The Longevity Dashboard: Stop chasing data, start getting results

Introduction & Medical Disclaimer

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Chapter 1: Lab overload and wearable obsession

All right, in this episode of Sell the Systems, we're going to be talking about the optimization or longevity dashboard uh that we patients uh tend to bring to our providers or we're obsessed with tracking. And then uh for providers, how do you deal with those patients who are doing just that? Uh I think it's really interesting. You know, you take a look at I'm tracking stuff on my Apple Watch all the time. Um and then we have people who are looking at stuff on aura rings and whoop and this and that. Then function health. Uh where you know we get so many um markers that you know people say well what do I do with all of this u and is it actually really helpful uh when you take that to your provider.

So today we have the benefit of talking to people who are actually working with that every single day. And then we also get to talk to Leonard and Frank who are doing something really interesting with new HX which I think is going to become sort of a next level piece of the puzzle in where we are. Um so you know there's lab overload for sure. Uh that became clear when we looked at what Dr. Hussein a bit Hussein who is a cardiologist uh in longevity medicine and in in his talk he talked about wanting:

Apo B RDW MCV Total cholesterol HDL ratio Neutrfilic lymphocytes ratio

So it was like hey I only want these particular things to tell me what I'm looking for uh when somebody comes in with these other tests. as I recall what he said was it's like this just way too much information. So how do we maximize the labs that we're getting? So I want to start off with you uh Suzanne and just ask you when you're looking at labs uh when you have a patient who's who's coming in where do you start?

Chapter 2: The Oura Ring Paradox: When metrics cause panic

So it's that's a great question. I just saw a patient today that's very much this this exact issue. So this patient is she um owns an international skincare line and she brings in her aura ring which I thought was going to be a great idea. So this is where we have to be really careful with selection of client. Correct. And uh I think she's kind of a metrics person. She's into she's into marketing. Her her business is actually marketing. But uh when I give her this and she comes back to me with the results, now she's not sleeping because she's panicked about what her orus ring says that she's not sleeping. Right?

[laughter] So we have to realize that the um all of these things that we do to monitor our people are a um it's a measure typically a measure of a second in time. It is an optimization tool. This is not a scorecard like what is your HRV? Well, what is my HRV? This is what I hear all the time. I'm sure you guys are all nodding your heads that our that our clients are doing this. And so uh I also start out every conversation by saying let me just tell you in this panel which is about 25 labs that I typically draw in my um in my annual kind of where are we today exam and um in that lab one of the things we look at is a um glucose for example.

Chapter 3: Scorecard vs. Dashboard: How to view your labs

I know that there was a study done back in 2004 maybe it was 14 14 where they demonstrated that a glucose for every point above uh 87 that your blood sugar goes, your risk of developing diabetes in the next 10 years goes up by 6%. So, I'm not going to wait until you develop diabetes, which is what they usually recommend. I'm going to start to say, "Hey, you're at 88, you're at 89." I do the calculation in front of them and I say, "Hey, we got to look at what is optimal for you. What is the thing that's optimal for most people and how do we what can we do to get things moving?" Most of these are things we're going to monitor over time.

So, I really like rather than just a fasting blood sugar, I really love to do that glucose continuous glucose monitor where we're watching people move. There are other metrics that we use that I'm sure everybody's uh familiar with that we use over that are going to monitor things over time and it's going to give me a better idea of rather than scoring you good or bad that this is where are we going, what is affecting this and how do we move. So the other thing my staff were just talking about this morning we were talking about how you you prepare. So, we go through their labs ahead of the the appointment visit. All of us will. And then we have a plan in our minds about, oh my gosh, look at this thing and this thing. I bet they're doing that and the other thing, especially if they're patients we know well.

