Gil Blander is the Chief Science Officer and co-founder of InsideTracker, a company dedicated to providing personalized health and wellness recommendations through blood and DNA analytics. Gil received his Ph.D. in biology from the Weizmann Institute of Science and completed his Doctoral fellowship at MIT. Gil is widely recognized as an expert in the science of aging and leads a team of specialists in nutrition and exercise physiology.

InsideTracker is designed for people who want to enhance their performance, increase their energy levels, feel better, and maintain a healthy weight. It is widely used by a variety of professional athletes as well as everyday people interested in health optimization. By analyzing a vial of blood, a DNA sample, or the two together, Gil and his team at InsideTracker provide their customers with a detailed look at their current health and share a personalized diet, exercise plan, and other key recommendations for improving and performing at their best.

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SHOWNOTES

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7:30 - LISTEN ON HIMALAYA!: Download The Free Himalaya App (Www.himalaya.fm) To FINALLY Keep All Your Podcasts In One Place, Follow Your Favorites, Make Playlists, Leave Comments, And More! Follow The Melanie Avalon Podcast In Himalaya For Early Access 24 Hours In Advance! You Can Also Join Melanie's Exclusive Community For Exclusive Monthly Content, Episode Discussion, And Guest Requests! 

07:40 - Paleo OMAD Biohackers: Intermittent Fasting + Real Foods + Life: Join Melanie's Facebook Group To Discuss And Learn About All Things Biohacking! All Conversations Welcome!

The Melanie Avalon Podcast Episode #17 - David Sinclair

9:10 - Gil Blander's Path To Longevity And Inside Tracker 

14:00 - What Are Conventional Blood Reference Ranges Based On? 

16:00 - Normal Vs. Optimized Range

16:20 - How Often Are Reference Ranges Updated? 

17:30 - How Have The Reference Ranges Changed Through The Years?

18:45 - Which Biomarkers To Test?

23:45 - Addressing Underlying Issues (Thyroid)

25:00 - How Fast Do Blood Biomarkers Change? 

27:50 - Blood Glucose Vs. HBA1c

30:00 - The Importance Of Testing Multiple Factors  

31:45 - Cholesterol And Diet

32:35 - Normal Vs Optimized Ranges 

35:40 - Predictive Analytics 

37:00 - Blood Glucose On High Vs. Low Carb Diets

39:00 - Micronutrients And Total Body Status

41:15 - Uncommon Tests 

42:20 - Interpreting Iron Blood Tests

49:20 - Interpreting Markers Of Inflammation 

55:45 - The Role Of Knowledge In Blood Tests

58:05 - Interpreting Liver Enzyme Results 

1:03:45 - Testosterone, Cortisol, And Anabolism Vs. Catabolism

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The Melanie Avalon Podcast Episode # - Matt Gallant And Wade Lightheart

1:09:45 - Differences In Lab Facilities (Quest, Labcorp, etc.) 

1:12:45 - Genetic Testing At Inside Tracker

1:17:00 -  The Placebo And Nocebo Effect With Genetic Testing

1:22:05 - Testing Food Sensitivities

1:25:20 - How Fast To See Changes, And Retesting 

1:27:10 - Uploading Your Own Data

1:28:45 - Finding Your Inner Age

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TRANSCRIPT

Melanie Avalon:
Hi, friends. I am super excited to be here today with Gil Blander. He is the Chief Science Officer and co-founder of InsideTracker. Guys, it is really a very, very cool company. It's a really modern perspective that makes interpretations of blood test results and what it means for your health. Very accessible, very helpful, very intuitive, and knowledgeable for the everyday person. I think you can get a lot more information than you would get from just going to your doctor and running standard blood tests.

Melanie Avalon:
They also do really cool things with DNA testing as well. I am really excited to have Gil here today. I was actually introduced to his company through David Sinclair, who I had on the podcast previously. Yeah, this whole world of blood tests, and health biomarkers, and anti-aging, so Gil, thank you so much for being here.

Gil Blander:
Thank you so much for inviting me, Melanie. I'm really excited.

Melanie Avalon:
I am too. I have a lot of questions in general about blood tests and so many things, so I'm really excited. I've been looking forward to this for a long time. But I thought to start things off, would you like to tell listeners a little bit about your personal history, and what brought you to your interest in not only InsideTracker, but your interest in longevity, and health, and all of those things?

Gil Blander:
Sure. Yeah. You can hear from my accent that I'm not a Native American. I was born and raised in Israel, and from a very young age, I was fascinated by the aging process, I assume similar to what you discuss with David Sinclair a few weeks ago. When I was 12, a relative of mine passed away, and instead of being worried, or basically sad about her, I was sad about myself because I realized that I won't live forever. At that time, I decided to dedicate my life to try to understand and try to find a way to live longer, better life.

Gil Blander:
That's the reason that I decided to study biology, and that's the reason that I decided to come to MIT, and join the lab of Lenny Guarente, which is one of the leader of aging research, and actually the same lab that David Sinclair done his postdoctoral fellowship. There, I studied aging for five years. It was a very fascinating time. I learned a lot, I worked on a lot of cool protein, and genes that related to longevity. During that time, I started to be exposed to the biopharmaceutical environment of Kendall Square, which is there around MIT.

Gil Blander:
I realized that I might contribute more to humanity if I start my own company than being a professor in academia that might publish one or two papers say, that maybe two other scientists will read. I realized that I can start my own company, but I wasn't sure what will be the company, or what should I do. I decided to move to the industry, and learn from the industry, and try to find a subject that related to longevity, and aging, and started my company on.

Gil Blander:
Make a long story short, I joined a nice startup in Cambridge. This startup to use system biology and computational biology to try to find and understanding very complex processes. I decided to apply this platform to study and use the caloric restriction, which I'm sure that you know a lot about. As a biohacker, I'm sure that you've done a lot of that. I decided to try to use all the data that publicly available, run it via the platform, and try to understand what is going under the hood, why caloric restriction extend the life of so many model organism.

Gil Blander:
I built the model, and it was very exciting model. I presented it in aging research meeting, scientific meeting. I also showed it to David Sinclair and Lenny Guarente. That was actually the genesis of InsideTracker in a way, because what we realize that in caloric restriction, you don't only have one major contributor to caloric restriction. There are a lot of different pathway that contribute or influence by caloric restriction. Even if you have the best caloric restriction mimetics such as a resveratrol or NAD booster, that won't be enough. You will need a lot of those.

Gil Blander:
If you need a lot of those, we came and realized that may be instead of using synthetic manmade compounds, let's try to use food as a drug of choice. Let's move our drug cabinet from our bathroom to the refrigerator. Let's try to use that and give you the best recommendation that you can in order to optimize the most complicated machine that we have, which is our body. Based on that, let's say try to use that and allow us to live a longer, better life. That's basically the genesis of InsideTracker in a nutshell.

Melanie Avalon:
I love it so much. You're really coming from a place that I love biohackers, like you mentioned, are really passionate about ... It's just as far as the calorie restriction and all of these factors that can influence lifespan. I love what you were saying about how the food as medicine, and going from that route versus just supplements or things like that. With InsideTracker, one of the things I do love is how it does demystify blood tests and blood results. I'm one of those people that love getting blood tests done. I love getting them from doctors, because I love seeing all the readings, but it could be really hard to know what they mean, even when ... 

Melanie Avalon:
With blood tests today, it typically shows if you're in the reference range or not, but it can still be, I think, very confusing, and it's hard to interpret what it actually means. I was wondering if we could discuss a little bit about blood testing in general before looking at how we're dealing with that InsideTracker. The typical ranges that people test for today, what are those based on? Are they based on healthy populations? Are they based on averages of people now, people from years ago? What are the reference ranges based on?

