Two Doctors Walk Through the Blood Panel They Actually Use — and the 4 Pillars Behind It
Matt Kaeberlein sits down with Dr. Nicole Burn and Dr. Kevin White to open up the diagnostic playbook they use with clients: the four pillars — eat, move, sleep, connect — and then the blood panel itself, marker by marker. The recurring theme is that no single number tells the story; fasting insulin, ApoB and Lp(a) are the ones they look at first, and the picture only forms when the markers line up together.
Overview
The conversation opens with a story that frames the whole episode: an active woman in her eighties arrives at the hospital after a large stroke, carrying two pages of supplements prescribed by a longevity practitioner whose stated goal was to make her labs look like a 25-year-old's. As Dr. Burn puts it, a 25-year-old is optimized to have babies, not for healthspan. From there the three walk through the four pillars used at Optispan. Eat means whole unprocessed food first, roughly 0.7 to 1 gram of protein per pound of ideal body weight, and far more fiber than most people get.
Move is built on consistency above all, with lean muscle described as the currency of aging, VO2 max as one of the strongest correlates of mortality, and balance work added for older clients. Sleep is largely about the evening routine — screens, news, and alcohol — and both doctors describe wearables changing their own behaviour. Connect covers relationships, contribution, and a reframing approach to stress, which they argue is not something to manage but something to build a better relationship with.
The second half is a marker-by-marker walk through the panel: ApoB and Lp(a) first, then C-peptide, hs-CRP, HbA1c, fasting insulin and glucose, the NMR lipid profile, omega index, liver and kidney panels including cystatin C, ferritin and iron, B12, magnesium and vitamin D. They close with heavy metals, blood-based cancer screening, why they stopped ordering direct-to-consumer biological age tests, how they weigh genetic risk scores, and a long, candid segment on hormone therapy in men and women.
Key quotes
5Why does someone think a 25-year-old is optimized for health span? They're optimized to have babies.
If you eat something, you can't unsee that glucose spike.
I think of lean muscle as kind of the currency of aging. It's like money in the bank for a rainy day.
Most people should have fasting insulin measured. That's got to be one of the most important.
There's no single magic bullet. It's what you eat, how you're moving, how you're sleeping, your connection to others.
Key ideas
9A 25-year-old's labs are not the target
Chasing the biomarker profile of a 25-year-old is one of the most common patterns in the longevity world, and both doctors push back on it. A young body is optimized for reproduction, not for the healthspan of someone decades older.
Protein and fiber are the two levers most people miss
The guidance discussed is roughly 0.7 to 1 gram of protein per pound of ideal body weight, with leucine-rich sources, plus 25 to 30 grams of fiber for women and 30 to 35 for men as a minimum. A single large salad at lunch does not cover the day.
A glucose monitor is a teaching device with an expiry date
The four-week structure described is two weeks eating normally, then two weeks of self-experiments — swapping white bread for whole grain, cooling and reheating rice. Wearing one continuously is discouraged because it can create its own stress.
Muscle is the currency of aging, and balance is underrated
Lean muscle is framed as stored resilience for illness and emergencies, tracked with DEXA. Beyond cardio and resistance work, the doctors emphasise balance training for older clients, since a broken hip carries very high mortality.
The evening routine decides the next day
Both describe screens, work, and emotionally charged content late at night as the main sleep disruptors, with alcohol after dinner as the most consistent offender. What works differs by person — one falls asleep reading, the other has no trouble with screens at all.
Stress is not something to manage but to relate to differently
Dr. Burn describes cognitive reframing as a core tool in the connect pillar: reading a short email reply as dismissal versus reading it as a busy person acknowledging receipt. Stress woven through all four pillars is why it isn't a fifth pillar.
ApoB and Lp(a) get read first, but never alone
ApoB counts the atherogenic particles rather than weighing the cholesterol, with a target discussed around 60 to 80. Context matters: a high ApoB with zero plaque on imaging reads very differently from a lower number with significant stenosis.
