Dr. Leroy Hood and Nathan Price believe we're at a watershed moment in medicine. After reading their book, The Age of Scientific Wellness: Why the Future of Medicine is Personalized, Predictive, Data-Rich, and in Your Hands and this interview, I'm inclined to agree with them.
Let's Say Hello
[00:02:48.870] – Allan
Hey, Ras. How are you?
[00:02:50.700] – Rachel
Good, Allan. How are you today?
[00:02:52.810] – Allan
I'm doing okay. Got some news. I've been really quiet about this over the last 20 plus weeks. In my meantime, when I'm not doing anything else
[00:03:06.090] – Rachel
when is that, by the way?
[00:03:08.910] – Allan
I set up to take the Precision nutrition level two on my way to being a Master Health coach. But I I passed my final last week for my level two.
[00:03:20.100] – Rachel
[00:03:21.160] – Allan
I basically been so I was for the last 21 weeks, I've been spending about 8 hours per week on this course. It's pretty intense. I would basically kind of put it up there and say I was taking multiple college courses at the same time to do this because it was pretty deep. I printed out their text just from the lectures. It was 180,000 words.
[00:03:48.490] – Rachel
[00:03:50.650] – Allan
Just to kind of give you an idea of how much content was in this. And then it was a final 100 multiple choice questions that you go through. So I passed that test, and by the time you're listening to this episode, I'll have my level two and be working towards my Master health coach with precision nutrition. So I'm pretty excited that that's over.
[00:04:15.410] – Rachel
Yeah. Wow. Well, that's fantastic. Congratulations. That's really huge.
[00:04:20.600] – Allan
Thank you. And it basically ups my game a lot, because from that coaching perspective, it kind of gives me the it's not so much the credentials, it's just the things I learned during that 20 weeks and how I can apply that for my clients and get them even better results. That's what I'm excited about. I know when I'm doing my coaching that I'm doing kind of that highest level of coaching that I can possibly do, because there's nothing harder. I mean, there's nothing higher, like getting to that point where it's okay, I'm the most credentialed I can be as a health coach, so health and fitness coach. So that's pretty exciting. Put all the tools in place for me.
[00:05:06.370] – Rachel
That's wonderful. Congratulations.
[00:05:08.550] – Allan
All right. How are things up there?
[00:05:10.370] – Rachel
Good. I mentioned last week that I was going to be running an ultra, and I did. It was 34 miles, and I had a great run. Earned first place in my age group. Set a two minute thank you. Got myself a two minute PR on this course. This is my fourth time running this course, and it was a great day with really terrible conditions. We got rained on at the beginning, and then it only got colder from there. You had snow in the afternoon, so it was kind of a muddy mess, but it was wonderful. Painful, but wonderful. It was a good run.
[00:05:49.870] – Allan
Yeah. You add the poor weather and the PR, that's pretty impressive. You you must have trained really hard for this one.
[00:06:00.070] – Rachel
You would think so, but not nearly as hard as when I trained to run this the first time. But it's been four or five years since my initial PR on this course, so it's not so much the training as the wisdom from the last few years. I really know what I'm doing, so I can persist through some uncomfortable conditions. And truthfully, this kind of gets me a little bit fired up for pushing my limits on a good weather day. I mean, if everything went better, then how much faster could I have been? There's just a lot of room there to ponder that, so I'm pretty excited about whatever might come next. I have no plans, but I am definitely thinking about something.
[00:06:48.660] – Allan
Good. I saw Mike had post a picture of your prep and then his prep. I think he had a PR too.
[00:06:58.600] – Rachel
Yeah, that was a good picture. Yeah. I've got a lot of gear to run 34 miles. I need quite a bit of food. And I had a couple of wardrobe changes because I knew that it was going to get rained on and they provide drop bags. So I had a change of clothes as needed on the course and everything. And Mike had all the celebratory beer ready, so his prep was a little different than mine.
[00:07:24.370] – Allan
Some of it was left when you got done.
[00:07:26.370] – Rachel
At least I got a beer out of it. Yeah.
[00:07:28.160] – Allan
[00:07:30.370] – Rachel
[00:07:31.850] – Allan
All right. Well, are you ready to have this conversation with Dr. Hood and Dr. Price?
[00:07:37.860] – Rachel
[00:08:29.570] – Allan
Lee, Nathan. Welcome to 40+ Fitness.
[00:08:33.100] – Dr. Price
[00:08:33.740] – Dr. Hood
Great to be here.
[00:08:35.000] – Allan
Yeah. Your book is called The Age of Scientific Wellness. And as I was going through the book, I just had a whole lot of thoughts. And what I liked about it was I would be thinking something like, well, what about what about what? And then here you guys go and answer that question. So you answered a lot of my questions about health care and well care and kind of the direction some of this stuff is going or very much could go. And even though it sometimes has a feel of science fiction, I see enough around me otherwise to say that you guys are probably spot on. That change is coming fast, and it's going to be kind of interesting how the next, I would say one or two decades shapes up as far as how our visits to our doctors go and how we personally can step in and make some changes for ourselves. So I appreciate this book because it's a lot of food for thought and it covers a few things that I really want to get deeper on. But this is a really good book.
[00:09:42.170] – Dr. Hood
[00:09:44.570] – Allan
Now, in the book, you compared and contrasted health care, which is what we have pretty much today, which is get sick, have a symptom, go to the doctor, take a medication, usually for the symptom, not always for the cure, and then rest and repeat. Literally, we just keep going back and then for a lot of us over the age of 40, it's counting how many pills you have to take in a day. And then we sit down and start having those conversations. Well, I'm on seven, I'm on eight. My doctor changed this one and put me on these two, and this one gave me that, so I took that. And it just seems like a case of whack a mole, if you will, and you go into that and then the look forward of what we could have is what you call wellness care, which speaks to wellness, the transition, and then disease. Can you kind of talk through that and why that different paradigm can completely flip the way we look at medicine?
