Live Long and Well with Dr. Bobby

#63 The Million Dollar Question: Which Health Predictions Actually Help You Live Longer?

• Dr. Bobby Dubois • Season 1 • Episode 63

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Can you predict when “bad things” will happen to your health—and more importantly, can you do anything about it? In this episode, I break down which prediction tools actually help you live long and well (because you can act on them), and which ones are mostly expensive fortune-telling. Joined by cardiologist Dr. Anthony Pearson (author of The Skeptical Cardiologist), we dig into heart-risk calculators, dementia genetics, and why biological age clocks aren’t ready for prime time.

Guest: Dr. Anthony Pearson, cardiologist and writer of The Skeptical Cardiologist (Substack)

Key topics & takeaways

  • Why “prediction” only matters if it changes what you do—and improves real outcomes.
  • A red flag to watch for: is the person promoting the tool also selling the test, supplements, or “hacks” to fix it?
  • A sobering reality check: even doctors’ YouTube claims often lack strong evidence (and the least evidence-based content gets more views).
  • Heart disease risk equations: the gold standard in prediction because we can reduce risk factors (BP, LDL/ApoB, smoking, diabetes) and clinical trials show outcomes improve.
  • But even good tools miss people: a study of <65-year-olds who had heart attacks found many were labeled “low risk” beforehand.
  • Dementia genetics (ApoE): ApoE4 raises risk (especially E4/E4), but it’s not destiny. You can’t change genes—so the value of testing depends on whether it motivates healthy behaviors or creates anxiety.
  • Biological age clocks: fascinating research, messy consumer product. Different tests disagree, repeat testing can vary wildly, and most importantly—no proof that “lowering” a clock improves health outcomes or longevity. My advice: save your money (for now).

Links & resources mentioned

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If you found this useful, please share the episode with a friend and leave a quick review on Apple Podcasts or Spotify. Want my newsletter on practical, evidence-supported ways to improve longevity? Visit drbobbylivelongandwell.com.

And don’t forget to vote on what we should call this community: N of One Nation, Outcome Optimizers, Health Warriors, or something better.

Can Health Risks Be Predicted?

SPEAKER_01

Can you predict when bad things will happen to your health? It's a question worth billions of dollars. Companies want to sell you tests that measure your biological age. Doctors want to calculate your risk of a heart attack. Genetic tests promise to tell you if your dementia is in the future. But here's what nobody's asking. Even if these predictions are accurate, can you actually do anything about them? Today we're going to explore which prediction tools are backed by real science that can help you live long and well, and which ones are just expensive fortune telling. Hi, I'm Dr. Bobby Du Bois, and welcome to Live Long and Well, a podcast where we will talk about what you can do to live as long as possible and with as much energy and vigor that you wish. Together we will explore what practical and evidence-supported steps you can take. Come join me on this very important journey, and I hope that you feel empowered along the way. I'm a physician, Iron Man triathlete, and have published several hundred scientific studies. I'm honored to be your guide. Welcome, my dear listeners, to episode 63. The million-dollar question: Which health predictions actually help you live longer? Or can we predict and avoid bad things happening? There was a recent article in the Wall Street Journal where the author looked at a few longevity calculators or how long she might live. The article focused on how much money she needed in retirement. That's a good question. It takes less retirement money if you die at age 79 than if you live to be 100. The Social Security calculator estimated she would live to 86. Other calculators range from 90 to 102. So for her, the question about how much money she needed in retirement, the calculators weren't very helpful. I got to thinking, as doctors, we work with patients to help them live long and well. And sometimes there are risk prediction tools that we use. And increasingly, we hear in media and social media about biologic age clocks. Just spend$500 on a blood test and you can learn whether your body is younger or older than your actual chronologic age. So broadly, do any of these tools work? Can they actually help us to live longer? By the end of the episode, I hope that you will have a better sense of would knowing your risk of heart disease or dementia be helpful? How to separate what helps from what's hype? And should you consider paying for a test of your biologic age? I also wanted to share with you the early results of my poll on what we should call you my listeners. So far, N of One Nation is in the lead. But there is interest also in outcome optimizers and health warriors. Some of you know with your vote. I am fortunate once again to have Dr. Anthony Pearson, a cardiologist and author of the skeptical cardiologist Substack. Do sign up for it. Dr. Pearson joined me on episode 46 about reducing our risk of stroke, and in episode number 37, reducing our risk of heart disease. Welcome back, Dr. Pearson. How are you today?