Gil Blander:
Yeah. I think that it's a great question, and I assume that the majority of us don't understand how and what is the normal range. Basically, what the labs are doing, they are looking at thousands or ten of thousands of patient or humans that they have been run their blood via those machines. Then they basically look at the mean of those results, and also two standard deviations above or below. But that's basically the normal range. The normal range is a range that basically, very statistically mean that look at whether you are inside, or outside of a two standard deviation from the mean, inside that, inside the calculation, you have a lot of sick people, you have everyone together. Basically, it's a normal range, it's not an optimal range. It's not a very exciting range, let's say it.

Melanie Avalon:
Yeah, that's one thing I was noticing when I was looking at my results in InsideTracker, was that some of my blood results for instance, were showing up in the normal range. But then InsideTracker was interpreting it as not optimal. I was like, "Oh, that's actually much more helpful than the typical interpretations that I receive." One more question about those ranges in general though, how often are they updated? Or are they updated for the actual each lab, the lab that you're testing with?

Gil Blander:
Yeah, so each lab have usually its own normal range. Sometimes there are some update by a specific entity, like for example for cholesterol, there have been some update recently based on a new research. It's not what I said before is the general, but sometimes there is some movement based on the association that relate it to a specific disease that adjusting a bit the range. But again, those range are for the whole population. They are not distinguished between young and old, athletic active or couch potato, someone that drink a lot of alcohol. All of us get the same range, so it's a bit sad that we are still using those range in 2020, almost.

Melanie Avalon:
One more last question about the ranges, just because I don't know who I'm going to ask this to in the future, are the ranges now vastly different than the ranges 40 years ago because of how health has changed so much? Do you know?

Gil Blander:
In the big picture, they are not. But some of them have been changed slightly. One example is vitamin D. Until a few years ago, no one range for vitamin D was about 20 units. Around five years ago, they decided to increase it to above 30. There are some movement, but generally, it's still very similar to what happened 40 years ago.

Melanie Avalon:
That's interesting. I'm guessing they didn't increase it because people were getting more vitamin D, right? Were they increasing it because they thought people needed more vitamin D?

Gil Blander:
Yeah. They increased it because what happened is when they looked at the population, they realized that actually, the majority of the population need more vitamin D than the 20 units that was the normal range. There have been a lot of studies and research that show that they we need more than 20, so that's why they change it. It's based on the research.

Melanie Avalon:
Blood test ranges covered. Okay. When you're designing InsideTracker, how did you decide which blood tests to focus on and which biomarkers to test? There are different options that users can choose, but Gil, how did you decide at the company, which biomarkers to focus on?

Gil Blander:
Yeah, it's a very important question, and actually that was happening at the genesis of the company almost 11 years ago. What we have done, so we came to the point, as I discussed before, that we realized that let's make food as a drug of choice, and let's say recommend food based on what happening inside the body. Then we said, "Okay, so what is the marker, what is the biomarker that we'll use in order to understand what happening in the body, and then tune up the body?" Very similar to what we are doing to the car. I'm sure that you know every 5,000 mile or so, you take the car to the technician, the technician plug a computer into the car, and the computer telling the technician exactly what should he change. Should he change oil filter, oil, and so on so forth.

Gil Blander:
The technician do that, and then the car is good for another $5 miles. Then after 5,000 miles, you take it again to the technician, he plug the computer again, and you might need to change different part of the car in order to allow it to live longer. Research show that a since incorporation of this technique in the '80s, actually the lifespan of the car increase significantly. We said, "Let's do the same for human." And the question was, how can we do that? Because today, you can't connect the computer to your brain and then know exactly what's happening in your body. Not yet. We said, "Let's use another marker or biomarker to do that," and we came with blood, because blood is a liquid gold, and it's so important.

Gil Blander:
I started to look at the catalog of the big diagnostic companies such as Quest Diagnostics and LabCorp, and realize that there are thousands and thousands of blood biomarkers. When you started to think about it, you will need a lot of blood to measure all of them, and also it will be very expensive. We can use a few criteria to allow us to choose the most important blood biomarkers. The first criteria was that we'll look at the biomarker of health and not a disease. Actually, let's look at marker like blood glucose, or fasting blood glucose. But not PSA, which is Prostate-Specific Antigen, which is a biomarker of cancer. That was one criteria.

Gil Blander:
Another criteria is that those biomarker need to be modulated using a simple and natural intervention, so such as food, supplement exercise, and lifestyle changes. I don't want to look at the biomarkers that I cannot change because then I feel like I'm wasting your money. The last one is biomarkers that are at least 1% of the population are outside of the normal range. I don't want to look at a bizarre biomolecule that only one in a million will be out of the normal range, because again, then I feel like I'm wasting the money. After doing all of that, we pinpoint around 45 blood biomarkers out of a list of around 5,000 biomarkers that are fitting all of those criteria that I mentioned before.

Melanie Avalon:
Awesome. Now I'm just super curious. What would an example be of both a biomarker that is not easy to change, and then a biomarker that barely anybody is out of range in?

Gil Blander:
Yeah. Biomarkers that are not easy to change all the thyroid-related the biomarkers.

Melanie Avalon:
Okay.

Gil Blander:
T3, T4. A lot of our user are asking us to test them, and they're asking, "Why aren't you using them?" We are saying, "Yeah, yeah, they are very important, and they definitely, especially in women, they are regulating a lot of the metabolism. But it's really how to moderate them without drugs." That's an example of a biomarker that we are not testing because of that. There are some other biomarkers that are really, really not very commonly out of range for a lot of the population such as heavy metals and other that it's literally one in 1,000, one in 10,000, so we decided not to test them. 

Melanie Avalon:
Hokey dokey. Well, I suppose there's ... No, I actually failed on the heavy metal front of things. I was out of range for mercury, which was not fun. Just going off that really quickly, so if somebody knew that they had a thyroid issue, for example, could they work on that in conjunction with working with anti-tracker on these other factors, or would that be something they would want to work on first, and then do more of the with InsideTracker? Or could they be doing all of it at the same time? They would just be working with a different doctor for thyroid?

Gil Blander:
Yeah. I think that that's a very, very important question. We are not a service that diagnose or treat a disease, and we are a wellness solutions. If someone, as you said, have issue with the thyroid hormones, we strongly suggest that he or she will work with their physician. Their physician can clear them and tell them, "Hey, it's okay that you will empower or work with InsideTracker, and then we don't have a problem with that. But we are very seriously looking at the wellness domain, and we are not trying to replace or work around the physician. We are trying to stay in the wellness domain.

Melanie Avalon:
Okay, got you. Another question about taking the blood test and the results before we go into maybe the details of the individual things that you're testing. But when a person does take their blood test, is it just a snapshot of that current moment? How fast do things change in the blood based on your last meal, whether or not you exercise that day, whether or not you're stressed? How fast do those things change? For example, if somebody were to test their blood, all the same things in the morning, and then in the afternoon, and then in the evening, do you think it would look completely different from those three tests, or should it be pretty much sort of the same for that day?

Gil Blander:
Again, a very important question. I will say that some are very transient, like if you will measure your random glucose, and it can change in a few minutes if you ate assumption, or in case that you have ate anything. That's why we are using a fasting glucose in order to give you a better benchmark. We are asking all of our user to do the test after overnight fast. We also recommend you to test more or less at the same time of the day because some of the markers are changing during the day. I can say that the hormones such as cortisol, which is the stress hormone, or testosterone, which is the male hormone, they are changing over the course of the day, so they can increase or decrease during the time based on when you woke up.

Gil Blander:
Some are very, very stable. A good example is hemoglobin A1c, which is a basically measure of the amount of glucose that you have in your blood in the last 90 days. It doesn't matter if you will test it in the morning, in the afternoon, or in the evening, or today, or yesterday, it should be very similar. As I said before, some markers are changing very often, some are changing much less often.

