Dr. Peter Attia’s latest podcast episode explores the topic of how to interpret lab results in the context of longevity. It is an AMA episode, which is only available to members of his site. I would like to summarize the information in this podcast because I think it is very helpful for people who are interested in optimizing health for longevity.

Longevity has two components:

1) Life span - How long you live

2) Health span - How well you live

Living longer boils down to how long you can delay the onset of chronic disease. There have been many studies of centenarians (people who live to be 100+). Even though these people seem to be genetic lottery winners, there is still useful information that can be gleaned from studying this population. One of the key takeaways of these studies is the following:

Centenarians don’t live longer once they get a disease. They just take longer to get a disease.

If you want to live longer, the goal is to delay the onset of chronic disease instead of figuring out ways to live longer once you have a chronic disease. Unfortunately, the entire healthcare system is mostly geared toward the opposite. Prevention is not the mainstay of medicine. 

Life span comes down to 4 primary disease processes that lead to over 80% of deaths of people over 50 who are non-smokers.

4 disease processes

1. Atherosclerotic disease, e.g., cardiovascular disease
2. Cancer
3. Neurodegenerative disease, e.g., Alzheimer’s disease
4. A spectrum of conditions related to inflammation, e.g., type 2 diabetes, high cholesterol, high blood pressure

Health span comes down to three primary areas:

1. Cognitive
2. Physical/structural
3. Emotional

For longevity, labs are ordered and interpreted based on what they can tell us about the four disease processes and the three areas that affect health span.

Atherosclerosis - This is a well-understood disease that is primarily driven by lipoproteins. 

ApoB, VLDL remnants, and LP(a).

Inflammation and metabolic health both play a significant role.

ApoB and LP(a)- can be measured directly

VLDL remnants - cannot be measured directly but VLDL cholesterol is a reasonable proxy

There is very little in a blood test that can predict cancer.