SPEAKER_00

I'm good, Bobby. Thanks for inviting me back. It's always a pleasure to be here with you on the podcast, and I'm excited to talk about our topic today. Wonderful.

Evidence Vs Hype In Health Media

SPEAKER_01

I'm excited to chat as well about an important topic. Today, we are going to explore tools that predict heart disease events or death, likelihood of getting dementia, and the new biologic age clocks. Spoiler alert, biologic age clocks are not ready for prime time. Please save your hundreds of dollars. By the end, I hope that you'll have a better sense of what tools might be right for you and what questions you might ask before using one of them. As Dr. Pearson and I explore this topic, some of the questions that you might think about are the folks talking about the prediction tool selling something? The test itself, ways to improve the test results like supplements for your mitochondria? Or is the predictor a research tool to help us understand aging or promoted as a way to live longer? Before we dive in, I wanted to share a really interesting study that relates to why I do this podcast and what I hope you, as my audience, gain from it. You may have heard the saying believe half of what you see and none of what you hear. Now it's not clear if it was Ben Franklin or Edward Allan Poe who said it first, but it's relevant to what I want to share with you. The research study asked the question in YouTube videos by doctors, how much of what they say is based upon evidence. Guess what they found? Now think for a moment, I'm gonna pause. What they found is that 62% of claims had little or no evidence to support them. So just the doctor's opinion. Perhaps based upon some biologic mechanism or study in mice, but not based upon testing in people. Only 20% of the videos had high quality evidence. Here's something intriguing. The videos with the lowest evidence score had 35% more views. What we call eminence-based medicine or confidence-based medicine. Probably not surprising since the doctor could just make a strong statement, since there was no evidence required. Anthony, what are your thoughts about this study? Does it reflect your sense of podcasts and videos?

Cardiologist Joins For A Skeptical Look

How Risk Equations Are Built

SPEAKER_00

Yeah, it's uh it's a pretty good reflection. I think this is a Korean study. So I'm I have no idea what the situation is like in Korea, but in the United States, these kinds of videos and podcasts are ubiquitous on the internet. And as the article notes, it seems like the wilder the claims, the more popular they are. It's hard for me to get a handle on how many people are taking medical advice from charlatans with entertaining videos, but not uncommonly. I'll talk to patients about why they are taking a certain supplement or why they're engaging in certain activities, and the source is often a YouTube video. That's something I don't understand, as I I really don't like to get my information from videos. I like to see it in print. I think I I absorb the information faster and better. And usually if you put something in print, you you if you're uh solidly evidence-based, you're providing links or references that tell, you know, support your position. If you're doing it on on a video, you don't have to do any of that. I've been writing the skeptical cardiologist for about 13 years. And in my early years, I spent a lot of time kind of trying to debunk people like this. I described the red number one red flag of quackery as a kind of an unceasing uh goal of selling supplements or selling something, making money from these kind of false claims. Back then, a guy named Dr. Charles Gundry, his videos were popping up constantly when I was viewing things on the internet. And I feel he's a classic example of someone who has very low evidence, but makes outrageous claims based on this minimal mechanistic evidence and no clinical evidence, and it's coupled with the incessant selling of supplements. And the problem is that Gundry, like many of these people, might have uh reliable references. He was a reputable pediatric heart surgeon. So it seems like he has a solid or authoritative scientific base. But his theories that humans weren't designed to eat grains, beans, or tomatoes because their uh gut lining is damaged by that, are just totally not supported by science, and there's no evidence that his blocking, his lectin-blocking supplements help you in any way. These people like that are all over the place, and they're influencing my patients and my readers. I hear from them all the time. The worse the evidence, the more outlandish the claims, the the more popular they are. There's a guy on YouTube named Ford Brewer. He's an MD, uh preventive medicine specialist, who patients have pointed me in the direction of looking at his videos. He his videos have titles like I cleaned my arteries out in one year. And these are just unrealistic claims, but they people seem to be attracted to them.