Melanie Avalon:
Okay, hands on. You touched on a few. I'd love to go deep into some of the actual things that you mentioned that you guys test. For listeners, I did do their ultimate plan. Super awesome. I learned a lot from it. We can go through some of the things that it tests, and what you can learn from it. Then what I love is they do, at InsideTracker, groups by different categories. Rather than just these results with all these seemingly random biomarkers, you can group it by metabolism and weight, by electrolytes, by inflammation. So you can really see what category everything falls into, and then there are actually suggestions and recommendations how to optimize it. It's a very, very cool service. I love it. 

Melanie Avalon:
You're talking about glucose. Okay, there's a question that's been haunting me actually about this for quite a while, so I'm thrilled to be able to ask you. People will often measure blood glucose, and then also A1c, the HbA1c, like you're mentioning. I've heard it that people may have a low HbA1c, which indicates that they don't have a long term negative effect of high blood sugar. But then somebody was saying that actually, that can be misleading because maybe your red blood cells are turning over faster due to high blood sugar, and that's why you have a lower level. Have you heard that before?

Gil Blander:
Yeah, yeah, yeah, definitely. Because as I mentioned before, the A1c gave you more or less the view of your glucose in the last 90 days, because you're ... In an average person, the red blood cells renew every 90 days. Basically, red blood cells are not as the other blood cells such as the white blood cells that can live much longer. They actually don't have even no clues, and they leave for 90 days, and then they die, and they're replaced. It could be that some of us have a faster turnover of red blood cells. Again, it's not something that I'm aware of, or I looked into so I cannot say if it's really up in nature, but it's definitely something that can happen, that your A1c can be lower because actually, your average age of your red blood cells is much younger than 90 days.

Melanie Avalon:
Okay.

Gil Blander:
It could happen.

Melanie Avalon:
Yeah, because it's just one of those things that I heard one time, and it stuck with me forever, because prior to then, I was like, "Okay, if you have low HbA1c, you're good. But then I was reading that you might actually have glycated red blood cells, and they're turning over faster, and then that's why you have a low HbA1c. I was like, "Great." There's always some caveat, but in general, a low HbA1c is likely a good thing, I'm guessing.

Gil Blander:
Yes, and that's why also we are not looking at A1c alone. We are looking at it together with fasting glucose. As you said before, everything that we are doing, we're trying to combine them into a group. That's what we call the sugar group that they have A1c and glucose. In the case of iron, we have almost 10 different markers related to iron. You mentioned some of them such as the red blood cells, where we have hemoglobin there, we have ferritin there and other. All of that allow us to get a good picture of what happening for you in the iron metabolism-related. We are doing the same for inflammation. We have another group of maybe 10 markers that are allowing us to understand better what happening with your inflammation. I think that what you raise is a very good point, and that's why it's better not to look at one marker alone, but look at all the group of the marker, and based on that make interpretation and decision.

Melanie Avalon:
That's awesome. I think that is something that, I mean, I don't want to make a blanket statement about doctors across the board, but I think oftentimes, people do go see doctors, and whatever they're looking at, the doctors won't take into account the whole picture. I think that's so important because if you're just looking at one factor, it just doesn't necessarily tell, paint an accurate picture of what might be going on. I love that whole picture perspective. Cholesterol and fats in the blood and things like that, because I know that's a very hot, and heated, and debated topic, at least as far as that relates to diet.

Melanie Avalon:
What are your thoughts on all the studying that you've done as far as longevity goes and everything as far as HDL, LDL, cholesterol markers, triglycerides, what do you see in the blood tests as far as how that relates to health and longevity, and also have you seen any general correlations between diet and these markers, because there's so many debates about fat in the diet and how it affects these things?

Gil Blander:
Yeah, so like everything in biology, it's more complex than the work it looks like. There is the genetic effect. Some of us are predisposed to high cholesterol. Actually, I'm a good example of that. I play this position of high glucose. But the majority of us don't have that.

Melanie Avalon:
What would you consider to be high blood glucose, not just the reference range, but your personal perspective?

Gil Blander:
Okay. Okay. What we do at InsideTracker, and the thing that we haven't discussed it here, it is what we call the ... we have the normal range, and we have the optimal range. You can be normal, but not optimal. For example, for glucose, we calculate the optimal range for each person based on his or her age and gender. We're doing it based on the papers that show that basically there is a correlation between the level of your glucose when you are relatively young and your longevity. That was done based on Framingham Heart Study. Basically, Framingham is a small town next to Boston that the NIH decided to take the older population of that town and start measuring a lot of markers, and following this population for decades.

Gil Blander:
One of the study look at the correlation between the level of glucose in a young age and basically mortality. What they found that there is a strong correlation between lower level relatively of glucose and the longevity of those persons. Based on that, we came with a range for each person based on his age and is gender. That's the optimal age. Now, for the normal range, for glucose, you have two different level. You have the 100 to 125, which considered to be pre-diabetic. Then you have above 125 was considered to be diabetic. Those are the different range. 100 to 125, it's pretty easy to know it's fit for everyone. The optimal range that we have, it's a bit different for each person based on his age and gender. Hopefully, it wasn't too complex.

Melanie Avalon:
No, not at all. Just going off of that really quickly, with InsideTracker, are you gathering data on people's diet and these blood markers to find correlations between things?

Gil Blander:
Definitely. We're asking you what food you eat, what supplements you take, what exercise do you do, what lifestyle activity do you do, and all of that helping us to give you the best recommendation, but also allowing us later on to get some correlation. What we are building right now is what I call predictive analytics. As you know, you and me love to do blood tests. We have excited about that. We are biohacker. But what everyone like to do that. The idea of addictive analytics is basically using a machine learning and looking at a big population that we already have, and based on that, try to find what defined a population that have, in this example, high glucose. Based on all the question that we're asking, we can find that, let's say, that gender is important for a level of glucose, and BMI is important for glucose. Let's say that the amount of fiber that you consume is important for glucose.

Gil Blander:
Then we cannot ask someone that we don't know if they have high glucose or not, a few questions. Based on that, we can come and tell him, "Hey, based on the question that you answered, there is a 70% chance that you have high glucose. We're not sure. But there is a 70% chance that you have it. You have now two options. You can go left and get tested, and then you will confirm whether you're via glucose or not. Or option two, you will take the 70% chance, and based on that, intervene. Hopefully, that will decrease the glucose that might be high or might not be high. That's something that we call predictive analytics that we are planning to integrate into our product soon. That will allow basically everyone that want to use the value of InsideTracker without the pain of the [inaudible 00:28:53]. But again, the value will be a bit lower because we are not sure. It's just a machine learning tool.

Melanie Avalon:
Speaking more to that, have you seen trends with blood glucose with specifically lower carb or higher carb diets? Just because I know a lot of people, especially with ketogenic diets, I mean, a lot of people experience obviously, lower blood sugar levels when they are ketogenic. But a lot of people report having higher blood sugar levels on lower carb diets due to gluconeogenesis and cortisol. Have you seen any trends there?

Gil Blander:
Yeah. I think that's it's a bit more complex than that. Generally, we see that a population that on a keto diet have a lower glucose. But some people are not behaving like that. I can give you another anecdote. There was a publication at New York Times, I don't know, a year or two ago, about long distance runners that have high glucose. We tested it in our database, and actually, we have a lot of mountain runner and a lot of foreigners, and we haven't seen that. I think that I really believe in personalization. Yeah. You can look at population can say on average this population have a higher that or lower that. But at the end of the day, what is important is what happening in your body, and therefore you, and for that, you need either to test or to live in the speculation because it's ... 

Gil Blander:
We are so complex machine that include the genetics, and the physiology, and the environment, and the blood, and it's very hard to come and say, "Everyone that on keto have low glucose, or everyone on the high carb diet have a higher glucose." It's very hard to do that.

