Heretic
Compound

Rapamycin

The best animal longevity drug we have. The human data so far are mixed, and a 2026 trial suggests it may blunt exercise gains.

Updated 15 Oct 20265 sources13 min read
Short answer

Rapamycin (sirolimus) is an FDA-approved transplant drug now prescribed off-label at low intermittent doses for longevity. The animal data are the best in geroscience, with 9-30% mouse lifespan extension, but no human trial has shown a lifespan benefit. The two key human trials are PEARL (n=114, safe, modest lean-mass and pain signals in women) and RAPA-EX-01 (n=40, weekly dosing attenuated exercise training gains in sensitivity analyses). The open question has shifted from safety to dosing interval.

Summary drafted from this entry’s sources; editorial review pending.

01Key questions

Does rapamycin slow aging in humans?

Not demonstrated. It extends lifespan in mice by 9-30%, even when started mid-life, and improves surrogate markers like vaccine response in the everolimus trials, but no human trial has shown a lifespan or clear healthspan benefit. PEARL found modest signals only in women; epigenetic clocks were null.

Is rapamycin safe at longevity doses?

Reasonably, in trials: PEARL's 48 weeks of weekly dosing showed balanced adverse events across arms, and one possibly drug-related pneumonia occurred in RAPA-EX-01. The theoretical concern is mTORC2 inhibition causing metabolic dysregulation; LDL and HbA1c did drift slightly upward in the exercise trial.

Does rapamycin interfere with exercise?

Possibly, and this is the big 2026 update: RAPA-EX-01 found weekly sirolimus did not enhance and in sensitivity analyses significantly attenuated chair-stand training gains versus placebo in adults 65-85. The authors propose spacing doses 3-6 weeks apart to alternate mTOR activation and inhibition, an untested fix.

Is rapamycin approved for longevity?

No. It is FDA-approved only for transplant rejection and certain cancers; longevity use is entirely off-label via clinics and telehealth. Compounded versions can under-deliver: PEARL's formulation had roughly a third of commercial bioavailability.3

What would change this rating?

Human outcome trials. Watch VIBRANT (ovarian aging, with an un-peer-reviewed claim of ~20% slowing), the reported IVF trial, the 580-dog TRIAD trial, and any test of the proposed 3-6 week dosing interval.33

02Executive Summary

Rapamycin (sirolimus) is an FDA-approved immunosuppressant now prescribed off-label for longevity at low, intermittent doses (~5–10 mg/week). Human evidence now rests on four pillars: (1) the PEARL trial (48 weeks, weekly compounded rapamycin, relatively safe, lean-mass and pain signals in women); (2) the RAPA-EX-01 trial (April 2026) — the first RCT to combine weekly sirolimus with structured exercise in older adults, which found 6 mg/week did not enhance and in sensitivity analyses attenuated training gains; (3) everolimus immune-remodeling RCTs (Mannick et al.); and (4) the ongoing VIBRANT ovarian-aging and canine TRIAD trials. The central open question has shifted from "is intermittent rapamycin safe?" to "what dosing interval preserves exercise adaptation while retaining geroprotection?" — with RAPA-EX-01's authors now proposing 3–6-week interdose intervals.

03Molecular Mechanism (Summary)

  • Sirolimus is an allosteric inhibitor of mTORC1 (FKBP12 complex); mTORC2 inhibition only after prolonged exposure — the basis for intermittent scheduling.
  • mTORC1 inhibition → reduced S6K1/4E-BP1 signaling → reduced protein synthesis, increased autophagy, reduced senescence-associated secretory phenotype (SASP).
  • Tension: mTORC1 is also the central anabolic driver of muscle hypertrophy; exercise and rapamycin act on the same node in opposite directions. See 11 - Longevity and Anti-Aging/mTOR and AMPK Pathways and 11 - Longevity and Anti-Aging/Autophagy.

04Lifespan Data (Preclinical)

  • Mice: Harrison et al. 2009 — 9–14% lifespan extension; Miller et al. 2011 (J Gerontol A) — rapamycin, but not resveratrol or simvastatin, extends lifespan in heterogeneous mice.
  • Bitto et al. 2016 (eLife 5:e16351): transient midlife treatment increases lifespan and healthspan in mice — key precedent for intermittent human dosing.
  • Partial mTORC1 inhibition reverses sarcopenia in rodents (muscle mass + fiber CSA up, senescence/denervation gene programs down) — cited in RAPA-EX-01 as the optimistic counterweight.
  • A single large rapamycin dose abolishes post-exercise muscle protein synthesis in young men (classic human anabolic-blocking study, ref [7] of RAPA-EX-01).
  • Monkeys: supportive but limited; translational gap remains.

