In a January post, I provided an overview of all the supplements I take which I believe will help extend the number of healthy years I get to enjoy on the planet. Here, in this post, let me fill in the other half of the equation: the diagnostic tests which I, and my patients at Raffaele Medical, take. These “biomarkers of aging” tests give us a detailed picture of our health at this moment and a strong indication of how it’s going to look in the future, a strong motivator to make any changes that will give us a happier aging trajectory.
Make no mistake, the foundation of healthy aging is still lifestyle: exercise, diet, sleep, social connection and managing stress, not smoking, not overdoing alcohol. We all have a family history of disease (and wellness) that, in some measure, is encoded in our genes, and our lifestyle will in large measure determine how those genes express themselves in our day-to-day lives.
But building out from that, we can enhance what genes and lifestyle have given us, and shore up where they’ve fallen short. The diagnostic data we collect helps us determine which supplements, and potentially, pharma drugs, should be on the table to maximize the odds of having the kind of senior years we all want. In my practice, we go through the body’s systems one by one – cardiovascular, metabolic, pulmonary, immune, cognitive, hormonal, and so on – and measure them in every useful way we can think of -- functional tests, imaging tests, blood tests, epigenetic and genetic tests. My job is to figure out, at an individual “n of 1” level, what each patient needs and how those needs change over time. Put simply: our testing “stack” determines our therapeutic “stack.”
People unfamiliar with longevity medicine might ask: “Isn’t that why I see my primary care physician? What about all those tests?”
In my practice, the tests at your annual physical are a reasonable starting point. Let’s take the diagnostic tests that look at cardiovascular function, which for most any physician is pretty much the first order of business, heart attacks being the leading cause of death in this country and the world. The primary care doc measures blood pressure and orders up a lipid panel, to evaluate potential heart disease and heart attack risk. If it’s too high, out come the prescriptions for hypertension drugs and statins.
We do the same, but we go deeper. To get a fuller picture of cardiac risk, I’ll order up additional blood tests, for lipoprotein (a), an independent risk factor, which forms an especially harmful type of sticky LDL cholesterol, prone to turning into an artery-clogging atherosclerotic plaque. I’ll also check ApoB, the protein that assembles and carries these most atherogenic LDL particles, as well as LDL-P, the number of LDL particles themselves. To round out the picture, I’ll look at the inflammation marker high sensitivity C-reactive protein (hsCRP), along with Lp-PLA2, an enzyme that fuels inflammation and accelerates plaque buildup.
I also want to be able to see what’s going on in those arteries. Whereas most cardiologists won’t order up heart imaging studies unless there is a strong indication of atherosclerosis, I’ll steer my patients over the age of 50 (in some cases, earlier) to get a first-level imaging test, the coronary calcium scan. If I harbor any suspicions that the atherosclerosis process might have already begun, I’ll push for a cutting-edge (and yes, more expensive) imaging test, a CT angiogram with the AI-powered Cleerly analysis so I can see the earliest manifestation of coronary heart disease – soft plaque.
I view overall cardiac health through a longevity lens. Using the Sphygmocor device to analyze “arterial stiffness,” we come up with a patient’s “CardioAge. To a considerable degree, the aging of the blood vessels is “baked in” -- the collagen and elastic fibers wear down with age. The arterial stiffness results can reveal a functional decline that can be addressed, before BP numbers rise alarmingly. Not only do I want to forestall the late middle-age heart attack, I want to help slow down the cardiovascular decline that could mean heart failure (caused by a weak heart muscle and inflexible vessels) in my patients’ 80s or 90s.
When it comes to metabolic health, yes, we do the standard fasting blood glucose and hemoglobin A1c blood tests. But to get another window onto metabolism, we look at the whole body, measuring body fat percentage – basically, the ratio of body fat to total body weight – using bio-impedance technology. We’re less concerned about body weight than what that weight is made of. Muscle protects metabolic health, excess fat does the opposite. How well your muscle is working we can discern with a functional test measuring grip strength. Another functional test, done with spirometry tech, measures how much air the lungs can expel in a second, giving us a PulmoAge, an excellent lifespan predictor. (If the number isn’t good, that’s a strong signal to try to upgrade every aspect of your health regimen.)
Brain aging is, naturally, a major focus of longevity medicine. We track brain function at regular intervals with a battery of video-based cognitive performance tests to arrive at a CognoAge. But we also encourage our patients to get a genetic test to determine whether they carry a single copy of the APOE4 gene variant (about 1 in 4 do) that puts them at higher risk for Alzheimer’s, or the rarer double copy variant that significantly worsens those odds. We don’t yet have particularly effective drugs to push back against AD but knowing your genetic status does give you a sense of your margin for error, in other words, how strict to be about exercise and diet, the lifestyle basics which are still our best bulwark against neurological decline.
For my money, immune function is where we can most effectively slow down the aging clock – as the immune system ages, so does the rest of the body. Again, standard immune function tests that you might get at an annual physical as part of your CBC are a start, but in my practice, we go next level with the UCLA immune aging panel which gives you a reading on the number of “naïve” T cells, ready to fight novel infections and malignancies, versus the number of “senescent” T cells, worn-out and no longer up to the job. This is paired with telomere length testing to see what reserve your immune cells have for continued replication. Advanced tests like GlycanAge (a measure of how inflammatory your IgG antibodies are) and the SapereX test (analyzes T cell gene expression to get a to get a handle on senescent cell load and autophagy – the body’s ability to recycle senescent cells), both of which are key aspects of immune aging. The results help us manage hormone optimization and determine whether autophagy-boosting therapies like rapamycin or SGLT2 inhibitors or senolytic supplements like quercetin and fisetin are appropriate for any given patient.
Perhaps the deepest dive reveals aging at an epigenetic level. We use tests licensed by TruDiagnostic from major academic centers to measure changes in the epigenome (the sum of the chemical messengers that control gene expression) of an immune cell to come up with an epigenetic age for individual organs as well as a “rate of aging” for the entire system. Combine that with our non-blood, more “macro” bio-markers of aging and you’ve got a higher-res picture of the aging process in toto, and a better road map for longevity therapies.
If you don't have access to a longevity medicine practice like mine for the full testing stack, affordable home tests for body composition and arterial stiffness can still give you a good read on your physiological aging. You can also use direct-to-consumer lab tests, though interpreting any result in isolation should be done with caution.
The value of testing lies in providing a clear starting point. A personalized health "stack" shows where you are now, helping you make informed decisions to reach your optimal health goals.
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