Melanie Avalon:
Okay. I'd love to look a little bit more at some these other markers that you test as well just because I'm so, so fascinated by all of it. I feel like calcium, for example, or vitamin B12, even though you guys, you place these in different categories, are fully even. How accurate of a picture do you think measuring micronutrients like that are when it comes to indicating the overall micronutrient status of the body? With calcium, for example, somebody might appear to have normal blood calcium levels, but really, they're pulling calcium from their bones, so they might have ... heading towards osteoporosis, or something like that, or with like B12, depending on methylation, or how they're processing B vitamins, it might not actually indicate that the bioactive amount of B vitamins in their body like B12. What are your thoughts on micronutrients and what they do tell about the overall picture of the body. In general, is that a pretty good gauge, or how often do you think it might be a little bit mistelling?

Gil Blander:
Yeah. I think that it's a very good question. Some of them are giving a very good picture such as B12 and D. Some of them are not giving a very good question. You mentioned before calcium. Calcium is highly regulated in the blood, and it's vary, how to see a change because as you said before some of it go to the bones, and the calcium from the bone can go out into the bloodstream in order to maintain the level in the bloodstream. But you might have a very low level in your bones.

Gil Blander:
Another good example is magnesium. That's why we are testing both RBC magnesium, basically, red blood cells magnesium, and the blood magnesium because the blood magnesium is, again, very regulated, while the red blood cells magnesium is much less regulated, and you can see easily or easier whether you have a deficiency in magnesium in your body based on the red blood cells magnesium.

Melanie Avalon:
Oh, wow. That is fascinating. I don't know that I've ever had my red blood cell magnesium tested before, and I've had a lot of testing.

Gil Blander:
I think that if you've done it with us, you should have been-

Melanie Avalon:
I did with you. I mean, before you guys.

Gil Blander:
Okay, okay.

Melanie Avalon:
Yeah.

Gil Blander:
Yes, yes. Yes, it's definitely not something that is routinely tested. Also, a lot of other markers are not routinely tested by physician. I can give you an example, even a marker such as vitamin D or vitamin B12 are not routinely tested, not to mention markers such as cortisol, which is the stress hormone, also ferritin, which is a very important marker for iron metabolism. It's not routinely tested, and especially in young women, and especially in young women that are athletic active, a high percentage of them have iron deficiency, and testing ferritin is very important. Unfortunately, not a lot of our physicians are testing for that.

Melanie Avalon:
Speaking to the iron, because I know a lot of women struggle with iron regulation issues. I do personally. I've been struggling with anemia issues despite having a very iron-heavy diet, so trying to get to the root of that. When you are looking at markers for iron regulation, so there's the typical just iron. When I tested mine recently with InsideTracker, it was pretty high because I've been treating my anemia. But you also test, for example, hemoglobin, which should be, I'm guessing a slightly longer term indicator of iron since it's the storage form, right, of iron, or is ... Can you explain actually the difference between like ferritin and hemoglobin?

Gil Blander:
Yeah, yeah, definitely. No, it's very confusing. I completely understand what you're saying. It's not easy to understand, and it's very important, especially as you said, to young women that are especially athletic active. Actually, also athletic active males because when you exercise, especially when you are running, you have a micro-bleeding from your gut, and you are losing a small amount of blood every time that you are running.

Melanie Avalon:
Wow, wait, you just blew my mind. Really?

Gil Blander:
Yes.

Melanie Avalon:
From running?

Gil Blander:
Yes. Because every time that you hit the pavement, you get some shock, and some of the ... again, a very small micro bleeding that making you to lose blood, and not to mention that young women lose blood every month. Because of all of that, up to 30% of the young women have a low level of iron. It's very bad because iron is not only important for exercise, it's also very important for performance at work because as you mentioned before, hemoglobin is a molecule that connect the oxygen to the red blood cells and carry it from the lungs to the muscle and to the brain.

Gil Blander:
If you have lower amount of hemoglobin, that means that you have less oxygen that come to muscle, and that's mean that you compromise your athletic performance. But also less oxygen that coming to your brain, so you can compromise your performance at work. Most of this population doesn't know that they have low amount to iron, so it's really bad. Now, let's go into what happened with iron. As you said, there is the free iron. That's basically the iron that you absorb when you eat iron-rich food, or when you supplement use iron. This iron go into the body, and it's bound to a protein called ferritin. Ferritin basically bind the iron, and basically, it's sort of a storage iron that ready to be load into red blood cells in the form of hemoglobin.

Gil Blander:
It's allowed the body to build the hemoglobin, which is the molecule that they located on the red blood cells, and basically, carry the oxygen from the lungs to the muscle. I just mentioned three out of four out of around 10 blood biomarker that we're looking at. We developed an algorithm that based on the level of all of those markers, we are coming in telling you whether you have low iron or good iron, and then we are telling you, if you have low iron, what should you do in order to increase it. What kind of supplement, what kind of food, and what kind of lifestyle, and so on.

Melanie Avalon:
Okay. Some more iron questions. I think this is the first time that this is starting to make more sense to me. The iron, it's like the free iron, to the ferritin, to the hemoglobin, is the order that it goes in, it seems?

Gil Blander:
Correct. Yes, yes.

Melanie Avalon:
Is that why, because I actually had to get iron infusions, I got very, very anemic, is that why they said it takes a while for your hemoglobin to build up again because the iron has to go through that chain?

Gil Blander:
That's one reason. The other reason is what we discussed before about the hemoglobin A1c. The red blood cells are building every 90 days. Even if you ever high iron today, it might take up to 90 days until all of the red blood cells will have the hemoglobin with the enough hemoglobin because you add hemoglobin only when you produce the red blood cells.

Melanie Avalon:
Okay. That makes so much sense. Okay. Then iron binding capacity is my layman's interpretation, I'm probably completely off with this, but it seemed that it was the marker that is the blood cells asking for iron. Is that what it is? Because I know people who are anemics, oftentimes it'll go high.

Gil Blander:
Yeah. Yeah. Total Iron-Binding Capacity, we call it TIBC, is basically measure of the maximum amount or iron your way blood can carry. Basically, it's another marker that allow you to understand what happening with your iron in the body. Again, it's a bit more complex marker than the, let's say ferritin, or hemoglobin, or iron, or white blood cells. But it's also something that we are using in order to give you a better understanding of your iron.

Melanie Avalon:
Okay. Because I've been tracking my iron a lot recently, and I've noticed ever since, because everything was very low, severely low, and ever since building it back up again, my iron is dropping now, but my iron-binding capacity is going up. I'm just trying to figure out what's going on there. I've been, of course, working with a doctor on it, but it's just really nice to be able to take, I think, something that users of InsideTracker will find so helpful is the ability to look at these markers themselves, and then get the recommendations and interpretations as far as you can give them without diagnosing disease or anything like that. It's just it's very, very helpful and very freeing, and it's coming from a trusted source, which I think is so important. You get the interpretation from a third party source that's not the doctor system, so I think it can add a lot of clarity for a lot of people.

Melanie Avalon:
One other category you do test is inflammation markers. Do those very a lot with ... I'm guessing they do since you chose to include them. The reason I'm asking if they vary a lot is because mine are always normal. They're the one category that have always been normal, so I'm like, "Do they get out of range?" So they do. What type of issues lead to them being out of range?

Gil Blander:
The first one is being sick, and they can give you an example. I got tested a week ago, and I caught a cold at that time. But I said, "Okay, let's test. It will be cool to see what happening in my body, what my biomarker was saying about my sickness. Indeed, a molecule called HSCRP, which is High Sensitivity C-Reactive Protein, which should be pretty low. It should be below one unit, jump to six units. That was literally less than 10 days ago. I tested for that marker in the last maybe six or seven years, and it's have never been higher than 1.2, and suddenly jumped to six. Okay? I could see that, indeed, I'm sick.