[00:10:52.990] – Dr. Hood
I think the fundamental idea is that health care in the future is going to be data driven. And the idea that we will follow each individual on a regular basis every three months or every six months, and we'll assess blood analytes and the gut microbiome and do digital health measurements. And these measurements will let us assess the three different features of health. So I see your health trajectory as made up of three components. So most of us start in wellness, whatever that means. Then often we will go through a transition to disease that will progress and then reverse itself and take us back to wellness. So the data driven transitions we can assess are wellness are the transitions and disease itself. And what's exciting about data driven approaches is they let us optimize health for each of those three phases. For wellness, typically, we would guess that ordinary person, even appearing well, would have maybe 30% of the potential wellness. And there are many actionable possibilities that come from data driven wellness that can further optimize that. And a very interesting question is it's up to you and how far are you going to go in being well?
[00:12:36.770] – Dr. Hood
The second point that's really fascinating is because we can detect in the blood transitions that occur years before you get the clinical disease, there is now the opportunity to think about reversing disease when it's simple at its earliest stage, so that you never get to the disease. And a really attractive idea of data driven wellness is we can deal with many, if not most, chronic diseases in this fashion. And then, of course, for disease itself, the enormous data density gives us fundamental new insights into how to deal with disease more effectively. And many people are doing that. But the whole idea is, in the future we will follow you, whether it be with fitbits and aura rings and things like that, and or with blood and your microbiome analyses. And they will give us the power to optimize your health.
[00:13:47.190] – Allan
So, Lee, on a simple basis, just to kind of walk us through this, can you go at a high level and say, okay, we know that there's a transition that occurs that puts us into diabetes. We've identified it now as prediabetes. But can you kind of talk through that line of how that would work for someone who's maybe going in that direction and how that transition would appear?
[00:14:09.320] – Dr. Hood
Nathan, do you want to take that one?
[00:14:11.390] – Dr. Price
Sure, I'd be happy to. One of the ways that diabetes is a great example because it's probably where we've worked this out the best just in medicine today, because there is at least a diagnosis that you can make or an evaluation of prediabetes and that relates to the ability for us to control insulin. So to look at controlling sugar via the secretion of insulin primarily. And so when you look at that, you can transition from waiting to some late stage disease and late stage diabetes care is pretty horrific, right? It's foot amputations. They're up like 40% in the United States over the last decade or something like that, which is just terrible. But if you're looking at prevention and earliest on, you can deploy new kinds of devices. So continuous glucose monitors, for example. You can wear a device on your arm, you can go in it's painless for a course of two weeks, and you can monitor how your body's response to sugar is being managed. You can get a sense for how good are you at that. You can actually look at exercises and changing your diet or even some supplements or drugs or different things like that that can have an effect on trying to blunt or get yourself to be better at controlling glucose.
[00:15:29.010] – Dr. Price
And as you improve that metabolic health, as you focus on wellness, that then reduces the likelihood that you would transition to diabetes. Now, if you want to broaden out from that and this is some of the things that we get into in the book. So we did a paper for the Proceedings of National Academy of Sciences a few years ago, and we looked at the genetic risk for 54 different diseases and conditions. And what you find is that even if you look in asymptomatic people, you can identify differences that manifest themselves as a function of being at high or low risk for a disease decades before the disease manifests. And in many of these cases, they relate to mechanisms that are happening early in the process that might be reversible. Just to give one example, we looked in the blood of people and stratified them by risk for coronary artery disease. Turned out there was only one protein whose concentration of the blood was correlated with that strength of genetic risk. In this case, that was PCSK nine. Well antipcsk nine drugs are the biggest that's the biggest blockbuster drug in that space in the last decade.
[00:16:37.810] – Dr. Price
And you could see that, and it's the only signal when you look early. And traditionally in medical research, we're always looking late. And you have these hundreds of changes, maybe thousands of changes that you're trying to suss through to figure out what matters but you're seeing a very complex picture at the end when you look early and you have more of a movie where you're starting from wellness to the early transition. The number of signals is small and the interventions are easy. So going back to diabetes, late stage can be loss of pain sensitivity, and all the problems that come with that early is fixing your diet, eating more fiber, things that are very simple. And that's kind of the whole paradigm, which is to shift healthcare much more towards understanding these fundamental processes and how good we are at them, like the control of glucose. But it could be combating oxidative radicals. How good are you at how well is your DNA repair happening? Are your telomeres shortening faster than they should, et cetera, et cetera, et cetera, aimed towards how do you live as long and healthy a life as possible?
[00:17:43.910] – Allan
Now, the term scientific wellness actually appeals to me a lot because we've seen a lot of things, I think, over the last few years and through nutrition my whole life. That really wasn't science. It was marketing, if you will. But that said, in looking at scientific wellness and you talked about data driven, which I think is important, there are three bits that you got into. One being the genome, which is just basically our genetic makeup. The phenome, which is the first time I've heard that term, actually. My spell check on my computer doesn't even know that word. I guess I'm not that dumb. And then digital measurements of health, which I think you brought up a little bit, was the fitbit or the continuous glucose monitor, those types of things. Can you go into those and how that data is going to because it sounds like a lot of data.
[00:18:45.910] – Dr. Hood
Sure, I can start on scientific wellness. The idea there is that humans are terribly complicated. And if you want to be able to assess that complexity, the best single approach is this belief that blood is a window into health and disease. Because blood bathes all your organs. They secrete molecules, be they proteins, or metabolites into the blood. And if you can learn to read the quantification of those analytes, you can assess the health of at least 25 different organs in the human being. So the idea then, with scientific wellness is we can look at proteins and we can look at metabolites that give us deep insights into how biological networks in different organs and for different physiologic functions actually operate in what state they're in. And we can begin in a scientific fashion to ask, are there ways that we can cure this kind of deficiency? And simple example of that was when I had my analytes analyzed. I found I was incredibly low on vitamin D. And vitamin D is really an essential vitamin for preventing diabetes and cancer and cardiovascular disease and aging, a whole variety of things. And what I was shocked at is when I used the normal doses on a regular basis of 1000 international units to bring me back to normal, it didn't phase my blood levels at all.