Fasting insulin moves years before HbA1c does
The body raises insulin to hold glucose steady long before the three-month average shifts, so a normal HbA1c with a fasting insulin of 20 is a warning rather than an all-clear. Paired with fasting glucose it also allows a HOMA-IR calculation.
Direct-to-consumer biological age tests were dropped
They stopped ordering them because results are variable and non-actionable. Kaeberlein describes the multiple-testing trap: when a report returns thirty findings, the four that match your expectations feel like validation while the twenty-six that don't get ignored.
Practical takeaways
7- 1
Anchor the first meal of the day 17:30
A high-protein, lower-carbohydrate first meal is described as setting the metabolic tone for the rest of the day, whatever time you eat it.
- 2
Use a glucose monitor in a short, structured block 23:40
Two weeks of eating normally to see your baseline, then two weeks of deliberate swaps, gives most of the learning without turning the device into a source of anxiety.
- 3
Consistency beats the optimal programme 34:00
The best exercise is the one you will actually keep doing, and the largest jump in benefit is from doing nothing to doing something. Around 150 minutes a week of zone 2 is the working reference point.
- 4
Move the anxious input away from bedtime 44:00
News, work, and emotionally charged content late in the evening are the specific culprits named, and alcohol after dinner shows up reliably on sleep tracking.
- 5
Ask for fasting insulin alongside glucose 1:01:30
It is the marker both physicians say is most often missing from a standard panel, and it opens a window to course-correct years earlier.
- 6
Read ferritin in two directions 1:09:00
Below 30 it is nearly always iron deficiency; at 400 to 600 it tells you little about iron stores and points instead towards inflammation worth investigating.
- 7
Ask about cystatin C if you carry muscle 1:12:30
Estimated filtration rate is calculated from creatinine, so high muscle mass or a high-protein diet can make kidney function look worse than it is.
Topics & chapters
15Cold open: the spike you can't unsee
Clips on glucose monitoring, a homemade vegetable soup that pushed one doctor to 160, and what annoys them about the longevity community.
Two paths into healthspan medicine
Dr. Kevin White from emergency medicine and trauma, Dr. Nicole Burn from hospital medicine and a dermatologist father who prescribed lifestyle.
The patient with a 25-year-old's lab goals
An active woman in her eighties arrives with a large stroke and two pages of supplements, prescribed to make her labs look decades younger.
Lifespan, healthspan, and reverse engineering
Healthspan as the proportion of life spent healthy, and the practice of starting every plan from where someone wants to be in their eighties.
Pillar one: eat
Whole unprocessed food, protein targets by ideal body weight, leucine-rich sources, and the fiber gap most people don't realise they have.
Continuous glucose monitoring as education
The four-week structure, N-of-one experiments, and why a single spike isn't the problem — repeated spikes across the day are.
Pillar two: move
Consistency first, lean muscle as the currency of aging, DEXA tracking, VO2 max testing including a resting estimate, and balance work.
Pillar three: sleep
The evening routine, screens and news, alcohol's reliable effect on sleep scores, breathing exercises, and the after-dinner walk.
Pillar four: connect
Community, contribution, and new relationships as drivers of neuroplasticity — plus why this pillar resists quantification.
Stress: relationship, not management
Cognitive reframing with patients, why stress weaves through all four pillars rather than becoming a fifth, and its useful side.
ApoB, Lp(a) and the lipid picture
Particle counts versus cholesterol weight, target ranges, plaque imaging as context, and how hard Lp(a) is to move.
Insulin resistance markers
C-peptide, HbA1c, fasting insulin and glucose, HOMA-IR, the dawn effect, and why standard definitions lack individual resolution.
The rest of the panel
NMR lipid profile, omega index, complete blood count, liver panel and ALT, kidney function with cystatin C, ferritin, iron, folate, B12, magnesium and vitamin D.
Heavy metals, cancer screening and biological age
Lead and mercury from frequent seafood, blood-based cancer screening and false positives, and why direct-to-consumer age tests were dropped.
Hormones, menopause, and closing thoughts
The full male hormone picture beyond testosterone, perimenopause and hormone therapy, dosing for bone protection, and what excites them most.