What Your Annual Blood Panel Misses About Aging

Nick Urban [00:00:01]:
You’re listening to High Performance Longevity, the show exploring a better path to optimal health for those daring to live as an outlier in a world of averages. I’m your host, Nick Urban, bioharmonizer, performance coach, and lifelong student of both modern science and ancestral wisdom. Each week, we decode the tools, tactics, and timeless principles To help you optimize your mind, body, and performance span. Things you won’t find on Google or in your AI tool of choice. From cutting-edge biohacks to grounded lifestyle practices, you’ll walk away with actionable insights to look, feel, and perform at your best across all of life’s domains. Here’s something that should bother you. You can get a full panel of blood work, hear your doctor say everything looks normal, and still be aging fast on the inside. My guest today spent years at Mayo Clinic as one of the first pharmacists in the country trained to read your genes.

Nick Urban [00:01:12]:
Then she left to build a company called Futurome that measures thousands of markers most doctors never look at. Her whole philosophy can be summed up in one line, know your cells, know yourself. Welcome to the show.

Adrijana Kekic [00:01:29]:
Thank you so much for having me, Nik. I look forward to our chat.

Nick Urban [00:01:32]:
Yeah. Well, let’s start right there. You say, know your cells, know yourself. What does that mean? And what are we measuring that you don’t get at an average checkup?

Adrijana Kekic [00:01:44]:
Yeah. Let’s start with a bang, right? So here is where we are currently in our healthcare system. I’m sure you had these conversations with folks who came to your show before, but here’s what I have observed both as a healthcare professional and also patient going through our healthcare system. It is designed to do exactly what it’s designed to do, and that is to help mostly and mainly with reactive issues. So perhaps acute issues, we’re really good actually at addressing acute issues. Where we have major opportunities to improve on would be how do we prevent folks from becoming patients in the first place? A lot of folks who I work with are, that’s exactly what their goal is. Can I be at the driver’s seat of my health so much so that I understand my body, that I understand, first of all, what I can do on my own, and second of all, identify those things that require further work with my healthcare team? I am, My whole family actually is into racing, so I’ll be using some racing analogies here. Anybody else who’s listening and who loves like NASCAR or Formula 1, I’m a huge Formula 1 fan.

Adrijana Kekic [00:02:59]:
You can think of it like this, and this is how I view all of this as far as the testing and as far as being at the driver’s seat of your health and where we are and where we really need to be. If your body is like a beautifully designed F1 car, it’s designed to do what it should do, perform well. And then that means not only physically, physically, mentally, cognitively, spiritually, all of those things is who we are. And then, how I think of us healthcare professionals is we’re basically your pit crew. And that pit crew can be your physician, your pharmacist, your nurse, your functional medicine provider, perhaps, maybe a functional integrative nutritionist, performance coach, number of folks who are part of that team. The problem right now is that Technology is advancing and continues to advance, and yet we have enormous gap between what’s happening in terms of maybe very advanced testing. And we can talk about that in greater detail, be it genomics, proteomics, metabolomics, microbiome, mitochondria, all of these elements of your cells, meaning yourself. And yet we have this disconnect in terms of the advanced testing, advanced insights, and the lack of clinical guidance.

Adrijana Kekic [00:04:18]:
We don’t bring them to the clinical practice for a very simple reason. Overall reason would be we lack guidance. And of course, because of that, we lack insurance reimbursements. So they become disruptive because they’re expensive and so on. The know yourselves, know yourself comes from my philosophy, and that is everything is information. Our conversation is information that our body, that is going to do something to our body and vice versa. What you eat, how you move, the environment live in, conversations or relationships that you have, supplements that you take, peptides that you might be researching, red light therapy, stem cell therapy, plasma exchange. All of this is information that does something to the body and vice versa.

Adrijana Kekic [00:05:06]:
Your body does something with that. If you don’t know what your cells are actually doing at this very elemental level, be it that eventually that may lead to Diabetes, cancer, Alzheimer’s disease, maybe early perimenopause, and so on. All of this is happening still at the very elemental levels of your cells and even energetically at the level of your cells. So my goal really is for us to understand better what is happening inside of ourselves so that we can own our health and help really our healthcare teams can, like a pit crew, can help us With precision and personalization, course-correct things that need to be corrected, and then optimize things that we need to further optimize with one singular goal. And that is to chart our path towards longevity, meaning really healthspan, the number of years that we live in this optimal physical, cognitive, mental, spiritual, emotional health. That’s a long answer.