05PEARL Trial (Human, 2025) — Primary Source

Citation: Moel M, et al. Influence of rapamycin on safety and healthspan metrics after one year: PEARL trial results. Aging (Albany NY). 2025 Apr;17(4):908–936. doi 10.18632/aging.206235. PMCID: PMC12074816. PMID 40188830.

  • Decentralized, double-blind RCT (NCT04488601); 48 weeks; n=114 completers (50–85 y); placebo / 5 mg / 10 mg compounded weekly.
  • Safety (primary): AE counts balanced (117/116/122); GI slightly higher; compounded bioavailability ~⅓ of commercial sirolimus (effective under-dosing caveat).
  • Signals: women 10 mg — lean mass ↑ (ηp²=0.202, p=0.013; OR=28 for improvement, p=0.008) and pain ↓ (SF-36, p=0.015); 5 mg — General Health/Emotional Well-being ↑; visceral fat (primary) null; epigenetic clocks (TruAge, n=24) null; minor microbiome shifts.
  • Limitations: small female n, self-reported adherence, health-conscious cohort, formulation under-dosing.

06RAPA-EX-01 (April 2026) — Rapamycin + Exercise RCT ⚠️ Key Update

Citation: Stanfield B, Leroux B, Kaeberlein M, Jones J, Lucas R. Exercise and Weekly Sirolimus (Rapamycin) in Older Adults: RAPA-EX-01 Randomised, Double-Blind, Placebo-Controlled Trial. J Cachexia Sarcopenia Muscle. 2026 Apr 15;17(2):e70274. doi 10.1002/jcsm.70274. PMCID: PMC13082878. PMID 41985884. Registration: ACTRN12624000790549 (protocol published in Trials).

Design: Single-centre (Aotearoa Clinical Trials Trust, Auckland NZ); n=40 sedentary adults 65–85 y (mean 72.2; 47.5% female); 1:1 sirolimus 6 mg once weekly (3×2 mg Rapamune) vs matched placebo × 13 weeks. Both arms did identical home-based exercise 3×/week: chair-stand "density training" + exercycle (10→25 min progressive). Dosing deliberately timed "Day 6" — ~24 h after the final weekly exercise session — a direct test of the hypothesis (alternate mTORC1 activation with inhibition).

Results: - Primary (30-s chair-stand, ITT): adjusted difference −2.13 reps (95% CI −4.61 to 0.34; p=0.089) favoring placebo. - Sensitivity: complete-case −2.46 (p=0.045); per-protocol −3.44 reps (95% CI −5.86 to −0.99; p=0.007). - 6MWD −4.87 m (p=0.706); grip −1.13 kg (p=0.344) — both non-significant, direction favored placebo. - CRP: +4.26 mg/L nominal excess driven entirely by 2 outliers (17 and 50 mg/L); Epigenetic clocks (TruDiagnostics): mixed, non-significant. - Labs (statistically significant, clinically modest): MCV −2.90 fL (p<0.001); platelets +17.6×10⁹/L (p=0.025); ALP +5.56 U/L (p=0.012); LDL +0.32 mmol/L (p=0.036); HbA1c +1.74 mmol/mol (p=0.030). - Safety: 17/20 (85%) per arm with ≥1 AE, but total burden 99 vs 63 events (sirolimus vs placebo); one possibly drug-related SAE (pneumonia).

07Women's Health / Ovarian Aging (VIBRANT + IVF)

  • VIBRANT (NCT05836025; Columbia, PI Zev Williams / Yousin Suh): n=50 healthy women 38–45 with regular cycles, weekly oral rapamycin vs placebo. Primary completion Oct 2025 (actual); study completion est. Sep 2026; CT.gov last updated Dec 2025. Early institutional reporting (Columbia OBGYN 2024 annual report): ovarian aging slowed ~20%, monthly follicle loss ~50→~15 (press-level claim; peer-reviewed publication pending).
  • Mechanistic backdrop: Li J et al. 2025, Cell Reports Medicine 6(11):102424 — ribosome dysregulation in age-related infertility as an mTOR-linked target.
  • A late-2025 IVF RCT in women with prior failed cycles is reported as showing improved reproductive outcomes with short-term mTOR inhibition (secondary-source summary; primary citation to be captured on library update).
  • Converges with PEARL's female-specific lean-mass and pain signals: rapamycin's strongest human signals are currently in women — a differentiation angle for women's-healthspan clinics.