[00:20:45.620] – Dr. Hood
And it turned out that in addition to low vitamin D in the blood, I had two genetic variants that blocked the uptake of vitamin D. And the one effective way of getting around that was to use very large doses, 15,000 international units. And that brought me up to normal. And then I had to use more than normal to maintain that kind of level. And those are all beautiful examples of how we assess assay blood analytes and could change the dimension of wellness in a single individual. And in fact, in our initial studies for scientific wellness, we were able to correlate six different types of data and come up with 2500 correlations. And going to the literature with some of the correlations between those various combinations led to actionable possibilities that could be then given to individuals. And if they did them, they improve wellness in a voided disease. But the ability to quantitatively assess the blood and draw inferences about general functions and specific organ states, I think is a very important idea. Nathan, did you want to continue with the rest of the question?
[00:22:20.110] – Dr. Price
Sure. So there's many things that you can get into that I think really guide a person as they're trying to implement something like this in their life or have an impact. So one of the really interesting elements that came out of analyzing these data and it does bring together genetics and the blood measures was when we looked at people who were going through a program aimed at improving their wellness, this scientific wellness program that we were running as we did that, what we found was that you can take a genetic prediction, let's say, of something like LDL cholesterol in your blood. Right.
[00:22:54.730] – Dr. Price
Millions of people are on statins to control this. And so when we looked at that, it turned out that you could predict in advance who was able to lower, for example, their LDL cholesterol by lifestyle interventions. And the key variable turned out to be that if your genome predicted that you could be low but you were high. In other words, if there was a gap, you could change it. And if your genome predicted high and you were high, there wasn't a gap, you couldn't. Now, one of the things that's really fascinating is that if you think about medicine, and something as common as that is in our healthcare system today, essentially no doctor uses the genetic information about what the genes say about your level of LDL cholesterol. It's everyone is treated the same, and it turns out that their responses are totally different. That's also true for HDL cholesterol, so called good cholesterol you're trying to raise. It's true for things like hemoglobin, A1C, for the transition to diabetes, because there are genes that predict the residence time of red blood cells, for example. So the average is 120 days. But some people will be more at 110 or 130.
[00:24:05.460] – Dr. Price
Totally predictable by genetics. So the main diabetes marker is hemoglobin, A1C, which is a molecule that's circulating, and it accumulates these sugars, essentially, that go onto the edges. And the amount of time you have makes a difference in how long that accumulates. So based on different genetics, a person could have the same readout and be at high risk for transition to diabetes, and another person could have the same readout and be at relatively low risk for transition to diabetes. Totally predictable by genetics and so forth. So there's many, many things that you could get into.
[00:24:38.810] – Allan
Now, Lee, you came up with the concept of 4 P medicine. Could you walk us through that? Because I think this is where the rubber hits the road. This is where we actually start getting this stuff done.
[00:24:53.390] – Dr. Hood
I agree with you completely. Back in the early 2000s, when we were just starting the Institute for Systems Biology, and the mission of that institute was to take a systems or global holistic approach toward both wellness and toward disease. We also took a systems approach to thinking about health care in what are the most fundamental elements of health care we need that are absolutely necessary. And we came up with the four P's. So prediction, the ability to predict whether or not you might be susceptible to a disease, and if so, the second P was prevention. How can we deal with that disease and maybe deal with it before it ever manifests itself as a clinical entity? The third one was personalization because it was clear from day one that humans are a unit of biological organization and health had to be focused at individuals because different individuals differ in every way, and their genetic and their genetics, their behavior, their environment and so forth. So these first three PS, prediction, prevention and personalization, really are the scientific meat of what this data driven health care is all about. We think after the Air Veil program, where we, over a four year period, brought 5000 people to scientific wellness and accumulated data clouds, we think we understand very well how to approach the science end of things.
[00:26:48.500] – Dr. Hood
But the fourth P is participatory, and the question there is, how do you get the system to change? How do you persuade patients to actually have the initiative to participate in scientific wellness? How do you persuade physicians to take advantage of it? Many have skepticism about it, they don't see it as real science or I think others are actually intimidated by the fact, namely genetics, that it entails a lot of things they don't understand and they're very hesitant to get involved. How do we persuade the physicians, how do we persuade the healthcare leaders? How do we persuade pharma and the technology companies that this is going to be the future and get them to focus on wellness and prevention rather than just on disease by itself. How do we get those that are the FDA, that are Adjudicating drugs and all of these things? And how do we get the whole educational system? The training of MD's has to change in a really radical way. When I went to medical school many, many years ago, I was appalled later to learn I never had a course in genetics. Fortunately, I was an undergraduate at Caltech and I had a good background, but I never had a course on diet or the gut or any of these kinds of things, or I never had any kind of course that ever mentioned the word wellness.
[00:28:28.860] – Dr. Hood
And frankly, I think a lot of things I was taught then is what our students are getting taught today. And there is enormous resistance in the medical schools to say, well, we're all filled up. We have all these courses because we have all these requirements and we don't have time to think about anything new. So anyway, how do we get the senators, representatives, the executive to realize that if you spend money today on prevention and wellness, tomorrow you'll have enormous savings and strikingly increased quality of health care? So those are the challenges of the four P, science on the one hand, but sociology and economics and psychology and so forth, on the other hand. So how do you get a system that's embedded in paying doctors according to how many times they touch the patient to change to one that's value based, where the doctors get paid on how well they keep all of their patients? And these are the challenges that come with data driven health.