Gil Blander:
Think about it, if you want to go to your ... If you are a student to your school, or if you are someone that walk in office to your manager and say, "Hey, I'm sick because my HSCRP is high." It's unbiased. Nobody can tell you that it's ... That's one thing. I also could see that my white blood cells was higher than ever before. Then you have what we are looking at, the other are a particle of the red blood cells. Some of them like lymphocytes are more like marker that showing whether you have a virus infection. Some other are more whether you have other kind of infection.

Gil Blander:
Now, the other reason that it can go up is overexercise. A lot of the time we see that people that exercise a lot have a higher level of those markers. Sometimes in stress, you can have a high level of inflammation. It's very interesting to see that in the past, there is a questionnaire that run every year in the US population, and in the last 20 years or so, it was always weight loss was the most important let's say pain point of the US population. In the last few years, it's changed significantly to stress. Everyone is trying to fight stress, and I think that is because the current society that we are hooked to, our iPhone, and iPad, and the iBook, and all of that, and we are online all the time, and we are seeing that our friend having a cooler life than us, and it's making us stressful. Stress also increase those markers, and that's why we are looking at it, and so important because there are so many things that can increase inflammation, and it's very important to look at it.

Melanie Avalon:
Okay. I do have one more follow up question about this, that I've actually been dying to ask somebody. This is an exciting moment for me. With CRP specifically, because I know ... Okay, so I have personally. Like I said, I mentioned in the beginning that I tested really high for heavy metals. Ever since that, and iron issues, and just some factors, and a lot of stress, I've been feeling intuitively very, and this is so vague, but very "inflamed", and I would always say, "I just feel very inflamed, like my body is reacting to everything." I know a lot of people experience, especially autoimmune conditions, or even people will say limbic system imbalances where they just feel like they're reacting to everything. 

Melanie Avalon:
Then I was always shocked because whenever I test my CRP, which is the "official marker of inflammation", it's always been very low. I'm like, "Oh, okay." CRP, does it relate more to inflammation, like you said in regards to viruses and actual infections? Well, you mentioned stress as well. I'm very interested by the connection of CRP to inflammation, and what affects it just because intuitively, I've felt off, and not not [uninflamed 00:46:06], but my CRP is always low. That's kind of a convoluted question. But I guess how accurate of a marker is CRP for?

Gil Blander:
CRP is a very good marker of general inflammation. There are some other markers, up to 70% of young women have low level of iron, interleukin is six and other. But what is nice about CRP, and the reason that we chose to look at hs-CRP is because it's not changing, not going up and down every second, or every minute, but it's can stay up up to a few days. It's a marker that it's much easier to measure when you are not testing your blood every second, or every hour, or every minute. That's the reason why we chose hs-CRP.

Gil Blander:
It's also a good marker for, let's say gut health. I know that again, that's another buzzword that a lot of people like to talk about, that they have a problem with digestion and all of that. I can give an example, people that have corn disease usually have a very high hs-CRP level. I think that is a very good marker for general information.

Melanie Avalon:
That is so fascinating. This is really makes me rethink things because it's so interesting about our perceptions of what we are, and then testing these actual biomarkers, and what they say, and what that might indicate, which actually brings me to a major question I want to ask you. This is more philosophical in nature. But what are your thoughts on people knowing their blood test results, and then how they react to them? For example, say somebody feels great, feels happy about everything, and then they realize a biomarker is off, and they fixate on that. Then they're worried about it, compared to somebody who, for example with me, I was worried about my CRP, but it's actually always been low. What do you feel about, and this might come more into play with genetic testing, which we can get to next, but what are your thoughts on the placebo effect, and even the nocebo effect, and how mindset plays into this as far as what we know about what our biomarkers are showing?

Gil Blander:
Yeah, so I think that knowledge is a power, and you can be an ignorant, and they come and say, "Hey, I don't want to know," and then you will catch the problem when it's big. It's much better to catch the problem which is pretty small and change a bit your behavior, or your nutrition, or your supplementation, or exercise regime, and then you all good. Then to come say, "Hey, let's wait," and then go to the physician, and then you will need to have a very strong intervention. I'm a big fan of let's know the issue when it's small, and adjust, and make it better. 

Gil Blander:
Exactly as the example that I gave about the car. You can either a take care of the car every 5,000 miles or drive it, drive it, drive it, and then be stuck on the highway in the middle of a snowstorm. It's your decision. You can do whatever you want. But I think that it's much, much better to react upon a small problem, especially with our body, which is the most important machine that we have. It's not like being in a computer game that you have a few life. You have only one life. Let's get the most of it, and then live it longer and better.

Melanie Avalon:
Awesome. I like that perspective a lot. Also like the liver testing, for example, ALT, AST. I think that's one of the few tests that people actually are pretty familiar with as far as the liver enzymes go. Historically, my liver enzymes are always ... we usually on the higher side, the past year, they've actually been in range, which has made me happy. Do some people though, have liver enzymes that are like five, the really low side of the range? I've just never experienced that, so I'm just wondering if that's actually a possibility.

Gil Blander:
Yeah, definitely. The liver enzyme, it's basically a marker of liver health because those enzyme located in the liver, and when the liver have some issues, some of the cells are basically destroyed, and the enzyme may leak into the bloodstream. There are a lot of reason that can make that. Some of them are issue of overweight, so some people that are overweight have this issue. Some people that are drinking too much alcohol have this issue. Some people that are consuming too much drugs, and drugs, I'm not talking about the drug that you buy from the drug dealer. It can be also a drug that you use as a painkiller that can basically make the liver working too hard, and basically challenge the liver. There are a lot of a different reason that the liver enzyme can be high.

Gil Blander:
That's one of the reason why we're looking at four of them. I can give you an example. When you have a, let's say, a high level of muscle damage due to overexercise, you can see the two of the liver enzyme ALT and AST are going off, but the GGT, which is another one, is not. Then it's easier for us to say, "Hey, it's most likely you have a issue with overexercise." Usually, we see in, on top of that, another marker that's called creatine kinase, which is a real marker of muscle damage because it's localized in the muscle. When the muscle erupt when you overexercise, it's going out to the bloodstream.

Gil Blander:
In other cases, you see all of them going together, and then you say, "Hey, it's a real liver damage that ... Then you need to try to understand, "Am I drinking too much alcohol? Am I taking too much drug? Am I eating too much fat?" Fat also can make that, because some of it, as you know, the metabolism of fat happening in the liver. There are so many reasons, and the liver is so important that we decided to dedicate four markers for the liver.

Melanie Avalon:
Okay. Now, I'm really fascinated by all this. GGT, it's just another enzyme similar to AST and ALT?

Gil Blander:
Exactly.

Melanie Avalon:
Why is it not affected?

Gil Blander:
Why is not affected by exercise-related damage?

Melanie Avalon:
Yeah.

Gil Blander:
One assumption is that ALT and AST are not only an enzyme that localized in the liver, but they are also localized in the muscle. That's why when you have a muscle damage, you'll see them going up. But that's just an assumption. But we definitely can see it, and we're also seeing some other peer-reviewed scientific publication that showing that.

Melanie Avalon:
In theory, could a person actually have a good functioning liver, but the ALT and AST are just mostly raised from overexercise. Is that a possibility, or is there always going to be some liver implications? I guess that's why you need the bigger picture, but ...

Gil Blander:
Yeah, yeah. No. I think that is a good point. But what is nice about muscle damage, it's usually transient. If you have high muscle damage, you can basically pause training for a week or two, and then test again, and then those markers should go down. If that's due to a muscle damage, it's pretty easy to challenge it and see whether it is or not.

