E.g. oxygenated phospholipids
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Do you have a source for that?
Just to be clear it’s not proven that the low levels as mentioned above will make atherosclerosis not happen as said in the language “probably”, but there is risk reduction from lowering there, and it’s not a large stretch.
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Here’s a new one.
Higher creatinine-to-cystatin-C ratios indicate better health status and are strongly associated with lower mortality risk regardless of the kidney function level.
Serum Creatinine-to-Cystatin-C Ratio as a Potential Muscle Mass Surrogate and Racial Differences in Mortality
Conclusions
Higher creatinine-to-cystatin-C ratios indicate better health status and are strongly associated with lower mortality risk regardless of the kidney function level, and the relation was similar for both black and nonblack veterans, but with different strengths of effect across racial groups. Thereby, use of a fixed race coefficient in estimating kidney function may be biased.
https://www.sciencedirect.com/science/article/pii/S1051227621002946
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GGT is interesting… Today I stumbled upon some info about GGT as a useful biomarker. The first paper is about glutathione, and speaks to GGT as a marker of glutathione status. It also says…
“GGT as Measure of Glutathione Need: GGT (gamma-glutamyl transferase) is upregulated in proportion to the need for glutathione […] Increases in GGT correlate with many diseases: metabolic syndrome, both fatal and nonfatal coronary heart disease (CHD) events, atherosclerosis, fatty liver, diabetes, cancer, hypertension, and carotid intima-media thickness.[…] Of particular note, these are elevations of GGT within the supposedly “normal” range. For example, men with a GGT of 40 to 50 have a 20-fold increased risk of diabetes. Research also shows a GGT 30 to 40—well within the normal range—is associated with a doubling of the risk of all-cause mortality” Glutathione! - PMC
A second paper dives into the many diseases implicated by GGT. Gamma-Glutamyltransferase Activity (GGT) Is a Long-Sought Biomarker of Redox Status in Blood Circulation: A Retrospective Clinical Study of 44 Types of Human Diseases
My first GGT test was a few weeks ago (13 U/L – normal range 3-70 U/L). I had never looked into it before that. If you have a high but normal GGT, it might be worth investigating.
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Did anyone do this? (Extra characters)
Others that I’d add:
- IGF-1
- Core body temperature
And given that you care about cardiovascular and neurological health:
- Homocysteine
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HRV as a measure of biological age?
https://paloaltoprize.com/prize-two/
“The $500,000 Palo Alto Homeostatic Capacity Prize will be awarded to the first team to demonstrate that it can restore homeostatic capacity (using heart rate variability as the surrogate measure) of an aging reference mammal to that of a young adult.”
Anyone heard of this program. They are using HRV to assess biological age. I had not heard of this before.
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I have heard about this. I find my HRV quite variable (mainly dependent upon how much alcohol I have been drinking which varies between nothing for a few days and quite a lot on multiple days in sequence).
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It’s an interesting idea. Heart rate is determined by so many factors…many of which are indicators of health status. The challenge is that HRV is so sensitive that measuring changes related to any targeted change can be confounded easily. I’m very interested in this…I am now using HRV biofeedback to help me bridge to a meditation practice.
Some factors:
- Devices: fingertip, ring, wrist, chest strap
- Phone apps: error correction, conversion of standard algorithms to proprietary indexes (0-100)
- Different algorithms …what should we use?
- Time of day: during sleep, 1st thing upon wakeup, other
- Body position: laying flat, laying on side, sitting, standing
- Drug interactions: beta blockers, BP medications, caffeine, nicotine, ?
- Breathing method: nasal vs. mouth, paced vs. natural
Aside from improved health, how to improve our HRV scores?
- Resonance breathing
- Co2 tolerance training
- Nasal breathing (mouth taping, nasal breathing while exercising)
- NO (lower BP, improved blood flow)…from diet and supplementation
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I think it is really hard to compare HRV measured on one device to that measured on another. It is also possible for it to vary a lot depending upon the autonomous nervous system.
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I really like the first paragraph of the article. It describes the aging process exactly as I have experienced it.
"WHAT IS HOMEOSTATIC CAPACITY?
