Eleven years of a low ferritin despite supplementation before his team did an endoscopic work up. Sounds like he needs a new team, which is further supported by the proposed unproven potential treatments.
Unsure whether I understand the situation correctly here.
Did Bryan try to turn his team's incompetence into yet another accusation of traditional medicine even though it was the latter that demonstrated the former?
Longevity is fool's gold, by the way. It's not about living longer, but about living better. I mean really, what good could a 48-year old possibly do with 3h8m of nightly erection?
It's the same mistake cardiologists make, by the way: treating the values of adolescents as prime targets for all age groups
In order to be seen as the one with the answers he has to make the current systems appear especially flawed. That's easy enough for many as most have been disappointed in some way. A little better understanding helps ease the disappointment and avoid some of the Bryans out there.
He has a team required to manage his health. Does each person on that team also need a team? It sounds like an unsustainable pyramid scheme.
Thank you for this. A very interesting reflection and a nice support and applause for traditional medicine. I think your piece also raises an interesting point about medical training and education. You frame his case, or give a “problem representation,” which for the trained clinician (or even clinical trainee that I am) triggers pattern recognition that nearly unconsciously leads to a differential diagnosis and workup that likely would have made the same diagnosis. In a world of AI, I get concerned that the prompt for this case would not have necessarily included a history of autoimmune disease and might have gone down a different path. In my mind, the language fluency is the ability to hear those lab values/demographic data and PMH and present it in a way that is medically meaningful. That problem representation will likely not be the one that catches attention as a headline, it will almost definitely be the one that leads to the appropriate diagnosis. As I continue to ponder the role of medical education in a world of AI (something I do for now as only a hobby without any official role or capacity) we must continue to emphasize the importance of gaining that language fluency and ability to synthesize information into a meaningful problem representation
I think that the purpose and role of medical education is changing rapidly with AI. Teaching residents to speak the language of medicine fluently is a major priority of the way I teach, but I think everyone in medical education needs to be really thinking hard about what it is that we are *supposed* to be doing in the contemporary era
Unfortunately too many of the AI tools being rolled out in medical education aren’t helpful or are actively harmful, imo
I was an IM resident in the 20th century. For Johnson to suggest that EGD with biopsy in the work up of Fe deficiency is cutting-edge anything, is quite comical.
As you note, “longevity” is long on mechanistic theories/biologic plausibility, and short/non-existent on outcome evidence (or really any sort of evidence).
He knows a lot of the vocabulary of medicine but he doesn't speak the language fluently. And I truly wonder if anyone on his team does. For some reason, the doctors who chose to work in longevity tend to self-select for people who aren't necessarily the most experienced with clinical reasoning
Your articles teach me how good “doctoring” is about evaluating the whole patient. It isn’t only book learning or looking at the labs and imaging. I think that is what smart lay people get wrong. We can’t learn medicine by studying up on one disease process. As one commenter said, study your disease process so you can kinda/sorta evaluate the quality of your physician and also ask valuable questions.
The June 29 New Yorker has a piece on longevity science that raises similar concerns, but doesn't capture a key point as well as you do: knowledge of medicine (e.g., the diagnostic process) isn't quite the same as understanding it.
I basically agree with all of that perspective but the “eat your ice cream” framing irritates me because it takes a finding from nutritional epidemiology and pretends it’s scientific
Great post! I would only argue that longevity has more than one”Bryan Johnson” facets and some are more scientifically driven turning longevity into what in fact is preventive medicine than just longer lifespan at any cost.
But as I work in obesity and metabolic diseases space, the gap between knowledge, critical thinking and patients’/consumers’ perspectives is wide and sometimes it feels it gets wider the more evidence is produced.
Brian’s article states that it was his new team of doctors aligned with his longevity goals who decided to finally do a GI workup for his low ferritin. Why his previous team didn’t is hard to understand.
