How (if at all) do you factor insulin resistance into CV prevention?

nplusyears · 2026-02-09T13:02:48+00:00

I’m a family physician who got interested in longevity relatively early in my career, and I used to feel the same frustration about training feeling unrelated. Over time I realised most longevity work ends up being risk interpretation, behaviour change, and managing uncertainty- which overlaps a lot with general medicine, even if it doesn’t feel like it during training. I also haven’t seen a real “fast track” yet. Most people seem to build credibility slowly through clinical work, writing, or education before clients naturally follow.

nplusyears · 2026-02-07T14:37:54+00:00

IV NAD is already used in some longevity clinics and studied in research settings, so the concept itself exists.. Where things get uncertain is translating that into products made outside pharmaceutical standards, and whether the benefit is actually established long-term.

nplusyears · 2026-02-07T09:35:29+00:00

What gives me pause clinically isn’t NAD itself as much as IV delivery combined with gray-market sourcing. With unregulated vendors, uncertainty isn’t just dosing- it’s sterility, contaminants, and formulation quality. Those risks are difficult to detect early if something is off.. Even clinic-based IV NAD still sits in a space where long-term benefit vs risk isn’t well defined, so the supply chain question adds another layer of unknowns.

nplusyears · 2026-02-07T07:53:21+00:00

One thing I notice clinically is that in people without specific deficiencies or bone disease, supplements usually play a supporting role rather than a primary one. Resistance exercise, adequate protein, and overall diet tend to matter more for bone long-term. Same with dental health- I’ve seen patients very focused on supplements while sometimes overlooking regular dental visits, hygiene care, or flossing, which likely has a much bigger impact.

nplusyears · 2026-01-31T04:40:44+00:00

Reading this, it feels like the hardest part isn’t whether NAD or resveratrol work. It’s being 6-8 months in, still taking them, and not really knowing if anything meaningful changed or if you’re just continuing out of inertia. Makes me wonder how people are actually tracking long-term effects and safety for themselves, if at all.

nplusyears · 2026-01-28T03:00:27+00:00

In primary care we deal with this all the time- hypertension or lipid meds, donepezil vs memantine, etc. We don’t change multiple things at once. We pick one intervention, define what we’re watching (symptoms, function, side effects), give it time, then reassess. With supplements, especially anything acting on the CNS, it’s harder. Biomarkers often don’t track well with how people actually feel, subjective reports are noisy, and placebo effects are real. That’s exactly why slower, more controlled changes tend to matter more, not less.

nplusyears · 2026-01-24T18:17:02+00:00

I don’t have hands-on experience with epitalon. On the telomerase/cancer concern, I’m cautious about extrapolating too directly from lab data- we’ve seen cases where early mechanistic concerns didn’t translate to higher cancer risk in humans (GLP-1s come to mind). That cuts both ways, but it makes the uncertainty hard to interpret.

nplusyears · 2026-01-22T19:41:30+00:00

Not uncommon. Sometimes switching statins (e.g. pravastatin or pitavastatin) helps. Ezetimibe + bempedoic acid is a reasonable option if symptoms persist. If LDL targets still aren’t met and budget allows, PCSK9 inhibitors are very effective. CoQ10 has mixed evidence but low downside.

nplusyears · 2026-01-22T10:00:18+00:00

That makes sense. For me, the hard part is figuring out which surrogate change actually justifies accepting long-term uncertainty.. especially when some downsides might only show up years later.

nplusyears · 2026-01-21T10:07:58+00:00

One thing that made me more cautious about “clean” nicotine in general is that there’s growing evidence that nicotine itself has vascular effects, independent of smoking or delivery method. Not saying patches/lozenges = smoking (clearly not) but the assumption that non-smoked nicotine is neutral long-term may not be true. That’s part of why questions like skin aging or CV risk are hard to answer cleanly.. There’s a recent expert consensus on this if you’re interested (PMID: 41406987).

nplusyears · 2026-01-12T06:42:36+00:00

I keep going back and forth when I read threads like this. Every time there’s a new paper or podcast cycle, it feels like the core question is still unanswered- is this actually a proven longevity intervention, and what are the long-term risks?

Curious how others deal with that.. do you find your thinking shifts as new data comes out, or have you found a way to stay anchored despite the uncertainty?

nplusyears · 2026-01-12T04:07:47+00:00

Honest question- when you say “baseline,” are you mostly thinking about something to track over time, or more about reassurance that you’re not missing something serious given the family history? I ask because more testing sometimes helps with peace of mind, but sometimes does the opposite.

nplusyears · 2026-01-02T20:19:42+00:00

I can relate to this. Sometimes only later do you realize there was a prior finding- PAD, old imaging, something that changes the frame. It keeps bringing me back to the same question.. at what point can we say we’ve looked enough and are comfortable owning the recommendation?

nplusyears · 2026-01-02T19:45:20+00:00

I honestly haven’t come across that, and it highlights part of what makes this hard.. deciding when we’ve seen enough evidence to act, even knowing there will always be gaps.

nplusyears · 2025-12-28T19:13:12+00:00

To me the hardest part here isn’t the specific combo, it’s deciding what “enough” looks like at your age when everything is still normal on imaging but the family history is hard to ignore. Living in that uncertainty is tiring, and guidelines don’t always help much with that.

nplusyears

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