And so, we'll make a plan and the patient will come in and we'll say, hey, your CRP is high or your TNF alpha or your whatever the other labs that we're doing. And then the patient tells us a story that's completely different. Oh my gosh, my mother-in-law just died and we had this whole thing that happened and blah and now that explains all the things. So you had this big long plan of what you were going to do with your client and how you're going to counsel them and then now you have to redo your entire thing because you so this is a collaboration with the client. Uh it is a an optimization um uh way that so I love the word dashboard. We talked about using that before, but sort of thinking about um how do we optimize you based on what's happening in your life right now and is there additional investigation that we need to do?

So, let's say your blood sugar is high. Great. Are there things we need to do to move the needle in a different direction? Is this a primary mitochondrial uh problem? Is this a primary diet problem? Is this are we dealing with someone whose adrenals are in overdrive? So, the blood sugar is high. Are we overtreating them with a couple of the peptides that we know will raise their levels of glucose? So, there's so many factors that go into play and this is not a one-off signal that your, you know, hemoglobin A1C is above six and now you fail. So, keep those in mind that this is not a scorecard. This is a dashboard that requires continued investigation and lots of modification from various points.

I love this. you know, this is this ongoing dialogue that you have with your provider where you're setting these goals. Leonard, you've talked about it. I mean, a bunch uh we've had conversations um a bunch about this the notion of this ongoing dialogue. Christy, we've talked about it. Craig, we've talked about it. It's really it's one of those things where it's like you want to be working on what's next. I love what Leonard says. Hey, if you're doing the same thing over and over and over again, it's probably you're not on the right pl right on the path. uh not on the right path. Excuse me. So, okay, cool.

Chapter 4: NuHX: The next level of longevity assessment

But let's break this up and let's talk with Frank. Uh what you and Leonard are doing at NewHX is so cool. That pre-conference day, I was blown away. Uh my son was there and he was like, "Dad, this is the coolest stuff ever. I can't believe this." You know, it was just it was just so great. And so tell us about what's going on with new HX and how you're using uh th those tools in a way that help a patient at a totally different level.

Oh, for sure. Um, you know, Leonard is really the the the big specialist at New Hex, but I can I can give you overload a little bit about what we do, but it's it's for us it's it's our approach to longevity assessment. you know how do we how do we leverage different uh assessment tools to provide what we think is is is a journey to longevity medicine right so one of the biggest thing that we have is you know we have at the core of it our pharmacist and what they do is they they provide uh a lot of a lot of guidance for patient um once we receive a lot of the data from all the assessments that we do uh we partner with with you know many different companies um the first one that helped us with this was Penoi where we're leveraging VO2 max uh to create a road map right for for for patients who understand things like you know their their mitochondria flexibility understand how GLP1s are working for you know how their you know how the muscles are working toward you know to towards their goals uh we brought in DEXA scans in there as well just to give a better visibility on on visceral fat content muscle mass content and how do you know bring that information with the V2 max and provide them even better clarity of what's going on right um then we have other tools you know we have an awesome machine now right called Oxfit um that you know basically provide exercise you know to to this patient or more precision exercise to this patient so we're trying to close the loop um with giving assessments and provide and prescribe exercise really at the end of the day um there's more there because we're actually working in collaboration with, you know, with with prescribers.

Um the the key is to leverage a relationship with doctors um to help them gain even more data to help them with um you know, with better quality um uh counseling for their patients. So, it's it's awesome thing that we're doing. We we're part of even more and more companies. Um you know, there's a lot of excitement there. Um so, it's it's it's uh it's it's fun. It's fun. And as you saw when you came in at the pre-conference um you know it it's not a very uh uh it's always changing and that's what we like about it. You know there's there's really not one data that gives you all the answer is it's always constantly changing. We learning something new each day. You know there there's you know biomarkers are changing and I can't wait to talk about that. You know the the you know the one size fit all model is gone. You know there's there's so many different ways to check bioarkers. There's so many ways to interact with labs, bring genomics into it, and add everything together with AI and then just kind of blow people's mind in there, too. So, um, yeah, that's what we do in the HX.

