Adding Colon Cancer Screening to Your Longevity Strategy
Early Disease Detection is Essential for Longevity
As regular readers of the Longevity Blog will know - we stand on the precipice of incredible advances in the technologies available for measuring, halting and even reversing the aging process.
As the fusion of AI and computational power with healthcare and biological data marches forward, rapid improvements can be expected over the coming decades.
Therefore, if you’re keen on leveraging these advances, you’d better have a plan to stay healthy in the mean time!
[Timesaver Tip: If you’re not big into reading a blog post - you can skip the details and order your own at-home colon cancer test here! ]
Searches for ‘Colon Cancer Testing’ surged to a 5-year high after Chadwick Boseman’s death in August 2020. Source: Google Trends
Thankfully, modern medicine has become exceptionally proficient at treating life-threatening diseases - so long as they are caught early at the so-called ‘treatable stage’.
However, what is not entirely obvious is who is responsible for managing your access to the technologies ensuring early disease detection.
While, as we’ll discuss below, healthcare systems have begun to take on the role of providing some early screening services, you’d be quite naive to think leaving your health up to them is a bulletproof strategy.
Quite the opposite is true, in fact - ensuring your longevity requires a radical level of personal accountability and a proactive attitude.
This is to say, that longevity strategy is yours to lead, and while it should absolutely include your doctor and the broader healthcare system, it should not entirely depend upon them.
You need to know your risk factors, educate yourself on the many resources available and stay on top of the emerging technologies available for your personal risk management.
Thankfully, Longevity Blog is here to help. In this post, we carve out a segment of that risk management strategy - focusing in on colorectal cancer - and will present some newly available resources at your disposal.
Early Detection of Colon Cancer is a Lifesaver
Hear more about Aaron’s journey of colon cancer survivorship on the Pelatonia podcast “One Goal”. Pelatonia is an organisation who have raised over $218M for cancer research through the sport of cycling. Pictured: Aaron Conley
Colorectal cancer is both one of the most common and most deadly (in terms of total lives lost) forms of cancer in the developed world.
It also strikes a personal chord with the Longevity Blog.
While our Founder Nick’s wife was awaiting her surgery for the treatment of appendiceal cancer in late 2013, one his closest friends (Aaron, see image) was besieged by this disease at the young age of only 27 years old.
The shock of these diagnoses evoked strong motivations for exploring the ways we might contribute to the end of late stage disease diagnosis, once and for all.
And while that is a big dream, the ambition of reducing human suffering through the early detection of disease is very much at the core of the Longevity Blog mission.
We believe we already have most of the technologies required to ensure the long-term health of everyone who chooses to dedicate their resources to a comprehensive longevity strategy.
Colorectal cancer screening is one such resource. Let’s explore this topic - starting with, what is ‘screening’ exactly?
Cancer Screening - A Key Component of Your Longevity Strategy
The highly detailed, full body MRI available at the Health Nucleus is a key pillar of the ‘screening’ component of my personal longevity strategy - this is a very high tech form of cancer screening & where the Longevity Blog got started!
The concept of cancer screening is quite topical for the Longevity Blog. It forms one of the pillars of our shared longevity strategy - detect disease early, while it remains treatable.
Longevity Blog believes this can be accomplished through the *right* combination of medical technologies.
This of course includes detailed, full body MRI imaging as central to this objective.
However, full body MRI imaging has limitations with respect to its sensitivity to certain disease types - chiefly with respect to gastrointestinal cancers, and specifically esophageal and colorectal cancers.
Therefore, in order to comprehensively screen, one must turn to alternative strategies to minimise risk with respect to the diseases not sampled. Thankfully, colorectal cancer has several screening technologies at our disposal…
Colon Cancer Screening
Outside of advanced facilities like the Health Nucleus, cancer screening is most often disease specific. Australia’s most common cancer - breast cancer - can be screened via mammogram, for example.
And thankfully, the same is true for the 2nd most common cancer in Australia (and 4th most common in the United States) - colorectal cancer.
Colorectal cancer is the result of uncontrolled growth of abnormal colon or rectal cells, which grow to form a tumour.
However, most such cancers do not immediately begin in the tumour phase, originating instead as small abnormal tissue growths (called lesions) and/or polyps.
Source: Harvard Health
The process of forming a lesion and/or polyp, followed by possible malignancy, is often associated with the release of small amounts of blood into the stool, as well as low levels of tumour DNA material in more advanced cases/recurrence.
It is from this blood and/or DNA, that currently available cancer screening technologies can detect this potentially malignant activity. Let’s dive into how that works.
Colon Cancer Screening Technologies
Direct visual inspection of the colorectal (nether?) regions (e.g. colonoscopy) with biopsy (direct tissue sample) remains the gold standard for colon cancer screening.
However, over the past few years, test kits which can be completed at home have become widely available, as well as generally accepted by the broader medical community (For more, read this JAMA article).
These kits are so popular and effective, that governments in many countries have rolled out widespread test by mail kits.
Such a move has created strong market forces for driving the supply of these kits up, and the associated cost per unit downward - to the point where purchasing such kits out of pocket has become possible (we’ll come back to this point shortly!).
In the ‘test at home’ market offering, there are three primary technologies in use today. Two are tests which detect blood in the stool (known as a faecal occult blood tests [FOBT]), and the third tests for tumour DNA directly.
Review of Three ‘Test at Home’ Technologies
The current standard of care uses FOBT tests as ‘first-line screening’. These can be either the ‘guiac-based form (gFOBT)’’ or the ‘immunochemical form (FIT).”
gFOBT tests look for haemoglobin (an important oxygen carrying protein in the blood) in the stool, however it has been shown to be sensitive to diet and medications (e.g. red meat or high vitamin C intake). The requisite chemical reaction can however occur locally, meaning the test kits don’t have to be shipped back to a laboratory for the results. For example, one of these kits might involve dropping a tablet into your toilet and seeing if it turns a signalling colour.
FIT methods use an antibody reaction instead, which removes any complications from the diet (or medications), identifying human haemoglobin directly. These kits must be sent back to the lab for processing. FIT tests have become the ‘go to’ testing method for widespread use.
A third, emerging testing option is the ability to detect tumour DNA directly, with a high degree of accuracy (92%). These kits have not yet become directly available to consumer, and I won’t mention them again here.
For further reading, you can find a detailed list of pros/cons of the above three methods here
Who Should Get Tested for Colon Cancer?
The age at which the general population is recommended a colorectal cancer screening varies by who you ask. However, one trend is clear - the recommended screening age keeps getting younger.
For example, longstanding recommendations from the American College of Gastroenterology state “Men and women at average risk for colorectal cancer should be screened starting at age 50”, but go onto several caveats (45 for heavy smokers or African Americans), and even ≤ 40 years anyone with:
A first-degree relative who has had colorectal polyps or cancer
Crohn’s disease or ulcerative colitis
Lynch syndrome or familial adenomatous polyposis (FAP)
More recently, the general testing age was also dropped to 45 by two influential bodies in the US. The American Cancer Society changed its recommended screening guidelines in 2018, from 50 to 45 years citing “rising rates of bowel cancer in young and middle-aged populations.” Furthermore, the US Preventive Services Task Force also changed the age of screening to 45 quite recently (October 2020).
Should You Get Tested for Colon Cancer?
Depending on your age bracket, you may already qualify for free or subsidised colorectal cancer screenings. If this is the case - the answer is obvious, you should definitely test according to the recommended guidelines.
But what about folks under the standard age in their region of care? Should they get a test? Well, there a few factors to consider when answering this question - let’s address them.
#1 Colon Cancer Screening Tests are Inexpensive and Easily Available
With a bit of digging around online, you will likely be able to find commercially available test kits in your country. The price point on these kits is pretty outstanding, costing the user only a few bucks a month to test every year or so. Let’s take a look at four options, all available for under $70 (3x United States, 1x Australia):
Our Top Choice: LetsGetChecked
Let’s Get Checked at Home ($69 USD)
Technology: FIT
Second Generation FIT ($25)
Technology: FIT
[Alternative Link] (CVS)
EZ Detect ($12)
Technology: gFOBT
[Alternative Link] (Walgreens)
ColoVantage ($42AUD)
Technology: FIT
#2 The recommended screening age is falling
As was briefly discussed before, the recommended screening age has been on a downward trend over the past decade.
This is because colorectal cancer occurrence in young adults is on the rise, as a part of a global trend in developed countries (read more).
Consider this startling statistic: People born in 1990 onwards have double the risk of colon cancer and quadruple the risk of rectal cancer compared with people born in 1950 (source).