[00:29:49.950] – Allan
Well, kind of. One of the things I took away from it was this is proactive rather than reactive. This is an opportunity to get out in front of everything and just tap it out before it becomes a fire. There's a hot spot and just tap it out now. Don't let it become a wildfire later. And I think the last P is really the answer. And the thing is, we have to participate. We have to be our own advocates in the way that we're taking care of ourselves and the things we're doing. And I think as tools become available to the patient, then the patient is really the one that has the best opportunity to drive a lot of this because generation before mine would have gone and the doctor says, okay, we're going to have to amputate your foot. It's like, okay, which one? And then you weren't going to say no. You were going to say, can I get a second opinion? You weren't going to question it. It's like, well, the doctor said so, therefore we are. And it's the jump, how high kind of mindset. And now we are a lot more likely to question things and do that.
[00:31:06.540] – Allan
But it goes back to the doing because if your doctor does come to you and says, okay, look, you have these analytes and this biology, this genome that's going to basically says that if you don't do something you're going to get diabetes. And for most of us that that's happening to, we know someone in our family that went down that aging curve and it's not pretty.
[00:31:36.510] – Dr. Hood
No, the other thing I would say, I think a big part of fourth P is education and we have really focused on that in very important ways. One, Nathan and I with others have written a textbook on systems biology and systems medicine and it's an ideal textbook for medical students and graduate students of various kinds to take up. It's written for someone who doesn't understand all the intricacies of biology. A second thing we've done with an education group I started more than 20 years ago at ISB now is we've created from the systems biology text on the systems Medicine chapter, a 20 module course for high school students that gives them deep insight into systems medicine and P four, healthcare. And I'll argue that and we'll be starting to use that course this year and be able to distribute it to many schools. I'll argue that that course will train students who will know more than 95% of physicians about the future of medicine and really where it's going to go. A third thing that we've done is the book that we're here talking about. And a fourth thing is that I've persuaded an Italian film director to make a 90-minute documentary on wellness over the last 5000 years.
[00:33:18.030] – Dr. Hood
That in a general sense talk about how our perceptions of wellness has evolved and where we are today with data driven health and what it means for you and in an artistic fashion try to appeal to people to activate this fourth P. That is I will participate in this kind of process. So we have lots of things going on that I think will be important in the educational process. But diving in and getting done these transformations is what we're all about. And I'm doing it from an academic side and Nathan obviously is doing it from the side of a wonderful company that's trying to bring health and wellness and prevention to people in small bits and pieces, which is one very effective way of doing it.
[00:34:24.290] – Allan
I want to thank you guys as I was going through your stories and what you guys have done to date is exceptional. But when that video comes out, when that's a documentary, when they get that done and they're ready to publish, that get me back in the loop. I'd love to have everyone back on the podcast and we can talk about that documentary because I think that's going to be extremely valuable and I'd like to help spread the word.
[00:34:53.310] – Dr. Hood
Okay, we'll take advantage of it. Thank you very much.
[00:34:58.590] – Dr. Price
Yeah, maybe if I can just add a little bit on that participatory piece, then, because one of the things that I could imagine listeners may be thinking, or if you start to encounter scientific wellness, I think you can see a lot of promise in it. But there might be questions of how do I easily implement this right? How do I make that something that's real in my life, that affects my wellness, my health, all those kind of things? And I think that so much of the onus of dealing with complexity of the kind we're talking about, really has to fall on the side of those of us who are working on the algorithms, the products, so forth, to try to make this as simple as possible. And so that's one of the areas that I think we're really focused on, on trying to deliver that out to people. And so some of the elements can also just be very minor, practical. I'll just share one example. So microbiome testing, lee and I are both big believers in microbiome and its future, and it's turning out to be important for so many health issues that people are getting into.
[00:36:04.980] – Dr. Price
But the process of getting a sample, for example, is not typically the greatest, right? So listeners that aren't thinking, what do. You have to do?
[00:36:16.710] – Dr. Price
You get a bucket or a piece of paper, poop on the bucket,
[00:36:20.510] – Allan
[00:36:21.890] – Dr. Price
take a little shovel. You got to dig it up. You got to put it in a little bile. You got to close it. Some of the tests require freezing. I don't know what you keep in your freezer, but I tend to keep food there, so it's not like the greatest spot, et cetera. So just to give an example, then. So that's an issue. So one of the things that we sat around and this was some work that we did at Thorne but basically to just say, well, what's the easiest way we could do a microbiome sample? Which led to the invention of something that we call the microbiome wipe, which is basically what it sounds like. It's basically toilet paper made out of a special polymer. So you wipe like normal. You throw it in a vial, you shake the vial, within 10 seconds, it dissolves away. So what that was was a way to get, like, the easiest way we could possibly think of to get a sample. Now, what that does is that lowers the barrier to people doing it. And we saw a big uptake. In fact, on another podcast, Sarah Godfrey was interviewed. She's a prominent physician and she's treating a bunch of NBA players.
[00:37:24.260] – Dr. Price
And she shared this anecdote that the NBA players would never do the microbiome samples for the reason we just talked about. Because it's gross, I guess. Or they didn't want to do it, but when switching to the wipe, they all did it and it was like, not a problem. So, anyway, not to get too bogged down by that, but ways that we can make the blood sampling easier so we can do this now, fairly painlessly at home. You can get your microbiome sample. You can wear a CGM, you can wear your wearables of all the various kinds you've got. There's so much of an ecosystem that's growing up around this where a person has to take ownership of their own health. But the number of companies and groups that are working to try to take so much of this science and make it available to people and give them things that are science backed and easily accessible is just growing immensely. So there's a whole enterprise on the discovery side that we're talking about. And also on the delivery side in.