08Canine TRIAD (Dog Aging Project)

  • Urfer et al. 2017 (Geroscience 39:117–127): 24 middle-aged dogs, 10-week low-dose rapamycin — improved cardiac systolic function, good safety.
  • Coleman et al. 2025 (Geroscience 47(3):2851–2877): TRIAD design paper — n=580 target, dogs ≥7 y / 44–120 lb, multicentre, ~3-year, double-masked, placebo-controlled; primary outcomes include survival, mobility, cognition, cancer incidence. Recruiting; no primary results yet.
  • Companion translational read-out for human dosing debates (intermittent schedules in large mammals).

09Uses

Rationale Status
PEARL-tested; S6K1 inhibition ≥5–7 d Most common off-label; RAPA-EX-01 cautions with concurrent training
— Tested — attenuation signal (RAPA-EX-01)
Lower cumulative mTOR suppression; clinical-judgment variant Untested head-to-head
Near-complete clearance; immune/anabolic recovery Proposed by RAPA-EX-01 authors; untested
Continuous immunosuppression Approved indications only

Swipe table →

  • See 11 - Longevity and Anti-Aging/Rapamycin Dosing Protocols for the protocol-level intelligence file.

10Systematic-Review Framing

  • Lee DJW, Kuerec AH, Maier AB. Lancet Healthy Longev 2024;5(2):e152–e162: rapalogs improved immune, cardiovascular, integumentary parameters in healthy older adults — but not endocrine, muscular, or neurological systems.
  • RAPA-EX-01 is now the sharpest data point behind that "not muscular" verdict for concurrent-training users.
  • Off-label use is growing via longevity clinics/telehealth while FDA reviews nothing for an aging indication; malpractice-exposure analysis remains relevant for prescribers.

11Competitive Landscape

  • Vs. senolytics (D+Q, fisetin): senolytics act on cell clearance, not anabolic signaling — no exercise-blunting signal to date; see 01 - Peptides/Senolytic Therapeutics - Evidence and Competitive Landscape.
  • Vs. NAD+ precursors: different mechanism (substrate vs. pathway inhibition); NAD+ market in credibility crisis (01 - Peptides/NAD+ Precursor Market in Crisis - Nature Metabolism 2026).
  • Vs. partial epigenetic reprogramming: earlier-stage, no clinic deployment yet.
  • Complementarity question: whether senolytics + spaced-dose rapamycin can decouple geroprotection from anabolic interference is now the live research program.

12Claims Audit & Regulatory Status

  • Off-label prescribing for longevity: growing, no FDA aging indication, no malpractice case law specific to longevity dosing.
  • Clinics claiming "proven lifespan extension" in humans: unsupported — mouse-only claim; PEARL/RAPA-EX-01 show modest, mixed healthspan signals at best.
  • Compounded formulations (PEARL) can under-deliver ~66% vs commercial sirolimus — a quality/audit angle shared with 01 - Peptides/Peptide Sources and Quality.

13Personalization Angles

  • AgelessRx / Dr. Stefanie Morgan: PEARL co-authors — pitch co-branded clinical translation guide covering RAPA-EX-01 interval implications.
  • Dr. Brad Stanfield: first-author GP with large audience — the every-3–6-week dosing proposal is his current talking track; natural collab target for protocol content.
  • Siim Land: covers mTOR — pitch evidence pack with PEARL + RAPA-EX-01 trade-off framing.
  • Women's healthspan angle: PEARL female signals + VIBRANT + IVF RCT — differentiated content lane with far less competition than generic longevity.
  • Next Next: canine longevity content (TRIAD) — pet-owner crossover audience for biohacking brands.

Primary-source focused; no medical advice. Evidence current as of 2026-08-24.