Concerningly, when the disease is detected in young adults, it is often at a late stage. You need only scroll back up to the top of this blog post to read about 27 year old cycling enthusiast Aaron for an example.
In his case, a fairly late (stage III) diagnosis, following him experiencing extreme fatigue on his regular rides. Chadwick Boseman was only 43 years old when he passed away, after battling colon cancer for four years (age of stage III diagnosis ~38-39 yrs).
While its not yet settled why later diagnosis is common among young adults, it is surmised they are more likely to write off early warning signs, and are also less likely to have health insurance.
None of these details are particularly important to the point being made here - individual young adults are still at risk for developing colon cancer, even if the average risk of this population is low.
Source: Bowel Cancer Australia
#3 Colon cancer screening tests are accurate and highly effective
Test at home colon cancer screening technology is highly developed, and so effective, that is has become the standard of care for early screening.
So useful in fact, the biggest challenge healthcare systems have with colon cancer screening is increasing compliance (link). Imagine that - a healthcare service where increased demand is viewed positively!
Why? Because the tests are cheap, save lives and reduce downstream costs. That’s a rare win-win for healthcare!
#4 False positive downsides are small
Positive FIT tests are about 80% accurate for detecting cancer, and positive findings only occur in about 5-8% of people.
If your test comes back positive, your doctor will likely recommend you for a colonoscopy. Colonoscopies (as Aaron addresses in the podcast) are not as unpleasant as they might first sound.
Aside from the inconvenience of missing work, and the potential costs (check your insurance policy carefully), there is very little downside ‘false positive’ test result.
Furthermore, if there is blood in your stool, but no cancer or pre-cancerous legions/polyps, there may be other health related issues revealed in the process (e.g. hemorrhoids).
One could perhaps think of these tests more broadly as a ‘blood in the stool’ test, in that regard.
Colon Cancer Screening Conclusions
The Longevity Blog can’t make any healthcare recommendations to you, full stop. However, following the logic of the previous four points brings me to a fairly obvious, personal conclusion:
Colon cancer screening tests are accurate, effective, commercially available without a prescription at low cost, with very little downside to a false positive result (miss work, potential out of pocket costs, anxiety for some). Risk rates for adults below the screening age are not negligible. There are very high costs to late stage diagnoses.
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FDA & TGA DISCLAIMER
This information is intended for educational purposes only and is not meant to substitute for medical care or to prescribe treatment for any specific health condition. These blog posts are not intended to diagnose, treat, cure or prevent any disease, and only may become actionable through consultation with a medical professional.
Full Body MRI Screening Technology - Interview with Health Nucleus Part 3
In this post you’ll learn about:
The power of Health Nucleus MRI algorithms (e.g. early detection of brain aneurysms or quantifying visceral fat levels)
Same examples of how multiple Health Nucleus visits enable deeper personalised analytics
How the Health Nucleus is prevention focussed, rather than on optimisation (but that’s a good thing!)
Part 3 - MRI Analytics & Health Optimisation
Be sure to read Part 1 and Part 2!
Longevity Blog (LB):
Q: What kind of data will you be pulling out of the MRI scans? Besides the heart analysis and some of the cancer detection, which we already discussed. What will be showing up in that data and what will you use it for?
The blood vessels of my brain as revealed by Health Nucleus MRI data. Aneurysm free and healthy :)
Dr Duchicela: I think primarily it’s used for detecting the big things that we don’t want to miss that we really want people to know about early on, so things like cancer or aneurysms. With the post processing that they do on it, they’re able to reconstruct vasculature and vessels to look for aneurysms, even without using contrast which i think is really neat.
And then we have these different imaging biomarkers, so for Alzheimers we do hippocampal volume assessment where we look at the volume of the hippocampus and the ventricles surrounding them, and essentially see how do you compare to a healthy peer group? Are you a little bit lower or a little bit higher in these volumes, which correlates with Alzheimer’s risk. That’s one aspect.
At left, my visceral fat levels are highlighted by Health Nucleus MRI algorithms. Visceral fat is known to increase with age, and increased levels are risk factor for many diseases.
With MRI we also get the body composition like visceral fat levels, liver fat levels, liver iron levels, and muscle composition. What we’re doing with the MRI data is essentially training algorithms to better detect the sorts of cancers that traditionally you can’t detect with a non-contrast MRI, one we are working on right now is pancreatic cancer. We’ve developed a screening tool to use in MRI for pancreatic cancer and we’re in the process of validating it which is really really exciting. But that will just add to the overall comprehensiveness of the scan and of the experience, so yeah there’s lots of different things we get from the MRi, it’s pretty amazing how much data you can get from it and how much you can start to train these algorithms.
LB: Diving deeper into MRI analytics - I have a full body scan from May 2018, I’m soon to have another scan from January 2020, and plan to continue to do these scans every 12 to 24 months depending on my travel schedule, so you’re going to get a bit of a time series going with the data.
You’ve talked about disease risk and obviously we’ll keep assessing those things but in terms of somebody who’s trying to optimise, like myself who’s a bit of a biohacker or maybe an athlete who’s thinking about their performance and their muscle composition…
Q: What kind of optimisation intelligence could we derive from MRI data over time?
“If you come back multiple times, year to year or every two years, we can trend many things and see how you’re doing. ”
MRI analytics of muscle mass. At left, my colour coded leg muscle groups in May 2018. At right, January 2020. I added 1.3L of muscle mass during that time. Note: the pictured images are from a slightly different ‘slice’ of the data.
Dr Duchicela: I would look at the imaging biomarkers, looking at the visceral fat measurements and subcutaneous measurements that we get and quantifying and trending that. The scanner software automatically marks out where your subcutaneous fat is, where your visceral fat is, we can trend your liver fat measurements, your liver iron measurements and then obviously your muscle composition too and where you’re distributing your muscle.
If you come back multiple times, year to year or every two years, we can trend many things and see how you’re doing. Some people, even if their metrics are “within a normal range”, they want to get them better, and so when you have such an accurate test like the MRI you’re able to make that quantification, you’re able to make those comparisons versus for example other machines out there that measure your visceral fat too and kind of trend it, but really MRI is pretty darn accurate for that and one of the most accurate assessments available, so if you really want to know the numbers and get that in addition to your cancer assessment and your aneurysm assessment, I think MRI is the way to go.
LB: That’s really spot on in terms of the answer I was looking for, one thing I’d like to prompt you on…
Q: Is there opportunity to analyse the strength or flow volumes of the heart from your MRI data?
Dr Duchicela: We can see that your ejection fraction or how much blood you’re pumping out of your heart changes over time, now the question is does that actually translate into performance increases? We don’t necessarily think so for healthy individuals, because there’s lots of other things, like how fast your heart rate is going etc. So I would say not yet, I see where you're going with the question in terms of, could it be used to measure and trend athletic performance, not only for elite athletes, but for lay people who want to really maximise their athletic performance. I don’t think we’re there yet and I don’t think that’s necessarily the overall goal of this test. I think there’s a different series of tests that probably could do better than just the MRI for athletic performance trending and monitoring.
LB: Q: Are there any unique Health Nucleus tools that could be applied to assessing athletic performance and/or optimisation?
Dr Duchicela: I think with genetics we’ll start to get more information on that. There's already genetic predispositions to things like muscle tissue fibers and that sort of thing. What I would want to do as a medical director is to try to delve more into that and gather information on athletic history and get these metrics like VO2max and mile time etc and then start to work with the genetics to see if there are any predictors where we could make some correlations. That I think would be really exciting to do at some point in the future.
“I’m really excited what we have in the pipeline with this sort of scoring ... incorporating that with the coronary calcium score and putting it together and getting a global integrated risk score”
LB: Yeah I agree with you that it would be very exciting, and again it’s not your current focus, but I was curious to ask a few questions on the topic of optimisation, so thanks for that.
One of my big outcomes from my last visit to the Health Nucleus was a ‘prescription’ for cardio exercise and to increase my muscle mass on direct guidance from one of your doctors. I took that exceptionally seriously and have been dedicated to cardio fitness routinely since that time. So I’m really curious what you think might be evident in terms of one’s biometrics and data coming from their visit to help one measure their improvement in fitness over time.
Q: You’ve talked about MRI, and a bit about genetics, what else in there might show up in this visit compared to last time if I’ve done a good job at that cardio and exercise routine?
“ the best areas to look for changes and improvements would be in your imaging biomarkers, your core lab tests for metabolic biomarkers, lipids, a1c and fasting sugar. ”
My blood lipid panel over time; some great changes in between my first Health Nucleus visit (May 2018) and my second (January 2020).
