The whole site, in one table
The evidence ledger
Every compound, drug and test we cover, graded on the strength of its human evidence and, next to each grade, the thing that is missing. Sort it by evidence and the cheapest interventions rise to the top.
How to read this table
Every row states three things: the strongest human evidence that exists for the compound, the gap between that evidence and what the label claims, and the grade that follows. The grade is not an opinion formed here; it restates the conclusion the compound's own page argues, so the table and the page cannot say different things.
Showing all 17 interventions.
| Compound | Type | Strongest human evidence | What is missing | Grade | Cost |
|---|---|---|---|---|---|
| GLP-1 receptor agonists | Prescription drug | A 20% reduction in major adverse cardiac events across 17,604 people in a randomized trial. | Almost all of it is in people who are already sick. Microdosing for longevity in healthy adults has no trial behind it at all. | Strong human evidence | $$$ |
| Creatine monohydrate | Supplement | The deepest randomized record of any supplement here, for muscle mass and strength in older adults. | The muscle case is settled; the cognitive and longevity cases are preliminary and are what the marketing leads with. | Strong human evidence | $ |
| Sitting-rising test | Testing | A larger published all-cause mortality effect size than any consumer epigenetic clock reports for its own score, and it is free. | It measures function, not a molecular age. It will not tell you what changed at the cellular level, because nothing consumer-grade reliably does. | Strong human evidence | free |
| Collagen peptides (skin) | Supplement | Reasonable randomized evidence for skin elasticity and hydration; weaker but real evidence for joint comfort. | The longevity claim rests on one 2025 study from a commercially affiliated group. Skin evidence does not transfer to lifespan. | Early / mixed evidence | $$ |
| Rapamycin (sirolimus) | Prescription drug | The strongest animal lifespan data in geroscience: roughly 9 to 14% in mice started at mid-life, replicated across dozens of labs. | No human trial has ever used lifespan as an endpoint. Every human dose in longevity use is extrapolated. | Early / mixed evidence | $ |
| Urolithin A (Mitopure) | Supplement | A four-month randomized trial in older adults hitting several secondary endpoints, including muscle endurance and inflammation markers. | That pivotal trial missed both of its primary endpoints. Most people convert the precursor poorly, and it is the most expensive compound here. | Early / mixed evidence | $$$ |
| NMN | NAD pathway | Reliably raises blood NAD+ in human trials and is well tolerated from 250 to 1,000 mg a day. | No clear functional benefit in healthy people. Blood NAD+ is a biomarker, not an outcome, and nobody has established the level to aim for. | Early / mixed evidence | $$ |
| Metformin | Prescription drug | Observational data in diabetic patients showing lower mortality than matched non-diabetic controls, plus modest animal effects. | TAME has published no efficacy results as of 2026, and a randomized study found metformin blunts mitochondrial adaptation to exercise. | Early / mixed evidence | $ |
| Rapamycin for dogs | Prescription drug | One completed randomized trial, 24 dogs, 10 weeks: two cardiac measures improved. | Ejection fraction missed significance at p = 0.058. TRIAD, the lifespan trial, has not reported. No product is approved for this use. | Early / mixed evidence | $$ |
| Topical rapamycin | Prescription drug | One exploratory randomized trial in which eight participants provided analyzable skin tissue, at 0.001% on the backs of the hands. | Published formulations run from 0.001% to 8% with no comparative dose-ranging study. Everything sold above the studied strength is unstudied for skin aging. | Early / mixed evidence | $$ |
| Epigenetic age clocks | Testing | The clocks do predict mortality at population scale, which is why the field takes them seriously at all. | Technical noise alone produced deviations up to nine years between replicate samples across six prominent clocks, before any biology. | Limited evidence | $$$ |
| Nicotinamide riboside (NR) | NAD pathway | Raises blood NAD+ metabolites reliably, and eight randomized trials report anti-inflammatory activity. | A trial in older adults found no effect on metabolic function, motor function or exercise capacity. Human doses are a fraction of the rodent ones. | Limited evidence | $$ |
| NAD+ (direct oral) | NAD pathway | None specific to the oral molecule. | NAD+ is a large charged molecule that struggles to cross the gut intact. The best-selling form in the category is the one least able to reach you. | Limited evidence | $$ |
| Spermidine | Supplement | An observational cohort linking higher dietary spermidine to lower all-cause mortality, measured on food, not capsules. | A placebo-controlled study of high-dose supplementation found it raised plasma spermine but not spermidine. The molecule on the label did not move. | Limited evidence | $ |
| Fisetin | Supplement | Clears senescent cells in engineered mice, and senescent-cell clearance genuinely helps in those models. | The NIA Interventions Testing Program tested fisetin and found no lifespan extension. Human data is small pilot trials. | Limited evidence | $$ |
| Quercetin | Supplement | Senolytic activity in preclinical models, almost entirely in combination with dasatinib, a prescription cancer drug. | Quercetin alone has essentially no senolytic human evidence. The combination is not what is sold on a supplement shelf. | Limited evidence | $ |
| Resveratrol | Supplement | Real anti-inflammatory and antioxidant activity, and some human metabolic data. | A nine-year study found no association between dietary resveratrol and mortality, heart disease or cancer. Bioavailability is poor and the sirtuin mechanism is contested. | Limited evidence | $ |
Why the strongest evidence sits on the cheapest shelf
Sort the table by cost and the pattern is hard to miss. Creatine and the sitting-rising test sit at the top of the evidence ranking and the bottom of the price ranking, while the costliest compounds cluster in the mixed and limited bands.