Several years ago while I was following a vegan diet I noticed that a pre-op hemoglobin was lower than my usual baseline, although it was still in the normal range. When I saw my PC physician a couple of months later I requested a serum ferritin in addition to a full CBC. The ferritin was low, and my RBC count had decreased to just below normal, and my MCV, which was usually slightly high, was down into the upper normal range. I had fairly recently had a colonoscopy for another issue, but I immediately was referred back to GI for an upper endoscopy, which was diagnostic for H. Pylori gastritis. To me this was quite straightforward. It also confirmed what others have described, that one shouldn’t ignore trends away from a patient’s usual baseline lab results, even though they may not be out of the “normal” range. However, after my hemoglobin increased and my MCV trended back up to a more typical 103, my physician was concerned and recommended checking folate and B12 levels, apparently forgetting that mild macrocytosis is “normal” for me. It is not due to alcohol intake, by the way.
Speaking as a patient, I think part of what this gets to is the patient's level of confidence in their doctor(s). I admit to much self-diagnosis and intense research when I was diagnosed with CAD nine years ago, and I rationalize it with a lack of confidence in my first cardiologist and the surgeon he sent me to (recommended for quadruple bypass but wouldn't answer any questions, "just leave it to me"). I was fortunate to discover Dr. Esselstyn and then Dr. Ornish and completed both of their programs (in person) at the time and achieved excellent results. But I also may have missed the opportunity to stent my LAD, which was 90-95% blocked nine years ago and was not stented at that time (nor offered), and is now 100% blocked (no heart attack) and cannot safely be opened up by drilling through the calcified rock (cardiologist tried three different ways with the laser). So I am living off collaterals to feed the LAD. Fortunately my new cardiologist (previous one retired) is a rock star and I have complete confidence in him; he placed four stents in May and opened up the right artery somewhat which the surgeon nine years ago said he could do nothing for because it was "gone." Through all of this I have learned the value of finding a doctor(s) you trust, the miracle of the amazing body God gave us and it's power to heal if given a chance, and to learn as much as you can about your condition/health so you can ask good questions and be an active advocate for your own good health. And all leavened by the acceptance that we are not permanent on this earth and to live as good, productive, and fun a life as you can.
I’m not comfortable giving out names on social media but my cardiologist was referred to me by my wife’s cardiologist. It was important to me to find someone that would listen to me and explain things to me and answer my questions. Also important was someone who is on the younger side and stays up with the latest. An example is my cardiologist put me on 5mg rosuvastatin and 10mg ezetimibe instead of a 20 or 40mg statin (which I was unable to tolerate previously) and then after placing the stents switched me to Leqvio (PCSK9 inhibitor) and Prasugrel (blood thinner). I am 100% plant based so my cholesterol markers are already good. The goal is LDL-C in the 30’s or 40’s and ApoB low also. I have high LP(a) so it’s important my cholesterol numbers are excellent and inflammation is very low (it is). All that is to say find a cardiologist like Dr. Katz who is up on the latest and will individualize your treatment with you even if you have to go through several to get there. I won’t tell you it’s easy to find a doctor like that but do it anyway. It’s your health.
A thoughtful perspective, bridging longevity and medicine will require both curiosity for new ideas and respect for the lessons that evidence has taught us.
Curious about your patient population? Are they affluent normal BMI worried well? Obese working class folk? A mix? Average age? What wearables are they using? Excellent article!
Huge mix. I have my biggest clinical focus post stroke secondary prevention, but also see a mix of other cardiology - primary/primordial prevention, afib, hypertension, significant cad, heart failure, shortness of breath, chest pain, palpitations.
Eleven years of a low ferritin despite supplementation before his team did an endoscopic work up. Sounds like he needs a new team, which is further supported by the proposed unproven potential treatments.
I was thinking the same thing. And wondering how he picked his team.
What longevity doesn’t understand about life – that’s what the title should be.
It’s on me that I didn’t A/B test those two options
The "life-extension" gambit has created a lucrative opportunity for all kinds of scammers, including some with medical degrees.
Unsure whether I understand the situation correctly here.
Did Bryan try to turn his team's incompetence into yet another accusation of traditional medicine even though it was the latter that demonstrated the former?