Nick Urban [00:06:09]:
Well, so, It sounds like the first step here is to understand where we currently are. And the way that most people go about getting a baseline is perhaps their annual physical at their doctors. And the, as part of the annual physical, the doctor will run a blood panel and there’ll be a number of different biomarkers that it measures. Maybe that number isn’t actually all that large. How does that compare to what you’re talking about here? What is the difference?

Adrijana Kekic [00:06:40]:
Yeah, the difference is essentially the scope, number of biomarkers, and the depth of those biomarkers. So for a comparison, if you do your physical, yearly physical, let’s say that you may get about 30 to 100 biomarkers, and I’m being generous here. I think most of us are between 30 to 50 biomarkers. So think about like your H1C, your average blood sugar over a 3-month month time period is what your A1C will show. You may get maybe biomarkers related to your lipids, like bad cholesterol, which is really not a bad cholesterol called LDL, or good cholesterol, HDL, or maybe homocysteine, something along that line. So those are maybe your hormones, thyroid hormone, estrogen, testosterone, and so on. Those are your standard labs. Well, you actually, like was the case for me, by the way, all that I’m talking about here, I’m both a healthcare professional and a patient.

Adrijana Kekic [00:07:40]:
You can have, you can be developing diabetes, for example, many years before that shows up on your standard tests.

Nick Urban [00:07:50]:
Why?

Adrijana Kekic [00:07:51]:
Because we don’t go with more precise early indicator type of biomarkers. Case in point would be, if you do In comparison to standard testing, if you did advanced testing, even if it’s additional 100 biomarkers, you could include some of those early biomarkers like fasting insulin, for example, or HOMA-IR, and some other ones as well. Standard testing, let’s say about 100, even if you went with function health, maybe up to 200. What we are talking about here and what we do at Futureome and some other colleagues in our space are starting to do is really apply system biology thinking. So we’re talking about Thousands of biomarkers, not only blood-based ones, but even like your microbiome, your metabolome. Your metabolome is the number of little molecules that are circling in your body that are product of cellular metabolism, which is not just, oh, am I going to gain weight or not? It’s more to do, are your cells able to do their function based on what you feed them or what they’re exposed to? Do they have a lot of toxic byproducts? Is there maybe a bottleneck In some of these cellular metabolic processes, things like Krebs cycle. And if there is, with precision, now we can see where that issue is before you end up on some enormous dose of, I don’t know, glutathione or NAC or whatever that is. We need to understand where is the disruption happening so we can, with precision, then decide what to do.

Adrijana Kekic [00:09:27]:
Standard testing number is limited. Advanced testing number is not only greater in terms of the biomarker, but the depth of it.

Nick Urban [00:09:35]:
Precision.

Adrijana Kekic [00:09:35]:
allows us to, you know, figure out what’s happening in your body is much greater.

Nick Urban [00:09:42]:
So, level 1 would be the typical annual doctor’s physical where they measure between 30 and say maybe up to 100 biomarkers. And then, level 2 would be something like a Function Health or one of these independent services that supposedly tests more, usually between 100 and 150, maybe up to 200 maximum. And then, level 3 is going to be looking at not only more, but also deeper, more depth, so you can understand not only why these are wrong, but then, or not only that these are wrong, but why these are wrong as well.

Adrijana Kekic [00:10:13]:
That’s exactly right. Some of these are going to also, let’s say, so I’m a pharmacist and nutritionist trained in genetics, and I always really start with that foundation, meaning does genetic testing give us anything valuable in terms of an actual insight that would therefore then tell us what to do with that? And the problem right now, Nick, is that Some genetic testing may, and some genetic testing will not. So case in point is this. Let’s say that you did, you know, methylation test or genetic test that will indicate if you have a certain genetic predisposition. Those are the genetic variants, mutations, if you will, genetic variants that you got from your parent, from your mom, from your dad, basically from your ancestry. However, if those genes are fully expressed, meaning certain genes can be switched on and switched off. If those genes are fully expressed, meaning are they switched on and off, is dictated by epigenetics or really the lifestyle primarily. So imagine this, you do the genetic testing, you say, oh, I have a predisposition for, I don’t know, Crohn’s disease or celiac disease.