14Rapamycin: Regimens Studied in Trials

Rapamycin (sirolimus) is the most extensively studied pharmacological longevity intervention in model organisms, with emerging — though still preliminary — human evidence. This file covers dosing paradigms for longevity applications, with emphasis on the critical distinction between transplant/medical doses and the much lower intermittent doses used in the longevity context.


Mechanism: Why Rapamycin Targets Aging

Rapamycin inhibits mTOR (mechanistic Target of Rapamycin), a central nutrient-sensing kinase that exists in two structurally and functionally distinct complexes:

mTORC1 — The Growth/Repair Switch

Property Description
Senses Amino acids (especially leucine), growth factors, ATP, oxygen
Activates Protein synthesis (S6K1, 4E-BP1), lipid synthesis, mitochondrial biogenesis
Inhibits Autophagy, lysosomal biogenesis, stress response genes
When active Cell growth, proliferation — the "anabolic" state
When inhibited Autophagy induction, metabolic reprogramming, longevity-associated gene expression

Swipe table →

Key insight: mTORC1 inhibition shifts cellular physiology from growth/accumulation toward cellular repair and recycling. This shift is central to the longevity effect observed across species.

mTORC2 — Metabolic Regulation

Property Description
Senses Growth factors (insulin, IGF-1)
Functions Insulin signaling, cytoskeletal organization, cell survival
Concern Rapamycin at high doses or chronic use inhibits mTORC2, causing metabolic dysregulation

Swipe table →

The critical therapeutic window: Selective mTORC1 inhibition without significant mTORC2 inhibition is the goal of longevity-oriented dosing. Intermittent, low-dose regimens aim to achieve this selectivity.

The mTOR/AMPK See-Saw

High nutrients / Growth factors → mTORC1 ACTIVE → Protein synthesis, growth
                              ↓
Low nutrients / Energy stress → AMPK ACTIVE → Autophagy, fatty acid oxidation
                              ↓
Both pathways respond to cellular energy status, creating a metabolic rheostat

Rapamycin tips this balance toward AMPK-dominant, autophagy-promoting state.


Animal Data

Species Effect Dose Notes PMID
Mice (multiple strains) 10-30% lifespan extension Various Most robust effect in female C57BL/6J 25908634
Mice (late-life initiation) 9-14% extension when started at 600 days Intermittent Effect persists even when started mid-life 29652921
Dogs (Dog Aging Project) 0.15 mg/kg/week — ongoing Intermittent Lifespan endpoint pending; healthspan markers improved 30820546
Yeast ~50% replicative lifespan extension Low dose Historical first observation —
C. elegans Modest extension Dose-dependent Best with pulsed exposure —

Swipe table →

Human Evidence

Study Population Finding Limitations PMID
PEARL trial (everolimus) Elderly (65+) Increased influenza vaccine response, reduced senescent T cells Small n, surrogate endpoints 31734926
Transplant patients (long-term) Various Increased infection risk, metabolic effects at high doses Not longevity-dosed —
Rapamycin off-label survey Self-selected longevity users Self-reported improvements in pain, fatigue, cognition Significant reporting bias —

Swipe table →

Summary: No RCT has demonstrated lifespan extension in humans. Human evidence is limited to surrogate endpoints (immune function, markers of senescence) and mechanistic plausibility. Proceed with appropriate caution.


Doses in studies

The most influential longevity dosing framework comes from Mikhail Blagosklonny (Roswell Park), who has argued since 2010 that:

  1. Weekly dosing achieves sufficient mTORC1 inhibition while sparing mTORC2
  2. The goal is "young-old" mTORC1 activity — enough to inhibit tumor growth and cellular senescence without the costs of full immunosuppression

Blagosklonny Protocol: - Dose: 5-10 mg once per week (for a 70 kg adult) - Target: ~20-30% of transplant-level immunosuppression - Rationale: Maintains enough mTORC1 inhibition for autophagy induction without impairing mTORC2-dependent insulin signaling - Blood level target: <10 ng/mL (well below the 20-40 ng/mL targeted in transplant patients)

Doses in studies

Kaeberlein's group at the University of Washington, running the Dog Aging Project and related human work, has published the following framework:

Key monitoring: - Fasting lipid panel (rapamycin ↑ triglycerides in some subjects) - Fasting glucose / HbA1c (mTORC2 inhibition → insulin resistance risk) - Complete blood count (immunosuppression monitoring) - Whole blood rapamycin trough level (if available; target <10 ng/mL)

