Dr. Peter Attia — “The Top Five Biological Tests Everyone Should Take”
Dr. Peter Attia is among the world’s foremost biohackers and an expert on biological tests. He also happens to be a practicing medical doctor and researcher. Wouldn’t you like to hear what he says are the top five biological tests you need to get to help make sure a long and healthy life free of disease? It’s all right here.
A COUPLE of days ago I was listening to a podcast of renown biohacker and medical doctor Peter Attia being interviewed by autodidact and author Tim Ferriss about five biological tests he recommends everyone take.
Dr. Peter Attia is someone to listen to intently.
Tim says this about Dr. Attia:
Peter Attia, MD, is the President and co-Founder of the Nutrition Science Initiative (NuSI). He is an ultra-endurance athlete, compulsive self-experimenter, and one of the most fascinating human beings I know. Peter also earned his M.D. from Stanford University and holds a B.Sc. in mechanical engineering and applied mathematics from Queen’s University in Kingston, Ontario, Canada.
On the podcast, Dr. Attia was asked,
“What are the top five biological tests everyone should take?”
Read on for his answer, simply because it can make a big difference to you, your health and longevity.
In this article, we’ll cover:
- Why knowing your ApoE is about the most important insight you can have about yourself;
- Why your LDL particle size and their number is more important than its ng/dL level;
- One important test to assess your risk of metabolic disease stemming from insulin sensitivity and blood sugar;
- How IGF-1 (insulin growth factor) can either promote disease or save you from it.
Let’s dig in and learn about five very important biological tests.
Tim Ferriss Interviews Peter Attia, MD
I’ve used Dr. Peter Attia’s insights about extending health and longevity — as told to Tim Ferriss in his podcast, Episode 50 — as a jump off place from which to dive more into each of the five areas Dr. Attia describes being necessary to optimize for a long and healthy life.
What I’ve done is to do a deep dive into each of the five areas (and corresponding tests) that Dr. Attia described as “the top five biological tests everyone should get” if they wish to increase their healthspan.
Everything attributable to Dr. Attia in quotes comes from this transcript (scroll down to Episode 50).
The five biological tests Dr. Attia recommends will help extend your longevity are:
- ApoE genotype, a test for Alzheimer’s and cardiac risk
- LDL particle number, another test for cardiovascular disease.
- Lipoprotein (a), which when combined with LDL particle number substantially improves understanding the risk of heart disease.
- OGTT, an oral glucose tolerance test to measure your insulin sensitivity to blood sugar.
- IGF1, insulin like growth factor, a test that needs to show a balanced number, as being too high or low promotes diseases like cancer.
The Life Extension Foundation tells us that Apolipoprotein E (ApoE) is an important regulator of cholesterol and triglyceride levels in your blood, and supports lipid transport and injury repair in your brain.
Dr. Attia says this about ApoE:
“… the ApoE gene codes for proteins that are involved in the metabolism of cholesterol, but in particular they play a really important role in the development of cardiovascular disease and Alzheimer’s disease. And so knowing somebody’s APOE status allows you to determine what you need to do to mitigate those risks, both through nutrition, but also through pharmacology.”
In its description of the ApoE test, LEF goes a bit deeper.
There are three different forms of the ApoE gene known as E2, E3 and E4 alleles. Genetically, E4 is the strongest risk factor for developing LOAD, an acronym for “late-onset Alzheimer’s disease” (typically >65 years).
In the cardiovascular system ApoE is involved in the transportation of fat molecules out of circulation and into your cells. Each of the allele variations, E2, E3 and E4 mediate cholesterol metabolism in a different manner. E4 is associated with increased levels of cholesterol and triglycerides, which leads to atherosclerosis, heart disease and stroke.
According to the National Institute of Health, inheriting a single copy of ApoE4 from a parent increases the risk of Alzheimer’s disease by about three-fold. Inheriting two copies, one from each parent, increases the risk by about 12-fold.
