Issue #324: Medicine 3.0
Good morning. It’s Tuesday, April 2nd.
Stat of the Day
The percentage of people who wish their healthcare provider took more time for them. Stop “wishing” and make it happen. (AAPA)
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You Control Your Health
In the past couple of weeks I talked to two guys who are really focused on their health and they both said “I’ll never go to a doctor again, unless I’m really sick.”
I totally get it - no matter how well intentioned, most doctors aren’t really there to help you unless there’s a symptom they can treat.
I’ve been to the doctor for a physical and after a 5-min exam she said, “Everything looks fine. Let’s make another appointment for next year.” What??
Why did I just spend so much time out of my hectic schedule to learn next to nothing?
But despite the problems of this $4.3 Trillion market - there are ways to take advantage of the healthcare system you pay into right now.
Dr. Peter Attia makes a call for Medicine 3.0 in his book “Outlive”. Here’s what’s different with 3.0:
Change focus from treatment to prevention
Treat all of us like individuals, not a set of symptoms
Shift how you look at risk (nothing is without risk)
That sounds great - but what can we do until the system changes?
Well that’s on us - we just have to be more informed, more empowered, and more forceful in what we want and need.
Compare these two scenarios - I’m a 43-yr old guy without any diagnosed disease - I could:
Schedule a physical and almost forget it’s on my calendar. I don’t think of any questions to ask - go through the routine, doctor says everything looks good and sends me down the hall for some blood work.
They take my blood and 2 days later I get a voicemail that everything is fine.
OR…instead:
Schedule a physical and request my doctor approve a lab test - including a few biomarkers not on the standard panel - 3 days before my physical. Then show up at the physical with specific questions for my doctor based on my results.
I don’t show up at a work meeting without and agenda and questions - why would I do it when it affects my own health??
For example, because I’m feeling slower than usual I request the following metabolic health markers (see Issue #216):
Fasting Glucose
Fasting Insulin
HbA1c
Because I’m over 40 and don’t want to mess with my heart for the next 50 years (not just the next 10), I request:
Lp(a)
And I’ve been really stressed lately so I make sure to get:
Cortisol (see below)
Because I got all this done in advance, I can go over the results with the doctor in the appointment, not a VM.
Maybe with an elevated ApoB - we schedule a Calcium Score or maybe I double down on my testosterone and free testosterone because of my high cortisol levels.
Or maybe with a more direct conversation about cancer running in my family I get a colonoscopy now instead of waiting until I’m 45.
The point is I’m taking control of my health. Yes, the doctor is still navigating me and the expert in many ways. But the reality is this - no one in the world is as invested in your health as you are - NO ONE.
Don’t feel like you need to wait for healthcare to change to get what you need - you can stop being the passenger and start being the driver right now.
Try
Request the Right Tests
As I mentioned - not all tests are part of your standard bloodwork at your annual physical exam, but most are covered by insurance if you ask for them and your doctor puts in the order. Here are a few:
Heart Health: ApoB, Lipoprotein a (Lp(a))
Immune Health: High-Sensitivity C-Reactive Protein (hsCRP), WBC with differential - the differential gives you a breakdown of your white blood cells
Hormone Health: Cortisol, DHEA-Sulfate, Sex Hormone Binding Globulin (SHBG), Triiodothyronine (T3), Thyroxin (T4)
Nutrient Health: request a full profile (e.g., folate, magnesium, selenium, etc.) - these measures help you determine any supplement needs
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Measure
Cortisol
Cortisol is a steroid hormone produced by the adrenal glands. It’s often referred to as the "stress hormone" because it is released in response to stress and low blood-glucose concentration. It plays roles in the metabolism of glucose, the reduction of inflammation, and the regulation of blood pressure.
We mentioned in Issue #19 that cortisol is good for you! Yes, you read that right - our bodies are programmed to manage acute stress - short bursts of potential danger. This fight or flight mode turns off other functions to focus solely on survival from the immediate threat.
This is good from a longevity perspective. Actively putting ourselves into safe stressful situations - intense exercise, extreme temperature exposure, or short-term fasting - creates hormesis that puts our body into a restorative state.
But elevated chronic stress for extended periods of time can lead to depression, anxiety, high blood sugar, and weight gain.
Part of the reason for this is that cortisol is inversely related to our sex hormones - you can’t create testosterone if you’re making cortisol.
What’s my number?
The body naturally produces cortisol - it’s at its peak before we wake up and the lowest shortly after we fall asleep - the opposite of adenosine. Here are general guidelines throughout the day:
No doubt you’ve felt your stress levels fluctuate - so there are other peaks and valleys within these ranges. That’s what makes this hormone so difficult to measure.
Some wearables are experimenting with real-time monitoring using sweat and saliva, but non-invasive sampling is currently less accurate. And then there’s me and needles - my guess is my cortisol levels are higher when I get blood drawn.
So what should I do?
The best approach is to get tested as frequently as your insurance will allow and your doctor recommends - at roughly the same time of day. This will help you determine your baseline value, and whether any lifestyle changes you make are having an impact.
Speaking of impact, here are our top 6 recommendations to optimize your cortisol:
In the News
What’s the Best Way to Clean Your Ears? Cotton swabs have become the standard, but there are safer and more effective alternatives. (NYTimes)
Muscle Magic: The secret to the ultimate fitness success? Muscle development is key for metabolic health and longevity, not just appearance. Check out these tips to inject some strength training into your workouts. (Levels Health)
Hidden Hazards: The US buried nuclear waste abroad in both Greenland and the Marshall Islands during the Cold War. A new report says melting ice sheets and rising seas could bring up waste from these US nuclear projects. (WIRED)
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The information in this newsletter is for informational purposes only and may not be appropriate or applicable based on your individual circumstances. Thrive25, Inc. does not provide medical, professional, or licensed advice. Please connect with your healthcare professional for medical advice specific to your health needs.