Longevity is fool's gold, by the way. It's not about living longer, but about living better. I mean really, what good could a 48-year old possibly do with 3h8m of nightly erection?
It's the same mistake cardiologists make, by the way: treating the values of adolescents as prime targets for all age groups
Medicine isn't perfect either. I don't really know the mechanics of what happens on his team
In order to be seen as the one with the answers he has to make the current systems appear especially flawed. That's easy enough for many as most have been disappointed in some way. A little better understanding helps ease the disappointment and avoid some of the Bryans out there.
He has a team required to manage his health. Does each person on that team also need a team? It sounds like an unsustainable pyramid scheme.
Thank you for this. A very interesting reflection and a nice support and applause for traditional medicine. I think your piece also raises an interesting point about medical training and education. You frame his case, or give a “problem representation,” which for the trained clinician (or even clinical trainee that I am) triggers pattern recognition that nearly unconsciously leads to a differential diagnosis and workup that likely would have made the same diagnosis. In a world of AI, I get concerned that the prompt for this case would not have necessarily included a history of autoimmune disease and might have gone down a different path. In my mind, the language fluency is the ability to hear those lab values/demographic data and PMH and present it in a way that is medically meaningful. That problem representation will likely not be the one that catches attention as a headline, it will almost definitely be the one that leads to the appropriate diagnosis. As I continue to ponder the role of medical education in a world of AI (something I do for now as only a hobby without any official role or capacity) we must continue to emphasize the importance of gaining that language fluency and ability to synthesize information into a meaningful problem representation
I think that the purpose and role of medical education is changing rapidly with AI. Teaching residents to speak the language of medicine fluently is a major priority of the way I teach, but I think everyone in medical education needs to be really thinking hard about what it is that we are *supposed* to be doing in the contemporary era
Unfortunately too many of the AI tools being rolled out in medical education aren’t helpful or are actively harmful, imo
I was an IM resident in the 20th century. For Johnson to suggest that EGD with biopsy in the work up of Fe deficiency is cutting-edge anything, is quite comical.
As you note, “longevity” is long on mechanistic theories/biologic plausibility, and short/non-existent on outcome evidence (or really any sort of evidence).
He knows a lot of the vocabulary of medicine but he doesn't speak the language fluently. And I truly wonder if anyone on his team does. For some reason, the doctors who chose to work in longevity tend to self-select for people who aren't necessarily the most experienced with clinical reasoning
Your articles teach me how good “doctoring” is about evaluating the whole patient. It isn’t only book learning or looking at the labs and imaging. I think that is what smart lay people get wrong. We can’t learn medicine by studying up on one disease process. As one commenter said, study your disease process so you can kinda/sorta evaluate the quality of your physician and also ask valuable questions.
Thank you!
The June 29 New Yorker has a piece on longevity science that raises similar concerns, but doesn't capture a key point as well as you do: knowledge of medicine (e.g., the diagnostic process) isn't quite the same as understanding it.
https://www.newyorker.com/magazine/2026/07/06/morbid-saul-justin-newman-book-review-eat-your-ice-cream-ezekiel-j-emanuel#rid=6c704c81-aa61-440d-a536-8f378a6c2398&q=longevity
I basically agree with all of that perspective but the “eat your ice cream” framing irritates me because it takes a finding from nutritional epidemiology and pretends it’s scientific
Nice article. I completely agree. My guess is a smart, thoughtful internist is missing from his team.
Appreciate those comments. Thank you!
Great post! I would only argue that longevity has more than one”Bryan Johnson” facets and some are more scientifically driven turning longevity into what in fact is preventive medicine than just longer lifespan at any cost.
But as I work in obesity and metabolic diseases space, the gap between knowledge, critical thinking and patients’/consumers’ perspectives is wide and sometimes it feels it gets wider the more evidence is produced.
Thank you!
Brian’s article states that it was his new team of doctors aligned with his longevity goals who decided to finally do a GI workup for his low ferritin. Why his previous team didn’t is hard to understand.