Homeostatic capacity is the capability of systems to self-stabilize in response to stressors. A simple way to visualize homeostatic capacity is to imagine a WeebleTM, the popular self-centering children’s toy. For organisms, it is life’s foundational trait—itself comprised of a hierarchy and network of traits—endowed by nature and shaped by selection. Because the trait is inborn and so pervasively effective, feeling healthy feels like “nothing” when we are young. We become aware of it only after we start losing it midlife. Roller-coaster rides begin to leave us nauseated instead of joyous. We can’t tolerate hot or cold weather like before. Sunny days feel too bright and reading menus in low lights becomes more difficult. Recovering from stressors—a late night, hangover, or injury—suddenly take far longer than it used to, if at all. Consider changes that wecan’t feel. When we are young, homeostatic capacity returns elevated blood glucose and blood pressure to base levels. As homeostatic capacity erodes with age, those levels may no longer self-tune. We call these conditions diabetes and hypertension, respectively. Indeed, the panoply of ailments associated with aging may be epiphenomena of eroding homeostatic capacity. If so, could restoring homeostatic capacity end or reverse aging?"
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I would think it is moreso that if you deal with the problems that cause aging (or at least most of them) you will reinstate homeostatic capacity and see how this has happened in test results. I don’t personally think HRV is the best of these to use as it is so variable on a number of bases.
However, the principle is good.
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I think it is similar to the hypergrowth concept for mTOR. Our sympathetic nervous system gets turned on too much in modern life, and gets “stuck” in the on position or just gets stronger while the parasympathetic system does not get stronger (unless we are meditating) or gets weaker (if we are not sleeping well). The system gets out of balance, and now we are not good at either responding to threats or recovering from life stress.
Learning to meditate is hard. HRV biofeedback is a nice bridge to learning to meditate effectively, and it might actually do some good in the meantime.
I just finished my interview with Marco Altini PhD of HRV4Training. Stay tuned for the episode. But I’ve already started using HRV biofeedback.
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Perhaps oddly, but I am a creature of habit and I take HRV readings twice a day and don’t find that much variation day to day. Fortunately, my readings are consistent with the 25-34 year old age group. I only choose these times because they are convenient for me.
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Very good article. Thanks. As opposed to your stable HRV, my HRV is highly variable, during the day as your graph shows, but also between days for readings done at the same time with the same procedures. If I worked out hard, didn’t sleep well, didn’t feel well…my HRV is 50% of my good days.
I get values from Polar and Fitbit. I only record the morning. There is a very obvious affect from alcohol and also a potential effect from the question as to the balance between sympathetic and parasympathetic systems (which can be impacted by melatonin usage).
Going back from today as examples. The larger figure is almost always Polar/Elite.
47/21 54/34 53 52/12 (insufficient pantethine) 53/25 43/43 54/26 44/18 60/29 50/36 60/31 50/49 60/35 50/33.
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Here, on this YT video, Richard A Miller from NIA ITP talks about “Aging rate indicators” from mice:
In short:
- low CRP
- low TGF-beta
- high CIT
- low mTorC1
- high mTorC2
- 10 different biomarkers
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I just stumbled upon this list that Troy Delaney has pulled together from what Peter Attia has mentioned in his various podcasts, etc.
Just one more data point for people to consider when they develop their list of personal biomarkers to track (and functional tests also)…
RECOMMENDED LABS, TESTS & METRICS
Recommended Labs
Details on the Recommended Labs
Things to Measure One Time:
- Lp(a) (Lipoprotein A): Phenotype – Peter recommends knowing Mass and Particle number
-
APOE Genotype: Risk for Alzheimer’s/greater risk from head injury. People have a mix of 2, 3, and 4 (one from each parent)
- Having 2 ApoE4 alleles can increase risk of AD (Alzheimer’s Disease) by 10-20x. Peter argues that this is definitely worth checking as you can in fact prevent Alzheimer’s disease
Things to test at least once a year:
- Cardiovascular Health
- APOB: APOB is the main protein found in LDL cholesterol. It is the total concentration of LDL and v-LDL which are the big atherogenic particles. Peter thinks a cutoff of less than 90 milligrams per deciliter is good, less than 70, you’re doing great, and less than 50 is pretty optimal and close to perfect. If you want to live to 100, keep it below 30.
- Small LDL-P: Peter wants this to be below 500 nmol/L or ~ 25th percentile (20 mg/dl)
- Trigs: Most responsive to diet changes (lower carbs); reference is < 150 mg/dL (< 1.7 mmol/L) but Peter wants this < 100 mg/dL (< 1.13 mmol/L); trigs should be lower than HDL.
