#73

I find that labs tend to offer a standard package which always includes some basic biomarkers, but also varies as to other ones.

As I am doing tests weekly I take the view to stick mainly to the standard package unless I am doing a specific tests for say Mn,Se,Cu,Li etc.

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#74

This seems like a very valuable test to understand metabolic health and for our optimization of longevity?

Has any done it? Any thought? Does below seems like a good way to do this:

3hr GTT (4 Specimens),3hr Glucose Tolerance, Glucose Tolerance Test, 4 Specimens

With Quest / ULTA

https://testdirectory.questdiagnostics.com/test/test-detail/10559/glucose-tolerance-test-4-specimens?cc=MASTER

With Life Extention

https://www.lifeextension.com/lab-testing/itemlc090365/glucose-tolerance-test-4-specimens-blood-test#

Paired with Insulin during the same window via something like this

https://testdirectory.questdiagnostics.com/test/test-detail/6694/insulin-response-to-glucose-4-specimens?cc=MASTER

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#75

@AnUser @L_H this seems to be in the intersection of what you both have argued is important - have you done any blood work like this? Any thoughts on it?

Does anyone else have any thoughts on it?

Ulta has it for instance:

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#76

@L_H @anuser
This one also seems to help measure things you both have mentioned.

https://bostonheartdiagnostics.com/test/oxpl-apob-c-2/

Anyone have thoughts on it?

Seems like normal Quest/Ulta, LabCorp, etc don’t have it? Anyone see anything similar or easier way to get it than via BostonHeart (via e.g. Rupa)?

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#77

It’s from older podcasts as well. oxLDL is useless according to Thomas Dayspring, OxPL-apoB useful for those with high lp(a):

If someone says something, even Peter Attia from five years ago or today, I must verify it first myself.

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#78

This one does seem like a very important risks factor…?

See review below.

Has anyone done this test?

Oxidized phospholipids in cardiovascular disease | Nature Reviews Cardiology

Abstract

Prolonged or excessive exposure to oxidized phospholipids (OxPLs) generates chronic inflammation. OxPLs are present in atherosclerotic lesions and can be detected in plasma on apolipoprotein B (apoB)-containing lipoproteins. When initially conceptualized, OxPL–apoB measurement in plasma was expected to reflect the concentration of minimally oxidized LDL, but, surprisingly, it correlated more strongly with plasma lipoprotein(a) (Lp(a)) levels. Indeed, experimental and clinical studies show that Lp(a) particles carry the largest fraction of OxPLs among apoB-containing lipoproteins. Plasma OxPL–apoB levels provide diagnostic information on the presence and extent of atherosclerosis and improve the prognostication of peripheral artery disease and first and recurrent myocardial infarction and stroke. The addition of OxPL–apoB measurements to traditional cardiovascular risk factors improves risk reclassification, particularly in patients in intermediate risk categories, for whom improving decision-making is most impactful. Moreover, plasma OxPL–apoB levels predict cardiovascular events with similar or greater accuracy than plasma Lp(a) levels, probably because this measurement reflects both the genetics of elevated Lp(a) levels and the generalized or localized oxidation that modifies apoB-containing lipoproteins and leads to inflammation. Plasma OxPL–apoB levels are reduced by Lp(a)-lowering therapy with antisense oligonucleotides and by lipoprotein apheresis, niacin therapy and bariatric surgery. In this Review, we discuss the role of role OxPLs in the pathophysiology of atherosclerosis and Lp(a) atherogenicity, and the use of OxPL–apoB measurement for improving prognosis, risk reclassification and therapeutic interventions.

Key points

  • Phosphocholine-containing oxidized phospholipids (OxPLs) induce chronic inflammation, including in atherosclerotic lesions, and can be detected in plasma on apolipoprotein B-100 (apoB-100)-containing lipoproteins.
  • A method has been developed to quantify OxPLs on a normalized amount of apoB-100 (OxPL–apoB), so that the measurement is independent of plasma apoB-100 and LDL cholesterol levels.
  • Lipoprotein(a) (Lp(a)) particles carry the largest fraction of OxPLs among apoB-containing lipoproteins; the OxPLs are bound covalently to apolipoprotein(a) and are free in the lipid phase of the associated LDL-like particle.
  • Plasma OxPL–apoB levels predict the presence and extent of anatomical atherosclerotic cardiovascular disease, and elevated levels are associated with disease in multiple arterial beds; measurement of OxPL–apoB improves prognostication of peripheral artery disease, as well as incident and recurrent myocardial infarction and stroke, and improves risk reclassification, particularly in patients in intermediate risk categories, for whom improving decision-making is most impactful.
  • Plasma OxPL–apoB levels are reduced by treatment with antisense oligonucleotides aimed at reducing Lp(a) production and by lipoprotein apheresis, niacin therapy and bariatric surgery.
  • Plasma OxPL–apoB levels predict cardiovascular events with a potency similar to or greater than that of plasma Lp(a) levels, probably because OxPL–apoB levels reflect the levels of the most atherogenic and pro-inflammatory Lp(a) and apoB-100-containing particles.

