What’s on offer at a luxury Bay Area longevity clinic | Hacker News Reader

What’s on offer at a luxury Bay Area longevity clinic

sfchronicle.com

33 pointsbrandonb53 comments

You can get 90% of the benefit of these longevity clinics for 10% of the cost.

First, advanced blood testing can cost <$200. Get ApoB and Lp(a) for heart health. hs-CRP for inflammation, A1c for diabetes, eGFR for kidney health, etc. https://www.empirical.health/product/comprehensive-health-pa...

Then, determine your nutrition goals based on your blood test results. For example, if your ApoB / LDL cholesterol is high, focus on getting more fiber and less saturated fat. If blood pressure is high, focus on potassium and sodium.

Exercise & sleep - use an Apple Watch or similar to track VO2Max and sleep stages.

MRI - I'd probably skip the MRI for cancer screening. While I think this will be the future, the evidence base is just not strong enough today to know what to do with the results. You can do a FIT-based colon cancer screen at home for <$10 (colon cancer is affecting people at younger and younger ages). Mammography and cervical cancer testing in a regular doctor appointment.

CAC scan (assessing calcium buildup in the arteries) - do if ApoB is high. You can book these for $200.

I thought Apple Watch doesn’t have blood oxygen sensing anymore.

Blood oxygen sensing is disabled in the US (due to the patent lawsuit with Massimo), but it still estimates VO2Max and sleep stages.

VO2Max is based on GPS and heart rate sensor measurements, processed by a deep learning algorithm that uses physiological ODEs (ordinary differential equations). Very cool algorithm.

Apple Watch sleep stages (and sleep apnea detection) is based only on 3D accelerometer data.

Just as an additional clarification. It’s only on new watches sold after that 2024 date. Only reason I have been reluctant to replace mine.

Do you get useful insights from blood oxygen data? The measurements seem pretty erratic on my Series 8 watch, and I'm not sure what conclusions I should draw from them.

Do you suffer from a health condition that requires monitoring O2sat?

When I had Covid I got value from tracking this metric. If it went below 90 I would have called 911.

Day-to-day, no value at all (I have it on my Garmin). Only in combination with respiration rate + HRV + RHR does it become a useful signal, and frankly, if all four of those are out of whack then the odds you feel sick or run down and don't need metrics to tell you so are very high!

Due to spending more time in a chair than being active I have a bit more interactions with Gravity than most. :) This has led to fairly significant sleep apnea, which is most easily tracked via monitoring of O2 saturation.

The Apple watch data isn't really useful for this at all as the frequency of monitoring is just too low. There are a bunch of ~$100 devices that you can get from Amazon that do a fantastic job monitoring O2 Sat for a night and have nice integrations into Apple/Android.

I do wish the CPAP's offered this type of integration - that is, they had a Bluetooth receiver to which I could pair an O2 sensor, and have the data coupled with my breathing analysis. This would be nice to have in OSCAR (the open-source analysis package) or even in Apple Health.

Instead, the manufactures like ResMed treat this data as a walled garden and try their hardest to require everything to go through a Sleep Doctor who pays them a non-trivial data subscription.

I really like collecting as much data as possible with my watch. I have found Apples analysis in the health app to be pretty helpful over longer periods of time. o2 probably the weaker of signals and to be honest I just like having it when I am sick. I will convince myself sick in bed I have Covid and then check my o2 and feel better.

Also IIRC it’s only watches sold in the US, you can still get a Canadian apple watch with oxygen saturation monitoring

Is that so?

It amuses me that Apple will block that EU mandated store stuff if you move a EUnphone to the US after a few weeks (at least I understand that to be the case) but doesn't do the same for this feature.

That’s correct.

VO2max is an estimate of your maximum oxygen consumption per minute per kg of body mass.

It is not related to your blood oxygen level.

The hardware is still there in all new watches, it's disabled in software due to the ongoing Massimo litigation.

