Garri: Time to talk about testing and creating a comprehensive medical history! If a patient comes to you and doesn’t have a lot of medical history to share, what kind of tests do you ask them to take? Does each patient need a different set of tests, or is there a standard set you like to request?
Evelyne: As I mentioned earlier, before any sort of testing can begin, we start at step zero – the patient reaches out to me themselves. This motivation is vital in ensuring the patient will be committed to the treatment process and willing to work together on a plan that fits their needs.
Once motivation is established, step one is to take a thorough history of the patient, including their goals for working with me. I need to see where the patient is now and where the patient wants to be to determine how the treatment trajectory will progress.
An important part of step one is understanding the patient’s goals and limitations. Not every patient wants to overhaul their life completely, which is okay. A healthy and long life prioritises balance and happiness too.
Sometimes a patient will come to me knowing about a suggested nutrition plan or another treatment component and be fully transparent that it is not a good fit for them. They say, “I will not do that [specific treatment], but I still want to do the other things.” Hearing this feedback is valuable for me to understand their goals, boundaries and desires.
On the other hand, I sometimes work with patients willing to overhaul all aspects of their lives for the most optimised experience. Then we will do the complete program. Knowing what a patient wants to achieve, what they expect it to be like and how motivated they are to do so is an integral part of working together. I am happy to meet a patient where they are to develop a plan that is realistic and effective.
The patients I work with are a diverse group. Some people want to try everything, and I have to encourage them to take their time in approaching longevity care. Others are very reserved and do not want to take many risks. By taking the time to complete a full assessment, I can determine how to best approach your treatment. You need to know what your patient wants and what they can do. Then, you need to evaluate their level of compliance and willingness to make changes.
Step two is all about previous data collection. As I said, I take all the retrospective data I can get. Whatever the patient can give me, I accept – the more, the better. From this data, I can start to see patterns and deductions: what the patient has done, their development, and any hormonal breakages. Even if a patient has always been “healthy,” I still want the retrospective data because I look at the longitudinal trends. Some people will naturally have more data to share. Athletes tend to give me years of data on body fat, visceral fat, or subcutaneous fat. It’s great to have this data when available, but it’s not necessary to get started.
Step three is actual diagnostics. The foundational program consists of lab tests, data sets and a complete analysis that I can use to measure the patient’s biological age and blood age. Currently, my program evaluates 45 different parameters as a base, with other parameters based on gender, age and history.
I also like to do liquid biopsies and extended tumour markers for patients, beyond what doctors do in a standard health screening. In terms of tumour markers, the typical tests include CA 19-9 (pancreatic cancer), CEA (colon cancer), AFP (liver cancer) and PSA (prostate cancer). My extended list would also encompass the MP2, the beta, microglobulins and so on. It depends on which country the patient is based. Most countries have what I need, but some do not.
Garri: Of course, part of your role as a longevity physician is working with patients worldwide. What does that look like? Do you tell them to go to specific clinics to get testing done?
Evelyne: Yes, this is correct. At this point, most of my patients are not in Shanghai. When I work with people in Shanghai, it’s incredibly convenient, but at this point, people in every country can get the lab tests that we need to get started. Finding tests is easiest for middle-level diagnostics, as many of these tests have to be outsourced. For example, no clinic offers in-house epigenetic methylation tests. Because I’ve been in the field for so long, I can recommend patients visit specific locations I’ve worked with before in many countries. I leave the where and when up to the patient, but I am here to tell them what to check and provide an analysis once they have shared results.
Garri: And what do you do with those results once you have them?
I evaluate the results a little bit differently than one would in reactive medicine. Something you may not know about me is that I am not only a longevity physician. I continue to work in traditional medical care because, in my perception, this is an environment where we can see longevity medicine in practice and learn what is needed. To achieve this balance, I like having one foot in “normal” medical care and one foot in longevity medicine.
To go back to the previous timeline of what to expect in longevity care, step two is gathering all of the retrospective data, and step three is conducting additional tests. Afterwards, I can calculate the biological age of the patient. While several clocks can give a numerical answer, I like to do the biological age or blood age as you calculate that most frequently, and you can see the changes most rapidly. The resulting number is only one part of the process, but it gives me a way to have an objective measurement.
You may be wondering: once we do all of these interventions, what is the difference between functional medicine, early prevention or internal medicine? This is an excellent and valid question. The difference with the longevity field is that my objective measurement will not improve one, two or even three of the parameters by themselves. Even if I evaluate them in a range that I think is appropriate for that patient, I will use the AI algorithms pulling the information and giving me trajectories to get the whole picture, which allows me to track my patient’s biological age at a specific point in time. Using AI also helps to pinpoint two parameters that are not optimal for that particular patient at that moment in time. In doing so, I can tell where they should be for that person at that specific point in time, giving us a goal on which we can focus.
This three-dimensionality is unique and goes beyond the human brain's capacity. We have to do this in reactive medicine because we need to act strategically and treat anything abnormal. But for longevity care, we are looking at both the entity and the complexity. I work with colleagues to bring those types of evaluations into reactive medicine, and at some point in time, I hope they will become a norm for the field. I think there is a belief that If a person does not take a pill, they will not express any change. If they take supplements, commit to lifestyle modifications and have positive external factors like job security, the patient usually expects to feel better or worse. The question we should be looking at is: how do they know that they are improving besides feeling better or seeing better blood values?
I am always pleased when the patient says they are feeling better, but I need to see the numbers to be sure. I need to see that the biological age decreases or stays the same. It is not always the case that the patient needs to have a decreasing biological age. Sometimes, the patient needs to maintain their current level.
For example, I had a patient that was 56 when we started. We predicted his optimum biological age at that time to be 53. By the time he was 57, we had brought his biological age back to 54. He is now 60 years old, and his biological age is still at 54 or 55. This example shows that reversing ageing is not always the end goal for longevity care. Maintaining stability is the most important, and that stability matches the optimum biological age calculated by deep ageing clocks AI.
In the next post Evelyne will be discussing how she builds a longevity treatment plan and how patients react to its implementation. Stay tuned!