Dr Duchicela: Yeah we’ve already mentioned the imaging biomarkers like your body composition, your liver fat level, those will definitely change with lifestyle change for sure, and then I would look at your traditional blood markers. You’ve probably already been measuring those, but making sure your [Hemoglobin] A1c is good, as well as your fasting sugars and your cholesterol numbers. In terms of trending data, that’s the kind of metabolic panel we would do. We can’t trend genetics so much, so I would say the best areas to look for changes and improvements would be in your imaging biomarkers, your core lab tests for metabolic biomarkers, lipids, a1c and fasting sugar. That’s where you’d probably best be able to see improvement and change.
LB: Cool, thanks for diving into that. And in terms of the genomic data that we’re pulling out, Q: what information in there will be actionable for somebody who wants to optimise? There’s examples of the ways you might metabolise certain precursors to vitamins, such as not being a good converter of beta carotene to retinol in the blood or the MTHFR mutation for methylation.
“It’s probably too early to hang your hat on these variants that tell you to eat a certain food or to do something very specific in terms of lifestyle unless you have one of these obviously high risk genes”
Dr Duchicela: Yeah I think that’s kind of the challenge with the genetics, the focus of the company from what I’ve seen so far is more on the hidden health risks with these high risk cancer genes, high risk cardiovascular disease genes or neurodegenerative disease genes.
In terms of optimising genetics, from what I’ve discussed with the clinical geneticist here and the genetics team, It’s probably too early to hang your hat on these variants that tell you to eat a certain food or to do something very specific in terms of lifestyle unless you have one of these obviously high risk genes, these monogenic findings. But I think it’s an area of consumer interest, what we're hearing from a lot of people is they want more specific lifestyle modifications based solely off genomics. I think that our genetics team needs to be a little more convinced that there are really good actionable things there.
It’s also a matter of prioritisation of where we put our resources, do we want to be more of a lifestyle service versus more of a medical service that’s catering towards physicians and the medical community? I think we’ll always have tension on where the focus should be. Right now the testing is looking for high risk medical issues that we can intervene on, like is there a BRCA mutation or a gene that puts you at high risk of colon cancer?
I am curious to know and to see where the science takes us with more of these lifestyle influenced variants, but i would say for right now for our testing [optimisation] is not one of the big focuses - we really want to try to prevent disease first and build off of that and then delve more into and put more resources toward lifestyle genomics.
LB: I think that that focus area is apparent from the way your suite of testing and reporting is arranged. In my view, everybody needs to be taking advantage of these proactive aspects of medical technology before thinking about health optimisation. You’ve got to take care of the core risk and any acute issues first, in order to maintain your wellness. So I don’t think that focus is misplaced at all. It’s intriguing to hear that your team is interested and noting increased demand for this sort of individual attention. I certainly think that that’s a growing market as well.
“what is the patient’s goal?”
Dr Duchicela: Totally. There’s a lot of companies out there that will do some direct testing and tell you exactly what to eat or avoid this food based off of you having this variant. I think we want to be a little bit more careful with that just because you really have to look at things holistically. I don’t think we really want to say - stop eating cucumbers based off your genetics, we really want to take into account what the patient’s preferences.
Like i was mentioning before with the wine example, really what is the patient’s goal, is their goal to have a super restricted diet so they can live forever, or is it to enjoy time with their family, or to be able to do a certain activity better, so I hesitate to hang everything onto genetics and dictate lifestyle just based on your genetics. We really want to develop something that's more holistic.
LB: That’s where the physician comes into the picture - in having a relationship with them that’s ongoing and aligned with your personal goals and values. I think it’s excellent you’re even mentioning personal values and thinking about them as a physician.
One of the things I think is totally rad is that - I’m sitting here interacting with you, I’m going to be talking to a doctor and several team members on my visit next week - Q: I was curious if you could remind me of how many medical professionals will be interacting with me directly or with my data as an outcome of my Health Nucleus visit?
I’ve split this interview into FOUR parts, due to its length! Part 4 will drop next week!
Previous Posts: Part 1 - Part 2
Follow-up Posts: Part 4
Note: the Health Nucleus has recently appointed a new Medical Director - Dr. Pamila Brar. Dr. Duchicela has transitioned to a role as full-time physician at the Health Nucleus, working directly with patients to optimise their healthcare!
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This information is intended for educational purposes only and is not meant to substitute for medical care or to prescribe treatment for any specific health condition. These blog posts are not intended to diagnose, treat, cure or prevent any disease, and only may become actionable through consultation with a medical professional.
Screening for Cardiovascular Disease with MRI and CAC - Interview with Health Nucleus Part 2
In this post you’ll learn ABOUT:
Health Nucleus tools for assessing cardiovascular disease risk
The role of the Coronary Artery Calcification (CAC) score in assessing risk, particularly for younger people (30s, 40s)
How CAC scores might influence statin use
The limitations of MRI data in assessing risk
How genetic risk factors might influence risk
Combining imaging data, genetic factors and blood tests to further clarify risk
Part 2 - Cardiovascular disease
Be sure to read Part 1!
Longevity Blog (LB):
We’ve talked a little bit about cancer. Another big killer whose risk is a function of how old you are and a number of genetic factors is cardiovascular disease and in particular atherosclerosis.
I understand my risk as a man in his thirties is low for an acute event now, but the disease risk grows with time as the result of a decade on decade buildup of plaque, inflammation and wear and tear on the arteries…
Q: So how does coming to the Health Nucleus help inform someone about how their risk might change as they get older? What could a young person do using this information to minimise their risk of atherosclerosis and cardiovascular disease?
Coronary Artery Calcium Scoring. Credit: Cleveland Clinic
Dr Duchicela: Yeah that’s a great question. So in terms of cardiac assessments, one of the most powerful ones that we do here is the coronary calcium score. This is looking at calcified plaque buildup in the arteries of your heart. Essentially, the more plaque you have the higher your risk is of a heart attack.
You’re right, for someone in their thirties, who’s young, who is otherwise healthy, the chances of you finding plaque are low. Based on the general standard of care in the community, we wouldn’t be getting a coronary calcium score on somebody who’s 35 years old or younger. But here, because we’re under a research protocol, we have a little bit more leeway to push the boundaries in terms of testing in groups that may not otherwise be traditionally tested.
“we’re finding that actually about 15 to 17% of individuals around the age of 40 to 45 or younger actually have significant plaque build up. ”
And so for the coronary calcium score for example we are able to do it on a 35 year old, or 36 year old and we’re finding that actually about 15 to 17% of individuals around the age of 40 to 45 or younger actually have significant plaque build up. So we are probably missing a good amount of people out in the community who have atherosclerosis and calcified plaque in arteries of their heart which will predispose them to heart disease.
So when you come here to Health Nucleus and you if you meet the age requirement of 35 years or older (that’s what do here for the coronary calcium score), you’ll see what your plaque level, your score is, and then we will compare you to other people your same age and gender. So you get a sense of how you stack up to a healthy peer group as well and based on that, we take that into account with your cholesterol numbers and so, let’s say you have high cholesterol numbers, your LDL is elevated and your doctor is trying to push you to be on a statin or a cholesterol medicine.
If you get a coronary calcium score and your score is 0, there’s no calcified plaque seen, then you actually have a pretty good case to make that you shouldn’t be on a statin just yet . A lot of men and women come through here and their doctors are pushing and pushing them to be on a statin because their cholesterol is on the higher side, and we scan them and we get their coronary calcium score and it’s zero or very low that actually is pretty powerful in that it makes it not as urgent to be on a statin and you can talk more about lifestyle modifications and the diet, the exercise and maybe hold off on that statin for awhile longer.
A lot of men and women come through here and their doctors are pushing and pushing them to be on a statin because their cholesterol is on the higher side, and we scan them and we get their coronary calcium score and it’s zero or very low
LB: That’s a really clear answer Keegan, thank you for that.
Q: Could you comment a little bit on what the Health Nucleus can do with the MRI technology in terms of cardiovascular risk?
My heart beating, as observed by the Health Nucleus full body MRI scan and post-processing technology.
Dr Duchicela: For heart attack risk you get most of the assessment from the CT scan and the coronary calcium score. From the MRI what we’re doing is more structure of the heart so this is like what the chambers look like, how large the chambers are, or if they are hypertrophied or thickened because of high blood pressure or if it’s not pumping as well as it should be, like the ejection fraction is low because of early congestive heart failure or some sort of other heart failure. That’s what we get from the MRI. The MRI is more structural. It can find congenital abnormalities of the heart sometimes too, where as the CT scan, the one that involves a little bit of radiation, that is more for heart attack risk.