- LDL synthesis: The most preset/not variable
* Better predictive markers than LDL-C (despite C being the more common test) - VLDL Cholesterol: Non-HDL cholesterol and subtract LDL cholesterol below 15mg/dl
* Endocrinology: Adult and Pediatric (Seventh Edition) - Total cholesterol is basically useless, HDL is minimally valuable
* Peter likes to see: TG < HDL-C (when measured in mg/dL) - IGF-1 (Growth Hormone surrogate) – strong driver of cancer; likely that cycling between low and high levels of IGF-1 is optimal;
Fasting can dramatically lower IGF-1
-
OGTT (oral glucose tolerance test): Metabolic health, try to get it with insulin measurements
-
- Goals = Fasting glucose below 90, 1 hour post prandial <130, 2 hour glucose below 100
-
Keto diet people will have very high levels after a challenge (low before), but this isn’t accurate
-
Fasting glucose: Only directionally interesting. This varies a lot during the day, difference from 90 or 105 is more about your cortisol level than metabolic issues
-
Peter uses a Continuous Glucose Monitor (CGM). He doesn’t like the Abbot Freestyle Libre (not accurate enough), has a test version of the Dexcom G6 which is much better. It has a tiny needle, no calibration needed and can connect with your phone
* A month of CGM data is > an OGTT test to Peter
* On CGM, “I like to see my patients with a mean glucose below 100 mg/dL, a glucose variability below 15 mg/dL, and, as noted above, no excursions of glucose above 140 mg/dL.” -
DEXA: Look at three things: Appendicular lean mass index (ALMI) and fat-free mass index (FFMI). “I [Peter] aim for my ALMI to be in at least the 90th percentile, if not above the 97th percentile as I age. The data are unequivocal: people live longer, better lives with an ALMI above the 75th percentile.”
-
He also looks at:
1. Segmental BMD
2. VAT
3. FMI Total -
ALT (alanine aminotransferase): Liver health
-
-
< 20 U/L and (reference upper limit: 42-44) and AST 40 but Peter wants patients below 20
-
Best test to see if your liver has issues (side note: ALT elevations are a signal that you should stop taking a new medication – many potential new drugs are stopped if they elevate ALT)
-
Don’t simply accept it if your Dr. tells you your levels are “normal” as those levels have drifted up over time as the average person has gotten less healthy)
-
Fatty Liver/NASH will be the leading driver of liver transplant in the future in US
-
Honorable mentions: Hcy, hs-CRP, fibrinogen, Lp-PLA2, ADMA, SDMA, Estradiol (E2) – these levels keep going up on average in American men; knowing your family history is important.
Family History: More important than doing a whole genome sequence. But behavior matters (e.g. if your grandma smoked and you don’t)
Longevity Markers: Longevity genes include APOE, Lp(a) and then the below:
- Heart Disease: The younger you are, the more blood tests can tell you about your risk of cardiovascular disease, older people need to rely more on scans (e.g. CT angiograms)
- Omega Index Plus Test: Likes to see EPA/DHA index above 8.5; OmegaQuant offers a good at-home test (use code TROY for 10% off). This is the same test used in Peter’s concierge medical program.
- Inflammation: Fibrinogen, CRP, oxLDL, and oxPL
- hsCRP: < 1 mg/L (labs say below 2)
- oxLDL: < 40 U/L (labs say < 60 U/L)
- Endothelial Health: Insulin sensitivity, homosystine, ADMA, SDMA
- Cancer: Blood gives up the least insight, until liquid biopsy tests become accurate (company like Grail)
- Most cancers are somatic mutations not germ line mutations so knowing your genotype doesn’t help much with a few exceptions (e.g. BRCA and Lynch)
- As a result, you can focus on inflammation markers and metabolic health
- Alzheimer’s Disease: APOE tells you low/medium/high risk and long with risk driven by the same drivers of heart disease, metabolic component, and toxins which we can’t understand/track the least
- TOMM40: A TOMM40 variable-length polymorphism predicts the age of late-onset Alzheimer’s disease (Roses et al., 2010)
Longevity Fitness Metrics (per Joe Rogan interview and Huberman interview)
- Grip strength – Dead hang test 2x/week – Goal is 2 minutes for men at age of 40 and 1.5 minutes for women (discounted by decade)
- Eccentric strength – step down from a 16″ block and take more than 3 seconds
- Strict air squat hold at 90 degrees, 2 minutes for men and women at age 40
- Hold 50% of your bodyweight and do a certain number of box step-ups
- Farmers carry – Male carry body weight for 2 minutes, females 75% of your body weight
- VO2 Max
- Ankle mobility
Below are the extensive tests you would get if you joined Biograph, Peter’s concierge medical practice:
Source: https://troydelaney.com/peter-attia/#elementor-toc__heading-anchor-6
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Excellent information! Exactly what I’ve been looking into. I’ll investigate testing for each one and try to decide what meets the standard for being essential and also worth the cost. The total could easily get too expensive. I’ve already added a number of things for my next blood test and picked up some reasonable home testing equipment.
And Biograph…
https://en.wikipedia.org/wiki/Fuhgeddaboudit
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