This post is about how to use modern science and personalized medicine to make yourself healthier, more productive and happier. Every day.
LEGAL DISCLAIMER: IT IS VERY IMPORTANT THAT YOU THINK CAREFULLY, EVALUATE YOUR OWN HEALTH, AND CONSIDER PROFESSIONAL ADVICE BEFORE YOU THINK ABOUT DOING ANY OF THE THINGS I DO. WE ARE ALL VERY DIFFERENT AND WHAT WORKS FOR ME MAY BE DANGEROUS OR USELESS FOR YOU. I AM NOT A DOCTOR. THIS IS NOT MEDICAL ADVICE. THIS IS JUST MY PERSONAL STORY.
Serge Faguet, Russian, 32, Cornell undergrad / Stanford MBA-dropout, started some tech companies (TokBox — leading B2B video communication infrastructure company bought by Telefonica; Ostrovok — largest online travel co in Russia, profitable with ~$500m gross turnover in 2017; new stealth-at-this-point AI co in Silicon Valley; been through Ycombinator; worked at Google very briefly).
Before all this I had a lot of challenges with anxieties, insecurities, introversion, weight, focus, anger management, bad moods, procrastination, and other things that many of us struggle with. Now all of them are effectively gone. I mean, I wrote these two huge posts in one weekend and didn’t procrastinate for a minute.
It seems obvious that whatever our goals are in life, certain things can help. I (and many others) want to be more energetic, have better willpower, not have bad moods, have the confidence to talk with the cute girl in the line at the supermarket.
All these things depend on transient mental states. And they in turn depend on your biochemistry (amongst other things). If you ever meditated, took drugs, had a bad night of sleep, or been sick you know this to be true: with these biochemical fluctuations your personality changes, and behaviors can become much easier or harder.
My goal is simple: manipulate my biochemistry to get more of the things I want, and less of the things I do not want.
Good mood, confidence, focus, energy, willpower, stress resilience, brainpower, calm, health, longevity, removal of social anxieties/inhibitions. All the time. With minimal investment of time and minimal risk.
I attack 6 major blocks:
In this post I will give just an overview of things I feel are most important in each area, and then in future posts will dig in at length.
Important note: all these go together. You cannot sleep well while eating like shit, not exercising, and stressing out. And you cannot exercise/eat well/not stress out if you sleep badly.
In all these areas I use roughly the following framework to decide regarding specific tactics:
I am actually very conservative and paranoid about these things. For example, I take months to research and talk with people before I decide to take a new compound, start with low doses, and consult with several independent experts. Be careful and don’t screw yourself up with this kind of thing.
Get plenty of restorative deep and REM sleep on a regular basis.
This book has more info if you’d like to really dig in http://biohackingbook.com/ (you want the free chapter on sleep, I don’t like the other ones as much)
Sleep is essential to willpower, which is essential to everything else here.
Keep in mind that things in other sections will help a lot. In a future post I will dig into a lot more detail and describe my personal journey to better sleep.
Eat good stuff. Don’t eat bad stuff. Habituate.
minimize insulin levels, maximize glucose disposal, optimize various growth factors (IGF-1, mTOR etc.) towards things we want (e.g. muscle) and away from what we don’t want (e.g. cancer).
Nutrition compliance is generally incredibly hard and may take years to develop. Don’t try to do this all at once, it is too hard. Just try to make small steps to improve. I still occasionally eat bread or pasta or have a glass of wine.
In a future post, I will describe how I gradually, slowly and very painfully improved in this regard.
Maximize metabolic benefits (hormones, insulin sensitivity). Minimize time spent and risk of injury.
I do the following:
I found gym to be one of the easiest routines to set up. Having personal trainers helped a lot. Now it is such an ingrained habit that I don’t need them anymore.
Maximize stress resilience, social support, sense of purpose. Eliminate bad moods.
I don’t talk much about sense of purpose because I never lacked it. I don’t know how to help discover that.
Mental health is the most complex of all the things listed here, and is helped by all other sections. So there will be a lot of extra posts on this.
Discover your bugs and fix them if possible. Everyone has bugs.
I wrote a very detailed separate post that includes a huge number of tests I have done, how I interpret them etc. Read it here, I promise it is very interesting, and it lists hundreds of metrics I consider. It is here: https://medium.com/@sergefaguet/hundreds-of-biomarkers-i-test-in-pursuit-of-focus-health-energy-confidence-and-happiness-dd01572c518b
Interpretation is hard. This is a new field, the data is very complex, and if you really want to get value out of this, you have to spend a lot of time and effort. It is just the way it is.