LB: That’s a good differentiation. Thanks for taking the time to answer that. And so in terms of a young person coming in, you’ve mentioned this kind of threshold of 35 years or older to do the calcium score, I don’t meet that criteria quite yet, but I’ll certainly do it when I get to that point.
Q: What other Health Nucleus tools can sit alongside the diagnostic imaging tests (MRI, CAC score) which can help a young person evaluate their lifetime risk of atherosclerosis?
Dr Duchicela: In terms of genomics, there are some genetic markers that predispose you to very high levels of cholesterol, that would be picked up not only in the blood screen testing, but also in the genetic testing.
Let's say you're twenty years old and we’re not doing a coronary calcium score, what we would use instead to help predict your overall risk would be the blood test, the lipid panel, your other metabolic markers like your haemoglobin A1c, your fasting sugar. And then from the MRI we’d be looking at your body composition, visceral fat deposition, visceral fat level. With MRI we’re now actually able to quantify pretty accurately your visceral fat volume and compare you to other people your same age and gender.
So those things would build into this risk profile, and then the traditional things like how much you drink, how much you smoke, how much sleep you’re getting, if you have signs of sleep apnoea. Even thirty year olds have sleep apnoea now, so those sorts of things all help build a risk profile for young people if you don’t have let’s say a coronary calcium score.
LB: Right and in terms of the genetic analysis, besides being predisposed to familial hypercholesterolaemia or other acute high LDL cholesterol genetics, Q: Is there another set or group of markers that you might be looking at at an early stage that can show someone’s risk?
Polygenic risk scores from my own Health Nucleus genomic report.
Dr Duchicela: What we currently have is a polygenic risk scale that tells you your relative risk. What we do is we look at gene variants that are more present in groups or individuals that have for example coronary artery disease, or who have had heart attacks and then we see if you share those same gene variants, there are weights given to each of these gene variants, and then you come up on a scale of low, medium or high risk.
“I’m really excited what we have in the pipeline with this sort of scoring ... incorporating that with the coronary calcium score and putting it together and getting a global integrated risk score”
But we’re not able to give specific numbers just yet, other than relative risk or absolute risk just because our dataset wasn’t large enough to do that. But what we’re developing right now, you’d essentially get a polygenic risk score or polygenic risk assessment that takes into account these genes associated with familial hypercholesterolaemia, but also other ones that on their own don’t dramatically increase your risk, but in aggregate if you take 20 or 30 of them together they can tilt you one way or the other.
So that’s actually the really exciting part, using polygenic risk scales and scores and building those models out. And we’re just at version one of this I’m really excited what we have in the pipeline with this sort of scoring and also incorporating that with the coronary calcium score and putting it together and getting like a global integrated risk score. So that's where we’re headed, but right now I’d say these polygenic risk scales can tell you you’re a little bit more like people with heart attacks or you’re a little bit less like people with heart attacks but it doesn’t give you an actual number just yet.
LB: That’s really clear and you’ve mentioned version one a few times so it’s clear that one of the things we need to do is get more and more people to come through the Health Nucleus and share their genetic information and family history etc.
One of the things I get really excited about and really enjoy in my visits to the Health Nucleus is going into the MRI machine. I think that’s one of the coolest things you guys do, I love picking the scene, the light color, the music, the things to look at. It’s really awesome.
Q: What kind of data will you be pulling out of the MRI scans and what will you be using it for? Besides the heart analysis and some of the cancer detection, which we already discussed. What will be showing up in that data and what will you use it for?
I’ve split this interview into FOUR parts, due to its length! Part 3 will drop next week!
Previous Post: Part 1
Note: the Health Nucleus has recently appointed a new Medical Director - Dr. Pamila Brar. Dr. Duchicela has transitioned to a role as full-time physician at the Health Nucleus, working directly with patients to optimise their healthcare!
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This information is intended for educational purposes only and is not meant to substitute for medical care or to prescribe treatment for any specific health condition. These blog posts are not intended to diagnose, treat, cure or prevent any disease, and only may become actionable through consultation with a medical professional.
Early Cancer Detection and Big Data - Health Nucleus Interview Part 1
Shaking hands with Dr. Duchicela (left) during my January 2020 visit to the Health Nucleus!
In this post you’ll learn:
Dr. Duchicela’s background
Big Data & healthcare
The definition of ‘Healthy’
Early detection of Cancer
Part 1 - Intro, Cancer Detection, What is Healthy?
In a series of three posts, Longevity Blog interviews Dr. Keegan Duchicela, Medical Director at the Health Nucleus in San Diego, California. Dr. Duchicela received his medical degree from UCSF in 2007. Since the completion of his residency, he has served as the Lead Physician at the Google Wellness Center (Google’s on-campus medical facility), and over the past three years has held several roles at the Health Nucleus including Clinical Director, Medical Director and Physician.
This interview, from the 24 January 2020, walked through a series of pre-written questions with Dr. Duchicela, and is presented in the form of a transcribed audio conversation.
Longevity Blog:
Q: What motivated you to become the medical director at the Health Nucleus? That’s a pretty cool job!
Dr Duchicela:
A: It is pretty cool! My training is in family medicine, so from the get go I have felt there is great value in preventing and detecting disease before it happens and having actual relationships with the patients to really delve into things other than just normal lab values and imaging. I think you really need to get to know the patient, their family, their socioeconomic context, and their culture, as well as where they live to really get a general sense of their health risks, because there are so many other things besides just labs that determine how healthy you are.
Corporate wellness centers, like those run by Premise Health, are becoming more common at big tech companies, like Google. And they recruit top-notch medical practitioners like Dr. Keegan to run them. Source
I come from a different perspective, I didn’t go into medicine to learn about genetics or advanced imaging or even precision medicine, my focus was more on getting to know the person holistically to really enable them to take care of their body, their mind and their family. I looked at health in that context. But as I went through training and through the kinds of places I’ve worked over my career; I worked for a few years at Google helping lead their onsite primary care clinics where I encountered a lot of interesting individuals, engineers who were doing some amazing things with Big Data, I started to really see the value in having a large data set on health metrics and what you can do with that sort of information and the impact you can achieve. I began thinking that the future of medicine for physicians is as good data scientists with excellent bedside manner.
If we could offer this testing at a very inexpensive price point to millions of people, how much better would our health improve overall? I think it could be pretty dramatic to be honest with you.
I really think that’s where we’re heading. And so as a physician I feel like it’s really important to grasp the implications of using Big Data and what it really means and how we can use these analytical tools to predict where we’re going with our health.
after I left Google, I was looking for a company that was doing innovative things
So after I left Google, I was looking for a company that was doing innovative things in this space and really Human Longevity was the only place that I found that’s using imaging, genetics, peripheral blood biomarkers, plus family history and past medical history and putting it all together and getting a comprehensive view of health. So that’s what attracted me to the position. It’s been a wild ride and very interesting to see how the company has evolved and progressed and I think we have a pretty bright future. It’s exciting to be the medical director and that’s kind of how I ended up here.
Looking at this from a primary care perspective, if we could offer this testing at a very inexpensive price point to millions of people, how much better would our health improve overall? I think it could be pretty dramatic to be honest with you.
Longevity Blog (LB): I love that vision and one of the things that attracted me to HLI (Human Longevity Inc.) was one of your founders Peter Diamandis. He’s one of my… ‘heroes’, I’ll call him, a mentor, somebody I look up to. He shapes my thinking a lot and that idea of inexpensive testing for millions and reaching and impacting people positively is a mission that I believe in. The Longevity Blog is me playing my small part in helping to accomplish that.
There’s a really interesting kind of dichotomy that we find between the healthcare industry and the Health Nucleus - and that’s thinking proactively about health care. If I were to go into my doctor’s office, my traditional GP here in Australia and didn’t have any acute symptoms of any sort and told them I was there to optimise my health, they would probably tell me to get outta there because they are there to take care of somebody who’s sick.
Q: So, I was curious what you think the Health Nucleus definition of “healthy” is and how might it be different from a traditional one?
From the Health Nucleus website
Dr Duchicela:
A: I think right now we are in version one of this, in that we are trying to create a suite of testing modalities. We are trying to detect the things that prematurely end people’s lives very early on. The broad categories of these would be things like cancer, metabolic diseases like aneurysm or heart disease, and neurodegenerative disease like alzheimer's. And right now our testing packages or testing suites are set up where we’re looking for those big categories of disease.