[00:38:32.390] – Allan
The book you brought up Flexner's report, and this was a report basically on the medical system way back when. Nathan, what would your thoughts be of something like that actually happening today? That there be someone just sit down and say, okay, we're going to look at this holistically to make a change because I just see so much opportunity for pushback. And you even mentioned that in the book. Pharmaceutical companies are not going to want to make 24 different types of medication for an item when they know, okay, this is only going to work for one of 24 people, and each of those other 24 people are going to need a different medication. They'd rather just sell 24 and then have those people that it didn't work, switch to something else and work their way through it.
[00:39:19.010] – Dr. Hood
The simple extrapolation from that is just to say we have to fundamentally change how pharma discovers drugs and we have to do it at a different scale and with different selective processes that can generate drugs extremely rapidly and make it well within the cost structure of the rare disease genes, which is one in 200,000 people. We want to be able to treat them. So I think that's one really important thing that we have to think about.
[00:39:54.750] – Dr. Price
Yeah, and the point you bring up is really important because there are so many entrenched interests that are centered around our current healthcare system, which is totally focused on disease. And I was on a panel right before the pandemic with former chair of Harvard Medical School and I really like the way he said this and he said that healthcare is the only industry that does not study its own gold standard, which is wellness. And that's really what we're talking about. But because that has been set up the way that it is, you do, you have billions and well, it's healthcare, right? You have $4 trillion in the US alone set up around that kind of process. So trying to change it is an incredible enterprise and undertaking. So we have to do both. Try to advocate because as individuals, there's no doubt that a healthcare system centered on wellness is better. Like if anyone could make the trade off between a drug that slightly improves your decline during Alzheimer's versus never getting it as a person. Any of us would take never getting it right. I mean, the value prop there is incredibly simple, but getting there is very hard.
[00:41:11.100] – Dr. Price
So there are certain things you can do within the context of the certain system. Lee was alluding to this in terms of you can help drug companies have much higher hit rates on getting favorable drugs. One interesting thing that people are waking up to now is the microbiome metabolizes away about 13% of drugs. So you could be taking a drug and it's never even getting to you. Your microbiome changes, it eats it, and it doesn't get to you. And it depends on the kind of species you have in your microbiome. That's like one small example. There's all the others that we've gone through in genetics and so forth. So it does help the drug companies upstream if they have drugs that are failing for these unknown causes. You're exactly right on the market segmentation, which segments their market, so they're not financially incentivized towards that. And so we get into a number of these things in the book. But this was also partly the point of writing this book, honestly from Lee and my perspective, where we're trying to advocate for a lot of this change in how medicine is done. Part of that is that we have to create a movement of individuals, of the patients and individuals themselves that basically demand a health care system that does much better for them.
[00:42:31.360] – Dr. Price
And we're so much in the situation in healthcare of a very uneven power dynamic between, say, the physician and you as a patient, and there's an element of trust there, and there's an element that's happening. But it does put you in this situation of if you really want to take advantage of the revolutions that are happening right now in medical science, in delivery, in ways that we can optimize our health spans and all these things, you do have to be an active participant and sort of seek that out. And then as more and more people are seeking that out and demanding that, that changes the underlying economics, and then that is what will really drive the top, so to speak, of the medical hierarchy to have to pay attention to this. I don't think it's going to be a top down driven revolution. It really has to be bottom up. I don't see there's any other way.
[00:43:24.690] – Dr. Hood
You know, the other thing I'd add to this, Nathan, is another way of looking at it is data driven health really is going to achieve two things. One is enormous increase in quality of individual health care, and we need it as the top 20 developed nations, we're right near the bottom, even though we spend much more than anyone else. But the second really important point for converting the system to a health and prevention mantra is the idea that we can save the health care system enormous amounts of money. And I would say if you take the five major cost driving things that we have to deal with today, they are one, the quality of health care. Two, the aging population. Three, the explosion of chronic diseases for the inequity that arises from data being generated only in the Caucasian race for the most part so far. And then five, this impossibly escalating crease of cost. But on the quality, scientific wellness is going to be transformational. On the aging, we now have a metric for aging that not only tells you your biological age, the age your body says you are, its metrics actually tell you how you can optimize your aging process.
[00:45:02.930] – Dr. Hood
And more than that, the ability to prevent chronic diseases before they get started could be a transformational event in cutting down the frequency of those kind of things. And of course, with big new programs, we're going to balance up the equity equation, which is utterly critical because different races have really strikingly different genetic consequences for disease and so forth. And our feeling is, with these things together, you're talking about saving trillions of dollars, especially because chronic diseases alone cost 86% of our health care dollars. And suppose we cut to very small fractions of major chronic diseases and things like that. So that's going to appeal to the payers. And in many ways, the payers could really be the catalyst for driving a transformation from a sick health care to a wellness and prevention health care.
[00:46:08.310] – Allan
So a relatively small investment today is going to pay off big time for us in the future.
[00:46:13.380] – Dr. Hood
Big time for us. Absolutely.
[00:46:16.410] – Allan
Now, I have this question I ask all of my guests after reading your book. I'm so super excited to ask you gentlemen these questions because you've seen the data, you've seen more data than just about anybody else that I've ever asked this question. So, Lee, I define wellness as being the healthiest fittest and happiest you can be. What are three strategies or tactics to get and stay well?