Framingham Study And Heart Risk

SPEAKER_01

Well, I think uh it keeps you and I rather busy trying to present uh a much more fair and evidence-based approach. And so I hope our read, our listeners kind of appreciate we are trying to come at this from uh an objective, defensible, and as uh Anthony mentioned, a reference-based approach so you can take a look for yourself and see if you agree with us. So keep this in mind as we work our way through today's episode. So try to do what I do, be an open-minded skeptic. And don't believe what you hear at first. What the evidence behind it is or isn't is what you really need to ask and think about. Okay, part one. What are risk equations and how are they developed? Risk equations help us predict whether you might have a heart attack or develop diabetes or get Alzheimer's disease. Sometimes these tools work, other times they don't. And importantly, with the results, can we do anything about it? To understand, we need to think about how these tools are developed. So, step one, find a database that has both the outcomes you care, like death or heart attack or dementia, and a bunch of clinical factors that might matter, like blood pressure or age or smoking. And we will start today with tools that try to predict a heart attack or death. So, step two, look at the database and try to find correlations that suggest what might relate to what. Those who smoke were more likely to have a heart attack. Men were more likely than women. Those with a high LDL cholesterol similarly were at greater risk. Now, the granddaddy of them all was the Framingham Heart Study, which created a huge and influential database. Framingham study began in 1945 when Congress authorized a study to find the risk factors for cardiovascular disease. At the time, half of all deaths were due to cardiovascular disease. Also, at the time, it was felt that death from heart disease was essentially inevitable. We actually didn't know what caused it. The thought was that high blood pressure just came with age. Well, why in the 1940s? The catalyst was Franklin Delano Roosevelt's death from a stroke. It was not known what caused heart attacks or strokes in terms of who was most at risk. So the study collected information from folks living in Framingham, Massachusetts. By 1971, the data showed that high blood pressure was clearly associated with heart disease, both systolic and diastolic. At the time, only diastolic was theorized. Back to creating a prediction tool. After statistically analyzing the data in your database and finding factors that seem relevant, we move to step three. Use those correlations to build your prediction equation. So for the Framingham study, in 1998, the investigators built a risk prediction model that is pretty much in use today. How old are you? Do you have diabetes? Do you smoke? Have high blood pressure or elevated cholesterol in BMI? The tool gives you a 10-year risk. Now, there are newer and somewhat expanded equations since then, but many of the same risk factors are included. Step four, and this is almost never done. Does the tool tell us that we are at risk of a bad event, or does it provide ways to reduce that risk? Ideally, you'd find the risk factors like blood pressure or cholesterol, and then show in a randomized trial that improving the risk factor, like lowering your blood pressure, actually reduces your risk of the heart attack or death. Now, the cardiac event predictors tell us that high blood pressure, LDL cholesterol, high blood sugar are risk factors. And clinical trials have shown that improving those risk factors reduces our cardiac risk. So the factors are predictive, and we can reduce our risk. But Anthony, these tools don't always work, and these databases sometimes come up with predictors that frankly we've then learned maybe aren't relevant. Some thoughts here from you.

Population Tools Fail Individuals

SPEAKER_00

Well, I totally agree on the value of the Framingham type approach for estimating the risk of what we call atherosclerotic heart disease, which is heart attack and strokes. It's something I think about on a daily basis as a preventive cardiologist. And I think in we in cardiology are way ahead of other fields, other organs, specialties in terms of having very strong databases on risk prediction in the cardiac and atherosclerotic cardiovascular disease in general. And um For every patient that's in front of me, I want I want to be able to share a 10-year risk of heart attack and stroke and CB death. And we start with these population estimates. The factors that that you mentioned that go into the Framingham study, we do have very good evidence for reducing high blood pressure, for lowering LDL, or a slightly better risk marker, Apohypoprotein B, and for stopping smoking, trying to get rid of or reduce the risk of diabetes. So all of those things have been well very well established. I think uh there are examples where we've identified a risk marker, such as HDL, that seems to associate with a better outcome. But when we've actually done studies where we've raised the HDL, there hasn't been an improved uh mortality risk benefit, and there hasn't been reduced heart attacks and strokes. And then beyond that, personalizing all there's also genetic factors like lipoprotein little A and looking at inflammation. So when we add in some more risk-enhancing features, we can become much more specific uh in terms of what your cardiac age is, if you will.