Yeah. What I love about that is it's just such a next level, right? It kind of and it kind of kills the noise of all these. Now, I'm not saying these devices are bad and I certainly use it for, you know, tracking my workouts, tracking my steps, my stand. you know, obviously I have a standing desk and have it for a reason. Um, because I want to stand for a certain amount of the day. Um, so I'm not saying these things are are bad personally. Uh, I like them, but uh, I think they you have to get it to a point and sort of understand are they really useful or not. It's really cool what you and Leonard are doing at New HX. Leonard, we're going to come back to you and at the end of the and have you kind of wrap all of this up. So, it'll be really cool to hear more about that. All right. Uh Christie, [laughter]

Chapter 5: The 4 pillars: sleep, movement, food, and stress

I remember the day that you said we need to have a real heart-to-heart, right? Um about um where my insulin sensitivity was. And I think that it's it's interesting when you when you really take a look at those labs and you're able to communicate that sort of information to someone and be able to tell them, hey, this is what you need to do. Uh so the metrics are super important and I'd love to hear from you. you know, I mean, I've lived it, but I'd love to hear from you like how you approach that in your mind. How how are you going to actually talk to a patient about labs and different ways of tracking things as someone who's so into fitness as you are?

Yeah. I you know I think the first thing that for us and for myself is you know you have to ask some very powerful directed questions at first of you know kind of basically we'll ask you know what what do you want to achieve with your health um and then we follow up with what does success mean to you and what does that look like because I think you have to understand you know for instance an an insulin or albumin or you know the ratios with CBC's and the neutri you know they don't they don't excite a lot of patients you have to kind of come to where they're at and understand what they're wanting to achieve.

Um you know some people it's just simply they want to walk through their day without pain or they want to sleep better. um or they they they want to be able to have enough energy to enjoy their kids more or literally sadly, you know, some of the elderly population that we see um as far ability to go from the floor to standing um which so anyway, so we start very basic there. But I think you know, yes, we do some lab testing at first, but I'm not a heavy lab tester. I mean, if a patient isn't responding the way I think they should, yes, we can add more testing as far as with prodal or, you know, GI mapping or, you know, genomics, anything we might need in that sense. Um, but you can't forget what does a person's sleep look like? What does their daily movement look like? Um, what does food look like to them? Um, and then their stress management because sometimes that's that's all you need to fix. I mean these they're not this magical button that we have. I mean it's it's literally nothing fancy about it. It's it's you have to have those basic pillars then you can start layering it up and really start working on optimizing their health um for longevity.

So so true. I I gosh I've learned so much from you guys in such a short period of time uh relatively speaking. Well, Leonard, let's, uh, let's hear your take on this whole thing.

Chapter 6: Signal vs. Noise: Identifying real risk

Well, I think that the, um, one of the most important things I see moving forward in all of medicine, not even just longevity medicine, is um, how great the medical practitioners have to be at assessing and identifying risk. Um, with all the tools that we have and the dashboards that you guys are talking about, um, we're just way better. we have more information on how we can identify risk earlier and earlier in people and be able to intervene on that and that's you know me as a pharmacist I've always been focused on biochemistry and medications and mechanisms actions side effects uh but even for me this is something that I'm paying much more closer attention to is all these diagnostics these dashboards these metrics and and what they mean and what they mean over time and and how we can use these to initiate therapy but also pivot therapy to see how what we're doing is actually working.

And so you can get really lost in this, right? There are so many biomarkers that you can look at. So there is so much noise compared to signal. So I think for patients thing that they may struggle with and even doctors, what they need to be focused on is identifying what that signal is versus noise. And so with new HX, that's why we started off very basic. And we have plans to get a little bit more complex over time, but we wanted to get the basics down really, really well. And so we found that things like body composition, B2 max testing, um, strength and some very basic biomarkers, we can do so much there. And just being great at understanding what those things mean for the patient like in the moment, but also what it means for them um, their lifespan. Like what does this say about their risk? Like what how can we prioritize how they exercise or what peptides they use or what nutrition they have. [snorts]