[00:46:46.450] – Dr. Hood
Well, I would say that one strategy to go after wellness is scientific wellness. We now have what will be an exponentially increasing analysis of wellness trajectories and they'll lead to actionable possibilities. From the era Fail 5000, we had perhaps 200 actionable possibilities that we validated by taking correlations and going to the literature and verifying them with the data that we're proposing to do. We're putting forth the idea that we should do a million person project with a genome phenome analysis, and in a sense, it's a second genome project. Do it over ten years, we'd have all the validation we need for everything I said about quality improvement and decrease in cost and things like that. I'm arguing that we'll have tens of thousands of new actionable possibilities that will have to be delivered by AI to do two things to physicians. One, explain what it is and what's necessary. But two, give the validation in a simple way they can understand and of course they then can bring these things to their patients. I think a second thing that's absolutely key is aging is absolutely the strongest correlation with all chronic diseases. If we can cut down aging, we can cut down strikingly the transition to chronic diseases.
[00:48:30.170] – Dr. Hood
So, I mean, not only will you keep yourself younger and healthy, you can begin to imagine that many people could go into their 90s or hundreds and be mentally agile and physically active. And we'll have to redefine what retirement means. We'll have to redefine how many jobs you have during your lifetime and so forth. And of course, the data driven part will deal with the racial inequalities and data that exist out there. And the million person project could formally prove in very powerful ways literally trillions of dollars we could imagine saving in health care. I think scientific wellness, I think optimizing aging process. I think avoiding the chronic diseases and dealing with the racial diversity. Because to give you a simple example, japanese are three to four times as likely to get Alzheimer's if they have two copies of a bad gene called ApoA four than Caucasians do. If you look at Latinos, they have almost no probability of getting Alzheimer's from two bad copies of that gene. So that shows you the striking differences that we must take into account for health for individuals of different origins.
[00:50:07.170] – Allan
Nathan, I'll ask you the same question. I define wellness as being the healthiest fittest and happiest you can be. What are three strategies or tactics to get and stay well?
[00:50:20.150] – Dr. Price
Yeah, so I'm just going to put aside at the moment like the three big obvious ones that we all know about physical exercise pretty much every day, sleep 8 hours every night and eat a nutritious diet. But then I want to give three that are more focused towards the kind of things we're talking about. So one is get a genetic profile so that you understand the probabilities of what are the most likely factors that might inhibit your health. The second is to measure the dynamics around especially blood and the microbiome that can be interpreted in the context of those genetics. And then by those comparisons, we've got to make this easier for people. But those comparisons make a huge difference in understanding where you're at relative to your potential and where you're at in the manifestation of the things that are likely to be the biggest problems for you. That gives you a personalized map for a return on your health effort investment, roughly. So where do you put your time and effort? That kind of a map lets you navigate around the most likely issues that would end in you're not having the long healthy life that you really want to.
[00:51:41.400] – Dr. Price
And then finally, I'm going to reiterate something that Lee talked about, which is do everything you can to reduce the pace of aging. And there's a lot of interest in this right now. And this involves both things like the various lifestyle things that we've talked about, but also there's a lot of interesting compounds that are available now that have the kind of evidence that they extend lifespan in a bunch of different animals. And we know they functionally hit very conserved pathways in humans. We're not far enough along to where we know for sure that this is going to have an impact on human longevity, but we won't know that until it's sort of too late to be useful for some of us because it just takes a while. But there are a lot of these that are coming out. And so if you look at all these different hallmarks of aging, if you want to try to control senescent cells, well, there's data that shows that quercetin and dosatinib can kill senescent cells. Like, that's an interesting one. NAD right. There's different molecules. NR disclosure Thorn sells that one, or NMN or things like this that you can use to try to increase NAD well, that's an important element of aging.
[00:52:57.670] – Dr. Price
Metformin is an interesting one because there's a big trial going on, the Tame trial nerve. Barcelona at New York is leading that to look at its effects on aging. So if I'm in this space, you want to keep yourself educated and look at the data as it emerges. But there are a lot of possibilities, including things like intermittent fasting and so forth, to think about how do I slow down that clock. And because of different biological age measures, and there are multiple of those, there's the epigenetic ages that are probably the most famous now. We do one based on clinical labs that I think just gives more actionable possibilities right now. But there's a lot of these abilities to monitor that and just track that over time and try to stay biologically as young as you can as that science is moving quickly, and it's not there to where we kind of where we would like to get to in a Sci-Fi type future. But you can do things that materially reduce your risk of dying. And that's the definition of aging that I'm using here, which is just what's the likelihood and give any given year that you will die.
[00:54:06.050] – Dr. Price
And that goes up as you get older. And so if you can just flatten that curve, it makes the likelihood of a long, healthy life much higher. And so those are the three things I'd focus on.
[00:54:17.170] – Allan
Well, gentlemen, I agree with your conclusion and your book The Age of Scientific Wellness that we're right on the cusp of something exceptional happening. You've convinced me. If someone wanted to learn more about you and learn more about your book The Age of Scientific Wellness, where would you like for me to send them?
[00:54:39.610] – Dr. Price
Yeah, so for me, obviously, just pick up a copy of The Age of Scientific Wellness wherever you get books. In terms of my work on trying to drive product development to make scientific wellness accessible, thorne.com thorne.com is where you'd find that.
[00:54:59.150] – Dr. Hood
For me, I would just say that I think our book really is the best place to see what we've done in the last 15 years in terms of pushing this idea of scientific wellness and so forth. But I can be reached at email@example.com.
[00:55:22.230] – Allan
Gentlemen, thank you so much for being a part of 40 Plus Fitness.
[00:55:27.370] – Dr. Price
Thanks so much, Allan. Great to be here.
[00:55:28.990] – Dr. Hood
It was a pleasure. Enjoyed your questions.
[00:55:33.850] – Allan
Welcome back, Ras.
[00:55:35.490] – Rachel
Hey, Allan. That was a great interview. And I probably could have listened for another 20 30 minutes. I love listening about genetics and the potential that it could deliver in our existing health care system. I actually prefer the word wellness care, like they had mentioned in the beginning. I mean, there's just so much potential for getting patients healthier earlier with a personalized insight into their genetics and other data.