Genes And Dementia Risk Explained

What To Do With APOE4 Knowledge

SPEAKER_01

You made the this the point, and I totally agree, that the cardiac area of predicting bad things happening is way farther ahead and more based on rigorous evidence than really every other uh part of the body that we're trying to predict things. But even as good as it is, there's a cautionary tale. This next study shows us that these risk tools may be useful to understand what happens to thousands of people, but these tools may not be ideal for individual patients. So there was a really interesting study. In the study, authors looked at folks with a heart attack and asked the question would the risk predictor have predicted this event? So they had 465 people less than 65 years old who had a heart attack. And it turns out the tool said half of these folks who had a heart attack were supposedly at low risk. So our best prediction tools do miss many folks. Now, keep this inaccuracy in mind as we talk about the next set of predictors, because it gets a bit worse. All right, let's turn to part two. The risk of dementia based on uh genetic testing. This is a critical issue. We all, as we get older, worry about the development of dementia, Alzheimer's, or other causes of cognitive decline. In episode 13, on can we do reduce our risk of cognitive decline? I talked about the APOE4 gene. It comes in three flavors E2, E3, and E4. And we have two copies of the uh APOE gene. I got my results when I did 23ME, but you can get this test uh pretty easily for about a hundred bucks. Now, the E3E3 is the most common prototype, and that's in 60 percent of Americans. And that uh is associated with about a 10 to 15 percent risk of dementia by age 85. Now, if you're lucky to have the E2, E2, perhaps risk falls in half, only five to eight percent risk. Now for the E4 gene, you could have no one or two copies of it. If you have one copy, so your E3, E4, that doubles or triples your dementia risk, or about 20 to 25 percent risk. Now, if you have E4, E4, you have an 8 to 12 fold increased risk, or 50 to 65 percent by age 85. Fortunately, only 2% of the population actually has this genetic type. Now, it is the E uh ApoE gene is an important risk factor, but it is not determinative, meaning it doesn't mean you're absolutely going to get dementia or not. Other variables can be added, looking at amyloid or tau proteins is something people are looking at and trying to figure out if that helps us from a prediction standpoint. So here's a risk prediction tool that's pretty powerful based upon your gene type. You may have a low, moderate, or quite high risk of dementia. But this risk tool doesn't tell us what to do. We can't change our genes. Now, listen to my episode. You can double down on reducing your other risk factors like exercise, sleep, good blood pressure control, smoking, alcohol, or taking saunas. Anthony, what are your thoughts here? I know you've done some of this testing. Any insights for the audience?

Biologic Age Clocks Under The Microscope

SPEAKER_00

Yeah, I've I've looked into this uh quite a bit, and I've become very interested in uh APO E4 because it turns out I'm a carrier, I'm an E43, and as you said, that increases your risk of developing dementia. Three to four fold. So what what the the big question I think is should we be doing something differently if we know we're an E4 carrier? If we did have a treatment for that, then as we do for say high blood pressure, high cholesterol, then probably everybody should be tested for E4 and identify that high risk early on. And in terms of it being a marker uh for, say, brain age, it's not really like that, but some companies now have started testing something called neuroage. Dr. Kristen Glorioso, who writes on Substack, runs a company that is devoted to testing neuroage, and it incorporates E4 and probably also amyloid tau proteins in the blood, which have some predictive value. And along with MRI findings, as we get older, our brain volume diminishes. So brain volume is kind of a surrogate for brain age. White matter hyperintensities form more commonly as you get older. So there's another thing. So you can kind of put those all together and come up with something that you're calling a neuroage. What the benefit of that is, it's not clear. We'd certainly like to be to diminish the advancement of our brain age, but I'm not sure that we have any proven ways to do that other than what you mentioned, which is mostly lifestyle factors, which are also good for cardiovascular disease and aging in general. I did a a test that wasn't specifically on neuroage, it was basically your true age. And I think we're getting on to that next.