https://www.nature.com/articles/s41569-023-00937-4

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#79

Yes, I suspect this will be the future of cvd prevention. I haven’t had the test but am looking for a provider in the UK. I’m particularly interested in the impact of the various ldl interventions. My guess would be that statins and then bempedoic acid would have a big benefit impact.

Oxidized low-density lipoprotein associates with cardiovascular disease by a vicious cycle of atherosclerosis and inflammation: A systematic review and meta-analysis - PMC.

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#80

Some fitness / functional biomarkers to target?

Here: Good Fitness Goals at Age 50 (Couzins)

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#81

Admittedly not a great take on functional biomarkers, but here it is just because its out there at a popular newspaper, from the Wall Street Journal:

Are You Fit for Your Age? Test Yourself With These Exercises

Measuring your cardiovascular fitness, strength and balance can give a read on how well you’re aging

Having an idea of your so-called fitness age matters. You can slow various declines in health through relatively minor changes, say academics and health professionals. Cardiovascular changes, for example, have been shown to add years to your life.

The first step is to track your fitness benchmarks in areas such as aerobic capacity and muscular endurance. Then, you should aim to keep them in an optimal range to help manage your aging, says Dr. Randall Espinoza, associate director at the UCLA Longevity Center. (You can try some sample tests below.)

While there is no universally agreed-upon way to measure fitness age, a true road map to longevityshould also consider diet, consistent and adequate sleep, and maintaining social ties.

Full article: Are You Fit for Your Age? Test Yourself With These Exercises (WSJ)

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#82

Attia has a new company focused on individualized exercise programs for longevity…

This article discusses the approach and some biomarkers they use:

The 10 Squared squad are like fitness precogs in Minority Report, connecting clues in the present to prevent a bad event before it happens in the future. They will triangulate the results from the 30 drills I do for stability, strength, and cardio; factor in my body composition from a DEXA scan; then prescribe a fitness plan to power me for the next five decades. That’s not a typo; this program is not 7-Minute Abs! or Great Shape in 4 Weeks! It’s a training blueprint for your whole life.

The Author’s Key Results & 10 Squared’s Target Numbers

DEXA SCAN: Lean mass (aka muscle)

RESULT: 97th Percentile

GOAL: 75th percentile or above

DEXA SCAN: Body fat

RESULT: 50th percentile

GOAL: 25th percentile (for body fat, lower is better) (I need to go from 23% fat to 18% or lower.)

CARDIO: Based on VO2 max

RESULT: 43.8 High for a 50 to 59-year-old

GOAL: 53+ Elite for 30- to 39-year-olds

STRENGTH: Using a hand grip strength device

RESULT: Right: 55.1 kg, Left: 49.2 kg, 85th percentile

GOAL: 75th percentile or above (Less than 30 kg is considered frail.)

STABILITY: Single-leg Romberg test: stand on one leg eyes closed

RESULT: Right: Not stable after 5 seconds, Left: Not stable after 2 seconds

GOAL: 20 seconds without foot or lower-leg movement, swaying, or arm waving

Peter Attia's 10 Squared: The Three Pillars of Forever Fitness

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#83

AST and ALT are not very good for assessing liver health. New info for me. Here is MedCram talking about liver function and markers.

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#84

I like these functional fitness biomarkers (as a quick way to see how fit you are) that were highlighted in the Peter Diamandis PDF: Peter Diamandis Longevity Protocol: Weekly 6mg Rapamycin + 100 mg Doxycycline - #90 by RapAdmin

Screen Shot 2024-04-21 at 7.18.02 PM
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More details:

https://medium.com/@acuregan/fitness-50-at-age-100-a6f30ebd3067

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#85

In other walks in life, I sometimes find it instructive to challenge myself to identify a sparse set of criteria.

Limiting the topic to vascular health, I think Apo(b) + Lp-PLA2 + hsCRP would capture most of the variance.

VO2max alone might do a pretty good job of tracking musculoskeletal health.

Has anyone here conducted an exercise to come up with what blood metrics they would track if the total number were limited to, say, five or even 10?

#86

Sure:

Albumin, Creatinine, Glucose, CRP, Lymphocytes, MCV, RDW, Alkaline Phosphatase, WBC, Cholesterol.