Adrijana Kekic [00:11:28]:
Now we go additional testing to say, well, how are those genes actually expressed? Proteomics or transcriptomic testing is usually what will tell us that. And then we go a layer beyond that to say, well, what’s happening right now in my body? Am I producing some of these metabolites that are actually linked to active disease, or am I still teetering on that line where I feel, I mean, my test results are coming back okay, but I don’t feel okay? That’s probably one of the biggest opportunities that I see with what we’re talking about here, and that is many of us who are walking walking this earth, getting everything okay or within the normal range with standard testing, and even with some of this advanced testing, 200 biomarkers or so, and yet we feel anything but okay. Brain fog, tiredness, gut issues, and so on and so on. And I see these folks on a daily basis. So that’s where this becomes a lot more impactful, understanding what’s happening and what we can do about it because it can pinpoint to where it’s coming from.

Nick Urban [00:12:31]:
So, what’s the role if ultimately it comes down to how genes are expressed or epigenetics? Why do you even care about the underlying genetics then? Because ultimately, if you can override them with a layer above the genetics, what’s the importance?

Adrijana Kekic [00:12:46]:
That’s a great question. So, if you knew your genetics, what are you gaining with that? I will give you an example of 2 clients that I had not too long ago. One of them has done the personalized protocol, but he did not elect to go very deep into the testing. So we kind of kept it at foundational level of maybe 500 or so biomarkers. So he did his protocol, he improved, he is reversing his type 2 diabetes, and then a family member ended up with type 2 diabetes as well. And now there came a question, is there actually genetics involved here? And what layer of genetics could be involved at this point? So the genetics, and then I had another client who basically did the testing, type 2 diabetes, did the protocol, completely reversed the type 2 diabetes, meaning normal A1C. Normal A1C is typically anything below 5.6, 5.5. Theirs was actually 4.8 by the time that they’re done with their protocol.

Adrijana Kekic [00:13:50]:
And they responded really well. 2 people with very similar labs, and yet they responded very differently. This person continued to struggle. This other person did not. When we did the genetic testing, we identified that, oh wow, this first person had issues with something called GLUT4. This is a glucose transporter. It’s like a little vehicle that helps transport glucose across the cells. He had that difficulty.

Adrijana Kekic [00:14:18]:
He also, through additional genetic inquiry and epigenetic testing, we found out additional pinpoints. And what that meant for him is we had to redesign his nutrition, supplements, and exercise to allow to work with that genetic predisposition. Meaning even if you followed the good advice, you know, eat clean, exercise well, take these supplements, you may have 2 people who are going to respond very differently, and genetics is going to play a role here. Knowing your genetic predisposition allows you to get in the driver’s seat to say before or Or even if I had that disease, I know with greater precision what I can work on to essentially change that. That’s the power of that.

Nick Urban [00:15:07]:
So, for the average person listening in right now, they’re probably thinking, okay, the likelihood of me having a defect or a variant in my GLUT4 transporter is pretty low. What good does this knowledge do for them? Like, are they able to, does everyone have some level of abnormality in a way that would warrant tweaking their overall lifestyle, their program in a way that would seem very strange if you didn’t have that information?

Adrijana Kekic [00:15:37]:
So, we, great question. I’m going to give you a twofold answer here. For the past decade or so, this is exactly what I did at the Mayo Clinic. I am a pharmacogenomic clinical pharmacy specialist, or I was there where we would look at the genetics, And then design treatments. So no 2 people have same milieu of genes or even the microbiome and other elements, therefore their treatment needs to be personalized. So if you take that, then you can say, okay, knowing that I have a certain genetic variance either in how I process food or not process food, actually, how I metabolize a medication, how I have a genetic variant on some of these receptors. And as a matter of fact, there is also a component here where your genetics with the interplay of the microbiome meaning your environment, can produce certain composition of short-chain fatty acids that have very pro-inflammatory signal.

Nick Urban [00:16:32]:
Hmm.

Adrijana Kekic [00:16:33]:
And then you also have some of these pro-inflammatory, if you will, amino acids, simply because genetically speaking, your genes are not encoding for the right type of an enzyme that can further break down the food that you’re putting in. And because of that, even if you’re eating cleanly, like protein, I’m eating all of the protein and I’m still not losing You know, weight and whatnot. Well, some of that could be related to these genetic variants, and we may need to think about what enzymes or supplements or medications would we need to use in that case to help you overcome that. So that’s more to do with, you know, understanding that part to drive nutrition, supplementation, and medications. The second thought is, even if you did not do the genetic testing, we can continue to do what we’re doing right now, and that is trial and error. A lot of us are familiar with trial and error. Let’s try this for 3 months or a few weeks and let’s see what happens. We could do that, and that even can pinpoint to some of these downstream issues that we can otherwise identify early on.