[00:56:06.070] – Allan
Yeah, I actually had another question on the plan, but we've gone so far. It would have probably gone another 20 30 minutes if I'd ask my final question. So it was what it was. But, yeah, this was really interesting because the technology with AI and data and knowing the genome and all the other data points that we can collect now relatively inexpensively with a watch or a phone or ring, there's a ton of opportunity here for us to do something. And kind of what was really interesting we didn't go deep on this, but Flexner's report was back before there were really good medical schools, there were medical schools. And for the time they were what they were. He did a tour around the country looking at all of our medical schools, and he tore them a big one. He ripped them up in some bad situations. Like, he went into one and he asked to see their lab. See what lab? The lab. And the guy says, Well, I can bring it to you. And he carried in one piece of equipment. This is for a major medical school. Not like a no name medical school either.
[00:57:22.820] – Allan
Like one of the better ones. People thought it was the better one at the time, and they didn't have a medical lab, which means all of the doctors that they were graduating had no idea how these labs were run. They had no idea how to read the results because they had not been trained to do these things. So he wrote this report, and it changed the way medicine worked across the country and the way medical schools were set up. But like most things, you solve one problem, you kind of create another one. And so now we have standard of care and we have all these rules, and so our doctors have to follow these things. And it really kind of hand holds them to say they see a problem, the symptom solve the problem. The symptom it's the symptom based sick care. That's binary. Are you sick or are you well? And it never really looks at as a continuum to say you're well, but you're moving maybe towards getting sick. If we catch it early, we can reverse this. So it's the difference between catching it when it's stage one cancer or even before that.
[00:58:27.810] – Allan
I mean, once there's like, the environment for cancer to form and they know that's happening, reversing that environment versus catching it when it's stage three or four when symptoms finally start showing up.
[00:58:43.620] – Rachel
I love that concept. Early detection, especially in terms of cancer, is so important. Everybody knows that. But they also mentioned we know pre diabetes. That's the exact same thing. And we're trending towards pre not we, you and I, but people are trending towards pre diabetes. But what if we could even go earlier than that to make some other assessments of our blood sugar levels? And not even just diabetes. There's the cholesterol situation.
[00:59:15.800] – Allan
Well, I picked diabetes because it was the perfect example that everybody can understand. You go into your doctor and you're like, okay, you're watching your A1C tick up each time you get this blood test. And the doctor is like, don't worry about it. Don't worry. It's ticking up. Don't worry about it. Until it hits 5.2, we don't care. Well, the fact that it went from four six to five, you should care. Something's going on. Your blood sugar is not being cleared as effectively as it was before. Something's changing. That's that thing, that's that transition where your body is starting to get to a disease state.
[00:59:54.910] – Rachel
But I want to sit on that for a second because I think I only have I'm 51, and I think I only have two, maybe three years of an A1C, because I don't remember how early you can be for them to take that test or to test for that. What if I could have had it when I was 40? What if I could have had it when I was in my 30s? And it's not even that. It's the cholesterol numbers and iron numbers and my thyroid situation. And there's just so much information if I had known it earlier.
[01:00:27.280] – Allan
That's the cool thing, is that data and the ability to get those tests is becoming more and more available. And so someone in their 30s can have this test. If you have children in their 20s, you can say, hey, for Christmas or for your birthday, I'm going to pay for this blood panel. And they're like, oh, thanks.
[01:00:50.190] – Rachel
[01:00:51.710] – Allan
But the whole point is to say, yeah, I'm going to pay for this blood panel because I want you to have what you need to be next. I'm interviewing this guy now, and he's actually a financial planner, but he's looking at health and he's saying, a lot of my clients, they build up a seven figure portfolio, and then they drop dead before they even retire. He's like, so they care about the return on their investment every year. And so he's talking about in terms of what we talk about, generational wealth, how can I give this money to my children? Well, how can I give health to my children? How can I find health for myself and give health to others in my family, people I care about? And it's like, give them a blood panel. At least at that point they have data, and it's like, well, what does this data mean? Well, your A1C is already over five, and you're 31 years old or you're 40 years old. It's like, okay, we don't know what it was before, but that's a number to look out for and to tell your doctor the next time you see them, which should be soon, my A1C is already over five.
[01:01:53.940] – Allan
It's like, okay, you're approaching pre-diabetes. Don't worry about it. That's what the doctor is going to say, because the standard care says that's not a problem. It's not a problem until it gets over 5.6, then you're in pre-diabetes, and now we have a problem.
[01:02:08.650] – Rachel
That's the frustrating part, right? It is
[01:02:12.750] – Allan
but I don't think there's going to be a Flexner's report now, just based on the way culture of medicine is done, there won't be someone to step back and say, let's redo all this. What this has to happen. And the reason I kind of press down on the participatory part of the four P medicine is this is on you. This is on you to make decisions for yourself and to say, I would really like to know what my genome says. I would really like to know what my blood panel says and if my doctor is not asking for it. But I kind of know there's a family history of diabetes or I kind of know there's a family history of kidney problems or heart disease or this or that. Go get your calcium score. Go check out your cholesterol. Check out your blood pressure on a regular basis. It doesn't have to be perfect, but finding the data points that you think are important based on what you know about your family history. And unfortunately, I have a friend that was adopted. He didn't know any of that at the time, and so he went and got a genetic test and went on ancestry and things like that and found family has found his siblings and his mother.
[01:03:27.880] – Allan
And so not that that's what it's for, but I guess it is what it's for because that's what they're using it for. I have all these fourth cousins all over the world, everybody's my fourth cousin, I guess, thousands of them, hundreds, millions of them. But anyway, the point being is this data can be your friend, and there are some ethical concerns about how the data is going to be used by businesses and this and that. But right now I would just poo poo that. And I'd say, look, being afraid and cowering and not doing something for yourself just doesn't make sense in my mind. Take a moment. Get the data that you know might be important to you based on what you know. It doesn't have to be everything. You don't have to go do the genetics things if you don't want to, but at least go get a blood test, check your blood pressure, have a blood pressure monitor at home, almost nothing. A blood sugar monitor at home, almost nothing to invest in these little pieces of equipment. Test your blood sugar. If it's over 100 much after a meal, after you had some cake, it's going to go over 100.