That is neither a coincidence nor a conspiracy. It is what the funding of trials produces:
- Old, off-patent and cheap: decades of use have produced trials, and nobody needs to sell the story.
- New, patentable and expensive: the product reaches the shelf before the trials that would grade it have been run.
What would move a compound up this table
For most of the limited rows the answer is short: a randomized trial in people, long enough to measure something a person would notice, with a pre-registered primary endpoint that the trial then hits. Who runs those trials is on the experts roster.
Several compounds here have exactly that kind of trial running or planned:
- TRIAD is testing whether rapamycin extends lifespan in dogs.
- TAME has been designed for a decade and has published no efficacy results.
- Senolytic trials are in progress at Mayo Clinic.
None of those results are in, and the honest position until they are is the one this table takes. A grade is a description of the evidence as it stands, not a forecast. When a trial reports, the row changes.
Common questions about these grades
Frequently asked questions
What do the three evidence grades mean?
Strong means randomized human trials reporting an outcome that matters to a person, not a blood marker. Mixed means human trials exist but are small, short, or missed the endpoints they were designed around. Limited means the human evidence is observational, absent, or was run and came back null.
Why does the best-evidenced list contain so few supplements?
Because the grading is done on human outcome data rather than on mechanism or popularity. Creatine has decades of randomized work behind its muscle claims. Most longevity supplements have short trials measuring a biomarker, and a biomarker moving is not the same as you being better off.
Does a limited grade mean the compound does not work?
No. It means nobody has shown that it does in people. Several compounds here are mechanistically interesting and cheap, and a limited grade is an accurate description of where the research is, not a prediction of where it will end up.
Why is rapamycin only graded mixed when the animal data is so strong?
Because the grade describes human evidence. Rapamycin has the most replicated lifespan data in geroscience and no human trial has ever used lifespan as an endpoint. Grading it strong would import the mouse result into a column that is about people.
How often is this table updated?
Each row restates the conclusion of its own page, and the pages carry their own last-reviewed dates. When a trial reports and a page changes, the row changes with it. Nothing here is graded independently of the page that argues it.
Why is cost shown next to the evidence?
Because the two together are the actual decision. A compound with limited evidence and a one-dollar-a-month cost is a different proposition from one with limited evidence at ninety dollars a month, and only one of those is commonly sold as a leap forward.
References
11 sources, all link-checked; oldest check
- GRADE: an emerging consensus on rating quality of evidence and strength of recommendations. Guyatt GH et al. BMJ 2008;336:924.The framework behind the strong / mixed / limited evidence grades used across this site.Verified Sep 14, 2026
- Cochrane Handbook for Systematic Reviews of Interventions. Higgins JPT et al., version 6.5, 2024.Risk-of-bias methodology used when this desk appraises a trial.Verified Sep 14, 2026
- Why most published research findings are false. Ioannidis JPA. PLoS Medicine 2005;2(8):e124.The base-rate argument for treating any single positive study as provisional.Verified Sep 14, 2026
- Semaglutide and cardiovascular outcomes in obesity without diabetes (SELECT). Lincoff AM et al. New England Journal of Medicine 2023;389:2221–2232.Publisher blocks automated checks · last tried Sep 14, 2026
- Rapamycin fed late in life extends lifespan in genetically heterogeneous mice. Harrison DE et al. Nature 2009;460:392–395.9–14% mouse lifespan extension started mid-life.Verified Sep 14, 2026
- The mitophagy activator urolithin A is safe and induces a molecular signature of improved mitochondrial and cellular health in humans. Andreux PA et al. Nature Metabolism 2019;1:595–603.First-in-human; authors affiliated with Amazentis (Timeline); note conflict.Verified Sep 14, 2026
- Astaxanthin and meclizine extend lifespan in UM-HET3 male mice; fisetin, SG1002, dimethyl fumarate and mycophenolic acid do not. Harrison DE et al. GeroScience 2023 (NIA Interventions Testing Program; cited 64).The most rigorous multi-site mouse lifespan program tested fisetin and found no lifespan extension.Verified Sep 14, 2026
- Resveratrol levels and all-cause mortality in older community-dwelling adults. Semba RD et al. JAMA Internal Medicine 2014;174(7) (InCHIANTI; cited 234).Urinary resveratrol metabolites in older Italian adults over nine years, 268 deaths among 783 participants: no association with all-cause mortality, cardiovascular disease or cancer.Publisher blocks automated checks · last tried Sep 14, 2026
- A computational solution for bolstering reliability of epigenetic clocks. Higgins-Chen AT et al. Nature Aging 2022;2:644–661.Documents test–retest reliability limits of methylation clocks.Verified Sep 14, 2026
- High-dose spermidine supplementation does not increase spermidine levels in blood plasma and saliva of healthy adults. Senekowitsch S et al. 2023 (cited 52).Placebo-controlled: supplementation significantly raised plasma spermine but did not raise spermidine in plasma or saliva.Verified Sep 14, 2026
- PubMed. US National Library of Medicine, National Institutes of Health.The index every citation on this site is checked against before publication.Verified Sep 14, 2026
Every link above is re-requested on a schedule by an automated checker; the date shown is when it last answered. Publishers that block automated requests are marked as such rather than reported broken. Our editorial standards explain how a source gets cited here in the first place.
Filed by the Rapamycin.store evidence desk. Each source is re-checked when the page is reviewed.
Own a longevity or health brand?
Rapamycin.store publishes sponsored and guest posts on an aged, topically-relevant domain, and offers display advertising. Tell us what you want to promote and we'll send our current options.