Nick Urban [00:17:39]:
Yeah, that’s a good point. Even if you don’t have the ability to test, you can still figure out what works and what doesn’t work. And in fact, you will do that over a long enough time horizon. This is just a way of collapsing the time, energy, resources it takes to figure out what works and what doesn’t. And for the science nerds to understand what it is that’s causing that particular issue.

Adrijana Kekic [00:17:58]:
Exactly right. Wonderfully said, Nick.

Nick Urban [00:18:00]:
Do you ever find someone that doesn’t need any genetic customization? Like they can just follow all the standard stuff and like, say they can exercise as defined what’s optimal by whatever exercise authority. They can eat a clean, unprocessed, unrefined diet. And that works well for them. They can sleep say, 8 hours, and there’s absolutely no customization that’s required?

Adrijana Kekic [00:18:24]:
Yes, 100%. 100%. And the beautiful thing about that is we humans are designed in the same way. So, we know what’s the basic, you know, elements here at play. Where I see greater opportunities is in terms of customization and personalization is as we age, as we have 2 major kind of spikes in cellular aging around the age of 40 and around the age of 60. And, you know, these numbers kind of can be 41 to 45, 60 to 63 or 64. But the whole point is there is an underlying mechanism that is deeply embedded. This is evolutionary, that we have 2 big spikes in cellular aging.

Adrijana Kekic [00:19:09]:
With those spikes is where I see the biggest opportunity as far as personalizing persons’, you know, let’s say weight loss journey or chronic disease prevention or chronic disease course correction. I mean, 93% of Americans are unfortunately metabolically inflexible or unhealthy. That means we have a whole new condition of diseases that we now call cardiometabolic diseases. And even that definition is starting to shift in cardio-neuro-metabolic endocrine diseases. Yeah.

Nick Urban [00:19:44]:
So, around those 2 cliffs, when people start to age faster, or there’s a discrete period of time when they do age faster, Can you actually slow down, or I guess reduce that spike of the aging process so that they don’t have the same huge surge of aging?

Adrijana Kekic [00:20:01]:
Yes, you can. The work that I am very aligned with is what I would recommend for most folks to pay attention to. It stands on these pillars of lifestyle medicine. So nutrition, movement, sleep, stress, relational health, and substances. And these substances can be exposure to environmental toxins, Toxic substances like microplastics. We know that microplastics are increasing, unfortunately, our risk of cardiometabolic diseases, heart attacks, and so on. This is a significant issue that we’re going to continue to have. And then also substances in terms of interventions, be it supplements, peptides, medications, and so on.

Adrijana Kekic [00:20:40]:
So in respect to that, I would say there is a lot that can be done in each one of these. I think the issue is going to be which one of these pillars do you, Adriana, or do you, Nik, have the greatest opportunity with? Well, maybe you eat cleanly, but you may not have, maybe it’s the sleep disruption that’s an issue, or stress reduction, or whatever that is. We need to work with you to identify what that is so we can focus on that. Because I can give you the most precise nutrition, the exercise plan, but if you have unhealthy environment that you live in, or you have toxic relationship or work relationship that you’re dealing with, the impact is still going to be limited. Remember, everything is information. All of this acts and, you know, your body reacts at the cellular level. So I think that’s where I would probably say, put your attention to something like that and work with this lifestyle because that’s the foundation of health, the way I see it.

Nick Urban [00:21:43]:
So say that I’m 39 or maybe 38, and that first cliff is coming up up quickly. Of course, a lot of the things you’re mentioning are things that we should be doing around the clock throughout our entire lives. Like, of course, if you sleep better, if you detoxify, you do these things, you eat clean, you’re going to be healthier regardless of when. But, are there any things around the cliffs specifically that can help us age more gracefully or slow down the aging process?

Adrijana Kekic [00:22:09]:
So, when you look at the interventions, I’m going to zoom in on interventions. Hormone optimization becomes really important around these stages. And when I say hormone optimization, I don’t mean just testosterone, estrogen, and progesterone. I mean also other hormones. Insulin is a major hormone here. And a lot of women, and I don’t know what the composition in terms of your demographics is, is it mostly men or kind of equal men and women?

Nick Urban [00:22:40]:
There’s both.

Adrijana Kekic [00:22:41]:
Both, okay, perfect. So I’m gonna be speaking to your women in this as audience for a bit. for a second here. So we women go through perimenopause, which is a period before menopause. Menopause is defined clinically as a cessation of essentially period for a full year. So 12 months, you don’t have a period, that essentially is menopause. But the period before menopause is called perimenopause. And this is a very reactive period in women’s body.