Also if you look at the testing post, you will see that:
Depends on the specific intervention.
Above are some of the supplements (not including pharmaceuticals) I currently take. A top-notch medical research team I work with went through a large number of studies related to most of these and felt the ones at the top are quite likely useful, the middle probably useful, and no opinion on the ones at the bottom. None of these supplements were thought at all likely to be harmful.
Keep in mind: pharmaceuticals act very differently on different people. Some of these may be useless of harmful for you, even if they benefit me. I have gradually phased these in over years of self-experimentation and deep understanding of how they work.
LEGAL DISCLAIMER: I AM NOT RECOMMENDING YOU TAKE ANY MEDICINE WITHOUT PROFESSIONAL SUPERVISION. PRESCRIPTION DRUGS SHOULD ONLY BE TAKEN BY PRESCRIPTION FROM A REPUTABLE DOCTOR. I AM NOT A DOCTOR.
On that note. I think given the way healthcare is organized today, this kind of personalized medicine could significantly increase social inequality beyond where it is now.
People like me will be able to pay for this out of pocket and use off-label prescriptions from private doctors who focus on upgrading and prevention rather than merely healing. Downstream the extra mood, energy, focus, health, willpower and social skills — enhanced over decades — will accrue further and further advantages to people who upgrade themselves, which will lead to a cycle of further concentration of wealth.
I don’t have any suggestions on this, just pointing out that this will be a far bigger problem than many other social-justice issues that get attention today.
Thanks to everyone who has read this, I hope it has been useful! Also again reminding — read this other post if you did not already https://medium.com/@sergefaguet/hundreds-of-biomarkers-i-test-in-pursuit-of-focus-health-energy-confidence-and-happiness-dd01572c518b
I am also happy to speak at high-quality events/podcasts, talk with journalists about all this — feel free to reach out! Best is to send me a message on Facebook Messenger (https://www.facebook.com/sergef) or Instagram (https://www.instagram.com/sergefaguet/).
This post is an in-depth review of hundreds of biomarkers I test with real data and commentary — insulin resistance, hormones, ketones, microbiome, toxins, athletic capabilities, bodyfat, mercury, allergies and a lot more. The idea is to illustrate the biomarkers I check and ways I interpret them. I have no sense of privacy at all so feel free to use in whatever way you like.
This is meant to be read together with my main post on biohacking: https://medium.com/@sergefaguet/im-32-and-spent-200k-on-biohacking-became-calmer-thinner-extroverted-healthier-happier-2a2e846ae113
My interpretation at the end of this is that I am extremely healthy, much younger than my chronological age, perform much better than the vast majority of humans on many dimensions, and will live longer/healthier than anyone who has ever lived as of 2017.
Bold claims — partially designed to persuade you to read this long post :) Let’s jump into it.
Excellent on inflammation markers — way better than suggested optima, CRP below detection limit. There is a lot of evidence that suggests inflammation is key in all major aging diseases (cancer, heart disease, neurodegenerative disease) so happy to see this. Everyone should know their inflammation markers.
Also great on endothelial function which is key for preventing heart disease.
Here should mention some key genetics things you should be aware of, especially your ApoE (key to Alzheimers risk) and MTHFR (which is what screws up my B12 metabolism).
My TSH is actually not great, the lab is wrong to consider that optimal. Optimal is under 2, so my thyroid is working a bit harder than it should. Wrong lab range is partially because reference ranges are based on sick people.
You should know your Vitamin D and homocysteine. My Vitamin D started at around ~24 and I supplemented it up. My homocysteine started at ~12 and I supplemented it down into optimal territory with a lot of B-vitamins. Both markers have significant associations with key diseases
(credit www.marksdailyapple.com — a great blog about health!)
The screen above shows data compiled from a bunch of studies suggesting that relatively high levels of Vitamin D are protective against a number of diseases. It is very unlikely you will get to these levels without supplementing unless you are a lifeguard on a beach in Israel.
Here the most important thing is that I have exceptional kidney function (eGFR and Cystatin-C) — in the top 5–10% of people in my age group. Especially important for me because all my supplements add workload on kidneys. eGFR is one of the key markers evaluated to calculate people’s “true biological age.”
This all mostly has to do with insulin sensitivity which is one of the most key pathways in the body in terms of staving off aging and disease. My baseline glucose, insulin and HbA1c are actually not that great, but they don’t matter as much.
