Qualy #6 - What are the best lab tests to request specifically for longevity
Episode Stats
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Summary
In this episode, Dr. Peter T. T.D.M. (PhD) discusses the role of blood biomarkers in cardiovascular disease, cancer, and neurodegenerative disease, and how they can be used to predict how long someone will live.
Transcript
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welcome to the qualies a subscriber exclusive podcast qualies is just a shorthand slang for
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a qualification round which is something you do prior to the race just a little bit quicker
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do you want to get into like if you could actually measure some things for longevity but
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you really can't in a lab test that you would want to look at so if we're talking longevity purely in
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terms of lifespan how long you know looking at someone's blood can you get a sense of how long
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until they're going to die the way to think about that so what you're not going to get on a standard
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blood test is any of the longevity genes i mean you can get some of them but you certainly apoe would
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be one of the longevity genes lp little a would be a longevity gene in inverse so the lower your lp
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little a the greater your chance of cardiovascular mortality so the way i really think about longevity
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in blood is the three things that you're looking for in blood disease wise are what is this person's
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risk of atherosclerotic disease so heart disease or stroke what is this person's risk of cancer what
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is this person's risk of neurodegenerative disease so as you march down those things you would say well
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cardiovascular disease largely driven by three things lipoproteins inflammation endothelial
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dysfunction how much of that can we see in blood actually a lot on the lipoprotein side we can see
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most of what we want which is the lp little a the ldl the small ldl i'm talking particle number
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not cholesterol and the vldl as alluded to on the inflammation side we can see specific and
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nonspecific markers of inflammation so on the nonspecific side we can see things like fibrinogen
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c-reactive protein on the specific side you can see things like ox ldl lppla2 ox phospholipid those
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things very helpful endothelial health is the hardest thing to see but i include insulin here because i think
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that insulin is in and of itself actually toxic at high levels to the endothelium and james o'keefe just
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recently was on a paper that looked at cardiovascular health in patients with type 1 diabetes so that
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they were able to actually use the insulin doses that people were using as a way to actually assess
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the impact on the i can't remember if it was myocardium or endothelium you can look at things
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like homocysteine we also look at something called asymmetric dimethyl arginine or adma and sdma which
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are inhibitors of nitric oxide synthase so the way i tell patients is the younger you are the more your
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blood tells me about your risk of cardiovascular disease so a 40 year old person who otherwise
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doesn't have like some dramatic you know lp little a through the roof or something crazy the blood tells
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me probably 80 85 percent of what i need to know the older a patient gets the more i would probably rely
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on things like ct angiograms or even usually by the time they're older a calcium score becomes less
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relevant calcium score can be somewhat helpful in a younger patient though but it's you know the
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latest study i saw which actually just was an editorial that came out two days ago based on a
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study in one of the atherosclerosis journals was you know looking at 50 percent of patients that had
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that had events had them at the site of non-calcified lesions not a huge vote of confidence for how why a
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low calcium score is that helpful on the cancer side i think that's really frankly where blood gives us the
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least insight you know until companies like grail have fully functioning uh liquid biopsies where
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you're looking at i think grail's probably looking mostly at rna and dna other companies have looked
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at circulating proteins but until these liquid biopsies are there we can't we don't really have
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much insight into it also virtually every cancer is a result of a somatic mutation not a germline
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mutation so knowing your genotype doesn't really help outside of a few outlier things like braca or
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lynch so it you know in cancer it really comes down to understanding inflammation which we've already
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addressed and metabolic health which again was also part of the cardiovascular stuff though i didn't go
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into it but so for me minimizing hyperinsulinemia becomes very important and and i suspect we'll probably
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have an entire discussion on the role of igf in cancer and igf bp3 because i think it's actually quite
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controversial but that can also provide some insight and then alzheimer's disease actually
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i think is more closely related to cardiovascular disease in terms of risk stratification so first
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of all knowing the patient's apoe immediately gives me a bucket to put them in which is you know low
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medium high risk i mean that's i don't call it that but that's sort of how you can think about it
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and then you look at the other dimensions of it which is there's a vascular component to that disease
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and that basically proxies what you're seeing in cardiovascular risk so the more you can improve
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the cardio metabolic profile the more you can improve that then there's the metabolic component
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period which is kind of like the glucose utilization part and that sort of reverts back into all the
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metabolic stuff you see in cancer there's a an entire thing around toxins which unfortunately is
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probably the one that we have the least insight into measuring and you know for very high risk patients
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we do refer them to richard isaacson's clinic at cornell which is a dedicated high risk clinic and
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certainly there if the cognitive test warrants it they'll do lumbar punctures and start to look at
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csf for other markers but obviously we don't do that um and unfortunately we don't have too many
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patients that are cross-mogenating over there i don't want to harp on this one but i thought it was a
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good point that you brought up you touched upon with the insulin and that some people will get a
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they'll get their glucose tested you know every year and they say my glucose is fine it's it's 82
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or whatever it is and you know if they assume that their insulin's fine too because they're
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clearing their blood sugar and it's 82 can you explain just why you're not i mean you're literally
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not looking at insulin but insulin could be elevated and you wouldn't know it yeah and usually
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the person walking around with a fasting glucose of 82 probably doesn't have a very high fasting
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insulin it's the postprandial stuff you worry about and then like this gets more complicated
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because you then have to worry about are you being misled by the test so i'm sure many people are
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listening to this who are already aware of this but i'm sure enough people aren't that it's worth the
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time but if you take somebody who's on a ketogenic diet or a very carbohydrate restricted diet it's
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more common than not when you do an oral glucose tolerance test on them that they will have
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this paroxysmal very elevated glucose very elevated insulin after being challenged so they'll have a
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low fasting glucose low fasting insulin and then you give them the glucola and their glucose and
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insulin are sky high i think i may have told the story once on a podcast about a guy i knew who you know
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had gone on a low carb diet and everything had gone great and blah blah blah he lost a bunch of weight
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and got healthier and everything was amazing and then his brother who had type 1 diabetes needed a
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kidney transplant and he was a match so they said well all right we just got to test you make sure
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you know you're not diabetic or anything before we take one of your kidneys they did an ogtt and he
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quote unquote failed and he called me in distress and he was like oh my god i can't even give my brother
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a kidney and i said well here's the thing you got to have them repeat the test and just you got to
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refeed with 150 grams of carbohydrates just eat 150 grams of rice potatoes whatever for about three days
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leading up to the test they repeated the test obviously everything was fine the next time he
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called me he was leaving the hospital after the transplant everything had gone well the other
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thing with fasting glucose by the way that's kind of useless is it's helpful if your fasting glucose is
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150 there's clearly a problem but i get patients that get you know very upset or phosphorylated if
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their fasting glucose is 105 and i gotta tell you now that i wear a continuous glucose monitor and i
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know my glucose 24 7 the difference between a fasting glucose of 90 and 105 in the morning is
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much more a function of my cortisol level than it is anything to do with my insulin sensitivity or you
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know any anything like that so it's you know it's important to understand the role that even stress can
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play on glucose and that's why i think fasting glucose is directionally interesting but it's the it's
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the insulin that gives you the the more fine-tuned insight i hope you enjoyed today's quali now sit
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