Melanie Avalon:
Okay. Then what does the albumin indicate about the liver?

Gil Blander:
Albumin is actually the most abundant protein in the bloodstream. It's also a liver-related protein. What is interesting also about albumin, I don't want to go to nerdy, but albumin is also a carrier of testosterone. Testosterone is carried by a protein called SHBG, or Sex Hormone-Binding Globulin, which have a high affinity for testosterone. But also albumin is another carrier of testosterone, but which much lower affinity to it.

Melanie Avalon:
Okay, yeah. Now, I'm looking at that because you list the testosterone and the sex hormone-binding globulin under the strength and endurance category. This is so fascinating, listeners. You're going to have to get this services. So much to learn. I'm looking at my strength and endurance category, and for example, my testosterone and my sex hormone-binding globulin were optimized, but my cortisol was high, and my creatine kinase was, in reference for the range, but noted as not optimized by the interpretation.

Gil Blander:
Yeah, yeah. If we want to dive a bit deeper to that, so testosterone is an hormone that is also important for women. It's actually, I'll call anabolic hormone. Basically, it's building muscle. When testosterone is in the right level, it's allow you to build muscle, while cortisol, which is the stress hormone, it's actually breaking muscle. I really like to give the analogy of us in, I don't know, 50,000 years ago, running in the woods and a bear running after us. At that time to the cortisol is going high, and then that's allow us to climb on the tree and run away from the bear. But what it is doing, it's because of that, in order to allow us to do that, it's stopping everything and allowing the body to start breaking protein in order to use it for energy. That's why it's a catabolic and not enzyme hormone that allow us to break muscle or break protein. That's why when you have a high cortisol, it's very hard for you to build muscle.

Melanie Avalon:
That's very interesting. What might be indicated, like for me when I have high cortisol, above the optimal range of creatine kinase, but then normal testosterone and sex hormone-binding globulin?

Gil Blander:
It could that at first, because your creatine kinase is high, and again, I haven't looked at your account, so I cannot say. But if I will ask you about the liver enzymes. Do you have AST and ALT high or not?

Melanie Avalon:
I was so bummed. They were higher than they've been like even a week prior. But they were both, the ALT was in the reference range, but it was yellow in InsideTracker, so not optimal. Then the AST was slightly out of range, and it was red in InsideTracker.

Gil Blander:
You had a lot of a athletic activity in the recent week?

Melanie Avalon:
No, I don't do a concentrated, I just do like functional movements, so like lifting. I don't go to a gym and lift weights or anything, I just move around a lot and lift things during the day. But I don't do with gym weights.

Gil Blander:
Yeah. Yeah. Another thing that can significantly increase cortisol is the quality of rest or sleep. It could be that you can improve the cortisol based on better resting or better sleep. Actually, we are now in the process of readying the activity tracker or physiological marker, and we are looking at REM sleep, and deep sleep, and awake time, and all of that help us to understand even better the user. When I'm not only looking at the blood and DNA, but also having some physiological marker, and giving the user a recommendation, what should he do based on the data of the physiological marker in order to improve his sleep, or improve his resting heart rate, which is also very important. Hopefully, very soon you will have these service as well.

Melanie Avalon:
Do you ever see differences in the different labs, because I know you guys work with Quest Diagnostics, for example? Just because I've done so much blood test this year because of my anemia, so I've seen very, very definitive trends and everything. I was always using LabCorp for every single one, and then this was using Quest. Does that ever play a factor in the major lab that you're using, or should it not at all?

Gil Blander:
Yes, it is. I think within a lab, so let's say inside Quest or inside LabCorp, they should be pretty awkward, even so that each of them have like, I would say 10 to 20 different central lab that they are using, because they are running hundreds of thousands of tests today. The different shouldn't be more than 10% between the Lab X and Lab Y. But if you compare Quest to LabCorp, those changes might be even bigger. One reason for that is that they might use a different machine, or different technology. I can give you an example. Vitamin D and testosterone can be measured by ELISA, which is more like immunoassay, or they can measure by mass spectrometry. Those two different kind of measurement can change significantly the result.

Gil Blander:
Some other reason is like a different machine. One of them is from Point A and one of them is from Point B. I'll always recommend user, if you started with one lab, try to continue to use that lab, because there are some difference. Again, it shouldn't be like a 50% difference, but definitely, it can be 10 to 20% difference between one lab to each other, even if you go tested at the same day.

Melanie Avalon:
Okay, that's really interesting. Yeah, because what I was thinking was like in all my tests, some of the red blood cell markers have always been a little bit off every single time, and I probably tested, I don't even know how many times, like I said, because of the anemia. But on this one, they were all coming up in range. I found that really, really interesting. Iron stuff is all wonky. Just before, and we will move on to the genetic testing, but what is TS. Is that iron saturation?

Gil Blander:
Yeah, it stands Transferrin Saturation. Yeah. It's basically show how saturated the iron in your blood. The basically, a saturation mean that how much or how many molecule of oxygen it carry or can carry.

Melanie Avalon:
Okay, got you. I kept hinting, or we keep hinting at the genetic testing aspects. That is something else you guys offer, is a new genetic testing portion. I haven't tried it yet. How does that work with the whole platform?

Gil Blander:
Yeah. When a consumer thinking about genetic testing, they mostly think about ancestry, and basically saying, "Hey, I'm 50% from Spain, and 20% from Italy, and 5% from Ireland." But there is a lot of more data in the genetics that can help us to understand what is your potential. I'm looking at genetic testing as a potential, basically saying, "Hey, you have what happening inside your body today, and that's basically the blood, and then you have the potential, what can you do." I can give you my example, I have a high risk to have high cholesterol. It's very hard for me using a natural intervention to have my glucose as low as someone that doesn't have a high risk high glucose, also of high cholesterol.

Gil Blander:
What we have done, we build in a test, or it's called microarray. It's actually a very small tiny plate that have around 800,000 sequences, or it's called SNP, or Single Nucleotide Polymorphism, that basically can measure a lot of changes, small changes between you and what is expected for the population. Some changes making you better and some changes making you worse. For example, those SNP or Single Nucleotide Polymorphism can show whether you have high risk to have high glucose, or lower to have high glucose. It can also show whether you have a food sensitivity. It can show whether you are more endurance versus strengths.

Gil Blander:
There are a lot of different things that you can find, like are you sensitive to coffee? Are you a morning person, or afternoon person? There is a lot of information that you can get from doing those DNA testing that can allow us and InsideTracker to come and tell, "Hey, again, not only that you have high cholesterol, but also you have a predisposition to have high cholesterol. So it's not surprising that you have high cholesterol. But let's look at someone that have a high cholesterol, but his genetic showing that actually have low with high cholesterol. That's mean that it's more like the effect of his lifestyle that he have high cholesterol. He have a better chance to decrease his cholesterol than someone that have high risk to have high cholesterol.

Melanie Avalon:
How many tests would you say that you test for when people get the service?

Gil Blander:
Currently, we have on our microarray, we have 800,000 SNP. But we are currently using 260 of them to tell you whether you have high risk for high glucose or high cholesterol. We are adding now 1,000 more that will give us around 65 different view into your life, and I can give you a few example if you are interested. It's really exciting, and that are scientist that looking into that, what is your way potential for lean body mass? Are you a corner type? Are you a morning person or evening person? About sleep efficiency, sleep duration. A lot of the markers that I discussed before, whether you have high risk or low risk to have high glucose, high cholesterol, or high inflammation and so on.

Melanie Avalon:
Okay, I want that so much. I'm dying to try that out. Although that is something I think is earlier, I was asking about the placebo versus the nocebo effect, and I do wonder how much that comes into play with the genetics because I know they've done studies where they'll tell people, I don't know the specifics, but like an exercise, for example, they'll tell them that they're more likely to ... I think one of them was they're more likely to burn more calories or be more energetic. I don't know, that the exercise would be better for them. They found that the people, even though people all have the same genetic results, the people who thought they had better genes actually performed better. It does make me wonder about that.