When we have enough data and we have enough people go through, and we are able to create advanced risk prediction tool kits and algorithms, that’s when the real promise of a company like this can come to fruition. We do get pretty rigorous metrics from things like genomics and also from the imaging biomarkers like liver fat and visceral fat, but what we really want to do and what we’re currently working on and what really excites me is taking your genomics - let’s say dementia or Alzheimer’s - taking your ApoE status and taking your hippocampal volume metrics from your imaging and also taking into account these other genomic variants that may not contribute to risk in such a large way as for example ApoE does, but on their own could tilt the needle one way or the other and putting this all together with your alcohol consumption, your BMI, your visceral fat levels and everything else and using machine learning and AI to come up with a ten year risk prediction for Alzheimer’s disease.
An example of the brain imagery data collected by MRI at the Health Nucleus, to compute metrics like hippocampal volume. Pictured: my own brain!
That’s where I think the true promise of this testing lies, but those algorithms need to be developed and it really does take a large data set to develop those algorithms. So right now I’d say in terms of our testing modalities we have a really good screening test for these five big categories of disease, but we really want to evolve into becoming the crystal ball for alzheimers, the crystal ball for metabolic disease, the crystal ball for prostate cancer or breast cancer by putting these algorithms or data modalities together and really deriving some good inferences from them, but we need a large data set first. I think that’s the biggest challenge with this.
LB: Right and so that kind of definition of healthy is actually shifting perspective out ahead of time almost, not just are you healthy now, but will you be healthy in the future and what can we do to minimise your risk and hopefully be able to be more predictive with more data and better algorithms that you’re continuing to develop.
Dr Duchicela:
it’s tricky to give a one size fits all definition of health. You really have to take in the context of the individual and see what their values and priorities are and what they want out of their life
A: Yeah and everyone really has their own definition of healthy, because different people have different values. For example I had a patient the other day who is a wine entrepreneur. This is his business, this is how he supports himself and his family, and to tell him, “Hey listen, if you really want to optimise your health and be quote-unquote completely healthy, you may want to avoid the amount of alcohol you’re drinking, because alcohol is a carcinogen.” For him, that would actually negatively impact his lifestyle. He wouldn’t necessarily be living a happy life if he gave up his profession. So, I think it’s tricky to give a one size fits all definition of health. You really have to take in the context of the individual and see what their values and priorities are and what they want out of their life.
And if you ask people about this, it’s not one size fits all. I think that’s the art of this, figuring out what drives them, what motivates them to come in to get assessed; Is it a family member who was recently diagnosed? Is it because they have a grandchild now and they want to be able to be healthy and active for when they get older?
And, at least as a physician that’s what I’m trying to focus on, how do we judge success? I don’t think it’s necessarily just not dying at an early age. It’s essentially living a fulfilling life and accomplishing the goals that you want to accomplish, whether that be having your own wine business and doing that as a profession or living to 100 and being cancer free the entire time. So, I think what we like to do here at the Health Nucleus is focus on the goals of the patient and really try to tailor our recommendations and counseling towards their goals.
LB: That’s great and I love that individual nature of it and the reflection of values and goals that the individual has. You’re right that the definition of healthy has to sit in that spectrum. That’s an encouraging answer and one I definitely agree with.
You just mentioned at the end of your talk there, cancer. Cancer is actually something that has personally impacted me, even directly in my own wife who has had to have two big peritonectomy surgeries for appendix cancer, thankfully she’s in remission now.
I think about the widespread availability of Health Nucleus technologies and MRI scanning etc. and think about if we had had routine access to something like that, how might that outcome have been different.
Q: Now, I don’t want you to go into theoretical outcomes for my specific case, but I’m really interested in helping to share with folks how the Health Nucleus can detect the actual presence of cancer, not just cancer risk but the actual presence of cancer at an early stage.
Dr Duchicela:
A: That’s a great question. When looking at our testing modalities, we have the imaging which is almost like a point-in-time disease test. We’re looking for disease right now, or early early disease, that’s the hope. With the genetic testing, it’s more your disease risk five years, ten years down the road. So the imaging is really powerful in that we can tell you within a few hours after a scan, if there is something concerning, a soft-tissue mass or an aneurysm even.
our goal is to develop a test that doesn’t use radiation, that we can give safely to many many people, that covers most cancers and then have a suite of tests to fill in the gaps essentially.
With our imaging, that’s really the goal, we cover some cancers pretty well, but we also have some gaps in our cancer coverage, just to be completely transparent. We don’t pick up colon cancer or certain other GI cancers very well, the MRI results are limited because we don’t have people do a bowel prep ahead of time, so we would still recommend a colonoscopy or a Cologuard test for that.
Certain pulmonary cancers you can’t get too well just yet with MRI but we’re working on that. No screening test is perfect, and you can’t catch every cancer with one single test, but our goal is to develop a test that doesn’t use radiation, that we can give safely to many many people, that covers most cancers and then have a suite of tests to fill in the gaps essentially.
My own Health Nucleus MRI scan (pictured), from 2018.
Or maybe they can go through their traditional medical provider to do the colon cancer screening if we don’t have a good option for it here. So in terms of developing a test for cancer, it’s tricky because we don’t want to say that if you have a completely clear scan you’re cancer free, there are gaps and limitations with the current technology. But over time as we are able to get more patients through, we’re able to do better processing on the images, so hopefully we will start to fill in those gaps with better early detection of cancer.
LB:
Q: You’ve made very clear caveats on the limitations there, but where does your technology excel and succeed? There would definitely be some anecdotal examples of detecting certain types of cancer at an early stage. You certainly have some excellent technology in that space, could you elaborate a bit further on that?
Dr Duchicela:
I think where it excels is that we’re able to get really good images without having to use contrast and that’s really important if we’re trying to scale this and bring it to many people at a low price point, we want to make it safe too. We do have pretty good post processing.
Let’s take prostate cancer for example, most men will die with prostate cancer, rather than from prostate cancer. So the trick is, how do we know which prostate cancer is going to be an issue and is going to prematurely end your life and which is so slow growing that they will most likely pass away from other things instead of the prostate cancer. With the post processing that the computer scientists and radiologists, people much smarter than myself, have developed, they’re able to light up and differentiate with the software these higher grade lesions in the prostate that have a higher chance of being a concern and being more aggressive and truly cancerous.
Image Credit: UC London. Prostate cancer screening by MRI is becoming more widely accepted. That’s very good news for early detection and treatment. Source
So that kind of differentiation on the back end is really powerful. We don’t want to be detecting things that won’t really harm someone in the long run. If you’re familiar with prostate cancer screening in general, it’s pretty controversial just because if we find something, we are almost obligated to biopsy it and there can be complications with biopsy. So we really want to make sure that we are finding things that are meaningful, and I think with the post processing that we do with our scans we can make that differentiation and better guide them to say alright this a lesion that is at a much higher risk, so we would suggest you get a biopsy, as opposed to alright this is lower risk lesion based on our scans and it may be more reasonable to watch and wait, get a serial PSA, that sort of thing.
LB: That makes a lot of sense, and you’re right in terms of wanting to minimise false detection or follow up treatment or biopsy to the really significant or possibly progressive forms of the cancer. That’s really fascinating.
We’ve talked a little bit about cancer, another big killer and one that is kind of a function of how old you are and how long you’ve been alive and a number of genetic risk factors is actually cardiovascular disease and in particular atherosclerosis.
I understand my risk as a man in his thirties is low for an acute event now, but that it’s really decade on decade buildup of plaque and inflammation and wear and tear on the arteries that increases the risk…
Q: So how does coming to the Health Nucleus help inform someone about their risk as they get older and what they can do as a young person to minimise the risk of atherosclerosis and cardiovascular disease?
I’ve split this interview into four parts, due to its length! Part 2 is coming soon :)
Note: the Health Nucleus has recently appointed a new Medical Director - Dr. Pamila Brar. Dr. Duchicela has transitioned to a role as full-time physician at the Health Nucleus, working directly with patients to optimise their healthcare!
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Four tools for managing cardiovascular disease risk
Cardiovascular Disease kills But longevity technologies help manage risk
In this post, we present you with four immediately actionable ways to ASSESS your risk
If you’re like us — you’re excited about the imminent increases to our healthspan that longevity technologies will soon offer us. However, if you want to stick around long enough to take advantage of all of the soon-to-be available lifespan and healthspan boosting technologies, you need to make sure you don’t die in the process!
But how will you die? Probability states it will be one of the four deadly killers
Atherosclerotic coronary heart disease is the single leading cause of death of men and women in the United States [Source: Medscape]
Ever since science effectively cured infectious disease through antibiotics, vaccinations and the like, there has been a distinct shift in what kills humans to the four deadly killers, which are considered ‘age related diseases’.