Doses in studies

The Dog Aging Project uses 0.15 mg/kg once weekly, which was selected to: - Achieve meaningful mTORC1 inhibition - Remain below the threshold for immunosuppression - Be practical for owner administration - Show acceptable safety in a 12-month toxicity study in beagles

Uses

Context mTORC1 mTORC2 Immunosuppression
Transplant ++++ +++ Full
Longevity (Blagosklonny) +++ ± Minimal
Longevity (Dog Aging) +++ ± Minimal
Everolimus (PEARL) +++ ± Mild

Swipe table →


Pharmacokinetics

Parameter Value
Half-life 57-62 hours (mean ~60 hours)
Time to steady state 7-14 days (with daily dosing)
Metabolism CYP3A4 (liver), primarily excreted in feces
Bioavailability ~14% (oral solution, fasted); increased with high-fat meal
Peak concentration 1-2 hours after oral dose
Duration of mTORC1 inhibition Pharmacodynamic effect extends well beyond plasma half-life

Swipe table →

Important: mTORC1 inhibition from a single dose persists for several days, meaning weekly dosing maintains continuous (though pulsatile) mTORC1 inhibition.


Approaches Reported in the Literature

Side Effect Management
Mouth ulcers (aphthous) Topical dexamethasone rinse; reduce dose
Triglyceride elevation Omega-3s, dietary modification; monitor
Glucose dysregulation Monitor HbA1c; discontinue if pre-diabetes worsens
Mild immunosuppression Low dose rarely clinically significant
GI upset Studies administered if needed
Skin effects Acne, rash (usually self-limiting)

Swipe table →

Contraindications and Cautions

Situation Concern
Pregnancy Contraindicated — teratogenic in animal models
Active infection May impair immune response
Pre-existing liver disease CYP3A4 metabolism affected
Concurrent CYP3A4 inhibitors Ketoconazole, erythromycin, grapefruit → ↑ rapamycin levels
Concurrent CYP3A4 inducers Rifampin, phenytoin → ↓ rapamycin levels
Patients on warfarin Monitor INR; interaction reported

Swipe table →

Drug Interactions

Interacting Drug Effect
Ketoconazole, itraconazole ↑ rapamycin AUC 4-5x — avoid
Erythromycin, clarithromycin ↑ rapamycin AUC — avoid
Rifampin ↓ rapamycin AUC — avoid
Grapefruit ↑ bioavailability ~30% — avoid
High-fat meal ↑ absorption — keep consistent
Proton pump inhibitors Variable; monitor
Calcium channel blockers Diltiazem, verapamil — ↑ levels; monitor

Swipe table →


Blood Level Monitoring

For longevity use, monitoring rapamycin whole blood trough levels is prudent:

Context Target Trough Level
Longevity (intermittent, low) <10 ng/mL
PEARL trial ~5-8 ng/mL

Swipe table →

Note: Most clinical labs can measure rapamycin/sirolimus levels. Trough levels are most reliable when drawn immediately before the next scheduled dose.


Combination Approaches

Rapamycin is increasingly used in combination with other longevity interventions:

Rapamycin + Metformin

Rationale Mechanism
Complementary mTOR pathways Metformin activates AMPK; rapamycin inhibits mTORC1
Metabolic benefits Metformin mitigates rapamycin's glucose effects
Clinical use Often co-prescribed; both started at low dose

Swipe table →

Rapamycin + Senolytics (Dasatinib + Quercetin)

Rationale Mechanism
Different anti-senescence mechanisms Senolytics kill existing senescent cells; rapamycin prevents their accumulation
Timing Senolytic course (D+Q) 3 days/month + weekly rapamycin
Evidence Preclinical only; combination in TAME trial pending

Swipe table →

Rapamycin + NAD+ Precursors (NMN/NR)

Rationale Mechanism
Autophagy + sirtuin activation Rapamycin induces autophagy; NAD+ precursors support sirtuins
Mitochondrial health Both pathways converge on mitochondrial function
Caveat Competing metabolic effects — theoretical

Swipe table →

Rapamycin + Fasting / FMD

Rationale Mechanism
Synergistic autophagy Both activate autophagy through different pathways
Fasting-mimicking FMD cycles may reduce mTOR between rapamycin doses
Approach Dose rapamycin at end of 24-36 hour fast

