March 11, 2025.
0:00 - Introduction & Overview 1:09 - Why Biological Age Tests Are Misleading 2:26 - Optisan’s Research on Biological Age Tests 4:40 - Understanding Biological Age Clocks & Their Limitations 6:34 - The Four Major Problems with These Tests 7:57 - Lack of Regulatory Approval & Oversight 10:28 - Are Doctors Benefiting from These Tests? 12:22 - Reliable Biomarkers for Longevity & Health
AI trancript:
Hey everyone, welcome to the Optispan podcast. On today’s episode, I’m going to talk briefly about biological age tests. I know there’s a lot of confusion out there around what these tests are, whether they work, what they actually measure, and uh, I definitely have um, developed a strong opinion um, based on a fair amount of information that I’ve collected. So I thought I’d share that with you. So for those of you who really just want the 30-second TikTok version, here it is: um, direct-to-consumer biological age tests don’t work. They are statistically meaningless, um, in my view, they provide no actionable or useful information to consumers or to medical providers. I sort of feel like the industry is a mess. There’s no internal standards or quality controls, um, and again, in my opinion, these tests are net harmful to consumers and to the reputation of the field. So my recommendation is don’t waste your money on direct-to-consumer biological age tests and instead use it for something useful like healthy food or a gym membership or even better, spend it on something that brings you joy. So that’s really the take-home.
And now what I want to do in the next 15 minutes or so is kind of tell you why I feel that way and how we got here. So um, as many of you know, Optispan is a healthcare technology company that I run, um, and our mission at Optispan really is to figure stuff like this out, to create tools that enable rigorous science-based health optimization for as many people as possible. And as part of this effort, we have been developing clinical programs where we can assess various approaches and again, part of the goal is really to understand what works, what doesn’t, where the friction points are both within the current healthcare ecosystem and then also what does it mean to do state-of-the-art longevity medicine. And so of course, one of the areas that we’ve been assessing in our clinical programs are a variety of different what we would consider biological age assays that at least in principle measure different aspects of biological aging or different hallmarks of aging, for lack of a better way of saying it. And so among those are some direct-to-consumer epigenetic age tests, um, and so based on the outcome of these studies, we have decided that Optispan will no longer be using these biological age tests as part of our standard clinical programs. We’re pulling the plug until they provide value to our clients. Um, for people who still want these tests and are part of the Optispan family, we’ll help enable access to the tests and do our best to interpret them, but again, our recommendation is that at least for now, these tests don’t really provide anything in the way of useful information.
And so if you haven’t yet watched the video on this podcast channel where I did my self-experiment using four different types of epigenetic age tests, eight different kits in total, I highly encourage you to do so. I’ll talk just briefly about that in a few minutes. And so in some, the data from that experiment, from our own internal uh information across dozens of clients at this point, and then conversations that I and other members of the team have had with, I would say, a variety of thoughtful clinicians and researchers in this space really leads us to the inescapable conclusion that at least right now, the direct-to-consumer biological age tests don’t work and are not providing any real value to our clients. And so we’ve decided not to use them, um, anymore.
Okay, so let’s take a step back and talk briefly about biological age clocks in general. Um, and again, I think it’s important to start from the foundation. The basic science here is pretty solid, right? We know that there are molecular markers, those include things like DNA methylation, so that’s epigenetics, um, can correlate with age and with health status, and that evidence is really compelling. So you can create algorithms based on these molecular markers, and again, there’s nothing special about epigenetics per se. You can do it with proteomics, so proteins, metabolomics, metabolites, transcriptomics, RNA levels. You can do it with facial features. You can do this with a lot of different types of data and just create subsets of features that are strongly correlated with whatever you’re interested in. That could be chronological age, it could be risk of developing a specific age-related disease, it could be risk of dying, mortality. So you can do that, and the math here is pretty straightforward, and these things work pretty well, and they’re really useful research tools in the laboratory that I think most people in the field would agree one day should become useful diagnostics in the clinic and may even be useful in clinical trials as what we call surrogate endpoints to give us a hint as to whether or not different interventions are working or not. Um, but also think it’s important to say that even in the research setting, in the academic world, we still don’t have a direct mechanistic link between the changes that these clocks are using in the algorithms and biological aging or any specific age-related disease.
And so what I mean by that is if you think about the epigenetic clocks, they use a subset, dozens, maybe a couple of hundred specific epigenetic changes in the genome out of millions, um, that are correlated with chronological age or age-related disease or risk of dying. So they’re using a small number of specific methylation changes. None of those have been mechanistically shown to be connected to the outcome of interest, whether that’s chronological age or age-related disease or risk of dying. And again, just to get a little bit more granular, we know that epigenetics regulate gene expression, they turn up or turn down genes. So when I say there’s no mechanistic connection, what I mean is specific epigenetic changes have not been shown to regulate the expression of any specific gene that is mechanistically connected to the feature of interest: chronological age, age-related disease, risk of dying. So these things are really a correlation to a correlation to the thing we’re really interested in, which is health or mortality, and that’s in the academic research setting.