These are — cardiovascular disease, neurodegenerative disease, metabolic disease and cancer. If you manage to escape the most likely causes of death as a young person, which are largely accidental death (mostly car accidents), homicide or mental illness related (suicide) — then it is most likely that one of those four deadly killers will end your life.
But here’s the good news — there’s a growing body of immediately actionable longevity technologies that you can engage with to offset your risk of dying of these diseases.
In a series of posts on the topic, we’ll cover a few key resources at your disposal for managing your risk for each of these four categories.
First-up, cardiovascular disease.
Deadly Killer #1 — Cardiovascular disease
Heart attack, stroke, thrombosis, heart failure — the chances are overwhelming that you have lost someone important to you in your life to one of these causes.
It is often seemingly sudden, but in most cases, the acute cause of death by cardiovascular disease has been brewing for a very long time — decades even.
From A to D, the progression of atherosclerosis. At A: healthy aorta with no disease. D: an abundance of plaques and ulcerations.
The term ‘cardiovascular’ encompasses disease of both the heart and blood vessels, which is driven by the build up and eventual displacement of plaque that accumulated in the arterial wall in a process called ‘atherosclerosis’.
It’s not our role to explain all of the mechanisms of this disease.
Instead, we’ll focus on four actionable tools you can work with your doctor to obtain access to, which will help you assess your risk profile and detect any elevated risk of an acute event (e.g. heart attack, stroke) at an early, treatable stage:
1. Action 1 - Test your ApoB (“A-PO-B”)
Stop using your LDL-C as your only risk assessment tool (The “LDL” value too commonly called the “bad” cholesterol), and add tracking of your ApoB.
ApoB is a particular type of molecule attached to the types of lipoproteins carried by your LDL (and VLDL) that are the most likely to enter the arterial wall and lead to plaque formation.
You need to know *how many* of these atherogenic particles you have present in a given volume of you blood — this drives your risk.
Your ApoB value is influenced by diet and lifestyle and can be controlled with pharmaceutical intervention and possibly through certain forms of supplementation.
Learn more about ApoB at Healthline.
Self-order your own Apo-B test (+other cardiovascular markers)!
No doctor required!
HealthLabs.com (USA) - Single Test
UltaWellness (USA) - Panel
I-Screen (Australia) - Panel
2. Action 2 - Do you have elevated Lpa (”L-P-little-A”)?
Lpa is another cardiovascular disease bad guy that may be in your bloodstream.
Lipoprotein-a is a particle which carries cholesterol, fats and proteins and is made by your body, and how much of it you make is inherited.
Elevated levels of Lpa increase your risk of a heart attack or stroke as they are known to cause atherosclerosis.
You certainly need to know if you carry the genetic risk factor, and the earlier the better (i.e. get this test done as early as possible)!
Levels of Lpa don’t change much over one’s lifetime, so testing it once is enough in most cases!
Know your Lpa status, and better know your risk, and whether or not you should modify your diet, lifestyle and treatment options.
Learn more about Lpa from the lipoprotein-a foundation
Self-order your own Lp(a) Test
No doctor required!
HealthLabs (USA) - single test
UltaWellness (USA) - Panel (includes ApoB)
i-Screen (Australia) - Panel (includes ApoB)
3. Know your Coronary Artery Calcium scan score
Coronary artery calcium (CAC) scans are created by using computed tomography (CT) scans, which are a type of X-ray scan, to detect the presence and quantity of coronary artery calcification (the warning signs of atherosclerosis).
A CAC test reveals both the location and quantity of calcium located in three of the main coronary arteries. The scan provides a score which represents your risk.
The lower the better! This score will change over time, and is known to increase with age, so it is important to record it regularly (in a manner that balances the downsides of the X-ray radiation — ask your doctor what’s best for you).
Atherosclerosis is a disease of ageing, and that means your risk is increasing over time. If you are aged 50 or above and have never had one — work with your doctor to get one performed.
Read more about CAC scores in our interview with Health Nucleus Medical Director Keegan Duchicela.
4. Track your inflammation with C-Reactive Protein (CRP)
At its roots, atherosclerosis is known to be intimately connected with inflammation.
In fact, it is often damage to the arterial wall that attracts the formation of plaque in the first place.
This damage occurs over time, and is known to be increasingly likely with high blood pressure and high blood glucose levels.
CRP is a very common and relatively low cost blood test that can be easily ordered up by your doctor, and should be tested annually at the very least.
High levels of CRP are indicative of increased risk of cardiovascular disease, and once again can be influenced by changes in diet and exercise.
If you have the option, go for the high-sensitivity CRP (hsCRP) test if possible!
Self-order your own hsCRP Test
No doctor required!
HealthLabs (USA) - single test
UltaWellness (USA) - Panel (includes ApoB & Lpa )
i-Screen (Australia) - Panel (includes ApoB & Lpa)
Take Action!
Everything that we have discussed in this post encompasses longevity technologies that are available to you NOW.
Ultimately, it is up to YOU to demand access to these technologies, in one way or another. No one is going to do that for you.
If you are aged 50 or older, the importance of getting each of these tests performed is exponentially more important with each decade of life!
Follow us on Twitter for the latest! @longevity_blog
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FDA DISCLAIMER
This information is intended for educational purposes only and is not meant to substitute for medical care or to prescribe treatment for any specific health condition. These products are not intended to diagnose, treat, cure or prevent any disease.
Immediately Actionable Insights via Micronutrient Testing
Considering a micronutrient test? Do these two things first!
Want to take a micronutrient test? Order your own without a doctor!
Micronutrient test results are in!
Imagine my excitement as the moment finally arrived - the comprehensive results from my 15 vials of blood and four detailed blood tests arrived in my inbox. After 4 weeks of waiting, the mountain of data arrived and the real fun of digging through it for actionable insights began. To get started, I’d like to share with you three immediately actionable insights I gained from my micronutrient blood test.
Micronutrient Test for Glutamine (Actionable Insight #1)
Huffing and puffing my way towards my cardio goals (I plan to run my first 10km race this year) sure leads to a lot of SWEAT. Much more than I’ve personally been used to. I’ve established a solid routine where 6 days/week, I am up early in the morning getting in a vigorous walk of 5k+ steps or run workout (trail runs, endurance training - follow me on Strava). However, unbeknownst to me, that SWEAT was taking with it a critical micronutrient needed for the success of many different bodily systems - Glutamine.
Glutamine is an amino acid that plays a critical role in the synthesis of proteins, which has impacts for many bodily systems. In fact, it is the most abundant amino acid in the human body. This being the case, it is also abundant in a wide variety of our food choices - including meats like beef, chicken and fish, dairy products, eggs, and many vegetables (leafy greens, carrots, cabbage, beets).
After a deep dive on all the best options, I opted for this L-Glutamine powder from California Gold. They also offer a capsule form. Save 10% and support the Longevity Blog with code EYU021
But my levels were low, as in rock-bottom low, and that had many knock-on effects to my neurological function, gastrointestinal barrier, my liver performance, my joint health, my skin vitality and my mitochondrial function. Just check out the useful summary graphic provided in my report (the one with the multiple indicator “gauges”, note that you can click on the image to see the full size)
Low glutamine is simply put - bad news. For a young and healthy person looking to optimise his wellbeing and longevity, this was certainly limiting my performance. For some perspective on just how low my levels were, check out the reference ranges in the next image. The ‘Serum’ levels (what was detectable in my blood liquid - not the actual cells) was only 23.6 nmol/mL! Thankfully, the amount in my white blood cells (WBC), which is an indicator of long-term micronutrient availability was in the normal range, but the serum level was nonetheless quite problematic.
Needless to say, I jumped on a high quality glutamine supplement from my brand of choice (California Gold - save 10% and support Longevity Blog with code EYU021 ) within a few days. I immediately enjoyed a noticeable improvement in my gastrointestinal health, with knock on effects to the health of my skin (less acne breakouts) within just a few days. The bottom line here - this was incredibly valuable and highly actionable information that was available to me through this micronutrient test.
Micronutrient Test for Chromium (Actionable Insight #2)
My glutamine levels weren’t the only important micronutrient that was critically low, as my intense levels of exercise and SWEAT were also depleting an important mineral - Chromium. Further research revealed that Chromium is commonly deficient in athletes for this reason.
Chromium plays a very important role in metabolism, and is directly involved in the breakdown of fats and carbohydrates. With respect to fats, it stimulates the synthesis of cholesterol and fatty acids. For carbohydrates, it is involved in the regulation of insulin. It also is involved in the metabolism of some amino acids. Once again - very important!