Almost 40% of Alzheimer’s Disease patients have inherited an E4 allele.
|E2||Associated with a decreased risk for cardiovascular disease except for people with hyperlipoproteinemia.||Studies indicate that people with this variant are at a reduced risk for developing Late Onset Alzheimer’s Disease.|
|E3||Considered the non-risk group for cardiovascular disease.||Results in normal expression of APOE and believed to play a neutral role in the disease, neither increasing or decreasing risk.|
|E4||Associated with the highest risk for cardiovascular disease due to decreased HDL levels, increased triglycerides1 and cholesterol levels (both total and LDL). It is also associated with increased risk of heart attack and stroke.||E4/E4 carries the highest risk and may increase risk up to 12 fold with an earlier age of disease onset.8 The APOE4 variant is implicated in 40% of Alzheimer’s cases.|
Here’s a screen shot of part LEF’s report for ApoE Genetic Test for Alzheimers and Cardiac Risk:
Much of the rest of the Report presents an extensive list of interventions you can do to help prevent or mitigate the cardiovascular and/or Alzheimer’s issues associated with ApoE genetic variants
The three most basic suggestions are these:
LEF’s Cardiovascular Nutrient Suggestions
|Omega 3||1400mg EPA and 1000mg DHA/day|
|Studies have shown that omega-3 fatty acids support healthy vasculature via multiple mechanisms, including, supporting healthy triglyceride levels, supporting a healthy blood pressure and improving the function of the inner lining of blood vessels.|
|• CoQ10 is critically important for vascular health, as it is directly involved in the production of ATP, the “energy currency” of the human body. CoQ 10 is also a potent antioxidant.|
• CoQ10 is the first line of defense against LDL oxidation; oxidized LDL is a major contributor to endothelial dysfunction and atherosclerosis.
|Vitamin K |
|2200mcg/day; providing K1, MK-4 and MK-7|
|• Vitamin K supports healthy blood vessels by directing calcium away from the arteries and into the bones.|
• A large study of more than 4,800 subjects followed for 7-10 years in the Netherlands demonstrated that people in the highest one-third of vitamin K2 intake had a 57% reduction in risk of dying from vascular disease, compared to those with the lowest intake.
Those three supplements are a good start, but do yourself a favor and Check out LEF’s Sample Report for its ApoE Genotype Test (pdf file), which shows recommendations for diet, nutracueticals, minerals and herbs.
The last point I want to leave you with on the subject of ApoE genetic variations is one that Dr. Attia underscores:
“It is important to understand that although carrying the ApOE E4 allele increases your likelihood of developing disease, it does not mean that you will. Genetic testing is about probabilities, not guarantees – and should always be interpreted in the light of other considerations such as age, family history, environmental factors, ethnicity, and other coexisting medical conditions.”
Biological Test #2 — LDL Particles
What’s Dr. Attia talking about here?
Let’s start with LDL particles, the focus of this test of LDL particles.
You already probably know a bit about LDL (low-density lipoprotein), the so-called “bad cholesterol” counterpart to HDL (high-density lipoprotein), the “good cholesterol”.
Typically, when we get our cholesterol test ordered by our doctor, it measures total cholesterol (LDL + HDL), LDL, HDL, sometimes trigycerides, and various ratios between any of these.
What most cholesterol tests ordered by your doctor do not measure is what’s most important to know — the number of LDL particles in your blood.
In his article about NMR Lipoprofile, Dr. Joseph Mercola made these observations:
- Your total cholesterol number is not a good indicator of heart disease risk. One of the most important tests you can get to determine your risk is the NMR lipoprofile, which measures your LDL particle number. This test also has other markers that can help determine if you have insulin resistance, which is a primary cause of elevated LDL particle number and increased heart disease risk.
- The primary cause of heart disease is not high cholesterol but insulin and leptin resistance, which increase LDL particle number via a couple of different mechanisms. Poor thyroid function can also directly increase LDL particle number, and should be checked if your LDL particle number is high.
