- How to assess our current health?
- How to assess its trajectory in terms of well-being?
- How does health and wellbeing in its trajectory specifically relate to testing, like laboratory testing (blood work) and diagnostic testing?
- Is blood work necessary for a typical person with no acute illness, at any age? If so, how frequently?
Before answering these questions, we have to first establish the objective that we are trying to achieve here.
If a person’s goal is to break the 2-hour record in a marathon, it is doubtful if blood work is going to be the game changing aspect of their health trajectory and training.
They are going to benefit much more from a functional analysis to improve performance.
However, if the question is to utilize how blood work analysis could assist the length of living longer and better for lifespan and health span, it could be beneficial.
Most people have some sense of their vitality or lack of vitality. However, everyone wonders whether they could feel better or whether blood work can give an insight into how they might be able to feel and perform their best.
In order to answer this question, there is much more than depending on blood work which has a lot of blind spots. First, we need to identify health in two sectors, namely:
- Health span
What are the goals here?
To improve health span
To extend lifespan
First, let us discuss what we call Lifespan.
Lifespan is essentially binary: we are either #1 alive or #2 not alive meaning, we are either respiring or not respiring.
What gets in the way of lifespan?
It is essentially the four horseman (drivers) of disease
- Atherosclerotic disease
- Neurodegenerative disease
- Metabolic disease.
Metabolic disease is not the direct cause of many deaths but basically creates the foundation to all those other diseases.
Again, if a person is a non-smoker, the above four are 80% of causes affecting our lifespan (death).
The rest of the 20% caused by infections, accidents, suicides and homicides.
So now, let us ask ourselves a question:
How does blood work help in these aspects of disease?
From this standpoint, blood tests can be a very good predictor of risk to some extent if we know what we are looking for. Primarily:
a) Apo protein-B would be the single most important lipoprotein that is of significance
b) other causes of inflammation
c) Endothelial health ( Vascular health )
d) Metabolic health
When it comes to blood testing and biomarkers, is not particularly helpful for detection of cancer. Outside of knowing that the second leading environmental or modifiable cause of cancer is metabolic ill health next only to smoking.
We actually do not know a lot about cancer or “what causes it”?
Is really stochastic in it is a lot of bad luck.
However, we do know:
#1) smoking drives it
#2) high insulin leading to both metabolic dysfunction and also obesity drives it.
So it is probably the high insulin (HYPERISULINEMIA) that comes with obesity that drives it. In this case biomarkers for hyperinsulinemia can help to some extent but there is still enormous blind spots for cancer detection.
We can also talk about liquid biopsies on a different note but they are not really biomarker studies in the blood.
- Neurodegenerative disease
With regards to neurodegenerative disease, we do not have a lot of insight with understanding of Parkinson disease.
With regards to dementia, particularly Alzheimer's disease-(the most prevalent form of dementia), in some cases biomarkers like Apoprotien_ E can be helpful since they overlap with atherosclerotic disease.
The same thing that drives the risk of heart disease driving the risk of dementia and then there is also some novel genetic testing as well. If we include genetic testing and blood tests we get a whole gamut of genes not just Apoprotien _ E. Far more nuanced testing can also play a role so that we can stratify risk in that sense.
In aggregate, we can say blood testing of some biomarkers provides pretty reasonable insight into lifespan overall.
- Metabolic Disease
Encompasses all chronic medical conditions such as diabetes, hypertension, lipid disorders, fatty liver disease, and various other related conditions which can be tested by biomarkers in the blood.
The second aspect of health is our Healthspan When we talk about health-span we can divide it into 3 domains.
- Cognitive Health
- Physical Health
- Emotional Health
Here the biomarkers(BLOOD TESTS) are far less helpful. We have to rely more on functional testing.
- Cognitive Health.
Within the cognitive domain in terms of long-term risk a lot of things which imply good cognitive function and health as you age are in line with the same things that you would do to reduce the risk of dementia so all the biomarkers that would look to improve through dementia risk reduction would be improving through cognitive health.
- Physical Health.
In the physical domain, outside of looking at hormonal levels, other things that we will look at extensively and understanding how these might aid in or prevent some of the metrics that matter are:
a) DEXA scan
b) CPET testing
c) VO2 max testing
d) Zone 2 lactate testing
e) Fat oxidation.
These are markers that should be considered for functional testing from a physical domain. It gives us far more insight into functional assessment of physical performance and fitness.
- Emotional Health.
The third domain or the emotional component is primal in the sense that, none of what we have discussed so far matters without proper adaptability, with mal-adaptable emotional state in our relationship with nature and environment. In terms of biomarkers and giving a better insight is pretty self-evident and self-explanatory that, no biomarker matters when it comes to emotion.
The other question that comes to mind is,
If I feel pretty good in taking a number of steps like exercise, nutrition etc. to extend lifespan and improve health span, is once a year blood test frequent enough?
Should a 20-year-old start getting blood work done just to get a window into what is going on?
The answer is: maybe and depends for one aspect, which is to detect early atherosclerosis. In that case the single most prevalent genetic driver that contributes to atherosclerosis as high as 20% is the biomarker Lipoprotein a, (LPa).
Finally, the question that is of importance is,
How frequently do we need to test an adult after 40 with the idea of preventing atherosclerosis, neurodegenerative disease cancer and metabolic disease.?
It really comes down to the state of interventions that are mutually agreed upon by the physician and the patient. In general, a ballpark number of 3-4 times a year of testing is reasonable .
In summary, attempting to be proactive in improving health span and lifespan from a functional and performance perspective, not merely from a biomarker perspective should be the focus. Rather than addressing the consequential disease reactively, a dynamic participatory approach would be extremely beneficial.
Knowing or not knowing answers for to any of the above questions, one observation prevails:
“People who are really, really stronger, live longer than people who are weak”.
The essence lies in how to get strong.