Melanie Avalon:
Or the worrier versus the warrior gene. It's like the people who have the worrier tendency as in worrying, like over-analyzing, overstressing, maybe they would benefit from not knowing some of their genetic tendencies. I don't know. That's a whole nother aspect. But I do agree that information is power. But I do wonder how much the placebo effect, or mindset does come into play.

Gil Blander:
Yeah. But I think that in this case, the placebo effect might be good. Again, I can give you an example. Even in food sensitivity, let's say that you are nuts-intolerant or not intolerant, we found that your gene are telling us that you might be, or have a high risk to be nut-intolerant, that only mean that instead of having 1% chance to be nut-sensitive, you are 6%. Basically, yeah, it's six times more, but it's still only six out of 100 that have these genetics really cannot eat nuts. Okay? It's good to know. But it's again, good to understand that the genetic is not the old story. There are a lot of other that include the environment, and what happened inside your body.

Gil Blander:
What I'm trying to say, looking at the genetic alone is not good enough. You need to combine the genetic with the blood and the physiological marker, and look at your body in a holistic way instead of coming saying, "Hey, my genetics said that I'm nut-intolerant, and now I shouldn't eat nuts again." That's not always true.

Melanie Avalon:
I'm so glad you brought that up, because that actually really drives home why it would be so important, I think, to combine blood tests with the genetic testing, which I mean seems to be pretty groundbreaking. I don't know of any other companies that are doing this at the moment. Are you guys the forefront in that?

Gil Blander:
Yeah. It's actually our vision from day one. We're all trying to give a solution, a turnkey solution that looking at as much data as we can, and then give you the best interpretation, then the best recommendation. There are a lot of companies that looking at genetics. There are a few that looking at blood. They are a lot that looking at activity tracker. There are a lot now that looking at the microbiome. In our view, microbiome is not ready yet, but we are starting to look into that, and we'll add that as well. Then if you are have all that information going as an input, and based on that there is a smart algorithm that looking in all of that, and based on science, of course, and giving you the best interpretation that's saying, "Hey, you have this issue," and then giving you a few recommendation. That's the future of personalized wellness or personalized performance. 

Gil Blander:
I think that that's the future, and we see it around us. A lot of very interesting and big organizations that are coming to us and telling us, and again, I don't want to sound cocky, but they are coming to us and say, "This revolution of the person's nutrition is very similar to the revolution of the E-commerce that at beginning everyone say, "Hey," and nobody will go and buy. I don't know. Is the shelter online? You can go to the store, but now, almost everyone is doing that. The person's nutrition, based on what happened inside your body can be the next evolution. We are aiming and trying, and currently we consider to be the leader in this revolution. I think that that's something that will allow all of us, hopefully, to live a longer, better life.

Melanie Avalon:
That is amazing and so perfect because like I said, I have wondered so much about, A, how to properly interpret blood tests, B, the problems of knowing your genetic tendencies, but then what does that actually mean on a realistic level. Combining that all together, and then I just got really excited when you mentioned that gut microbiome aspect and the future. Listeners, now, this is great. I am loving all of this. Okay, few more quick questions. You did mention the food sensitivities. That's genetics, that's not going to be like IGG type things, right? That's going to be more, I thought, a tendency.

Gil Blander:
Yeah. The food sensitivity based on blood, I can ... I actually wrote a blog about it like two years ago, because we have those question again and again, and everyone asking us, "Why aren't you testing for food sensitivity?" We feel like looking at IGG and IGA is giving you some information, but it's not very accurate. there is a big difference between a food allergy, meaning that you really, when you eat a specific food, you're willing a risk of becoming sick or even die. Then the food allergy that a lot of it is might be the placebo effect, as you said before, and those tests are not always inclusive. We found that we want give a good value for the user to test of those test. Very similar to testing for way the thyroid hormones, that yeah, we can test it, but then what is the value that will give you. So we decided not to include it in our service. I'm not saying that it's bad to do that. Nothing is bad if ... But I'm not sure that it will give you a lot of fun.

Melanie Avalon:
Okay. But you did mention it for the genetic side of things. So there are genetic tendencies towards food intolerances?

Gil Blander:
Yes. Yes. There are several SNPs, or Single Nucleotide Polymorphism code that we are already using, and looking at for sensitivity, gluten intolerance, nut intolerance and so on. Again, I want to caution everyone that even if you have that, that means that you have a high risk, but it's increase your risk from something like 1% to 5%. Even the genetic doesn't say that you are 100% have the sensitivity, just saying that you have a higher chance to have the sensitivity.

Melanie Avalon:
Okay. Yeah, I think for example, I think one example that people are actually pretty familiar with now, where I think it got a little bit overemphasized with something like MTHFR where people thought that if they have MTHFR, they're just this terrible situation. But in reality, I believe most people have some form of ... Not most, but more, rather than less have some form of MTHFR, one of the SNPs.

Gil Blander:
Yeah.

Melanie Avalon:
I feel like these few genetic ones get highlighted, and painted to be like the whole picture of our entire genome and epigenome, which is arguably more important. Not more important, but just as influential in the genome. I just think it's so important to have a more comprehensive, intellectual, and view, and interpretation of everything, which it sounds like you guys can provide. That's awesome.

Gil Blander:
Yes, go on.

Melanie Avalon:
All right, so people use InsideTracker. It does provide recommendations for dietary and lifestyle changes. How fast can a person, after adopting these changes, how fast would they likely see change? Is it recommended that they retest to see how things are going in the future? How does that work?

Gil Blander:
Yeah, I think that it's a very good question. Some markers can change pretty fast. For example, if you have low vitamin B12 or for low vitamin D, and you supplement with that, within a few weeks, you can see a nice effect, while when your glucose is high, there is no an easy solution there. You need to work hard, change your nutrition, and change your diet, change your lifestyle. That might take longer.

Gil Blander:
What we do is when you work on a specific conditional domain, we are recommending you usually four to six different intervention, and based on the intervention that you choose, based on the time span that the study that our recommendation is supported by, we calculate what is the length of time that you need to follow this intervention in order to see result, and then we'll recommend you to test again to be sure that it worked because again, our body's so complex that it's not always working. As you mentioned before about your iron level, it's not easy sometimes to some people because our machine is very complex, and we don't 100% understand it.

Melanie Avalon:
Okay. Then you also do offer the option for users to upload their own data.

Gil Blander:
Yes. Correct.

Melanie Avalon:
How does that work with the system?

Gil Blander:
Yes. We strongly believe that the more the merrier. Sounds like you have a lot of data. By any means upload all of it. We have a solution that we build that called OCR that basically, you upload the PDF file, and we have a software that extract the marker and the numbers, and they upload it into our server. Then it will allow us to understand you better because when you have one blood test, you have one point. When you have two blood test or two set of blood test, you have two points. When you have more than two, you started to see the trend. 

Gil Blander:
We really like to see the trend is important for us. But it's also important for you to see whether for example, the example that I gave you before about my inflammation, I never seen my hs-CRP so high because I never been tested when I was sick. Now, when I have, I don't know, 25 or 30 time-point of data, it's good for me to start playing with that and say, "Hey, what happen when I'm sick? What happen when I'm after fasting? What happened when, I don't know, I haven't slept for four days? I think that the more data that you have, you start to understand your body better. You see the trend, and suddenly you can see, "Hey, even so that my marker is still in the normal optimal zone, it started to creep into the higher, and I should be careful about it."

Melanie Avalon:
Okay, I'm going to be uploading so much data. This is exciting. It's like Christmas all over again. Also, you do have the InnerAge feature. Would you like to tell listeners briefly about that feature?

