#4: Blood Tests for Purposes of Chronic Disease and Longevity
Why routine blood work should be re-imagined.
The following is a brief discussion about chronic illness, aging, and longevity, based on ideas introduced by Dr. Peter Attia in his book Outlive.
Whether through consumer wearables or at-home testing kits, people want data to support the way they are feeling. Whoop and Oura measure sleep and recovery, while Viome offers gut and oral microbiome tests. Though useful, health fanatics and bio-hackers still seek more granular information about their own well-being.
Many are turning to traditional lab testing — which measures everything from cholesterol to blood sugar to hormones — to reveal insights for avoiding chronic disease and optimizing longevity.
Getting routine blood work done remains an essential way to combat chronic illness. Common tests — complete blood count (CBC), metabolic panel, and lipid panel — help providers quantify a patient’s risk for certain diseases.
No longer unique to clinical care, lab testing is entering consumer health. In Nov. 2022, Quest Diagnostics launched fitness-specific blood tests through their new direct-to-consumer channel. The leader in diagnostic services has since revealed a D2C blood test for detecting Alzheimer’s risk.
Regardless of the testing medium, there are certain key markers that influence a patient’s longevity and disease risk profile. Let’s look at some of them in the context of chronic disease below…
Heart disease & stroke (Atherosclerosis)
apoB: Lipoprotein that causes accumulation of arterial plaque and damage to the endothelium.
A better measure of cardiovascular risk than LDL-c.
Lp(a): Lipoprotein which fuses with apo(a), causing looped amino acid sequences called “kringles”.
Kringles carry extra lipids so Lp(a) is even more likely to get stuck in the arterial wall.
Alzheimer’s
apoE: Genotype that influences the risk of Alzheimer’s by way of cholesterol metabolism and beta-amyloid regulations
apoE4 drives increased beta-amyloid deposition
Inflammation
fibrinogen: Protein produced by the liver which helps form blood clots.
Uncommon levels can reveal blood clotting disorders.
C-reactive protein: Clinical marker of inflammation.
High levels indicate lots of inflammation due to infection, injury, or chronic disease.
Cancer
Cancer is impacted by metabolic health, immune function, and the body’s ability to acquire mutations and repair them
Unfortunately, blood tests can only deliver insights into the metabolic piece since most cancers are caused by somatic mutations
Despite certain biomarkers remaining important, blood tests are becoming less useful for the purposes of longevity.
For starters, biomarkers only predict risk. They do not reveal how much of a disease is actually present in a patient. This is especially an issue for tracking the progression of chronic diseases, which take decades to manifest. In the case of atherosclerosis, only CT scans and angiograms are capable of showing the amount of plaque built up in the arteries.
Reference ranges —responsible for determining what a typical lab result looks like — are also worsening.
Normal ranges for most lab metrics are defined by +/- 2 standard deviations from the mean. However, as population health declines, these ranges are evolving to be less reflective of good health. We are effectively lowering the standard for what it means to be “healthy”, leading to delayed diagnoses and intervention.
Longevity doctor Peter Attia, MD, airs on the side of extreme caution when looking at the markers of his patients. Here are some comparisons between Dr. Attia’s reference ranges for certain markers compared to the general recommendation:
Triglycerides
Peter’s reference: < 100 mg/dL + lower than cholesterol
General reference: < 150 mg/dL
Uric Acid
Peter’s reference: < 5.0 mg/dL
General reference: < 7.0 mg/dL
ALT
Peter’s reference: < 20 U/L
General reference: < 40 U/L
We can reduce risk all we want, and we absolutely should. But the average primary care blood test is far from a perfect indicator of health and well-being.
Unique markers for longevity go beyond a typical lipid or metabolic panel and instead include metrics such as VO2 max, mobility, quality of relationships, and even grip strength.
A comprehensive care model targeting longevity should be able to improve both physiological and performance-based markers in patients.
Dr. Ryan Greene of Monarch Athletic Club is doing just that. Leading a team of physicians, dietitians, physical therapists, and personal trainers, Monarch is practicing medically-driven services in a boutique wellness club setting. Members have access to nutrition counseling, strength & mobility training, metabolic panels, and other preventive medicine services.
With locations in West Hollywood and Brentwood, CA, and more on the way, Dr. Greene is reimagining the primary care experience by touting community and easy access to industry experts.
To learn more, listen to this week’s podcast episode with Dr. Ryan Greene, Co-Founder and Medical Director of Monarch Athletic Club.