Adrijana Kekic [00:23:11]:
So there is a lot of ups and downs. Women often think, oh, in perimenopause, I’m gonna be losing my estrogen.

Nick Urban [00:23:17]:
Mm-hmm.

Adrijana Kekic [00:23:17]:
That’s not what’s happening. Your estrogen is going up and down, up and down, and that estrogen also influences your other hormones. And a lot of times, Nick, what we see with women who experience more significant perimenopause symptoms, like even night sweats and brain fog and weight changes and fatigue and whatnot, is oftentimes this is the period where they’re now becoming metabolically inflexible. So you can see this on the blood work, not the standard blood work. You can see this in a little bit more advanced blood work you’re checking fasting insulin because that fasting insulin is going to indicate how much your pancreas needs to pump out insulin to basically bring the blood sugar down. And one of the reasons there is increased stress, hormonal changes, all of this is driving changes happening at the cellular level. So hormone replacement therapy is important. And I would say work with your physician.

Adrijana Kekic [00:24:17]:
Bioidentical hormones, both for men and women, have been linked to better healthspan. We still don’t have clear data as far as longevity, meaning lifespan.

Nick Urban [00:24:26]:
Mm-hmm.

Adrijana Kekic [00:24:27]:
But if we look at population-wide studies across the globe, it is exactly these sorts of interventions that are linked to better brain health, better cardiovascular health, and so on. So I would say that is one significant intervention when done right with somebody who understands hormonal changes, insulin, melatonin, cortisol, DHEA, you know, all of the sex hormones and so on. This can play a significant role. significant role in terms of slowing down the cellular aging. And of course, there are peptides and exosomes and other things that we are exploring, but the data is less clear on those.

Nick Urban [00:25:05]:
Yeah. So, that’s for the second cliff that you mentioned. What about for the first cliff at age 40? Because I could see that a lot of people go on hormone replacement therapy in their mid to late 30s, but it seems a bit early considering that we still who knows how much of life ahead of us, but potentially at age 30-something, we’re still less than halfway through, maybe a third with modern medical advancements of our entire lifespan.

Adrijana Kekic [00:25:33]:
So there is, well, 2 things in that case. I’m glad that you bring this up. The 40s is exact. I’m going to, again, comment for women. 40s is this cliff is exactly where majority of women are in perimenopause. And they’re walking around not knowing they’re in perimenopause. I was in perimenopause for almost 4 years, and I did not know I was in it until I ended up in ICU with something that was completely not related, actually. And that’s when I started to unveil the bigger picture here, the bigger story.

Adrijana Kekic [00:26:05]:
I nearly died from something that was preventable, and it was missed. I missed my own symptoms. This was the precipice for me to start this work that I’m doing with Future Home, really to identify some of those early things and things that you’re asking about. What are the symptoms? What are they and what can I do about them? So again, going back to women, many of you might be in perimenopause without knowing that you’re there. You could do your blood test and your blood test is not necessarily going to show that you’re in perimenopause because we do not have very good blood testing for that. However, if we looked at your mitochondria, mitochondria actually could reveal more of what’s happening. Why? Why? Because the highest concentration of mitochondria, which are little powerhouses of the cell, like engine inside of your Formula 1 car, the highest concentration in female body is actually in ovaries. The second highest concentration is brain.

Adrijana Kekic [00:27:01]:
And for men, the highest concentration actually is in brain. So these things tend to happen years before you see anything on those blood tests, as we talked about. So to answer your question, Maybe for both men and women, I’m going to go back to foundation. You need to ensure that your foundation is in good shape, nutrition, movement, and all of those things. There are certain senolytics. Senolytics are basically now supplements and medications that can, you know, act on these so-called zombie cells. Are you familiar with the concept of zombie cells?

Nick Urban [00:27:37]:
Yeah, go ahead and explain them because I’ve talked about them on several podcasts, but not in Okay, cool.

Adrijana Kekic [00:27:43]:
There is something in science of longevity or longevity sciences that we call hallmarks of aging. If you haven’t talked about hallmarks of aging, it’s a robust topic. I’m going to keep it short. Right now, we used to have 12 hallmarks of aging, like inflammation, genomic instability, epigenetic or telomere changes, and so on. And now we have expanded that to 15, so 3 additional biomarkers of aging, cellular aging. This is where you see the biggest We see 2 major spikes we talk about, we’re still talking about, the age of 40 and age of 60, roundabout. One of those hallmarks of aging is senolytic cells or zombie-like cells, and they’re exactly what they sound like. They’re essentially cells that no longer perform function.