Swipe table →


Older Adults (>65)

  • May benefit more from immune-senescence effects
  • Start at lower end of dosing range
  • Monitor for metabolic effects more closely
  • Some sources discuss rapa + flu vaccine combination (everolimus data)

Middle-Aged (40-65)

  • Most common demographic for off-label longevity use
  • Foundation should be lifestyle first (exercise, sleep, nutrition)
  • Some sources discuss rapamycin only after optimizing foundations

Younger Adults (<40)

  • Generally not recommended for longevity purposes
  • May be appropriate for specific conditions (autoimmune, rare diseases)
  • mTOR is essential for development and growth — inhibition theoretically concerning in reproductive-age women

Cancer Patients / Survivors

  • Active cancer: Generally contraindicated — may protect cancer cells
  • Cancer survivors: Discuss with oncologist; some evidence for prevention but timing critical
  • History of pre-malignant conditions: May be appropriate; individual assessment

Diabetes / Metabolic Syndrome

  • Pre-diabetes: Monitor glucose carefully; rapamycin can worsen insulin resistance
  • Type 2 diabetes: Use with extreme caution; metformin co-administration often necessary
  • Metabolic syndrome features: Optimize metabolic health before starting

Notes

  • Human lifespan data: Does not yet exist. All longevity claims are based on preclinical data, mechanistic reasoning, and surrogate endpoints.
  • Off-label use: Rapamycin is FDA-approved for transplant rejection and renal cell carcinoma; longevity use is entirely off-label
  • Compounding pharmacies: Reliable compounding sources exist; verify quality and third-party testing
  • The TAME trial (Targeting Aging with Metformin): While metformin-focused, may establish regulatory pathway for longevity drugs; rapamycin inclusion was discussed but not adopted
  • Bovine vs. rabbit vs. human studies: Much of the mechanistic data is from mice — human responses may differ substantially
  • mTORC2 inhibition concern: The most legitimate safety concern with chronic rapamycin use — metabolic effects may outweigh benefits if mTORC2 is significantly inhibited

Getting Started

  1. Baseline labs: CBC, CMP, fasting glucose, HbA1c, lipid panel, creatinine
  2. Consult a knowledgeable physician: Off-label prescribing requires a doctor willing to monitor
  3. Studies started low: 2-3 mg test dose, assess for GI side effects
  4. Monitor: Repeat labs at 4 weeks, then every 3 months
  5. Hold during illness: Major infection, surgery — immunosuppression concern

Sourcing

  • Rapamune (Pfizer) — FDA-approved, expensive, reliable quality
  • Compounded sirolimus — Significantly cheaper; use reputable 503B pharmacy
  • International pharmacies — Lower cost but verify regulatory status

Contraindications Absolute

  • Pregnancy or plans to become pregnant
  • Active severe infection
  • Known hypersensitivity to rapamycin

Connection to Other Files


What studies and practitioners report

Amounts as reported in the cited sources: trial doses with the population studied, and practitioner-reported ranges marked as such. Not medical advice.

  • Trial 5–10 mg/week · Rapamycin (PEARL) healthy adults 50–85, n=115 PMID 40188830

Further reading: detailed protocols

15Connections

Neighborhood · 8 linked entriesOpen full map →

16Sources

  1. DOI 10.18632/aging.206235DOI 10.18632/aging.206235
  2. Moel M, et al. Aging (Albany NY) 2025;17(4):908–936. PMID 40188830 / PMC12074816 . (PEARL)PMC12074816 · PubMed 40188830
  3. NCT05836025 (VIBRANT; results posting pending); ACTRN12624000790549 (RAPA-EX-01); NCT04488601 (PEARL).NCT04488601 · NCT05836025
  4. DOI 10.1002/jcsm.70274DOI 10.1002/jcsm.70274
  5. Stanfield B, Leroux B, Kaeberlein M, Jones J, Lucas R. J Cachexia Sarcopenia Muscle 2026;17(2):e70274. PMID 41985884 / PMC13082878 . (RAPA-EX-01)PMC13082878 · PubMed 41985884

17Entry history

Latest content update.

Folded in 1 earlier page: rapamycin-regimens-in-research.

Heretic informs and never prescribes. Where amounts appear, they describe what published studies used. Talk to a qualified clinician before acting on anything here.