Gil Blander:
Yeah, definitely. The InnerAge is actually something that I done together with David Sinclair and Lenny Guarente. It's something that we developed in 2015, and we worked on it for a couple of years. The idea was to give our user a reading of some estimation of what is their biological age based on five key blood biomarkers and a few physiological markers that are related to longevity. I think that we, Melanie, we'd already discussed a few of them during our discussion. Definitely, glucose is a very important marker for longevity. We discuss HSCRP be deeply, we discuss ALT, which is a liver enzyme. We have there a couple of more markers, vitamin D and testosterone for males, and DHEAS, which is a precursos of a female hormone.

Gil Blander:
All of them, we looked at them, and then we see whether your number making you older or younger, and then we combine all the data together, and coming with a number that called InnerAge, and we compare it to your chronological age. The meaning of that is less to come and say, "Hey, again, your age, your chronological age is X, and your InnerAge is X plus five," but more to come and give you a kick in the behind and telling you, "Hey Gil, your InnerAge is older than your chronological age. Work harder in order to make it younger, and by doing that, you have a better chance of fully to live a longer, better life, or don't be sick in the future."

Gil Blander:
It's a way to give you a warning, and having one number instead of looking at all the 45 markers and be confused. That's a way to give you one number that will allow you to understand better what is going on with you.

Melanie Avalon:
Got you. I find I'm really fascinated by the ones that you chose. It adds a very comprehensive picture, so like the blood glucose, the vitamin D shows how important that is. The CRP for the inflammation, the ALT and the DHEAS, as well as the Body Mass Index in your activity. I love it so much. Then something also for listeners that's really cool is InsideTracker will recommend very specific foods and changes that you can make. It's a very, very cool system. Just two more questions before we go. With your own personal, I mean, you've done so much work with all of this. How does this manifest in your own personal life? Your personal diet and lifestyle, have you made a lot of changes based on your own findings with your own blood work? What have you seen with that?

Gil Blander:
Yeah, I think that is a great question. Actually, I strongly believe that the creator of a platform should they be a super user of the platform. I'm a definitely a super user, and I'm trying to get tested at least four times a year. Every time I adjust my recommendation accordingly. One thing that I adopted maybe a few years ago based on my result was to start to do intermittent fasting, which as much as I remember from listening to you, you're doing it as well. I'm doing it for the last two years, and I think that it's a appointing easy intervention that if you get into the routine, it's pretty easy to maintain.

Gil Blander:
There are more and more publication that show that there are a lot of benefit of intermittent fasting. Is it for your biomarker, but also for your blood pressure? Some are even saying prevent cancer. Again, we're not getting into that. Intermittent fasting is one of the intervention that I had had. Another one that is very interesting is I have high glucose. Again, not out of the normal, but not optimal, also high cholesterol as I mentioned before. A fiber is a very good way to decrease the cholesterol and the glucose, and InsideTracker recommend me to eat beans. I really didn't like beans. Literally, I couldn't stand beans at all. But because I understood that beans are my focus for the super food, I started to eat them, and now I'm enjoying more and more beans. 

Gil Blander:
It's very interesting that I go to a new kind of food based on my InsideTracker recommendation. I just want to give you an anecdote. If you look at the USDA catalog of foods, there are more than 8,000 different food items that are available for us in the catalog. When you look at the average American in an average week, we consume only 20 of those. Basically, we are using a very small portion of a huge universe of foods that we can consume. What in InsideTracker is doing is introducing you to your super food that you should eat in order to improve your level. 

Gil Blander:
Another super food that I'm eating more and more are berries, again, because of the fiber. Another one is avocado that I really ate, and I still don't like it too much, but I'm eating it because it's a good for my HDL. I may also, based on currently, the high inflammation, I'm trying to practice more yoga and doing some meditation. Sometimes I'm introducing swimming to, again, decrease my inflammation. Every time I'm introducing a different intervention. Sometimes I'm also adding some supplementation, even so that it's not as pure food, but it's easier and more concentrated, so I'm currently consuming vitamin D supplementation. I'm consuming some probiotics, and now because of the high inflammation, I started to consume some magnesium, which is also good for my sleep, by the way. That's what I'm doing currently, but every time that I'm getting tested, I'm changing my intervention based on the recommendations.

Melanie Avalon:
Wow. You said so when they identify the five foods that it recommends for you, that's out of 8,000?

Gil Blander:
Yes.

Melanie Avalon:
Did you say 8,000 potential ones that InsideTracker could potentially recommend?

Gil Blander:
Yeah, yes.

Melanie Avalon:
Oh, wow. Wow, that's impressive. I love that. Then just speaking to I love that you are actually using the system yourself. I think that's so telling. It's nowhere near the aptitude of this, but I developed an app for the iPhone called Food Sense Guide, and it catalogs like eight different potentially problematic compounds and foods, like histamine and glutamates, and FODMAPs and lectins, and things like that. I just created it because I needed it for myself. I think that's, like you said, is such a mark of the intention behind the company, and when it is serving, when the person creates it out of the need, because they need that product themselves, or they want the services that it can provide. That's awesome.

Melanie Avalon:
So grateful for your company, which brings me to my last question that I ask every single guest on this podcast. It's just because I've realized how important mindset is when it comes all of this, just health and longevity and everything. What is something that you're grateful for?

Gil Blander:
Yeah. That's, again, a great question. I'm grateful for all the people that helped me to build this company. I want to say that it's not easy to start and build something from scratch. I'm sure that you have seen it with what you build. It's take a village to build something, and so I want to start with my wife that actually stick with me in all the hard time, and you have a lot of hard time when you are starting company, and we're doing it for 11 years. Before that, when she spent a lot of time with me as a postdoc and postgraduate student, so I really appreciate the support and patient.

Gil Blander:
I also grateful for my kids that actually competed with another son that I have my company, so also it's very nice from them to be patient and support me. My parents that believe in me and basically also were the first investor in the company when nobody else was willing to invest, they invested in the company. Definitely, my team. We have now a pretty big team. We have more than 50 team member in InsideTracker, so I really grateful for them and the amazing job that they're doing. Definitely, the investor and advisors. I want to say that we have a great day scientific advisors such as David Sinclair, Lenny Guarente. They are the key and maybe one of the best in the aging research. But also we have a key scientist in the nutrition domain and exercise physiology such as Roger Fielding and Jeff Blumberg from Tufts University and many more. I think that they are helping us all the time to shape and make the company better and serve better our customers.

Melanie Avalon:
Well, that's a fantastic team right there. Yeah, ever since I interviewed David Sinclair on this podcast and got connected to you guys, I was just like, "Wow, this is amazing." I'm so grateful for what you're doing. I think it really is the future of where we should be headed with the biohacking world, the blood test, the genetics, and then how that all relates to longevity, and really providing clarity, and putting responsibility and power in the individual's hands. I cannot thank you enough for what you're doing.

Melanie Avalon:
Super grateful that you guys are also offering our audience a amazing discount. If you use the code MELANIEAVALON at InsideTracker.com, you can get 20% off of any service, excluding the new DNA service, but anything else 20% off, so that's amazing, so thank you so much for that. Again for listeners, the show notes for today's episode where I'll put links to everything as well will be at melanieavalon.com/InsideTracker. Thank you so much, Gil. This conversation, I learned so much, so many things I've been dying to understand, and I was already obsessed with the company and what you're doing, but now I'm even more obsessed. I'm going to go add in all my other blood results, I want to try that DNA testing. Yeah, you've got me hooked. Thank you so much.

Gil Blander:
Thank you. It was a lot of fun.

Melanie Avalon:
Awesome. Well, hopefully, I will talk to you again in the future, and I wish you the best.

Gil Blander:
Thank you. Bye.

Melanie Avalon:
Bye.

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