Adrijana Kekic [00:28:32]:
They’re dead. Functionally speaking, they don’t do what cells is supposed to do, but they have not died. They’re still hanging in there. And the problem with that is those zombie cells start to infect nearby healthy cells. And how they do that is they send these little signals, the little molecules, inflammatory, very inflammatory molecules. And over time, you have more and more and more and more of those zombie cells. And now you start to feel some of that effect really translated into your mitochondria, even genetic, your genes, and you start to feel them, brain fog, like all of these not specific symptoms. It just takes you longer to recover from, I don’t know, intense workout, from flu, from flying, from stress.

Adrijana Kekic [00:29:20]:
That’s where some of that is coming from. Those are senescent cells. We have interventions, and there are many of them now in kind of research and pipelines. And there are certain supplement companies that have been working on like over-the-counter senolytic cell removal or reversal of those cells. There is some really really good data. We also have data from urolithin A. Urolithin A is a compound that’s really kind of made through metabolism in our gut. There is a significant, remember what I was saying, your genetic predisposition is only one part of the story.

Adrijana Kekic [00:29:52]:
What your environment is baiting in, like your microbiome, is really important. Not just microbiome, but microbiome I’m using here as an example of why that is so important, because it directly signals your genes that have a predisposition to make diabetes type 2, or cardiovascular disease, or Alzheimer’s. They’re sending those bad signals to them, and those genes are now starting to turn up the volume where you may end up with that chronic condition. That’s why your genetics is actually still important to understand, because you want to know where that signal is going to go and what you may end up with.

Nick Urban [00:30:27]:
Beautiful. You were one of the first pharmacogenomics specialists at Mayo Clinic. A minute ago, you were talking about your own backstory.

Adrijana Kekic [00:30:34]:
What was it that made you leave to build Future Well, I am very grateful for all of the amazing things that I was exposed to at the Mayo Clinic. I always say I felt like a kid in a candy shop because Mayo Clinic is this wonderful place where you can bring clinical research component and then education, and I was involved in all 3 of them. So I really felt like I had this beautiful, robust practice, and my job really was to help people understand their genetics better so they can have better treatments for them. And so I worked very closely with their physicians to be able to do that. It wasn’t until I had my own healthcare scare that I reflected then on experience of my parents. Both of my parents unfortunately died from cancer. My mom was only 50. She had glioblastoma.

Adrijana Kekic [00:31:28]:
My dad was little, I mean, he was older. He was 67 when he died of colorectal cancer. And you know, Rick, Nick, I have spent years teaching folks about medications and really I always would try to bring these elements of preventative health to really maybe prevent some of these conditions from happening in the first place. And then I’m a former amateur athlete. I trained martial arts my whole life, and then I stopped training when I had my kid, and I went through perimenopause not knowing that I was in it. My body changed significantly. And then in November 2021, I injured my right knee, not because I was training, I don’t even have a cool story to tell. I just squatted to pick something up and 3 ligaments broke.

Adrijana Kekic [00:32:16]:
Like, I tore 3 ligaments just by squatting.

Nick Urban [00:32:19]:
Hmm.

Adrijana Kekic [00:32:19]:
And so therefore, I’m at Mayo and they said, no problem, we can have a surgery to repair them. So, a month after that injury, just a couple of days before Christmas, I’m supposed to go have my surgery. The day before my surgery, I pass out on my kitchen floor. And eventually, when I came to it after 5 or so minutes, I am not able to breathe. I had to go get transported to ICU at the Mayo Clinic, and they realized that I had massive blood clots that generated from my knee and over a month time period continued to lodge into my lungs. I had massive pulmonary embolism called silent killer. Luckily, my heart, usually people’s hearts will fail because heart is not able to pump the blood. It didn’t.

Adrijana Kekic [00:33:09]:
It really took me out and I reflected for about 2 months, what am I going to do with my life now that I’m given this second chance? To shorten that story, I pitched something very similar to Mayo Clinic. They have these innovation competitions. I won at this competition. It was personalizing medicines through this advanced testing. We’re talking about the digital twin technology called AI twin, digital twin, and also 3D drug printing. But what I really wanted to do is this, what I’m doing with Futurum. I wanted to be at the driver’s seat of my health. I did not want my son, who was 4 years old at that time, to have to go through what I went through with my mom especially.