I took a pretty picture for you! Chromium Piccolinate to the rescue!
Dietary sources of chromium include broccoli and green beans (which I eat daily!), meats like beef and poultry, and fruits like apples and bananas (which I regularly also enjoy). However these dietary sources are still relatively low.
This makes chromium supplementation a well-informed choice for me and for anyone else who is moderately active (or wants to better manage their insulin levels, e.g diabetics), which is the second immediately actionable insight I garnered from my NextHealth micronutrient test. I turned to my vitamin supplier of choice - Thorne for a Chromium Piccolinate supplement, but later pivoted to the cheaper version from Now and take it twice a week with my Vitamin C and B-vitamin complex to improve absorption. Just like with the Glutamine options on iherb - use the discount code EYU021 to save 5% and support the Longevity Blog!
Micronutrient Test for Vitamin K1 (Actionable Insight #3)
There are two forms of the fat-soluble vitamin K needed by the body - K1 and K2. These are important for blood clotting, regulation of calcium (particularly bone metabolism) and cardiovascular health. Vitamin K also plays a role in mitochondria producing energy for your cells.
It also turns out, that despite plenty of dietary intake of Vitamins K1 and K2 in my vegetable rich diet, my micronutrient testing revealed critically low amounts of Vitamin K1 in my blood serum. Additionally, despite my 100mcg/day supplementation of K2, it was also fairly low. This clearly made supplementation of Vitamin K1 (and continued supplementation of K2) the third immediately actionable insight gained from my micronutrient testing at NextHealth.
Conclusion - Micronutrient Testing is a Valuable, Actionable Tool
There is so much more that I gained from my micronutrient testing that I hope to share with you in upcoming posts (be sure to subscribe to the Longevity Blog!), including my Omega 3/6 balance, copper-zinc ratio and antioxidant levels. However, even without these added benefits, I believe the outcome of my first micronutrient test is clear - regular assessment (I’m guessing every 6-months) of one’s micronutrients provides actionable insights that can be used to improve your health and optimise longevity.
I’d like to close with my sincere thanks to NextHealth for living up to their mission as a Health Optimisation and Longevity Center, and making is simple, straightforward and affordable to access this resource. I’ll certainly be back for my next micronutrient test in 2020!
Follow-up Post: Considering a micronutrient test? Do these two things first!
READY TO Test Your Micronutrient Status?
We’ve found three valuable DIY options for you! No doctor required!
HealthLabs USA)
UltaWellness (USA)
I-Screen (Australia)
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FDA & TGA DISCLAIMER
This information is intended for educational purposes only and is not meant to substitute for medical care or to prescribe treatment for any specific health condition. These blog posts are not intended to diagnose, treat, cure or prevent any disease, and only may become actionable through consultation with a medical professional.
Why I Just Gave 15 Vials of Blood at NextHealth
Visiting NextHealth in Los Angeles to See and Experience Proactive Healthcare in Action
I’m coming off a real high having just been to LA and San Diego over this past week and not just because I had my face bathed in some awesome infrared radiation with a “Light Stim” (see this IG post and be sure to give me follow 😉). No, I’m jazzed because I FINALLY visited NextHealth in Century City, LA - and let me tell you, it was a life changing experience!
What is NextHealth?
NextHealth refer to themselves as a “Health Optimisation and Longevity Center” - as you can imagine, I fit quite squarely into their market segment (I am trying to Biohack my way to a vibrant, healthy, long life after all). They do everything from cryotherapy to dermatology and IV vitamin infusions to blood testing.
Why Did I Visit NextHealth?
This time I was out for blood 💉!!
NextHealth offers a few blood test products that I was very interested in for supporting my longevity journey. These are:
And then, upon further digging into some other options during my visit to the site, I decided to also add on:
My Motivation: Get Feedback and Optimise
There is simply no way to start to introduce all of the different things that will be covered by the above blood tests, those are quite extensive! But I do have a select number of things that drew me to these blood test options, by blood test product they are:
Total Baseline:
I was very interested in my NMR spectroscopy results so I can better understand what the particles sizes make up my LDL cholesterol
I am in my early 30s and undertaking many ‘hacks’ to keep my testosterone high - are they working? (dutch test hormone data!)
Micronutrient Testing
I have an aggressive supplement regimen (30+ supplements a day and climbing), and micronutrient testing will help me adjust the levels of supplementation very accurately
Genomic Fit
I am interested in optimising my diet and athletic performance (going for a sub-20 minute 5K at the moment) and ‘Genomic Fit’ will give me some actionable info on this
Food Sensitivity Testing
Figuring what foods you are sensitive to (different from being allergic) is very difficult to do with dietary testing alone, and I can tell I still have some foods in my diet that give me inflammation - what are they? I must know so I can ban them and protect my gut lining!
All Up I Gave 15 Vials of Blood in the Name of Science
“It’s less blood than it looks like”, Ashley, the gorgeous phlebotomist let me know. “We’re almost done”
Good, cause I was totally light-headed already.
“Yeah, I passed out once when I gave about 30x vials for a scientific research study”, I let her know. “But don’t worry, I totally gave that nurse a heads up that I was on my way out”, I joked.
She just laughed and smiled re-assuringly (and probably thinking “God, don’t let this guy fall over on me…”). Thankfully Nick stayed conscious this time, and just like she promised - the blood draw was over quite quickly.
And might I say - it was an exceptionally professional job done on the blood draw, complete with a comfortable chair and warm-up blanket over the arm to kick it off. A smoother experience than I have had in many hospitals!
While I’m Waiting for the Blood Test Results…
I am not going to get my blood results back until early December, so this story is far from reaching its conclusion. In fact that visit to NextHealth was so life-changing, I easily have 10-15 more blog posts I’d like to write about it.
One thing is for sure, I will have plenty of material to work with. I once again am going to find myself with a stack of amazing health data to dig through! It is my plan to walk through some key lessons I learn from those blood results in upcoming blog posts, so be sure to subscribe to the blog if you’d like to see what happens!
3 Technologies for Monitoring Heart Health
Three heart health technologies looking after your ticker
Monitoring heart health is a top priority. When it comes to listing your vital organs - those needed most for your overall well-being and the joy of being alive, the heart comes up at the top of the list (along with your brain, liver, kidneys…).
It should be at the top of the list for all longevity enthusiasts keen to look after their long-term health. But what technologies are accessible and valuable for this purpose?
Heart Health and the EKG
Health Nucleus EKG results for Nick were all fine and dandy!
An EKG is short for ‘electrocardiogram’. The EKG is on the frontlines for assessing heart health, and is particularly valuable in the case of an ongoing heart attack.
An EKG is completed by checking the electrical activity of the heart by attaching several small sticky electrode pads to your arms, chest and legs.
The EKG provides the following information:
Analysis of blood flow to your heart muscle
The electrical signals of heart rhythm
A first line of detection for abnormalities
Detect electrolyte imbalances
What’s fascinating about EKGs is how accessible the technology has recently become.
Perhaps the biggest impact on accessibility of this test has been made possible by the Apple Watch, for which Series 4 and above have EKG capabilities
But the Apple Watch is not alone! Several other ‘test at home’ technologies are also available. “Emay” is another technology brand which has entered the space.
They have an impressively compact and slick device, which we personally prefer over the Apple Watch due to its lower cost and dedicated function (does an iMessage on your wrist help your heart health?).
Don’t get confused about the “ECG” term, EKGs and ECGs are the same test.
Heart Health and Cardiac MRI
In an earlier post we discussed the merits of full body MRI and cardiac MRI.
Example of Nick’s cardiac MRI findings. Note the very particular measurements of the heart anatomy.
MRI stands for magnetic resonance imaging. A heart or cardiac MRI looks into the structures of the heart and its neighbouring blood vessels in great detail.
A Heart/Cardiac MRI is used to diagnose/check for:
early signs of heart disease
assess the the heart for any signs of damage
detect any imminent heart failure or defects
assess inflammation of the membrane lining the heart
While you certainly can’t perform a cardiac MRI at home, you can work with organisations like the Health Nucleus or a specialist to have these tests completed.
Heart Health and THE ZIO
Wearing the Zio
Two weeks of detailed heart-rate data, under all conditions - exercise, rest, day-to-day activity. Including tracked events where Nick pushed the button for closer inspection in the report (see below).
As a part of Nick’s preliminary Health Nucleus visit, he was sent away with a small stick-on device called a ‘Zio’ that he wore for two weeks.