Reliability, Oversight, And Black Boxes

SPEAKER_01

We are right there, ready to dive in. So I think you've introduced the concept of biologic age. So part three. Measuring your biologic age. Now we get to an area where, in my opinion, marketing way exceeds the science. The hype is start by measuring your biologic age or the effective age of your tissues, and use my test, the expert says. If your biologic age is higher than your actual age, then buy these supplements or do these hacks to improve that age. These are also called biologic clocks. And they're not inexpensive. As Anthony mentioned, true age has a$500 test or a discount of$1,800 if you repeat it four times during the year. The crucial premise here is that aging is something you can measure in your tissues, not just on a calendar. If we find a driver of that aging or things that push your biologic age higher, we can then treat those factors. And when we treat them, we can show that the aging measure gets better and ultimately people live longer and healthier. Is your biologic age lower than your actual age? You've won the lottery, you're doing something right. Is your biologic age higher than your actual age? You need help. Now the hope is real and the arguments make sense. But we are a long way from having a tool that works and can help us. Here's the dilemma. One, what did you measure to reflect how your body or tissue is aging? Problem number one, there are many targets, many approaches, many tests. Some focus on epigenetics or DNA methylation or DNA structure changes or proteomic assessments, those are blood assessments, or telomere length. It's not like measuring how tall you are, where many different approaches give you the same answer. Use a tape measure, a yardstick, or a ruler, you'll get the same height. So one test might say that your liver looks older than it should be, your heart might be younger, and your lungs are about right. Now, what do you make out of this information? That's problem one. Problem two is that the tests give differing results for the same person. Now, to be helpful, you would repeat the same test another day and get the same results. Or you'd use a different test and find your biologic age and get similar results. Unfortunately, both of those characteristics don't appear to be true yet. In a study of the test's reliability, they compared results of six different tests in the same people and found nine years differences. Problem number three, and this is why I say these biologic clocks are not ready for prime time. No clock has been tested to see whether improvements lead to better outcomes. For our heart disease predictors, we know that high blood pressure or high cholesterol or high blood sugar increases your risk. And reducing those levels does reduce your risk. But for biologic clocks, there are no studies that show even if you could improve your biologic age, it will make a difference in what actually happens to you. My take is that biologic age is a fascinating research tool, but there's no evidence to support using them to live longer. From my viewpoint, save your hundreds or thousands of dollars for now. Anthony, what's your take on the biologic clocks? I'm a skeptic. I am an open-minded skeptic, but I come down on the side of not ready for prime time. What do you think?

What Actually Changes Outcomes

SPEAKER_00

I totally agree with everything you've said. I have been very interested in them and checked out the true A's that you mentioned there. And I this is a test that's looking at DNA methylation. And there are big problems with the DNA methylation technology in terms of being something that consumers should be using or patients should be using. And that you outlined them pretty well. I would say number one, no consumer-facing biological age test has been validated or approved by a regulatory body, uh, not by the FBA nor any any sort of independent group that can say with any level of confidence that the test is measuring anything relevant. Number two, there is no industry oversight or transparency on quality control. We really have no idea how these companies are doing what they're doing and getting the data back to you. So the test, the true age test, I spit onto uh a piece of paper and mailed it back to them, and I and a couple weeks later, the only information I got was that my chronological age was 4.3 years younger than my uh biological age. And in terms of looking at where that came from, it's a black box, you have no idea. Um but even more importantly, if I were to repeat that test with that company and sent them the same sample twice, uh it it's likely it would vary by anywhere between five and ten years. Meaning, if I had sent them two samples, one would come back saying I was four years younger, and one would say I'm a one-year older from the same exact same sample. So the the variability in these clocks um has been pretty well established, as you said, in an article, and there's various individuals online who have reported the same intense variability on the same samples, and is just too high to have to be meaningful. And the final thing is is even if they were precise, you could that you could get repeated samples coming back with the same number, and if they were accurate, if they had if they actually told you your biological age, they don't give you any actual insights into to improving your health. You know, how can you make your uh age younger?

SPEAKER_01

And even if you could make your biologic age younger, what really matters is does that mean you live longer? And those studies have not been done. And until they're done, you know, it's it's a great research tool. And if it helps us understand aging a bit more, wonderful. And I'm sure it will lead to insights, but save your money. That's that's my take.

Closing Takeaways And Listener Poll

SPEAKER_00

So there's a distance of like looking at DNA methylation might uh correlate with chronological age in some way. But the question is, does that correlation with the chronological age uh correspond to anything meaningful? And the other aspect of this is that it's definitely being, and in the end, it uh we just don't have any evidence that that it's working, that it's accurate, that it's useful, and it's probably just a big waste of money.

SPEAKER_01

Expensive urine, as they say.

SPEAKER_00

Yes.

SPEAKER_01

All right, I think it's time to wrap up. Many of us would like to know if something bad is going to happen, especially if we can do something about it. For cardiac disease, I believe the tools can help motivate us to take care of the risk factors that we know matter. For dementia, you may or may not want to learn your genetic risk. If it just paralyzes you, then skip it. If it helps you to do more exercise or get better sleep, then great. The biologic age tools are conceptually interesting, but not ready for prime time. May you live long and well. And let me know your vote for N of One Nation or Outcome Optimizers or something else. And please tell your friends about the podcast and about the skeptical cardiologist, which is a great Substack newsletter. Until next time, take care of yourself and those around you. Thanks so much for listening to Live Long and Well with Dr. Bobby. If you like this episode, please provide a review on Apple or Spotify or wherever you listen. If you want to continue this journey or want to receive my newsletter on practical and scientific ways to improve your health and longevity, please visit me at Dr. Bobby Livelongandwell.com. That's doctor as a dr Bobby Livelongandwell.com.