Adrijana Kekic [00:33:52]:
And I really thought, we have such a beautiful place where we’re at, advanced technologies, AI-based technologies. Like, there is so much that we know. Why are we not acting on that? And what I really wanted to bring is this company called FutureHome, which you can think of as a precision health intelligence company, assessing your risk, understanding what’s happening, and then doing some, you and us doing something about it to either course correct or optimize so you can live long and healthy. That was my precipice as far as, and the reasoning why.

Nick Urban [00:34:26]:
Interesting. Would Futurome have helped you in your situation specifically? Because it doesn’t sound like you would’ve been able to detect what was going on internally unless you just happened to get your blood drawn in between those 2 I, yes, absolutely.

Adrijana Kekic [00:34:42]:
I was my first patient, actually. So, all of the testing that I figured out, what do we do? What insights in terms of layering these insights do we need for proper clinical decision-making and acting on that? I did. So, I went from having fatty liver disease. I did not know I had any of this until I ended up in ICU. Remember, I had to get a clean bill of health and an MRI done before I could have that surgery. I did. I don’t know how, but I did. So there is much missed here.

Adrijana Kekic [00:35:12]:
And I don’t blame any of my physicians. We did exactly what the guidelines would recommend that we do. We went a little bit further even than those guidelines. And yet it’s not enough. And that’s what I’m trying to communicate here. This is not enough. And actually what is also not enough is a lot of, this is what I see also. People do a lot of data, a lot of A lot more testing doesn’t mean a lot more clarity.

Adrijana Kekic [00:35:39]:
This is what I did with myself first. I did it all. Genetic, telomere, epigenetic, proteomic, metabolomic, microbiome, all of that. And then I realized, my God, now I understand why so many of my family members have these conditions actually. It’s coming from here. And then the second step was going to be, poof, now that I know know that. What do I do? And how do I work with my physician if I needed medications or further testing down the line, like full-on MRI or whatever that is? I’m not a huge proponent, by the way, just because of radiation and some other issues here. But essentially, the short answer, Futurum helped me reverse my fatty liver disease, type 2 diabetes, and I’ve navigated really menopause without any hormone replacement therapy because, and I’m going to change that likely because no physician would prescribe it to me because that pulmonary was a major contraindication.

Adrijana Kekic [00:36:34]:
Well, now we know that there are ways how to do bioidentical hormone optimization therapy for women like myself, where that is still going to give me protection for brain health, cardio, metabolic, and bone health years to come. So, I don’t need to suffer through those symptoms that I suffered through without the hormone therapy. But yes.

Nick Urban [00:36:56]:
In your own data, in your own instance of Futureproof, Did you see anything that stood out to you as like something that you wouldn’t have been able to guess, like changes you should make that aren’t the basic things that we’ve covered, such as like eating clean, whatever that means, sleeping, all that kind of stuff?

Adrijana Kekic [00:37:15]:
Oh my gosh, Nick, there is so much. Every time I meet with a client, every client gets their own personalized dashboard, essentially what’s going on, what do you do on a daily basis, weekly basis, and phases. And that’s exactly what I built for myself because there were so many opportunities. Opportunity number one for me was this, sleep, sleep optimization. I was functioning on 2 to 3 hours of sleep for 4 years. And really now reflecting on that, like, how did I not address this myself? But I also continued to underplay what was going on. No, I got it, not a problem. I can continue to power through this.

Adrijana Kekic [00:37:55]:
My first order of business was prioritizing sleep and doing very strategic interventions that allowed me to do that sleep optimization without any medications. So, you know, be it early light exposure, obviously your eyes are part of your brain. There is a melatonin, cortisol, insulin signaling loop that’s happening all the time. Your sleep actually starts in the morning, not at night. Your melatonin supplement can be doing more damage than help for many of us. So this is another thing that we would need to be careful in terms of supplementation. I’m a minimalist and I’m very precise. Do you actually need it and for what and for how long and so on? Then I had to how I eat.

Adrijana Kekic [00:38:36]:
I was even starting to count. This is going to sound silly, but there is a reasoning behind it, is I had to slow down with my food. I did not even change anything food-related. I just changed my relationship to food. Chew 40 to 60 times. Have you ever tried to do that, by the way? Chew your food for 40 to 60 times?

Nick Urban [00:38:56]:
It is very laborious. It makes eating a task and makes eating take Yes, I know you’re talking about it.