And so, um, I think that anybody getting into this space or or being overwhelmed, I think you have to first for yourself is prioritize like what your main goal is. And then once you prioritize what your main goal is, then you can work on just maybe the five top biomarkers that you that you want to actually make a make an impact on. And so I I think that this is this is a fun place to be because you can get very foundational, but there's so much room to grow, right? Once you have those foundational biomarkers of what you're looking at and how you're assessing them and how you're changing over time, then you can start getting into more fancier stuff like metabolomics and genomics and epigenetics and um you know the the all the stuff we have for preventative cardiology. You can that's what that's what gets me excited about this field is that I I don't feel like I'm ever going to know everything. There's so much room to expand and know um and and sometimes even with a a very basic biioarker, right? like um looking at the at our recent conference we were talking about this big risk with LP little A that everybody's looking at and then this new study comes out in 2025 saying hey if you have that elevated but you have low visceral fat you actually don't have that amplified risk and so here we are going back to a very basic biioarker of visceral fat and decreasing that and we can make a big big change in someone's life and someone's risk profile by looking at that so it's a it's a really fun game to play with but it could get overwhelming but you that's why at New HX we just we're starting with the basics. Um and and that's a lot of fun and there's a lot to do there.

Yeah, it's just so cool. I mean um I was so impressed by that and I think at the end of the day, you know, now speaking to the patient side, Craig, let's turn this into action. Um and really talk about what you're doing because you have a Penoi.

Chapter 7: The "actionability" test for metrics

Um, and I know everybody here has a bunch of different types of equipment that they use in their practice, but you know, how how are you putting these uh, you know, a dashboard into action in your practice? You know, a longevity dashboard for me is really about um, it it's not about just a slew of numbers and statistics that people are following on some sort of technology. uh it's really about the few items that are going to correspond to something that we can uh measurably change and that has to be actionable, right? So if the measure if the metric is not going to correspond to a change in our behavior, then it's really not worthwhile to incorporate that sort of thing on our dashboard.

And so for me, it's all about simplicity. what can we monitor that really will promote uh you know some new uh progression of somebody's health down the road. Uh some examples that we utilize a lot in my practice you know we're looking at fasting insulin we're evaluating uh that in the context of meal timing nutrition timing uh postprandial activity and exercise we're also looking at uh carbohydrate load and the nutrients that somebody's taking in. We're looking at an individual's HRV. We know that HRV is highly variable from person to person. Um but you know how is somebody sleeping? Are they hitting their uh you know 40 40% restorative sleep metric that qualifies um you know improvements in recovery and uh also is going to be associated with improvements in their HRV. Uh V2 max you talked about penoi. Yes. So we want, you know, somebody to have a good V2 max on average, you know, 40 to 45 milliliters per kilogram per minute in their V2 max is sort of a good marker and that's going to decline, you know, uh, per somebody's age.

But the goal is really to have clarity around these things. Um, not just a whole bunch of numbers that people are just following willy-nilly. And the reason that's so important is because if say somebody takes a biologic signal, maybe that biologic signal is their HRV or their fasting insulin. If they implement five changes, uh, and then over a 2 to four week time span, they're noticing that that biologic signal is improved on the next assessment. Uh, they may not know which to attribute that to, which lever it was that they pulled that actually brought about that change. So we want to um make simple and uh you know slight um you know trajectory adjustments that we can clearly define this is what caused this to improve um and so you know continuous tracking surrounding sleep HRV uh activity levels these are the things that we're following regularly in the practice uh again for the purpose of clarity and once somebody has a dashboard that is standard standardized, you know, standardized across a population. At that point in time, we're really able to assess disease risk uh long before somebody develops diabetes or cardiovascular disease or dementia. And um you know, we can be proactive as opposed to reactive. So, that's really what it's about for me here at Remedy.