“NMR [nuclear magnetic resonance] is a technology that can count the number of lipoprotein particles in the blood, and the LDL particle, as its name suggests, counts all the LDL particles.
“So an LDL particle is a particle that is defined as a lipoprotein with an ApoE-B 100 ApoE lipoprotein on it. These are the dominant particles that traffic cholesterol in the body, both to and from the heart, by the way, and to and from the liver, but they sort of gain their fame because these are the ones that traffic sterols into the subepithelial space where it leads to atherosclerosis…. We know beyond any shadow of a doubt that the higher the number of those particles, the greater you are at risk for cardiovascular disease.”
I ask you, dear reader — do you know your LDL particle number?
Perhaps you know your total cholesterol number and maybe even what your LDL and HDL numbers are. Perhaps your focus is to bump up the HDL and tap down the LDL. This isn’t folly by any means, but it’s insufficient if your aim is to prevent cardiovascular disease, the number one killer of people over 40 world-wide.
On the page describing its NMR LipoProfile test, LEF echos Dr. Attia’s exhortation of its importance, which I’ll summarize.
Small, dense and many is a problem
LDL and HDL particles are the “containers” that transport cholesterol through your blood stream. LDL particles interact with the arterial wall and if oxidized forms plaque. These LDP particles can be small and dense or large and “fluffy”. The higher the number of small LDL particles, the greater the risk for coronary heart disease. Small, dense particles are also closely associated with insulin resistance and an increased risk of developing type 2 diabetes.
Higher levels of HDL are protective
On the other hand, a higher number of HDL particles is considered to be protective against heart disease, since HDL removes LDL by transporting it to the liver. In general, people with higher levels of HDL particles are at a lower risk for coronary heart disease.
The NMR® LipoProfile has the following tests:
• LDL particle number (LDL-P)
• Small LDL particle number (small LDL-P)
• HDL particle number (HDL-P)
• LDL particle size
• A standard cholesterol test (LDL-C, HDL-C, triglycerides and total cholesterol)
• LP-IR (a measure of insulin resistance)
Here are two screen shots from a NMR LipoProfile sample:
Biological Test #3 — Lipoprotein (a)
LEF says that its Lp(a) test is used to measure the blood level of small dense lipoproteins, which are a direct link to the formation of arterial plaques (atherosclerosis), and is a strong indicator for coronary heart disease:
“Elevated blood levels of lipoprotein are associated with increased risk of cardiac death in people with a history of acute heart attacks and coronary bypass procedures. Lp(a) also increases your risk for coronary heart disease and ischemic stroke.”
As in basketball, to be small is not a good idea when it comes to LDL particles.
“So LP a is another LDL particle, but it also has another apolipoprotein on it called apolipoprotein a. Now I know what you’re thinking, which is, “Could they come up with worse names?” And the answer is, “Maybe.” But nevertheless, the LP a particle is perhaps the most atherogenic particle in the body, and while it’s included in the total of LDL particle numbers, I definitely want to know if somebody has an elevated LPL(a) particle number, because that in and of itself, independent of the total LDL particle number, is an enormous predictor of risk, and something we’ve got to act on, but we do so indirectly. In other words, diet, drugs don’t seem to have any effect on that number, so we pull the lever harder on other things.”
Biological Test #4 — OGTT, Oral Glucose Tolerance
Glucose Tolerance Test with Insulin (8 specimens)
Glucose is the primary blood sugar used by cells to make energy. Among the many ways the body regulates blood sugar, the most understood involves insulin, a hormone secreted by the pancreas that delivers glucose to cells throughout the body.
When you eat a meal, the pancreas responds by releasing insulin to transport the glucose into the cells. As long as receptors on the cell walls remain sensitive to insulin, the channeling of glucose out of the bloodstream occurs relatively quickly and without excessive insulin production.
Unfortunately (and way too often), the cells become resistant to insulin’s effects. When this happens, the pancreas has to pump out ever-greater amounts of insulin in trying to force the glucose into the cells. This effort is only partially effective in most instances, and may result in higher blood glucose levels, eventually leading to type 2 (“adult-onset”) diabetes.
