Qualy #6 - What are the best lab tests to request specifically for longevity
This Qualys episode, an AMA, discusses longevity markers in blood tests, focusing on cardiovascular, cancer, and neurodegenerative disease risks. It highlights the importance of minimizing hyperinsulinemia and improving cardio-metabolic health, while also clarifying the limitations of fasting glucose measurements.
Deep Dive Analysis
8 Topic Outline
Assessing Longevity Risk Factors Through Blood Tests
Key Blood Markers for Cardiovascular Disease Risk
Inflammation and Endothelial Dysfunction Markers in Blood
Limitations of Blood Tests for Cancer Risk
Evaluating Alzheimer's Disease Risk Factors
The Pitfalls of Relying Solely on Fasting Glucose
How Low-Carb Diets Affect Glucose Tolerance Tests
The Role of Cortisol in Morning Fasting Glucose
4 Key Concepts
Atherosclerotic Disease Risk Markers
These are blood components like lipoproteins (Lp(a), LDL particle number, VLDL), inflammation markers (fibrinogen, C-reactive protein, oxLDL), and indicators of endothelial dysfunction (insulin, homocysteine, ADMA, SDMA) that help assess an individual's risk for heart disease and stroke.
Physiological Insulin Resistance
This is a temporary state where the body, adapted to a ketogenic or very carbohydrate-restricted diet, shows an exaggerated glucose and insulin response during an oral glucose tolerance test. This is not indicative of diabetes but an adaptation to fuel utilization.
Endothelial Dysfunction
This refers to the impairment of the inner lining of blood vessels, which can be influenced by factors like high insulin levels and is a precursor to cardiovascular disease. Markers such as homocysteine, ADMA, and SDMA can provide some insight into this condition.
Somatic vs. Germline Mutations
Somatic mutations occur in body cells after conception and are not inherited, accounting for most cancers. Germline mutations are inherited from parents and are present in every cell, including reproductive cells, and are relevant for a few specific cancers like BRCA or Lynch syndrome.
5 Questions Answered
The three main disease risks to look for in blood tests concerning longevity are atherosclerotic disease (heart disease/stroke), cancer, and neurodegenerative disease.
For younger patients (e.g., 40-year-olds), blood tests can provide 80-85% of the necessary information, while for older patients, imaging like CT angiograms becomes more crucial.
Calcium scores can be somewhat helpful in younger patients, but a recent study indicated that 50% of cardiovascular events occur at sites of non-calcified lesions, suggesting a low calcium score isn't always a complete assurance.
A normal fasting glucose doesn't guarantee healthy insulin levels, as insulin could be elevated to maintain that glucose, especially after meals (postprandial). Also, morning fasting glucose can be significantly influenced by cortisol levels rather than just insulin sensitivity.
Yes, individuals on ketogenic or very carbohydrate-restricted diets often exhibit an elevated glucose and insulin response during an OGTT, which is a physiological adaptation rather than a sign of diabetes.
10 Actionable Insights
1. Prioritize Insulin Monitoring
Do not solely rely on fasting glucose levels; instead, prioritize measuring insulin, especially postprandial levels, for a more accurate assessment of metabolic health and to minimize hyperinsulinemia, which is toxic to the endothelium and linked to cancer risk.
2. Comprehensive CVD Blood Markers
Monitor specific blood markers for cardiovascular disease risk, including Lp(a), LDL particle number, VLDL, fibrinogen, C-reactive protein, oxLDL, Lp-PLA2, ox phospholipid, homocysteine, ADMA, and SDMA.
3. Improve Cardiometabolic Profile for AD
Improve your cardiometabolic profile and glucose utilization to reduce Alzheimer’s disease risk, as it shares vascular and metabolic components with cardiovascular disease and cancer.
4. Age-Specific CVD Screening
Younger individuals (e.g., 40-year-olds) should prioritize blood tests for cardiovascular risk assessment, while older individuals should rely more on CT angiograms as blood tests become less informative and calcium scores less relevant.
5. Assess Alzheimer’s APOE Genotype
Assess your APOE genotype to determine your risk bucket (low, medium, high) for Alzheimer’s disease.
6. Prepare for OGTT on Low-Carb
If you are on a ketogenic or very carbohydrate-restricted diet, refeed with 150 grams of carbohydrates (e.g., rice, potatoes) for about three days before an Oral Glucose Tolerance Test (OGTT) to prevent falsely elevated glucose and insulin results.
7. Limited Cancer Blood Test Insight
Understand that current standard blood tests provide limited insight into cancer risk, with exceptions for specific genetic mutations like BRCA or Lynch.
8. General Longevity Risk Assessment
Utilize blood tests to assess overall risk for atherosclerotic disease (heart disease/stroke), cancer, and neurodegenerative disease.
9. Access Qualies Podcast Content
Subscribe to the Qualies podcast for short, high-value episodes highlighting tactics from ‘The Drive,’ and visit peteratmd.com/subscribe for exclusive content.
10. Refer High-Risk Alzheimer’s Patients
For very high-risk Alzheimer’s patients, consider referral to a dedicated high-risk clinic, such as Richard Isaacson’s at Cornell, for specialized testing like lumbar punctures if cognitive tests warrant it.
4 Key Quotes
the younger you are the more your blood tells me about your risk of cardiovascular disease
Peter Attia
the older a patient gets the more i would probably rely on things like ct angiograms
Peter Attia
in cancer it really comes down to understanding inflammation which we've already addressed and metabolic health
Peter Attia
the difference between a fasting glucose of 90 and 105 in the morning is much more a function of my cortisol level than it is anything to do with my insulin sensitivity
Peter Attia
1 Protocols
Preparing for an Oral Glucose Tolerance Test (OGTT) on a Low-Carb Diet
Peter Attia- Consume 150 grams of carbohydrates daily.
- Maintain this carbohydrate intake for approximately three days leading up to the test.
- Repeat the OGTT.