Chapter 8: Assessing risk before disease develops

Craig, are you guys using those metrics uh practicewide? meaning are you are you monitoring what interventions make a difference in your entire practice in addition to for the individual? Yeah. Mhm. Absolutely. And some things, you know, we know just at baseline are going to significantly improve uh outcomes for patients. So, for example, you know, people that are uh seeing their HRV decline by five or seven points on a consistent basis, a lot of times they're, you know, getting to bed late, they're waking up early, they're not getting that restorative sleep. Um, you know, people who are eating after 7:00 p.m., they're taking, you know, a high caloric load after 7:00 p.m. They're not mobile after a meal. Uh, these are the people that we're seeing, you know, with their insulin levels that are, um, you know, suboptimal. So uh yes uh we're we're looking at those things across the board in patients uh and then virtually everybody in my practice who is able to exert themselves is participating in uh Penoi metabolic breath analysis and and this is key right for their uh V2 max testing and as we talked about in the first episode ideally we're you know measuring this quarterly.

So, it sounds to me like one of the things that's a common theme here is keeping it simple, right? I It sounds like everybody's trying to just narrow it down into the things that we need in order to get the patient where they need to go. And if you're a provider, I think that's instructive. Uh if you're thinking about getting into the field of longevity or cellular medicine, um you know, I think there's a lot to learn here from this group. Uh I think that's pretty clear. Well, when you're thinking about your dashboard, I think about like is this metric this these are these things are things I learned in medical school in alipathic medical school, right? So, so is your metric going to be predictive of an outcome? So, for example, blood sugar, diabetes, right? Is there an outcome? And then, so this is what helps us decide my team decide whether a metric goes on our dashboard. Um, does it have an outcome?

The second thing is are you able to um make is there anything that you can do to intervene? So okay, let's say you have a genetic variant and but there's no treatment specifically for that variant. Well then I don't really want to know that you have that variant because there's nothing we can do unless it's good to know for some reason like a G6PD. Um that that's a perfect example actually. So and then the third thing is can we move the needle with some kind of intervention? So it's sort of the two sides of the coin. is there no intervention then it's not really worth doing and if we do an intervention are we going to see a change and what's the metric to measure there so things are always coming on and off our panels as we try to see what how we can so like you guys were talking about are we going to do a a urine hormone test are we going to do a blood progesterone test are we going to do a blood uh let's I mean there's a million things that we do that that are different but these you know is an FSH or an SHBG going to be valuable for us in assessing the and so yes or no and if in part of the decision-m of whether it goes on the the dashboard or not is can I make a change that will be effectual because if not it's not worth being there just to know it.

So once again, I think it's pretty important for everyone to to really speak with your provider. Um feel comfortable with them, have them understand your goal, as Christie said, and um and then, you know, be in continuous communication about that and also be truthful about what what it is that you're doing. If you're doing something that's like, hey, I'm like Craig, uh hey, I'm eating ice cream at 7:00 at night every night. Um we're not going to we're not going to get the uh the right result, right? So, um, is are there any other thoughts? Anyone want to wrap up with anything that's, you know, come up along the way as we've talked about all of this?

Chapter 9: Leonard’s experiment: Taking a break from the data

I think how Suzanne opened it up, um, with that story, uh, about her patient and the aura ring is a really important one. I, um, I recently, my Aura ring recently stopped working and usually I run to go get another one. And I used to also always have this anxiety of if I went out for a run, I'd have to have a watch or something that was tracking my heart rate. And if I didn't track it, then I just it's like I didn't even exercise. It's like why even go for a run if it's not being recorded somewhere. Um and and and recently I've just been going for a run, not looking at what my heart rate is. Um I can tell if I slept well or not. And I've been I've been I've been enjoying it actually lately. I do love data. I mean I have new HX. It's just all revolved around on around data. But I think sometimes it's nice to just take a break from it and also just, you know, see your own intuition on how you feel, what your energy is, how you're sleeping. And I've [snorts] actually been enjoying that. And that's okay, too. Even from some coming from somebody that um loves loves health data. Um so that's that's an important thing to to also think about as well.

Chapter 10: Data obsession

Christy, I'm going to put you on the spot. What do you track personally? Do you have do you have a Whoop? Do you have an Aura ring? Do you have a a watch? Do you track any of that?