What matters the most is the OGTT (“Postprandial Evaluation” in the image above) — a test where you measure markers, then ingest a lot of fast sugar, then measure again couple more times after defined periods. This test shows the dynamics of how efficiently your body gets rid of sugar. In my case, it is extremely good — basically drinking 75mg of a very sugary solution has barely elevated my sugar, and then a small amount of insulin removed a huge amount of glucose out of my blood, taking me down to 46mg/dl. Most people would feel quite hypoglycemic here but I don’t because my sugar is constantly low and my body is used to it.
Alpha-hydroxybutyrate is raised because of my ketogenic diet.
Ferritin is fairly low because I eat well and give blood to do all these tests! This is quite key, especially for men. Lower iron is hypothesized to be one of the reasons why women live longer.
OK, so more on insulin/glucose pathways. Sorry about the Russian in the images. Above is a test called RQ (respiratory quotient) of how much oxygen/co2 you process at rest (you basically put on a gas exchange mask that is also used for VO2max tests below, and sit calmly). What it tells me is that my body runs 85–100% entirely on fat, a little on protein, and not at all on carbs. Which is exactly what you want. I start using the carbs in my body as a dominant energy source only after I get to >150 heartbeats/minute. This enhances athletic performance since glucose storage in the body is limited.
(credit Peter Attia @ http://eatingacademy.com — great blog by one of the most knowledgeable people about preventative medicine in the world, in particular about insulin resistance and ketogenic diets)
If you read up about how cancer cells preferentially eat sugar, how ketogenic diets are more metabolically efficient and generate less waste byproducts per unit of energy etc., you will see that keeping your insulin/glucose pathways extremely optimized is an interesting opportunity for material life and healthspan extension. Not to mention body fat % reduction. This also deserves a whole separate post.
On that note, here is my body fat graph. This was done in 33 separate measurements by the same personal trainer with the same equipment via measuring ~15 different sites for subcutaneous fat with calipers. This is error-prone. DEXA scans are better, but we didn’t have easy equipment access on a constant basis.
I think the absolute values are suspect, and bioimpedance suggests I am in the 10–11% range right now rather than ~7%. But the directional trend is very clear and encouraging. Also cool that I actually barely lost any weight, so I added a lot of muscle which has major health benefits (if you want a great detailed book on how muscle enhances your health, read https://www.amazon.com/Body-Science-Research-Program-Results-ebook/dp/B001NLL38S/).
I don’t good have before-and-after pics but I definitely used to be chubby, as all my friends and employees are delighted to keep reminding me :)
Also for those that are interested in ketogenic diets, you measure them via glucometers + ketometers similar to mine above. Be warned that keto blood strips are quite expensive. And that actually getting to a level of ketosis like mine above (after a ~16hr fast) will take a long time and a lot of work.
Also you can use CGM — an implant that tracks your glucose in real-time and sends data to your iphone. This can help figure out which exact foods, activities etc. alter your glucose and are harmful. The above image is from a night a couple years ago when I was stressed, stayed up late, and ate a lot of chocolate while sitting in a bathtub. Note how big the late-night jump is relative to the increase with good food around 6pm. This graph very clearly and unambiguously tells me “hey dude, you are fucking yourself by eating this sugary garbage. Like you just fucked yourself right now — look, let me show you in real-time how you are damaging your health!” Motivational stuff.
CGMs are very cool, but expensive (the Dexcom G5 I used was >$4,000) and a huge hassle. I do think this is the future and plan to use them a lot though. Imagine real-time monitoring of testosterone connected to a pump that keeps it at optimal levels depending on time of day or activity! This is already feasible (albeit not with all molecules), someone just needs to engineer it.
OK, back to more blood testing! Some notes:
As I mention in my main framework post, I boost thyroid hormones, IGF-1 and testosterone.
Testosterone deserves a special mention. In short, I have average-ish testosterone but low LH/FSH (which serve as inputs to testosterone). What controls FSH/LH is binding of estrogen at the pituitary gland. And because estrogen is a testosterone downstream product, there is a feedback loop.
So what I did is take an “estrogen blocker” which competitively occupies the same sites estrogen occupies at the pituitary, without inhibiting FSH/LH. The result can clearly be seen above — in a very short period of time (2 months), free testosterone jumped a lot. This has a noticeable effect on mood and energy. Also very noticeable effect on wanting to have sex all the time:)
This is a basic blood panel. Nothing too interesting, you basically just do these to make sure nothing is screwed up.
I have high EPA/DHA and Omega 3s in general + low Omega 6 and trans fats. Result of great diet + supplementation. This is basically what you want too.