The Zio watches heart-rate in great detail and and includes the ability for the user to track events of interest by clicking the device.
Nick noted he ‘clicked’ the button on a few events where his heart-rate seemed to pick-up and beat hard after lying down in my bed.
He’d actually noticed these events for most of his adult life, and had passing concern about what that indicated about my heart/body health.
Those events have now been analysed in great detail and revealed no underlying heart driven worries.
The Zio device is attached with a gentle adhesive which did not cause any skin irritation.
Beyond having to ‘bag’ the device in order to take a shower (covering it with plastic and tape), it is a very easy device to manage.
Notes from Nick: “Those ‘Black dots’ are regions where I clicked the button for closer inspection. These were events where I noticed my heart-rate seeming to pick-up, or be more noticeable after lying down in my bed.
I’d noticed these my whole life - now I know they have no underlying heart driven worries and can rest easy :)”
Zio IRhythm overall report after two weeks
Nick’s Zio report. 175bpm during an intense workout. 52 bpm minimum recorded during the overnight.
FDA & TGA DISCLAIMER
This information is intended for educational purposes only and is not meant to substitute for medical care or to prescribe treatment for any specific health condition. These blog posts are not intended to diagnose, treat, cure or prevent any disease, and only may become actionable through consultation with a medical professional.
Full Body MRI Data: Health Screening of the Brain, Heart and Abdomen
What is a 3D full body MRI and what did I learn from completing one at the Health Nucleus in San Diego?
Full Body MRI Scan Technology
Full body MRI data is an incredible advancement for health screening.
As we covered in our inaugrual post, our Founder (Nick), chose the Human Longevity Inc ‘Health Nucleus’ in 2018 as the starting point for his personal comprehensive health screening journey.
The San Diego based centre, focuses on employing cutting edge capabilities for detecting disease at an early stage. Full body MRI scanning is core to their offering.
This post offers a quick overview at what this technology is capable of.
What is a Full Body MRI? (With Video)
Magnetic resonance imaging (MRI) has the ability to image the inside of your body in great detail, through the use of strong magnetic fields and radio waves. It does this without the use of harmful electromagnetic radiation (like X-rays or CT scans).
At the Health Nucleus, the full body MRI scan emphasises the brain, cardiac health and cancer screening within the chest, abdomen and pelvis. It also produces valuable information about body composition.
Here is a great short video from HLI that you can view below that explains this a bit further:
Why purchase a Full body MRI?
The future of healthcare is proactive & preventative, and that future is underpinned by comprehensive health screening technologies like the full body MRI!
The current state of ‘reactive healthcare’ (only treat you once you are sick), has already pioneered nearly all of the medical treatments required to treat the most common life-threatening diseases.
This however requires that they are detected early at the ‘treatable stage’. This is where full body MRI scanning comes in handy.
A full body MRI like the one offered by the Health Nucleus, scans the brain, heart and abdomen in high resolution. Through their specialised suite of sophisticated post-processing algorithms, they are able to detect tumours that are only millimetres in diameter.
This technology can also discover brain aneurisms before they ruptures, as well as abnormalities of the heart or circulatory system.
You may be surprised to know that the Health Nucleus has found clinically significant findings in 40% of their clients! These aren’t all revealed by the full body MRI, but many of the more serious and dangerous findings are (e.g. pancreatic cancer).
What is a full body MRI experience like?
A fully body MRIO requires being inside of an MRI machine for up to 70 minutes (with a short break in between). This can be quite intimidating for some people.
Here is a short video describing Nick’s full body MRI experience:
What did a FULL body MRI reveal about me?
““I spent nearly 75 minutes in the MRI machine, watching amazing images from outer space on a ceiling-mounted monitor, while listening to relaxing transcendental music””
Example full body mRI Data - The Brain
Brain analytics, highlighting the different regions of Nick’s brain.
As is the case for many folks undertaking proactive health screenings, Nick’s full body MRI did not reveal any pathological findings.
What was gathered however, was a wealth of valuable baseline data. As an example, the brain scanning established normal values for the volumes of each of the major regions of the brain.
One area of particular interest is the hippocampus, whose volume is known to decrease with age, along with a decline in short-term memory and overall ‘plasticity’ (ability to adapt to new learning).
As Nick ages, we’ll be able to monitor his hippocampus for any changes in its volume. As well as other regions under increased pressure with aging, such as the hypothalamus.
Example of full body MRI data - The Heart
Nick’s heart beating away!
Cardiac MRI is a specific type of scanning approach, which can watch the heart beat and trace the flow of blood.
For example, the ‘ejection fraction’ can be quantified, and tracked over time. Any abnormalities in heartbeat are also immediately apparent.
Cardiac MRI reveals the structure of the heart, and in particularly can detect any hypertrophy (abnormal growth of a heart chamber) or thickening of the heart wall because of high blood pressure.
Example of Fully Body MRI data - Visceral Fat
MRI data is also exceptional at revealing body composition.
One of the more important predictors of the risk of disease and/or mortality (risk of dying) are an individual’s visceral fat levels.
Another important metric is the total volume of fat in your liver (e.g. fatty liver disease).
The full-body MRI can directly quantify these volumes, compare you to a reference population and give you clear advice on how much fat you need to lose to lower your disease risk.
FDA & TGA DISCLAIMER
This information is intended for educational purposes only and is not meant to substitute for medical care or to prescribe treatment for any specific health condition. These blog posts are not intended to diagnose, treat, cure or prevent any disease, and only may become actionable through consultation with a medical professional.
Comprehensive Health Screening: Health Nucleus
Health screening is the future of healthcare
In this short 5-minute video, our founder shares personal thoughts on the future of healthcare, and why it is proactive. The technologies to prevent disease are at your disposal, will you choose to access them?
medical screening in great socks
The Future of Healthcare
includes great socks 🧦
The future of healthcare is based on health screening that is proactive & preventative!
Today, we have all of the medical technology required to detect and treat the most common life-threatening diseases, provided that we can detect them early on.
This includes common killers such as cardiovascular disease (heart-attack, stroke, thrombosis), the chronic illnesses of metabolic disease (diabetes) and, of course, most cancers.
Even health screening and early detection of diseases of the brain (alzheimer's or parkinson’s) can result in extended healthspan, and slow the rate of disease progression (although a cure for these maladies will likely require changing the ageing process itself!)
Health Screening Gets Personal
As our founder shares, health screening is part of a personal motivation for creating Longevity Blog. “In my late 20s, I had three people quite close to me, also in their late 20s, be diagnosed with cancer. In fact, one of them, was my own wife (appendix cancer)!”
“Another had stage III colon cancer. The third, stage IV testicular cancer that nearly took his life.”
In each of these cases, treatments came well after the onset of the disease, which brought on deeper thoughts on the very nature of how we detect and treat these diseases.
Health Screening is how Healthcare catches up to the 21st CenturY
New longevity technologies are being developed and deployed at an increasing pace. Some forward thinkers, including our Founder, observe this trend to be exponential in nature.
This is particularly true for health screening technologies which are directly coupled with progress in computing capabilities (processing power, network communication speeds, memory availability).
However, your personal experience in the healthcare system does not make these changes immediately evident. The healthcare system has made great strides in responsive medicine - treating disease at later stages, after an acute event or advance systems are present.
comprehensive regular health screening is available now
All of the health screening technologies required to detect diseases at an early, highly treatable stage exist NOW (at the time of writing, late 2019).
It is not technological limitations which prevents your access to these technologies. Instead, the limitations are based on 1) knowledge of alternatives, 2) financial means to access them, and 3) your personal demand for access to them.
This foundational post from the Longevity Blog will be followed by all of the information you’ll require to learn about proactive healthcare technologies and how to access them.
It will include our Founder’s personal foray into this technology space, where we’ll use his experience to thoroughly vet and explore these new technologies, to help you decide which to add to your own personalised longevity strategy.
FULL BODY HEALTH SCREENING: the Health Nucleus
Full Body 3D MRI - on the cutting edge of proactive healthcare
As you’ll soon learn, many forward thinking technologists, scientists and medical professionals have already begun to create a healthcare system worthy of the 21st Century.
Where this adventure will start, is at one of the most comprehensive health screening treatment centres in the world: Human Longevity Inc’s Health Nucleus.
Based in San Diego, California, our Founder first visited the Health Nucleus in May 2018. Where he underwent the following:
a wide-reaching blood panel
microbiome sequencing (💩)
What followed on from this visit was a complete transformation in his approach to health and wellness. It’s precisely this type of self-experimenting that helps us create unique content to guide you on your own wellness journey.
Read more about the Health Nucleus in the following posts: