In this episode, I am speaking with Dr. Gil Blander – who is an internationally recognized expert in the biology of aging, and for translating his discoveries into new ways of detecting and preventing age-related conditions. We will discuss how you can use your blood test biomarkers to heal your fatigue.
If you want to work directly with Dr. Blander and his team to fix your fatigue, click here to sign up!
Table of Contents
In this podcast, Dr. Blander and I discuss:
- The right way to use blood biomarkers to test for fatigue
- Do your genes really contribute to fatigue?
- The role of metabolic dysfunction in fatigue
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Ari Whitten: Hey there, this is Ari. Welcome back to the Energy Blueprint podcast. I am very excited for today’s guest. His name is Dr. Gil Blander. He is an internationally recognized expert in the biology of ageing, and for translating his discoveries into new ways of detecting and preventing age-related conditions. He received a PhD in Biology from the Weitzman Institute of Science and completed his postdoctoral fellowship at MIT. He’s been featured in The New York Times, Forbes, the Financial Times and The Boston Globe. At InsideTracker, that’s the name of his business, he leads a team of experts in biology, computer science and nutrition and exercise physiology.
He founded the company in 2009, alongside top scientists from acclaimed universities in the fields of aging, genetics and biometrics. InsideTracker’s mission is to help people realize their potential for long, healthy productive lives by optimizing their bodies from the inside out. Their proprietary algorithm analyzes users biomarker and physiomarker data to provide a clear picture of what’s going on inside them. Based on their analysis, they offer user’s ultra personalized science-based recommendations for positive changes to their nutrition, supplementation, exercise and lifestyle along with a plan of action to track their progress towards their goals. Okay, so welcome, Dr. Blander, such a pleasure to have you.
Dr. Blander: Thank you. It’s great talking with you, Ari.
Testing biomarkers for fatigue
Ari: Tell me the backstory here, how did you get involved in this particular field of the study of performance optimization, energy optimization, anti-aging, longevity, how did that happen? What’s the backstory?
Dr. Blander: I’m a scientist in background, and as you can hear from my accent, I’m not a Native American. I was born and raised in Israel. From a very young age, I was fascinated by the aging process, I wanted to stop the clock, I wanted to live forever. I wanted to delay the onset of aging-related diseases, and that’s why I studied biology. I got my PhD in Biology from the Weizmann Institute of Science in Israel, and then I moved to MIT and spent five years at one of the best lab that studying aging. The lab of Leonard Guarente. This lab found that a Cr2 is a longevity gene.
During the time that I spent there, I realized that I can contribute more to humanity, if I will start my own company than being a professor in academia. I decided to leave MIT after five years, and spent a couple of years in a biopharmaceutical environment. Then started the company in 2009 with two other scientists. The idea is to help people to live longer, but a life based on what’s happening inside the body. Basically, we are looking into your body by looking at the level of your blood biomarkers, DNA, activity tracker data, and based on that we can understand your body and get a high definition view of your body. Then we can give you a set of recommendation, what should you do in order to optimize your body based on food supplement, exercise and lifestyle changes?
Ari: Got it. When it comes to energy optimization, obviously, there’s tie-ins various things like brain health, neurotransmitters to sleep and circadian rhythm, to one’s fitness levels, to one’s body fat, and levels of inflammation have been tied to chronic fatigue, there’s a number of potential factors that can relate to this. What do you think are the most important biomarkers that relate to human energy?
Dr. Blander: Energy is definitely a very interesting and important part, and I think that fasting blood glucose and A1C are definitely a very important marker of the energy that you have, but there are some other molecules that are related to that. For example, if you look at the level of iron that you have in your body, as we know, iron build hemoglobin that is a very important part of the red blood cells, and it carry the oxygen from the lungs to the muscle, to the brain. If you don’t have enough iron, or enough hemoglobin your energy level will decrease.
Another marker that is related to that is vitamin B12, because it’s important for building the red blood cells, so if you don’t have enough B12, your energy levels might be lower. I think that they are a different kind of marker that we can relate to that.
Ari: Let me throw a monkey wrench into all of this which is, several years ago there was a paper published in the Journal of the American Family Physician, and it was evidence-based guidelines for physicians on how they should treat their patients with fatigue. One of the key things they discussed in this paper was lab testing, and basically what they said is what they recommend for testing as far as people with fatigue is standard blood testing. However, they go on to say that only in 5% of cases of people with fatigue do they actually find anything of note, anything that’s abnormal on those blood tests that could explain the fatigue.
In other words, 95 out of 100 people who have fatigue, who get standard blood tests get told everything’s within the normal range. I guess, what would be your commentary on that? How could you do things differently than what the standard blood test would do with the typical conventional doctor?
Dr. Blander: I think that a routine blood test means a lot of blood biomarkers that are related to that. We discussed blood glucose, which is part of the routine testing, but for example, for iron, usually ferritin is not a molecule that is routinely tested, and B12 is another molecule that is not routinely tested. When we are looking at our population, we have a pretty high sample size we can see that the high level of our users have a lower level of ferritin, which is basically a protein that use the iron and upload it into the hemoglobin, and especially in a young female, pre-menopausal women, and in the athletic active people, especially runners, we can see a high prevalence of low ferritin.
It’s much higher than 5% that you mentioned. Also, the B12 is another good example that it’s not a routinely checked, and because of that, they miss that. I think that’s one issue is, first, they don’t test the right molecules and second, they don’t have time and the knowledge to look at preventative medicine. Our current healthcare system is more like working on whoever is working, but they don’t know how to treat the majority of the population that is healthy, but it can be better and optimized. That’s my answer for this question.
Ari: Got you. The benefit of standard blood testing is that most of those markers are extremely well validated so that we know that if something’s off, it’s really meaningful. On the other end of the spectrum we have a lot of the testing that goes on in functional medicine circles, much of which is not very well clinically validated. I’ve seen numerous examples, for example, the food intolerance tests as just one example, that really most of the science indicates that they’re not valid at all, and that they don’t work. On that spectrum of standard blood tests, those markers being the gold standard and a lot of the stuff that goes on in functional medicine circles being not validated at all, how would you position what you’re doing on that spectrum?
Dr. Blander: We are trying to use only tests that have been very well validated. We are definitely using the a physician-grade test. What we are doing, we are bringing the right test for the right people. As you mentioned before, the panel that they use to test these routine blood tests that miss some of the markers, but those markers are tested by physician if they needed to. If you look at the functional medicine, and you mentioned food sensitivity, so we researched that and realized the food sensitivities doesn’t have a lot of merit and a lot of science.
There is a merit in science in the food allergy, but not in the food sensitivity and a lot of people are redoing it and there are a lot of companies that’s selling it, and we decided not to do it because we don’t think that there is a value there. We are trying to test only markers that have been shown in the scientific literature to be relevant for population basically, healthy population marker that you can also modulate by a natural intervention, food supplement, exercise and lifestyle changes. If we cannot modulate it, we don’t want to test it and marker that at least 1% of the population is out of the normal. If everyone is the normal we won’t test it because the value for the user is minimum.
Ari: Excellent. Is there any recent research in these fields that you’re working on related to longevity or energy or sleep, brain health, anything like that that you feel is worth bringing up to discuss here?
Dr. Blander: Yes, I think that first we done a research and published it a couple of years ago and what we done, we looked at a population of around 1000 subjects. Our subjects that have been tested at baseline and at follow up, and the follow up was around seven months post-baseline, and between that, they follow InsideTracker recommendations. Basically, they were tested based on that they chose a goal, based on the goal we gave them a recommendation, and then they followed the recommendation on average for seven months. What we have seen also that this cohort of 1000 users selected around 500 different recommendations.
It’s a very personalized plan because only on average two people selected the same recommendation. Then we looked at the effect of those recommendations on the biomarkers based on follow-up and what we found is a significant improvement of those biomarkers in a subpopulation that started with high glucose, high cholesterol, or high inflammation, or a low vitamin D, or low vitamin B12 or low iron. We’ve seen a very nice correlation between using the InsideTracker recommendation and improving the blood biomarkers. I think that that’s very exciting because that said, that personalized nutrition is working, because the majority of them, as I said, selected a different recommendation.
Those recommendations was very personalized for this person and at the end of the day, when we combine all of them together, we’ve seen a population-based improvement of those biomarkers for baseline to follow up.
The link between genes and fatigue
Ari: Got you. How do genetics play into this? I’ll say, for context, a couple of things. I’ve seen different software out there and claims being made about if you upload your genetics to this particular software, it can tell you all these things about your health and your predisposition for this and that disease, it can give you practical recommendations on how to improve your health. When I’ve actually explored the actual evidence that some of those recommendations are being based on it is often extremely weak evidence. I’ve also talked to eminent epidemiologist Dr. Tim Spector, you might be familiar with-
Dr. Blander: Yes, of course.
Ari: -who has done a lot of work around genetics, and personalized nutrition. He has also agreed with me that a lot of those softwares that are out there are generally junk science and are not very good. I’m curious what your take is on the role of genetics in health more broadly, health, longevity, disease, and obviously, understanding that’s a very broad question. Maybe you can quantify how much you think it’s a factor and to what extent you feel that those kinds of genetic testing how that plays into what you’re doing and how much of a factor is it?
Dr. Blander: First, genetics is very important for disease, especially for diseases like cancer. If you know the mutation that you have in that cancer, it can allow us to direct the right personalized medicine, the right drug for the cancer. There it’s playing a very important role. There are also other diseases and cardiovascular diseases and others but genetic is very important to feed the right drug for the right person. In wellness, in high level, genetics is playing a pretty small role and I completely agree with Tim Spector, because genetic just shows that you have a risk for a specific condition.
For example, you have a risk for glucose, or risk for high cholesterol. That doesn’t mean that you have currently high glucose or high cholesterol, so it’s not enough to do just genetic I think you need to combine genetic with blood and that’s what we are doing. Now, if you will ask me, what are the percent that genetic explain. If we look at everyone that have high cholesterol, what are the percentage of them that the genetic explained the reason that they have high cholesterol? I would say that it’s pretty small. It’s maybe 5% to 10% but what we are doing with that is basically combining the genetic with the blood.
For example, you have a predisposition to high glucose, then we are looking at your blood and saying, “Do you have high glucose right now or not? Do you have optimal glucose or not?” Then based on that we are giving you the information. We also based on that, recommending to you the right recommendation, and allowing you to enjoy the value to genetic in combination of blood but having the genetics alone doesn’t give you a lot of value. I agree with Tim that having something like that is not the best scientific approach for your wellness and longevity.
Ari: Are you familiar with Dr. Robert Naviaux?
Dr. Blander: No.
The connection between fatigue and metabolic dysfunction
Ari: He’s a researcher at UCSD. He runs a lab for mitochondrial medicine there. He’s done a lot of seminal research around chronic fatigue syndrome and autism, in particular, and mitochondria, in particular, something called the cell danger response, which has been a very influential paper. He’s involved in something you’re probably familiar with, which is metabolomics research. For example, he did a metabolomic study on people with chronic fatigue syndrome, where they went way beyond the typical standard blood panel of 30 or 40 biomarkers and they tested over 600 different metabolites in the blood.
They found widespread dysfunction, they found that there was a downregulation in about 80% of the overall biomarkers that they tested in people with chronic fatigue syndrome. I’m curious what your thoughts are on metabolomics research, my understanding is that’s an emerging, really important field related to what you’re doing. Also, are there any other emerging lines of evidence that are really compelling as it relates to energy or longevity?
Dr. Blander: I think that metabolomic is an interesting and exciting field. There are a few companies that allow you to look at a lot of metabolites at once and the technology becoming better and better. I think that it’s very interesting to follow it. I think that the challenge currently with metabolomic, as you said, 40% of them went down but then not all of them are known and the function of them known. Also, then what can you do with that? What can you do with the data? Because how can we modulate it in order to bring it to the right level and improve the chronic fatigue as you said? I think that metabolomic, for me is very similar to microbiome that it’s interesting, it’s exciting but it’s not actionable yet and it’s very hard to get the action-reaction today. I think that it might be in a few years, but it’s not ready for the Primetime for users because the question of, “So what? Okay, I know that those markers went down, but what can I do is that?” I don’t think that we are there yet.
Ari: Before we go on to the next one. I’d like to follow up on that with another question. I’m trying to formulate these thoughts on the fly here. Let’s say that if you can do some kind of comprehensive testing, that tests for let’s just say it was possible to test for every different metabolite that’s known or testable in the human body and in an ill person, you find, like Dr. Robert Naviaux found this widespread dysfunction in, 50%, 60%, 80% of all these different hundreds of metabolites that you tested for. Then, to bring in your perspective, you’re saying, “Yes. 90% of what you just tested for, we don’t even know what those things are, what they do, we don’t know how to modulate them.” Well, I would ask you if that’s the case. If you’re only looking at the little sliver of the picture that we know what those biomarkers are and what they do, is it not the case that you’re just looking at a very small picture, a very small slice of the overall picture of what’s going on?
Dr. Blander: I’m not saying that we shouldn’t do that. What I’m saying that the value for the end consumer is limited. I’m not saying that you shouldn’t do that. I think that it’s a great work for something that the academia should do, the NIH should do and try to understand what does it mean. When it’s ready, then a company like us should offer it for a consumer, but just to give a consumer data for metabolome and showing that there are 50 small molecules that change the expression or the level. I’m not sure what is the value for the end consumer. That’s what I’m saying. I’m not saying that it’s wrong for the academia should do that, the NIH should fund it, and DARPA should use it. We need to come with a pharmaceutical company should do an experiment with them, but I’m not sure that today to have it in the product and ask the consumer to pay hundreds or thousands of dollar for that. What is the value for the consumer? That’s my question.
Ari: Got it. On the one hand, I agree with you, but here’s where I think this is relevant. I think there are different paradigms of ways that people approach human health optimization or fixing disease. We have a conventional medical model that whenever there’s someone ill with something they’re searching for- this is a bit of an oversimplification, but they’re searching for the one biomarker. The one thing that’s ‘the cause’ of this. If it’s depression it’s low serotonin levels in the brain. Then we create a drug that fixes the ’cause of depression’ with a specific serotonin reuptake inhibitor drugs, antidepressants. Or cholesterol is the cause of heart disease, and so we give statin drugs.
Let’s say you have an ill person and they’ve got high levels of inflammation. They’ve got metabolic syndrome. They’ve got high blood pressure. They’ve got insulin resistance, high levels of blood sugar. They’ve got high cholesterol levels, high LDL and so on. High triglycerides, they’ve got high levels of CRP, they’ve got on and on and on. You list 20 different abnormalities that that person might have. The conventional medical model might look at that person and say, “Okay, well, we’ve got all these different markers. We know this one’s off. We know this one’s off and this one’s off. Let’s give you antidepressants and let’s put you on statin drugs, and let’s give you blood pressure medication, and let’s give you Metformin for your blood sugar.
That’s the thinking of the conventional medical model. On the other hand, you have people in the natural health community who might look at natural interventions, let’s use exercise as an example. Exercise might affect and does affect dozens of different systems in the body and probably hundreds of different metabolites throughout the body and has effects on the brain and the heart and the arteries and the liver and the gut and so on and so forth. There’s two different fundamentally different ways of thinking about how you approach widespread systemic dysfunction? Is it, do you try to identify each of the biomarkers that’s off and modulate that specific one with some specific drug or other intervention? Or do you look at the whole system and think, how can I optimize this entire system?
How to heal your fatigue
Dr. Blander: We are using the latter. Basically, we are looking at all the biomarkers together and trying to find if there is one solution, like you said, the exercise might be the one or doing meditation. Losing weight is another one. We are trying to find what are the best recommendation that cover the most of the issues that you have. That’s our approach, but in a way we’re using the conventional medicine in a way that we still use them based on the peer review scientific publication. Believe it or not, there are a lot of peer reviewed scientific publication that look at exercise and weight loss and meditation in adults. We are trying to use the holistic approach if possible, but still, we want to give you the value that you will see from your physician, but instead of subscribing you to a drug, we are recommending you food supplement, exercise, and lifestyle changes.
Ari: Excellent. What does this look like on a practical level? If somebody wanted to work with you, what would they need to approach you with? What kind of tests would you have done and what would the process look like of working with them?
Dr. Blander: The way to reach us is basically come to insidetracker.com and we have a few offering there. You can either bring your own blood data if you done a test with the physician and upload it into our platform, and we’ll basically extract the data from the piece of paper using an application that’s called OCR. If you don’t have data, we can help you to get the data so we can send you a key to your house and you can prick your finger, a few drops of blood and send it to us. If you don’t want to do that, you can go to a lab. We have a partnership with Quest Diagnostics, which have around 1500 clinic around the US and you can test there. If you don’t want to go to the lab, we can send a technician to your home or office and the technician can take the blood and send it to Quest. That’s about the blood. DNA is similar.
Ari: Quick question. The kit, that’s just the finger prick kit with a few drops of blood?
Dr. Blander: Yes.
Ari: Is that more limited in the data you can get from that compared to drawing viable blood?
Dr. Blander: Yes, it’s much more limited. The reason for that is we spent a lot of time on finding the right kit and we really like that the value of the data will be as high as the value of the data from when you go to the lab like Quest Diagnostic. Because of that we found that only some of the biomarker get to that level. Yes, it’s limited. It’s more limited than what you can do in the lab. For DNA, we have a few options. If you done the test with 23andMe or Ancestry you can upload the data. If you haven’t, we have our own kit. Basically, we can send you the kit and collect some of your swabs collection and send it to us and we’ll analyze your DNA.
We also integrated with some activity tracker, Fitbit and Garmin are already connected to InsideTracker. If you have Fitbit or Garmin, you can connect it. We are working now on Apple watch. Soon we’ll have Apple Watch. We are trying to bring as much data as possible. Then when you have all the data, we can then build a plan for you based on your blood and DNA and activity tracker. We find what biomarkers, what DNA score, what physio molecules are not optimized. You can select a goal. Out of 15 goals that you have you can choose overall health, or you can choose loose fat or you can choose distress or you can choose improve performance.
Based on that, we are selecting the right biomarkers, building a plan for you. You can select from the plan what intervention you would like to do, and then you follow the plan. We have a way for you to check-in because we have the activity tracker some of the recommendation can be automatically check-in based on the activity tracker. If we ask you to exercise, we know if you exercise, we know if don’t [unintelligible 00:28:56]. If you slept, we know that you slept. We are trying to give you the highest value as possible. Then you should test again after three to 12 months. We’ve seen in a lot of our users that their biomarker significantly improved.
Ari: Excellent. Let me ask you what would be the critical differences between if I just went, let’s say to Life Extension, as I’ve done in the past and ordered comprehensive male blood panels, or obviously people ordering the equivalent of whatever they’re trying to order, comprehensive female for my wife and getting those blood test results. Which go considerably beyond standard blood tests that you get from the doctor. What would be the difference between doing that versus what you’re doing? Why should I switch from Life Extension and sign up with you?
Dr. Blander: First, you don’t need to switch from Life Extension, you can continue to do Life Extension and take the data and upload it to Insidetracker. I don’t want to make money on your blood test, I’m doing it because it’s a service. We start when Life Extension and the other are ending. Basically, they are showing you the data, as much as I know of Life Extension you’ll get the PDF files, which look very similar to Quest or [unintelligible 00:30:21] or the data that you receive from the physician, that’s it. Then, you need to understand what is ALT and what is SHBG and what is any other marker.
We are taking that, we are explaining to you what is the marker, we are plotting it to you and showing you the progress over time. Where in those services you get only the normal range. Basically, what is the physician decided as normal range, we develop also an optimal range. Based on your age, and gender, and ethnicity, we’ll show it to you whether you are normal optimal or out of normal. Then based on that, we are giving you a holistic plan of how to improve all the biomarker that you have based on your goal and optimize yourself. I think that Insidetracker start where Life Extension, the family physician and all the other companies are ended.