So um, nonetheless, many companies have rushed to start selling these things to consumers, and they have no idea how they’re working or if they’re even mechanistically connected to anything relevant. So here’s what I think you need to know, and there’s really four things that I have sort of focused on. One, no consumer-facing biological age test has been validated or approved by a regulatory body, not FDA, not any sort of independent group that can say with any level of confidence that this test is measuring anything relevant. No approvals, no validation by any independent regulatory body. Number two, related, there is currently no industry oversight or transparency on quality control. We really have no idea how these companies are doing what they’re doing or how they’re getting the data that they give back to you. Number three, the variation in the results makes them statistically meaningless, and I think again, um, the episode on this podcast channel, um, is a good example of this where I did eight tests, all on the same day, same biological samples. At the time, I was 53 years old, 53 and a half years old chronologically, and the results I got back were 43, 45, 48, 56, 57, 57, 60, 61, 61. So all over the map, completely useless for anything other than entertainment purposes, and I have to say I was not very entertained, um. And then number four, right now, even if they were accurate, which they’re not, they don’t give you any actionable insights to improve health. And I don’t really think anyone can argue with any of those four facts. If if anybody wants to argue, I would be happy to have a conversation or a debate about this, but I really don’t think there’s any arguing those are just facts.
And so then the question becomes, you know, why are these companies selling these tests and who benefits because I don’t think the consumer does really. The only idea I’ve ever heard that might suggest a benefit to these tests is that you know it motivates some people to practice a healthy lifestyle. I’ve heard actually heard people in the industry say this: well, even if the tests don’t work, maybe it helps motivate people to practice a healthy lifestyle. That might be true for some people, but personally, I think I know more people who get discouraged by these tests and especially discouraged when they realize they wasted $500 on something that doesn’t give them any useful information. And I would also say I think there is an additional component here where a lot of people believe this makes the entire field look bad. Um, I’ve heard people say that the entire longevity field is full of grifters based at least in part on these tests, and I think the fact that some academics are endorsing them, slapping their faces on these things, adds to the perception that the field is full of charlatans. The data are not statistically defensible, and when you have academics endorsing something that is not statistically defensible, it kind of makes the field look bad, um.
So it’s interesting though that despite the fact that I have yet to hear anyone really advocate that these tests are accurate or work well, we have a lot of longevity clinics and a growing number of functional health and integrative medicine docs that have started recommending these tests to their clients. And I get it, part of it is if your clients come to you and ask for it, you sort of feel obligated to give them what they’re asking for. But I would suggest if your doctor does this, you should ask them some questions about, you know, why are they recommending the tests. And among the questions you might ask are: are these FDA approved or approved by anybody? The answer is they aren’t. How does this inform my care? That’s a good question to ask. What specific actionable steps will you take based on the outcome if my results come back high or low or or right on my chronological age? How does that inform the way you’re going to care for me? And then finally, you can ask, ask them are they making a commission off selling these tests? Many are, and that obviously creates a conflict of interest. And then if you really want to have fun, you might ask them how do the tests work? What are they actually measuring? How do we know this is a measure of biological age? What is biological age? You know, is it unfair to expect a longevity doc to know these things? I don’t personally think so. I think in my view, a doctor really ought to understand how a test works, what it measures, how accurate it is, and what it means for their patient’s care if they’re going to recommend that test. And if they don’t have answers to those things, then I would argue they’re probably not a very good doctor.
So just to reiterate, here are my take-homes again: none of these things are FDA approved nor have they been validated by any independent body. There’s no transparency or quality control in the industry, and what that means is you’ve got no idea what you’re getting or how the data that they send you was derived. The noise outweighs any signal, making them statistically useless, and they don’t give you any useful information about your health. So if you know those four things and you still think you want to take these tests, by all means, shell out the $400 to $500, but um, I don’t personally see the value. And then I think related to that last point, we do have reliable biomarkers that we know actually give us some information about your current health status and where you want to go. I’m thinking things like VO2 max, body composition, physical strength, insulin sensitivity, inflammation, blood lipids, all sorts of different biomarkers that are clearly associated and in many cases, we know the mechanistic association with health outcomes and your risk of dying. So again, my view would be let’s spend our time and energy on what works and leave the other stuff to the side because we really don’t need it.
And since I’m sure I’m already going to be taking some heat for this episode, I figure you know why not just tackle the elephant in the room. So I’m going to finish up with a pretty direct message to the direct-to-consumer biological age testing community. So my message is really pretty simple: get your house in order, okay? Um, look, if your goal is just to make money off of gullible people, then you could just right off because we don’t need more parasites in the field. If your intentions are good, and I do believe that many people in the direct-to-consumer biological age testing industry have good intentions, I know many of them, I personally like many of them, then you need to do whatever you need to do to validate these tests, right? Show their value, get yourself FDA approval or at least create some sort of industry standard. We need an independent body who can actually validate these tests, and you need to demonstrate how these things actually help people. To me, I think that’s where we need to go. I absolutely believe the science here is sound. I absolutely believe that there is the potential for these kinds of tests to be very useful and to help move the field forward, and I’ll be the first to recommend them when they actually work and provide value. So please go out and do that.
All right, so I hope uh, this has been informative for those of you who didn’t know some of the problems with the biological age tests. Maybe this has given you something to think about. As always, uh, encourage you to leave comments or questions below. Um, if you’re not yet a subscriber to the podcast channel, please hit that subscribe button. And if you’re not yet a subscriber to our newsletter, uh, please go to the Optispan website, www.optispan.life, and sign up for the newsletter. There’s all sorts of interesting stuff in there that we don’t cover on the podcast. And as always, I hope to see you next time on the Optispan podcast.
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