It seems likely that one way or another it'll be resolved-- either by overturning the ruling in Apple's favor or Apple just gives Massimo a bunch of money-- and then it will come back.

what exactly are you going to do with a spot hs-CRP?

Elevated hs-CRP roughly doubles your risk of heart disease. Here's a few things people do to lower it:

* Eat anti-inflammatory foods (e.g., blueberries) or use cooking techniques that produce fewer PAHs (e.g., braising or steaming rather than sauteing or broiling)

* Drink less alcohol

* Medications (e.g., statins and GLP-1s also have anti-inflammatory benefits)

You don't even really need the testing. Everybody will either benefit or at least not be left worse off from eating high fiber and low saturated fat. Getting a sufficient electrolyte mix is not a real concern for anyone who isn't regularly exerting themselves in high heat and is then only a concern during the exertion. Exercising and sleeping well will give exactly the same benefits regardless of whether you also track VO2 max and sleep quality score.

Early detection of cancer and CVD are great but fairly standard anyway if you just follow recommendations that already exist.

The advanced blood testing is helpful since about 1 in 5 people with a normal cholesterol will have elevated ApoB (and be at higher risk of heart disease).

Getting sufficient potassium (lowers blood pressure) and not too much salt (raises blood pressure) does take deliberate effort. Those with high blood pressure need about 3500mg of potassium per day (about 8 bananas) and <1500mg of sodium; this applies during the whole day, not just during exercise.

VO2Max can be helpful for guiding the type of exercise at any given point in the fitness journey. People starting out benefit a lot from low intensity cardio (zone 2), but at some point, their VO2Max will plateau, which is a good sign to start layering in zone 5 or interval training.

People who are very dedicated to health can achieve all goals simultaneously, but for the average person, I think measuring your biomarkers and then choosing where to expend limited effort is a good approach.

> Everybody will either benefit or at least not be left worse off from eating high fiber and low saturated fat.

Depends on what you replace the saturated fat with.

Remember that the claim that saturated fat is 'bad for you' is based on correlations (nutritional research is hard, yo) and that saturated fat is in a lot of trash food. If you keep eating trash food with low levels of saturated fat, your health will still suffer. If you eat lots of saturated fat from healthy sources, you improve your nutritional situation.

tl;dr: 'Saturated fat' is a misleading proxy for 'unhealthy food'.

Lots of dietary fiber being healthy is pretty uncontroversial, though.

I'm frequently frustrated by journalism on these topics which show their ignorance or just "not getting it". It's important to focus not just on lifespan, but healthspan.

Even if I do not live a single year longer, improving the quality of those years is of value to me. There might even be some calculus underwhich its actually desirable to live a _shorter_ life but with far higher quality. Right now it sounds appealing to me if someone said "You'll only live to 85" (about a 2 year expected loss), "but you'll have the health of a 18-25 year old male for the entire time" ...

And if it does enable longevity... Society has a lot of catching up to do, and a lot of ripple challenges to effect. Things like what happens when someone who looks 25 is actually 55? Who should they socially acceptably date? (~25 year olds? ~55 year olds who look 25? ~55 year olds who look 55?)

What happens when your voter base has internalized values from far in the past? If we make someone live to 120, then we need to contend with values lasting for ~120 years, rather than dying off and being refreshed sooner.

>Things like what happens when someone who looks 25 is actually 55? Who should they date?

Genuinely, who cares about sci-fi questions like this?

Why aren't you worrying about how fairly matching four-armed martial artists against two armed? Answer: because it's so unlikely to happen, it's not worth it. We're not getting 55 year olds with the body of a 25 year old, we're getting slim 55 year olds wearing make up and taking TRT. That's not youth! It's a dumb facsimile.

> Things like what happens when someone who looks 25 is actually 55? Who should they socially acceptably date?