No, I don't, you know, I mean, I will wear my Apple Watch when I'm out for a run, but I only do it because of the distance. I just want to know, okay, when I need to turn back around. Um, because, you know, being a long-distance runner in college, I can run forever and but it's not what my body needs anymore. Um, but no, so as far as like devices, how I approach it with patients is, you know, wear it for a month, two months max. I mean, it's it's just to help you detect trends. Um, and then take it off. Um, I I don't think there are absolutely your, you know, your engineers. There's some people that just will not get off of them. Um, they feel quote unquote safer.

Um, but no, I I used to wear a ring years ago. I think I probably had the but I hated waking up when it said I failed already. I'm like screw you, [laughter] you know? I'm like whatever. And so and and I just I mean I think you know knowing myself knowing how I feel um like today I'm you know a little tired so this morning was a little challenging at work but it's justified just I just got back from a volleyball trip with my daughter. Um so um you know and I think my big thing is awareness always has to come before change and if a patient needs that awareness go for it. Um now when it becomes an obsession that's when we will I will redirect them with like you know myself my health coach um our dietician um our functional movement trainer I mean that's where I will try to help them start shifting away from the obsession of the data.

Chapter 11: Your wearable is just a "Behavioral Mirror"

You know what's funny? I um I went to a conference uh not long ago. It was a it was a tech conference in Vegas in healthcare and I was sitting with this gentleman next to me and this conference had a bunch of um you know tech people there saying you know selling a lot of wearables it was just wearables you know everything is wearable that's where the money is going private equity money is going into it um and this guy from Rang was talking CEO on main stage and then this gentleman next to me is like, man, there's so many of them out there. We we don't even know where to go anymore. Um, and you know, it's like, and he said something pretty profound. He said, you know, those things all it is is it's those wearable are just a behavioral mirror. And he said it to me, I was like, hm. It's like it's not a clinical statement. It's not a clinical instrument. It's just a behavioral mirror of yourself, you And I think if people prescribers and and and you know patient think about it just as a mirror image of a behavior and not a clinical instrument I think that's where the wind's going to be. You know what I mean? And the question is, you know, is is is not what to track at the end of the day. It's like, you know, uh what will you do differently based on what you see? And that's all and to me that's powerful. And and you know, when you go around and you see all those, you know, dashboards, all those wearables everywhere, it is absolutely insane, you know, and then then it's just overwhelming, you know, but it's like, you know, what are you going to do with it? what are you going to do differently with it? You know, and and that's that's the key.

I think looking I I agree with um what everybody said, you know, really great points and um especially what Leonard said about, you know, the Aura ring that um failed and he took some time off. You know, my uh after calm or during calm actually, my Whoop ran out of battery and uh for like you know, the past two weeks I've just sort of let it be out of battery. Um and I just recharged it and uh started looking at the data again and uh it does you know paint a nice picture uh that is a mirror of our behavior and um so one of the things that I like to do is really sort of just kind of check in on my sleep scores when I wake up in the morning um you know maybe five days of the week right and uh if I see that my recovery is in the green um that my HRV is up from where it was previously then this is a day that I know that I can put a little bit more effort into exertional training. Um, if I'm seeing, you know, the opposite, then maybe it's time to relax, get, you know, the kids to bed early so that I myself can get into bed early and really get some restorative sleep. So, um I I do love the data that they provide, but again, I think, you know, simplicity at the end of the day and ultimately, you know, using it as just another tool in our toolbox as opposed to something that we have to be heavily relying upon.

Yeah, we can definitely become obsessive with it. Well, hey guys, we need to move on um and and wrap up the episode, but I want to thank you all. It was really great to spend this time with you. Um again, if you're new to Selda Systems, please remember to like, share, and subscribe. Also, comment. We want to hear what you have to say. So, please comment uh in in the uh comment area so that we can answer any of those and also shape future episodes. We really appreciate your participation [music] and uh we look forward to seeing you in our next episode. Thank you so much.