OK, so in the graph above you can see I had elevated mercury and got rid of it. The hypothesis is that it is due to a dental amalgam. I fixed it by stopping eating any large predatory fish + enhancing liver detox capabilities via B-vitamins and the like.
Mercury is likely to interfere with a lot of neurobiological processes and contribute to many issues such as mood disorders. Good riddance.
This is a CIMT test. It basically shows the thickness of your neck arteries, which appears to be very predictive of cardio risks a long time in advance. Another factor that suggests that my lifestyle approach is working. The cool thing is that this compares you with people in your own age demographic, so I know that unless something changes, I should have low cardio risk even when I am 85. Cool test, non-invasive, highly recommended.
VO2Max is a measure of how your body performs in terms of gas exchange, and as such evaluates the capabilities of your cardiovascular and pulmonary systems. You measure it by exercising while wearing respiratory gas analysis equipment as in the photo of me above. As the quotes from New York Times above highlight, it appears to significantly predict lifespan and “fitness age.”
My VO2Max has risen a lot over time and is very high, not far from Olympic medalist levels although I have just about zero athletic accomplishments. I mostly credit high-intensity interval training and weights training, but I don’t really know. More recently in a period when I stopped doing HIIT, I saw this metric worsen. Another good indicator that I’m doing something right though.
The above is from a test called “GI Effects” by Genova Diagnostics. It tests your poop (which is very fun to mail) for bacteria, parasites, metabolites and a lot of other interesting things.
I think this is a very fascinating test, but I have no idea how to really use it yet beyond “do not take antibiotics, do take probiotics & prebiotics”. Microbiome is a super exciting new frontier of health, but we don’t know whether certain microbes cause health states or simply correlate with them. If you want to learn more, take this great class on Coursera which I did and learned a lot from https://www.coursera.org/learn/microbiome
Anyway, my latest entire test is linked to above. Now the entire internet knows exactly what bacterial strains live in my poop as of 2017. Enjoy :)
This is an interesting test (Genova Diagnostic Toxic Effects) that suggests somewhere I was getting significant exposure to VOCs (which are definitely bad for you). The actions I took were to enhance office/home ventilation, not eat/drink from plastic containers, not stand next to people who smoke.
On that last note, one time I took this test after smoking some pure-weed joints (which I do very rarely), and the toxins went off the charts high. If you can’t stop smoking, at least vape. Inhaling burned weed or tobacco is incredibly bad for you, I was shocked by the levels of toxic chemicals I saw in myself after just one evening of several joints.
This is from two tests of allergies/sensitivities by Cyrex. The reason I took it is that if you eat products you are sensitive to, you may increase inflammatory activity in the body which we do not want.
My takeaways are that I shouldn’t eat tuna or scallops, and that I am allergic to certain molds. Also that I appear to have a clearly-acquired gelatin sensitivity because of all the capsules I take. Fascinating.
Other interesting tests/metrics:
There are many other tests I have done, but this is already an incredibly long post.
The key takeaways are that:
Also here is a framework I like using. Below are all-age causes of death in the US. My markers suggest that I am at extremely low risk for a large number of them, even in my age group. So if I maintain a similar set of behaviors (and actually I keep improving every year) I should have low risks in my age group when I am 80 as well unless something screws up.
With the above framework I also identified that my key risk is cancer — which is why I am so focused on low sugar and insulin (which appear to feed cancer preferentially, https://en.wikipedia.org/wiki/Warburg_hypothesis) and my immune system which is somewhat weaker due to CMV, so very interested in iP stem cell therapies that could replenish naive lymphocytes.
I expect that even without major medical progress, I will be in excellent mental/physical condition at 100 and will live longer than any human who has ever lived as of 2017. With tech progress, it seems likely that immortality is reachable.
I could be wrong, but I suspect that today there are fewer than 1000 people out of 7 billion who know as much about their own health as I do. Because of how onerous, expensive, and non-intuitive this is.
But this should become much more mainstream. It really does give you a significant advantage in life across very many areas — thanks to this, I often feel “superhuman” because of how much control I have over my health and behavior relative to what I see in other people. And humans tend to adopt things that enhance their social competitiveness.
I am happy to speak at high-quality events/podcasts, talk with journalists about personalized patient-driven medicine etc. — feel free to reach out! Best way to reach me is to send me a message on Facebook Messenger (https://www.facebook.com/sergef) or Instagram (https://www.instagram.com/sergefaguet/).
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