I don't know man. There are already plenty of 55 year olds dating 25 year olds right now regardless of looks. Also, not as extreme, but looking like you're in your 30s throughout most of your later adult life is not that uncommon nor difficult. Barring any health issues, that's where most people's looks stabilize.

There is a strong correlation between living longer and being healthier. So going for one you pretty much get the other for free.

But "we can give you a 10% chance of living an extra 3-5 years" is possible. "We can make you feel and perform like a 25 year-old into your 80s" is not possible.

I often ignore Peter Attia these days (just like I also ignore Huberman), but I was listening to a fascinating pod he posted with two head/neck plastic surgeons who do both reconstructive & aesthetic procedures. It was the first time he's ever plainly admitted he knows not only far less than his guests about the subject, but also probably far less than the general public. For that reason alone, it was better than most of his pods.

One point stood out, though, when they started talking about evolutionary roots of things like facial fat pad thinning with age. That was this: historically, it was never important for humans to live beyond middle age because as soon as it stopped being possible to procreate, the job was done. With advances in technology having unlocked new methods of food production & preparation, safer shelters, better healthcare and more sophisticated information storing, retrieval and sharing, people are living far beyond their fertile years now, and this extension of both healthspan & lifespan is impacting how people are considering their approaches to healthcare (and crucially, lifestyle).

https://archive.ph/WYxYl

thanks, We need more people like you.

Measuring value in terms of GB per Dollar is ridiculous. An MRI produces many high resolution uncompressed images. Full bloodwork is a few kB but far more signal.

tl;dr; it's a spa for tech bros

sorry for how don't agree, but yearly full body mri should be mandatory for every >40 years. Ok, over treatment is a concert but any cancer is worst than it and basically most of people will have some cancer if live long enough. then if you have full body mri you will find most of the cancers on an early stage. Don't critics people that is doing it, but critics the system that don't provide it for every body.

I think the main problem is just that's expensive and time consuming to do full body MRIs, especially on everyone over age 40. The only person I know who gets a full-body MRI each year was my neurologist who had the resources to do it.

There's only so many MRI machines in the world, staff to operate them, and radiologists to interpret the images. A limited study like an MRI of the brain might take a few minutes to read, but a whole body would take much longer. You may even want subspeciality doctors to read individual body parts (e.g. neuro, MSK) which would cost more and take longer.

There's also the risk of finding something benign then putting the patient through treatment and surgery for something that wasn't harming them.

If we could somehow have inexpensive scanners and an inexpensive way to interpret the resulting images - then yes, we should expand access to MRIs as they're a generally safe way to screen for abnormalities.

AI interpretation could lower the cost of reading the images, but a lot of the expense is in the hugely complex scanner which requires liquid helium, etc. and the technologists to schedule and operate it.

If more people want MRIs then the market will create more machines. And hopefully the tech will improve over time, though we might be waiting for room temperature superconductors for real progress.

Lack of staff to analyze the results is a problem, but not a huge one. Simply having a baseline to compare for later scans is valuable by itself, without any detailed analysis of the original.

The American medical association will fight tooth and nail to avoid solving the real issue

Unsurprisingly, AI is now being used for MRI, both to make the data better and help analyze the results:

https://openmedscience.com/transforming-magnetic-resonance-t...

Compensating for patient movements (heartbeats, breathing, etc) seems really useful!

This really depends on the country. Almost every general hospital in small to mid-sized german cities has them. By that I mean from about 20.000 to 25.000 people upwards. Like https://maps.app.goo.gl/s2fd6QeAu9HPbpQA8 / https://en.wikipedia.org/wiki/Schwelm In larger cities of course even more have them, also adjacent to the hospital, indepedently operated ones, apart from the one(s) in the hospital, sharing just the cooling infrastructure. Visible by the big outside tanks, with partially iced pipes, and/or tiniest wisps of vapor.

