Precision Medical Care Newsletter - October 2024
Happy Healthy Halloween!
We have been very busy building our Precision Collaborative: a growing community of people who appreciate the impact of Precision Medicine on Healthy Longevity! I would like to thank the approximately 32% of newsletter recipients who actually open the newsletter! Your feedback and support keep it going, thank you!
(and if you are struggling with insomnia, I recommend trying to read the entire newsletter and see if you are still awake… )
Here are a few projects in progress:
Podcast: the vocaster and microphones are officially out of the boxes (they were shipped to the office over six months ago, one step at at time…) Now we are trying to figure out how to hook up the cables to these devices. We can talk endlessly about precision medicine and hormones but are a bit stunted by the hardware and software components of this podcast production.In September, Dr Agarwal and Dr Johnson were invited by PreNuvo Chicago to experience the “preventive” whole body MRI scan that was popularized by the Kardashians recently on TikTok. Many of you reading this newsletter have already had PreNuvo scans and can attest to just how “bougie” the experience is… who knew you could stream Netflix while having your body scanned?
The reception area looks fancier than the spa reception area at the new St Regis Chicago hotel, too. The direct-consumer price of the scans are $2499 (and that is the price Dr Johnson’s husband paid when he had his scan earlier this year, too). All this to tell you that if you are interested in the test, we can submit a referral to Prenuvo on your behalf and the scan will be discounted to $2099. The scan is of your brain, spine, chest, abdomen, pelvis and extremities. It takes about 90 minutes for the scans and the reports are sent within a week. The reports are the coolest part of the experience as you can click through an innovative and visually fascinating look at yourself. The images and report are basically a “highlight” reel of all the findings /“incidentalomas” found on your scan. Expect to learn that you have degenerative joint disease, bulging discs, random cysts and nodules in your organs and sticky fluid in your sinuses. Will these scans pick up findings of cancer? Yes, but only if your tumor is big enough… Can these scans tell if you will get Alzheimer’s? No, but you may see signs of vascular disease in the blood vessels of your brain. So, for the person who is curious and can afford the test while understanding the limitations of the test, at least don’t overpay for the test (as Dr Johnson’s husband did), as we can now offer you 15% off the retail price of a PreNuvo scan.
To be sure, DIAGNOSTIC imaging is very helpful to assess the symptoms and concerns of people who have active symptoms and signs of disease. The real question is… what about SCREENING imaging? Which modality? At which frequency? For which population? At what cost? Excellent questions and as a precisionist, I think we can go beyond population health screening guidelines and further personalize screening based on the risk (and risk tolerance) of each person who seeks preventive testing. The role of genetics, environment, diet, stress, sleep ,hormones, metabolism and immune health all impact the aging process.
So many of us fear a diagnosis of cancer. Is this a rational fear? The probability of a cancer diagnosis from age 50-64 is one out of every 8-9 people. The probability of a cancer diagnosis from age 65-84 is one out of every 3-4 people. (See Table 3, https://acsjournals.onlinelibrary.wiley.com/doi/10.3322/caac.21820) Every time someone tells me they have been diagnosed with cancer, my first thought is OK, now we know more about WHERE your cancer cells are in your body and we can focus on precision therapies for this cancer. Precision oncologic therapies are extending the healthspan and lifespan of cancer patients and this is an area of research that is very promising. As a reminder, WE ALL HAVE CANCER CELLS in our body. “No signal detected’ on Galleri or PreNuvo scan testing may be reassuring but we should not be falsely reassured by any ONE test. We depend on our immune system to target and clear our cancer cells. Our immune system is most impacted by age, but our immune health is also impacted by genetics, stress, sleep, inflammation, infections, toxins and environment. We are learning more and more about the impact of “gut health” and the immune system, too.
So, to the topic of healthy aging, a few quick pearls from the recent “Longevity Docs Mastermind” held in NYC earlier this month:
The American Heart Association includes SLEEP as a risk factor for heart disease. Protect your sleep and try to “anchor” the hours of sleep you get at night as consistently as possible for a minimum of seven hours. The goal is to wake up naturally before an alarm with energy.Mitochondrial Health is most impacted by MUSCLE MOVEMENT, a sedentary lifestyle is very aging. Add in “exercise snacks” throughout the day: calf raises, squats, push ups, arm circles, more walking. Bodies in motion stay in motion and motion is truly the best medicine.
It was the consensus of over 150 longevity physicians that the assessment of one’s intestinal dysbiosis (“gut health”) is a CLINICAL DIAGNOSIS. The physicians who have ordered (stool/vaginal) microbiome testing do not consistently find the results of these (often very expensive tests) clinically helpful. Microbiome testing is certainly an area of great research and until we have more data, save your money and focus on hydration and fiber intake to support your “gut health.”
A few notable papers:
The musculoskeletal syndrome of menopause https://www.tandfonline.com/doi/epdf/10.1080/13697137.2024.2380363?needAccess=true
70% of all midlife women will experience the musculoskeletal syndrome of menopause, 25% will experience severe symptoms and 40% will have no structural findings.
This podcast goes in-depth to explain how alcohol consumption sabotages metabolism: https://podcasts.apple.com/us/podcast/the-meta-health-podcast/id1581144869?i=1000673282760
Novo Nordisk recently updated the FDA about potential safety concerns related to compounded semaglutide. There are still manufacturer shortages of GLP-1 medications at retail pharmacies though the shortages aren’t as bad as they’ve been in the past. Some insurance companies are limiting coverage of these medications and the retail cost of the branded medications seem to be getting higher, too. These pressures are creating higher demand for compounded GLPs. Here is Novo Nordisk’s presentation to the FDA for review:
Supplement Spotlight: Magnesium
Book Recommendation
Dr. Agarwal and Dr. Johnson recently met Dr. Jessica Shepherd, the author of