Blood glucose levels that remain high over time can damage your eyes, kidneys, nerves, and blood vessels.
Your results from the Life Extension Foundation glucose tolerance test will typically display one of the following common patterns, which can be useful information in determining how your body responds to consuming glucose:
“Okay, the next thing I think it’s worth doing on pretty much everybody, if you’re trying to check their risk of metabolic disease or just figure out what’s going on at the moment, is a very simple test called an OGTT, an oral glucose tolerance test. And while simple in concept, it’s sort of a pain to administer which is why most people don’t get it done the way I would like it done, which is a time zero, time one hour, and time two hour test that looks at insulin and glucose.
“So out of the gate you have a glucose and insulin level, you drink the 75 gram sort of nasty cola-like drink that has 75 grams of glucose in it, and then one and two hours later you have this repeat blood draw.
“And why I think this test is important, especially is what you see at the one hour mark. A lot of people skip that and they just go straight to the two-hour mark, but that one hour one is where we see the early warning signs. So a lot of people don’t meet the criteria for diabetes, meaning they have a normal hemoglobin A1C and they don’t have a glucose over 200 in response to this test, but when they start to get very elevated levels of insulin at that one hour mark, and elevated is sort of a subjective term.”
Biological Test #5 — IGF-1
“Let’s see, one more. I think it would be a toss-up for me. It really does depend on what the person is at risk for. I like to see a person’s IGF 1 level. We know that this is a pretty strong driver of cancer, so if we have a person who is at risk for cancer or who themselves is a survivor of cancer, we really want to do everything we can through diet, both the type of food and the amount of food that they consume, to keep IGF 1 levels low. So I guess that would probably make my top five list.”
Insulin-like growth factor binding protein 3 (IGFBP-3) functions as a binding protein for IGF-1.
IGF-1 is primarily produced by the liver as an endocrine hormone and plays an influential role in almost every system from muscle, bone, and connective tissue growth and repair, to the selective regulation of various aspects of metablism, as well as helping keep up normal brain function and cardiac health.
Too many people think they need to increase IGF-1 to stay youthful, but doing so can come at a big price down the road — as Dr. Attia said above, too much of this can instigate cancer, as well as other diseases.
It comes down to balance — too high, and you can ignite various disease states; too low and you can become frail from reduced bone mass, muscle mass, as well as diminished brain function, says Dr. Joel Furhman, who advises:
“…for most adults, keeping IGF-1 below 175 ng/ml is likely important, and below 150 ng/ml should be even more protective. Serum IGF-1 levels below 80 ng/ml may be detrimental, especially after the age of 75.“
Well, perhaps Dr. Rhonda Patrick can bring some illumination:
Your Takeaway About The Biological Tests You Need To Take
Those with the habit of simply starring adoringly into their doctor’s eyes whilst he/she spouts bottom line summaries of your biological test results are probably not reading this, because they’ve long ago moved on from this web page.
I say this because anybody whose waded through all this sciency medical stuff is taking some responsibility for his/her own health, and you’re the reason I’ve written the many hundreds of blog posts on this website.
That said, only a determined biohacker, or someone very worried about metabolic disease, is going to take all the top five biological tests presented. For the rest of you, I suggest you choose the one or two biological tests that evaluate what you most want to know about or have a high risk exposure to.
Unhappily, when those biological tests were taken, they indicated that I had too many of the small dense LDL particle, and was at risk for some cardiovascular disease down the road. Given how tuned-up my diet and exercise are, this was a shocker, and I expect that when I finally take the ApoE Genetic Test I’ll discover that my body doesn’t process fat very well.
Take a look at this chart, pulled from my article, What In The Heck Is “ApoE” And Why Does It Reveal Your Perfect Diet?
My suspicion is that my genotype is ApoE4. If this is true, as the chart indicates, I need to eat a low-fat diet and abstain from alcohol.
Getting this test is on my list, so stay tuned.