Why? All but the cholesterol are the ones on the Levine-derived spreadsheet calculator.
I am including cholesterol because many in the forum place a high value on this.

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#87

I like this list. Are you referencing LDL-C or total? It seems like the evidence is that the single metric Apo(b) will capture most of the variance of interest and it can play even of TC is relatively low.

#88

I think Apo(b) is modulated by Apo A-1 and CRP but that kind of thinking makes for a bigger list.

#89

Judging from the responses on the various threads, LDC seems to be the favorite marker.
Though a lipid panel is fairly cheap. A lipid panel from Ulta Lab Tests is only ~$22
Chol/HDLC Ratio
Cholesterol, Total
HDL Cholesterol
LDL-Cholesterol
Non-HDL Cholesterol
Triglycerides

#90

Being reminded of an adage from another era, “Sorry I didn’t have time to write a shorter letter,” I find it easier to come up with a list of 20-30 metrics that cover the issues than I do with five or 10.

The only thing I’m reasonably sure of is that the list should be derived from how much variance it accounts for in life- and health-span outcomes. This is an empirical question. But aren’t most of the models we see about what should and should not count based more on theory than fact? And isn’t any short list going to be dynamic; e.g., if your lipids are optimal (whatever that is), elevated blood pressure will account for a smaller proportion of the variance.

One underexplored contribution to knowing what we should measure and manage might be obtained by working backwards from individuals who have excellent conventional metrics and yet die young from an ASCVD event. How does that happen and why don’t our current metrics account for it?

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#91

Yes, ApoB and LDL are very important for men. 1 in 3 people globally will die from heart related issues (CVD). 2 out of 3 men will have heart and cholesterol problems. I also have a familial history with my grandparents and parents having heart disease issues. In order for Rapamycin to work for me, I have to jump the CVD hurdle first by keeping my ApoB and LDL low!

3 Likes
#92

The new Outside magazine article / interview with Peter Attia has some discussion on the functional biomarkers that he uses…

VO2 max measures the amount of oxygen your muscles can utilize at peak effort. It’s the benchmark of cardiovascular fitness because it’s a picture of how well oxygen moves through your system. You can’t game the results. It has also, somewhat recently, become a useful predictor of longevity. If some fitness is good, is more better? Apparently so. Numerous studies have found that higher VO2 max scores correlate with longer life.

…

My score tops out at 41.6, which strikes me as low, but Bennett says it’s actually pretty good for a guy my age. I’m quietly thrilled to see my report sheet include the word “excellent.” Still, I’m a bit short of the Elite category, which requires hitting 50 or above. In Outlive, Attia states that he wants his clients to aim for a VO2 max score in the Elite zone for their gender but two decades younger. In my case, that would mean a score of around 53, a daunting target based on what it took to hit 41.

That seemed highly improbable, but Bennett assures me I can get there, or close. And what, I ask, might it require? Something in the range of four to six hours of Zone 2 work, plus at least one Zone 5 interval session, per week, he says.

Zone 2 is the quasi-magical aerobic threshold, where it’s possible to burn fat as fuel more than you’re burning carbohydrates. Zone 2 is the kind of effort you can sustain for a long time. Zone 2 is pretty easy. I love Zone 2.

Zone 5 training is quite hard, but it’s mercifully brief. A popular Zone 5 workout involves four minutes of maximum effort followed by four minutes of recovery, done a total of four times. One of my big takeaways from testing is realizing how these zones actually feel. What I thought was Zone 2 was probably more like Zone 3 or even 4. My easy workouts have not been easy enough, I discover, and my hard sessions are not hard enough. I’ve been trapped in the middle, a metabolic no-man’s land.
…

I’d long thought of lifting weights as essential for athletic performance, regardless of your sport, but I hadn’t considered the impact on healthy aging. Not only does preserving lean muscle deliver metabolic benefits, but it also helps keep us mobile and stable. Falls are the leading cause of death after age 65—the fifth horseman.

Not surprisingly, given my cyclist’s approach to upper-body development, I fare less well at strength. The goal for the arm hang is two minutes. That doesn’t sound like much, but it’s surprisingly difficult. I don’t even make it to one minute.

The goal for the hex-bar carry is similarly challenging: carry your body weight—in my case 186 pounds—for 60 seconds. Once again I come up short. Not to worry, Bennett tells me. With a dedicated lifting regimen, I can meet these standards as well.

…

Fitness Institute of Texas website: FITNESS INSTITUTE of TEXAS

Online Fitness Progams: Get FIT - FITNESS INSTITUTE of TEXAS

“There is no short-term fix,” Blue Zones’ s Dan Buettner told me. “If you want to live longer, you have to think about things you are going to do on a daily basis for decades.”

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