SPEAKER_00: Sweet for you get ulcers when you get there.
• 22:12
  SPEAKER_00: Oh, yeah.
• 22:13
  SPEAKER_02: Although it only happens in about 15% of patients, so not everybody experience that.
• 22:17
  SPEAKER_02: I think the most common dose that people are using is between five and ten milligrams.
• 22:22
  SPEAKER_02: And I think that now there's a relative consensus consensus that once a week or once every two weeks is probably the way to go.
• 22:30
  SPEAKER_02: Um but very little human data on this, very, very little human data.
• 22:35
  SPEAKER_02: There, I think there's one uh 52-week trial in a couple of hundred patients, and and it didn't show much.
• 22:44
  SPEAKER_02: I think in woman at the lower dose, I think which was five milligrams once a week, the woman had uh a little bit better bone density, I think it was, maybe less visceral fat with on the rapamycin, but in the overall cohort and all of the patients, I'm not sure it showed that much.
• 23:01
  SPEAKER_02: Um, and again, that was at the five.
• 23:03
  SPEAKER_02: Now, this study was a little bit uh it wasn't biased, but it was limited by the fact that they were using a compounded rapamycin, which they found to have very low bioavailability.
• 23:15
  SPEAKER_02: And so their 10 milligram dose was actually three milligrams in terms of bio.
• 23:19
  SPEAKER_00: Why did they do that?
• 23:20
  SPEAKER_00: I wonder.
• 23:21
  SPEAKER_02: They they realized it later.
• 23:22
  SPEAKER_02: They just didn't know that.
• 23:24
  SPEAKER_02: They were trying to do an A placebo match, and therefore they had to they had to um compound it.
• 23:29
  SPEAKER_02: Um so anyway, it was limited, right?
• 23:32
  SPEAKER_02: Uh and so I think that the data is yet to be uh published on on a true kind of unrestrained uh rapamycin study, you know, weekly or every two-week dosing in in humans.
• 23:46
  SPEAKER_02: Um safety seems like, again, as I said, there seems to be no problem with safety in that study.
• 23:52
  SPEAKER_02: There wasn't any lab abnormalities that were clinically significant, no AEs that that popped out in the rapamycin versus placebo group.
• 23:59
  SPEAKER_02: So overall, it looks to be pretty darn safe.
• 24:02
  SPEAKER_02: Although, my goodness, if you're getting ulcers in your mouth, where else are you getting ulcers, right?
• 24:06
  SPEAKER_02: Rapidly proliferating epithelium, you think maybe in your GI tract as well, which was a little bit scary to me.
• 24:12
  SPEAKER_02: But um, yeah, it's it's again TBD on the rapamycin invite.
• 24:18
  SPEAKER_00: So so everything we've talked about is kind of TBD.
• 24:21
  SPEAKER_02: Yeah, and that's the problem with longevity, isn't it?
• 24:24
  SPEAKER_02: But what we're gonna do at the summit is get past the TBD and get to the real science.
• 24:28
  SPEAKER_02: So that's the Sciences Game Longevity Summit taking place February 19th through the 21st in Scottsdale, Arizona, next year, 2027.
• 24:36
  SPEAKER_02: If you'd like any information, go to our website, sciencesskinsummit.com.
• 24:40
  SPEAKER_02: You'll see the longevity tab on the on the top menu bar, and you can uh put some your your interest in attending in there, and we'll get back to you.
• 24:49
  SPEAKER_02: We're limiting attendance to 200 dermatologists here.
• 24:52
  SPEAKER_02: Uh so you know, please, if you're interested in attending, we'd love to have you as part of this group.
• 24:57
  SPEAKER_02: There's gonna be a diverse faculty.
• 25:00
  SPEAKER_02: Uh non-derms are gonna be the predominance of our faculty, scientists, psychiatrists, you you name it.
• 25:06
  SPEAKER_00: You're you're gonna see medicine docs.
• 25:08
  SPEAKER_02: Oh, yeah.
• 25:08
  SPEAKER_02: And these are true experts in their field.
• 25:11
  SPEAKER_02: So if you want to learn the one-on-one on longevity as it pertains to the skin, this is a great place.
• 25:16
  SPEAKER_02: But if you want to be a part of the dialogue and help us understand what longevity means for the skin and define it, we need you there.
• 25:22
  SPEAKER_02: So scientists and skinsummit.com is a place to find out more about it.
• 25:26
  SPEAKER_02: Uh, thank you so much for listening.
• 25:27
  SPEAKER_02: I'm Dr.
• 25:28
  SPEAKER_02: Ted Lane out of Austin, Texas, and I've got Dr.
• 25:30
  SPEAKER_02: Patty Ferris, my partner out of uh New Orleans usually, but now in Sag Harbor.
• 25:35
  SPEAKER_02: I I I think you're kind of a Hamptons girl now, huh?
• 25:37
  SPEAKER_00: I kind of a Hamptons girl.
• 25:40
  SPEAKER_00: You're right.
• 25:41
  SPEAKER_00: It's the back of a 99 degrees in New Orleans right now, and I'm it's lovely here.
• 25:46
  SPEAKER_00: So it's all about the cool weather.
• 25:48
  SPEAKER_02: There you go, love it.
• 25:49
  SPEAKER_02: Thank you so much for listening, everybody.