Several years ago while I was following a vegan diet I noticed that a pre-op hemoglobin was lower than my usual baseline, although it was still in the normal range. When I saw my PC physician a couple of months later I requested a serum ferritin in addition to a full CBC. The ferritin was low, and my RBC count had decreased to just below normal, and my MCV, which was usually slightly high, was down into the upper normal range. I had fairly recently had a colonoscopy for another issue, but I immediately was referred back to GI for an upper endoscopy, which was diagnostic for H. Pylori gastritis. To me this was quite straightforward. It also confirmed what others have described, that one shouldn’t ignore trends away from a patient’s usual baseline lab results, even though they may not be out of the “normal” range. However, after my hemoglobin increased and my MCV trended back up to a more typical 103, my physician was concerned and recommended checking folate and B12 levels, apparently forgetting that mild macrocytosis is “normal” for me. It is not due to alcohol intake, by the way.
Speaking as a patient, I think part of what this gets to is the patient's level of confidence in their doctor(s). I admit to much self-diagnosis and intense research when I was diagnosed with CAD nine years ago, and I rationalize it with a lack of confidence in my first cardiologist and the surgeon he sent me to (recommended for quadruple bypass but wouldn't answer any questions, "just leave it to me"). I was fortunate to discover Dr. Esselstyn and then Dr. Ornish and completed both of their programs (in person) at the time and achieved excellent results. But I also may have missed the opportunity to stent my LAD, which was 90-95% blocked nine years ago and was not stented at that time (nor offered), and is now 100% blocked (no heart attack) and cannot safely be opened up by drilling through the calcified rock (cardiologist tried three different ways with the laser). So I am living off collaterals to feed the LAD. Fortunately my new cardiologist (previous one retired) is a rock star and I have complete confidence in him; he placed four stents in May and opened up the right artery somewhat which the surgeon nine years ago said he could do nothing for because it was "gone." Through all of this I have learned the value of finding a doctor(s) you trust, the miracle of the amazing body God gave us and it's power to heal if given a chance, and to learn as much as you can about your condition/health so you can ask good questions and be an active advocate for your own good health. And all leavened by the acceptance that we are not permanent on this earth and to live as good, productive, and fun a life as you can.
Who is your rockstar cardiologist?
I’m not comfortable giving out names on social media but my cardiologist was referred to me by my wife’s cardiologist. It was important to me to find someone that would listen to me and explain things to me and answer my questions. Also important was someone who is on the younger side and stays up with the latest. An example is my cardiologist put me on 5mg rosuvastatin and 10mg ezetimibe instead of a 20 or 40mg statin (which I was unable to tolerate previously) and then after placing the stents switched me to Leqvio (PCSK9 inhibitor) and Prasugrel (blood thinner). I am 100% plant based so my cholesterol markers are already good. The goal is LDL-C in the 30’s or 40’s and ApoB low also. I have high LP(a) so it’s important my cholesterol numbers are excellent and inflammation is very low (it is). All that is to say find a cardiologist like Dr. Katz who is up on the latest and will individualize your treatment with you even if you have to go through several to get there. I won’t tell you it’s easy to find a doctor like that but do it anyway. It’s your health.
A thoughtful perspective, bridging longevity and medicine will require both curiosity for new ideas and respect for the lessons that evidence has taught us.
thank you! I am still not sure if medicine and longevity are in the same field or not. the question of bridging is not one i have an answer to
Great piece.
Thank you!
Curious about your patient population? Are they affluent normal BMI worried well? Obese working class folk? A mix? Average age? What wearables are they using? Excellent article!
Huge mix. I have my biggest clinical focus post stroke secondary prevention, but also see a mix of other cardiology - primary/primordial prevention, afib, hypertension, significant cad, heart failure, shortness of breath, chest pain, palpitations.
Every type of insurance including medicaid
The full Monty! Curious the age of your secondary stroke prevention cohort? If you were to take a guess?
Big range - some are very young, some over 80