[01:04:38.170] – Allan
But if it doesn't fall right back down, that's a warning flag. If your blood sugar, you wake up in the morning and you haven't had anything to eat and it's over 100, that's a problem. That's the transition to disease.
[01:04:51.910] – Rachel
Yeah. And it sure would be good to know that catching it early. I mean, we talked about early detection. The earlier you can figure this out, the better you can make the changes in your lifestyle to adapt or get earlier medical care, if that was really necessary.
[01:05:08.460] – Allan
And for some of these, we just know, okay, yes, if I exercised more, I am because I'm sedentary, or if I stop eating the crap and drinking the beer and doing all the things I'm doing, smoking or whatever else, you know, quitting, that is going to improve your blood panel. You just know it. So get the low hanging fruit out of the way. But then if you really want to start optimizing your health so you're here for your grandchildren and maybe your great grandchildren and you want to live the last half of your life well, then start working on making the easy changes, the ones you know about.
[01:05:48.740] – Rachel
[01:05:49.200] – Allan
Get the blood panels, get the data, and then really start working on refining this. And it's not that you're going to be running ultramarathons or working out 6 hours every day, but it's just knowing the little things that you can do that are going to improve your health outcome. And I'm not going to say it's not medicine because there are some medications like metformin that have shown real promise. Vitamin D supplementation. Again, like our guest said, sometimes just a little bit of a supplement isn't enough. But you don't know if you need vitamin D until you get a blood test and you check, you see your blood levels are low, your iron level is low, your vitamin D is low, then supplementation might be the right thing to do.
[01:06:34.030] – Rachel
[01:06:34.740] – Allan
And I mean, I'm not a doctor, so I can't tell you that it is the right thing to do. But I can say it might be. The right thing to do. Get the blood work to check, the blood work to check, and then talk to your doctor, and your doctor can say, yeah, supplement, and then we'll get it checked again in about three months. And then you might find, yeah, there's a reason why that supplement is not absorbing the way that it should. I need to maybe do more or look at this from a different perspective. And so having the data lets you make better decisions.
[01:07:04.480] – Rachel
It does. At the very end of your conversation, you talked about being more proactive than reactive. And if you can act early and faster to the results of your blood work, then it will save you a lot of time and money in the outcome. Later on in life, you don't have to sit and wait for heart disease or diabetes to come get you. You can be more proactive and make changes right now so that you don't have to get there.
[01:07:30.560] – Allan
And I would say every single one of us knows what that low hanging fruit is in front of us. Yeah, if you need help doing that, get help doing that for sure. Get the low hanging fruit out of the way. Movement, nutrition, it's not rocket science. It's simple, simple stuff that's hard to do. But once you start doing it, you feel better. Once you start feeling better, you have more energy. Everything feeds on itself. It's a self fulfilling loop that just gets better and better if you're doing it right. And then the fine tuning and the knowing that, okay, I can be super healthy, but still drop of a heart attack. Well, get your calcium score, talk. If your family has a history, then understand that history. Get your genetics. If you need to look at your blood work, do those things so you have the data to make the right decisions for yourself.
[01:08:26.480] – Rachel
Yeah. Allan, I've been wanting to do genetic testing for a long time. It's been a little bit expensive, and no doctor, I think would give me a calcium score at this point. But paying for that out of pocket might actually be worth the investment just to have this data at this particular age that I'm at. So I mean, I know that insurance doesn't cover all this stuff for sure, and even doctors may not be willing to write up a prescription for certain blood work, but if you're willing to pay out of pocket for it, I bet different labs can help you with that.
[01:09:03.170] – Allan
They can. They absolutely can. And there are labs. I have some relationships with one or two. So if you're thinking about you want some labs, just message me and I can hook you up with one. They have doctors on site. Doctors will write up the lab request. Sometimes you can just go to your local Quest drawing center or some of them actually, they ship it and you have the test at home. If you want for some of these tests, not all of them, but if you want a panel, you can get a panel. If you want a calcium test, you can pay for one. You just have to go out there and get one done, something I'm going to be doing. And so the question I asked is, okay, so you have $1,000 in your bank. Great. And then you have a heart attack. Guess how much that's going to cost? And so it's an investment now to basically say, I'm not paying my deductibles and my 20% of everything for hundreds of thousands of dollars in medical bills ten years from now. What they call it? Pennywise, pound foolish.
[01:10:02.260] – Rachel
[01:10:03.330] – Allan
In many cases it is. If you're not willing to make the investment in your health, then you won't keep it. And that's time, money and effort, all those if you're not doing the work, if you're not putting in the time, and in many cases, getting the things done that you need it done and spending the money where you need to spend it, then you could be pennywise and pound foolish.
[01:10:25.500] – Rachel
[01:10:26.150] – Allan
And that's kind of sad, but nobody's going to do it for you.
[01:10:30.720] – Rachel
Right. It's definitely a hard decision, but I think that it's worth it in the long run, especially if you have plans to live long.
[01:10:40.270] – Allan
I do 105 wiping my own butt. I'm there.
[01:10:45.470] – Rachel
Yeah. I got goals.
[01:10:47.670] – Allan
I got goals. All right, well, Ras, I'll talk to you next week.
[01:10:55.200] – Rachel
Great. Take care, Allan.
[01:10:56.440] – Allan
You too. Bye.
[01:10:57.260] – Rachel
Thank you. Bye bye.
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