But! There are also many MRI-sites somewhere in the suburbs, or lesser downtowns/business districts in the periphery, and they don't have that visible big outside tank anymore! In smaller buildings. Like https://maps.app.goo.gl/5H65r4rf58LNiLDb9 , as opposed to this https://maps.app.goo.gl/jcpe3cpnpPtHSaCs6

(Hrrmpf. That stuff must be hidden between the trees from the air. I have seen that. Or they rebuilt that stuff and put it underground, or something.)

Anyway. Having a MRI is no problem at all, fast/no long waiting times, and costs you nothing, if necessary.

It's different for yearly 'vanity/hypochondriac' checkups, still fast, but head/brain are 300 to 400EUR, full body about 900 to 1000€, probably also depending on used contrasting agents, if any. I avoid these like hell. So no real clue about that.

In ze United Stätez that stuff isn't to be had under 3000USD, can easily go from 5000 to 9000 in my experience (Limited to CO, CA, TX), and no matter which insurance you have an infinite bureaucratic hassle. Guess where I'm doing it when I'm not in a hurry? ;)

> there haven’t been studies weighing the benefits of full-body screening, Smith-Bindman said.

blood test cancer screening (free form dna), provides most of the benefits at a fraction of the costs.

Can't help but imagine/expect a future where the greediest and most tyrannic people live practically indefinitely, protected by swarms of AI drones..

You can bet at least some of them are thinking about this too

Altered Carbon

Great show! Worth a watch for anyone into live action cyberpunk.

Great book first, the book is far better than the show :) (and I liked the show).

Truly great on so many levels.

The second season is best avoided though.

Yeah, I had a tough time getting into the second season. Joel Kinnaman was really great in the first season though.

They should read about the 14th century peasant revolts that make ISIS look tame in comparison.

What makes you assume that greediest and tyrannical people are the ones who would be preferentially selected for in a system that offers increased healthspan / lifespan?

It's my presumption that these services are expensive now but once proven will become commodity. In sufficient time it would be as cheap/free as penicillin or a multivitamin.

Who's getting these services now? The people with the most money. You can't just extrapolate any technology out and say "one day it'll be cheap", this is a labour-intensive process. MRI machines are not getting Moore's Lawed

What is the fundamental reason why MRI machines could not be produced in higher quantities at much cheaper unit costs?

Demand. When the first 5,000 units cost a mil a piece, few manufacturers are going to go all in, especially when a product improvement could make their systems obsolete before they're finished being built.

If you had a large country like china or the us or some other big baller walk in and say, "make 5,000 MRIs to these specs and we'll buy them" then by the end that manufacturer could quite possibly crank out another 5,000 for comparative pennies and flood the market, but until someone puts a few billion on the line it's not going to happen.

> MRI machines are not getting Moore's Lawed

Are you sure about that?

Commercial: https://hyperfine.io

'DIY':

https://hackaday.com/2015/05/04/hackaday-prize-entry-a-low-c...

https://www.eevblog.com/forum/projects/building-an-mri-machi...

https://www.ismrm.org/22/program-files/ET-08.htm

https://github.com/mri4all

https://www.researchgate.net/publication/385920900_ezyMRI_Ho...

^^^^ Those actually aren't the ones I remembered, there was something in between that 'DIY' stuff, and the commercial thing a few years ago. ISTR also commercial, but slightly less bulky. But can't be bothered to search for that now. (Probably something related to https://duckduckgo.com/?q=rebco+mri )

There is also commercial mobile stuff for veterinary use.

This is a common trope that's been covered by a few sci-fi creations I've consumed recently.

Everyone is complaining about boomers being selfish but just wait until longevity focused meglomaniac millenials are in power.

You sound depressed. Might want to have that looked into.

I'm only 25% being a jerk. That is how depression thinks and talks.

You sound like a gaslighter. That is how gaslighters talk.

But yeah I am depressed, cause I've seen and heard and read about too much shit.

You've probably mostly been in a bubble that has had no reason to expect anything but the best outcomes of everything.

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