Ari: Excellent. Great explanation. I’m very excited for this. I think you’re offering a great service, I’d love to try it out myself. Maybe we can work out something to help me recommend it to my audience, maybe you can offer them a discount or something like that. I have one final question for you which I’m very curious to hear. I would love for this almost to be its own hour-long conversation. I’m very curious to hear if there’s any unique insights that you’ve gathered in the realm of anti-aging and longevity? I just saw about a week ago some new research out of Israel where they’ve identified SIRT6 as a very unique controller of longevity. I’m curious to hear if you feel there are any particular biomarkers that are critically important, and maybe you can give one or two or three tips of things that you found are the best ways to optimize for longevity?
Dr. Blander: That’s a great question and a great point. Actually, I’ve started a podcast, we call it Longevity By Design. We are interviewing the smartest and the brightest professor in the academia about longevity. We already recorded I think five episodes. Surprisingly or not, almost all of them were discussing SIRT6. It’s definitely no coincidence that you mentioned that. I think that SIRT6 is very interesting and important. By the way, when I worked at the lab of Leornard Guarente, I worked on SIRT1 to SIRT6. Basically, SIRT is the homologous of the eSIRT2. In humans you have seven homolog of that, starting from one running out to seven.
Recently SIRT6 have been shown an interesting effect on longevity, at least on mice. I think that SIRT6 is definitely a very interesting candidate for longevity. I want to warn the audience that I haven’t seen a lot of research in human yet so be careful about that. It’s encouraging, but there are not a lot of evidence that it’s working in human. As to is specifically for longevities and tip for longevity and interesting information about longevity. There was an interesting paper that’s published I think a week ago in science that a group– I think it’s a group of Russian scientists that basically scan the big databases like the UK Biobank, which have around half a million human. They use the CBC, complete blood count molecules in order to see a correlation between longevity in a big population. As you mentioned before, CBC is part of the routine molecule that a physician tests. You can find it almost for everyone. They also compared it in another database in the US and they used that to do some computation of biology. Based on that they done some calculation and found, what is the theoretical highest longevity that human can live, and they came for something like 130 to 150. [crosstalk]
Dr. Blander: Basically, they found based on this computational biology approach, that the limit of our longevity is between 130 to 150, which was interesting. Now if you ask new technologies about longevity. There are a few exciting technologies, stem cells, CRISPR, and others that maybe will allow us if you think about it to replace our kidney when we have a kidney disease, or to replace our liver when we have a liver disease. CRISPR will allow us hopefully to cure diseases, because at least in one disease, sickle cell anemia, there was a research that showed that you can use CRISPR to convert the mutation and basically cure those patients.
I think that there are a few very exciting technology that theoretically will allow us to increase our longevity. I think that today the best intervention is lifestyle, change your lifestyle or improve your lifestyle. That’s what we are trying to do at InsideTracker. Try to eat the right food for you, try to do the right exercise, try to sleep enough and try to basically take the right supplement, don’t take too much. We see that a lot of people taking too much supplement, but take the right supplement based on what’s happening inside your body. If you ask me what are my recommendation for your audience, is they try to eat the right foods, try to exercise the right amount, don’t exercise too much, and try to sleep well and try to take the right supplement, and don’t overload yourself with supplement. We’ve seen that a lot of population in the US taking too many supplements and most of them they don’t need to take. That is my recommendation in a nutshell.
Ari: Excellent. Dr. Blander, this has been awesome. Thank you so much for your time. Where can people learn more about InsideTracker or sign up for it?
Dr. Blander: You can come to insidetracker.com. That’s our website and you can they have all the information there. If you want to contact me, you can find me there in the ‘About Us’ You can also find me on LinkedIn, on Twitter, on Instagram, and so on. Whoever want to find me, I’m there and I’ll be more than happy to talk with you.
Ari: Excellent. I’m looking forward to trying it out myself. Thank you so much for coming on and sharing your knowledge with my audience. Thank you for the work you’re doing. I really appreciate it and I find it very exciting.
Dr. Blander: Thank you so much Ari
Testing biomarkers for fatigue (08:28)
The link between genes and fatigue (19:09)
The connection between fatigue and metabolic dysfunction (22:55)