Adrijana Kekic [00:39:04]:
Yeah, exactly. And then I realized I was so used to these high-intensity training, boxing, kickboxing, all of that. I realized I no longer can do that actually. I needed a little bit different way of engaging in physical activity that was more focused on movement daily, not sitting. Like if I’m sitting, I think I see you bouncing on the, maybe like a yoga ball or Yeah, I want a Swiss ball. There you go. Doing that, or maybe doing the walking treadmill if I’m in like long meetings. All of these basic elements amounted to these massive changes that I started to see in my body.

Adrijana Kekic [00:39:44]:
But it wasn’t until I just, there is nothing that you can do that will replace your sleep. And if you’re struggling with sleep, I hear you, I feel you, and there are ways ways to go about addressing that. And I know it’s a challenge for many of us, even with ways addressing it.

Nick Urban [00:40:05]:
What I find interesting about this, and I was thinking about this the whole time, is that we’re using state-of-the-art cutting-edge technology to help us see our own blind spots. They tend to be the most simple of things, like going from 2 hours of sleep to 6 or 7 or 8 hours, increasing sleep or moving more or not being sedentary or getting sunlight, things like that. These are not revolutionary brand new ideas, but because of the way we live, we’re often blind to our own, I don’t want to say shortcomings, our own imbalances.

Adrijana Kekic [00:40:40]:
Yes. Yes. I was just having a conversation with a colleague. She’s a healthcare professional, and we were talking about trace minerals, adding trace minerals into your water. We were talking about structured water. I mean, water is obviously very fundamental part of our existence here on this earth. And so they have reverse osmosis system. They’re trying to do everything that they can to reduce the toxins.

Adrijana Kekic [00:41:01]:
And then the conversation went into, well, do you replace that? Like those minerals, are you adding any trace minerals? Even that is important. Like address your foundation first and see how much your body starts to adapt based on that. And then, you know, you can start layering these interventions. I mean, I come from world of interventions. I spent the last 3 decades in pharmacology. I mean, peptides even, they’re very popular and trendy right now. I was a pharmacy student in 1996 when my next-door university professors discovered Body Protection Compound 157, BPC-157. So, I’ve been in this world of peptides for the last 3 decades.

Adrijana Kekic [00:41:45]:
I believe in their power, but you cannot use that to replace the foundation of your body. So, foundation first. If you’re building up The pyramid. Foundation first, targeted intervention and testing, and actually longitudinal testing next, because what you don’t measure that actually moves the lever, you can measure a lot of things, but measuring the things that move the levers in the right way, if you don’t measure that, you’re not going to be able to manage it. I’m actually a huge proponent of CGMs. I think everybody should get continuous glucose monitor, especially in these big peaks around the 40s and 60s when you’re starting to get more metabolically inflexible to understand what moves the needle for you. And then, of course, there is stem cells and all medications and in future and even now gene therapies. All of that is fine, but if you’re not addressing your foundation, I think it’s very limited.

Nick Urban [00:42:42]:
You, I’m sure, understand this better than anyone, and that is the role of the foundational nutrients, for example, minerals and vitamins. is how essential they are as cofactors, their other myriad roles throughout the body. And yeah, you can layer on the cool, fancy, fun interventions, and you might get results from them. But, if you add in the cheap or sometimes free or almost free essentials, then it makes those things work better or with fewer side effects. And, it’s such an easy place to start, but it’s just not as fun to talk about.

Adrijana Kekic [00:43:12]:
It really is not. And, I really love and appreciate, Nick, that you’re bringing this up because I literally see this in my daily practice. So people will come in, they will want the next shiny thing. And then I say, okay, let’s look at, let’s start with ABCs before we start building complex sentences here. And then when I mentioned, you know, the magnesium, the vitamin D, the B complex, their gut, because your gut makes the B complex primarily, B1, B3, all of these are super important vitamins. That’s why they’re considered to be essential vitamins. Your vitamin D, which does a lot, it’s a hormone. It’s not a vitamin, it’s a hormone.

Adrijana Kekic [00:43:47]:
And So, you know, just approaching that topic, let’s take a look at your nutritional status. And I will use testing absolutely to say what’s happening in the blood and what’s happening inside of the cells so we can be smart. You know, if we’re layering certain supplements, and I’m very keen on starting with actual food, but unfortunately our food is also a big subject to massive change because the soil is very different than it was, you know, 20, 50, 100+ years ago. So adding very strategically and smartly, adding some of these trace minerals, like you mentioned, or supplements and, I mean, minerals and vitamins, and even certain amino acids is fantastic for most of us. So I love omega-3, although, you know, the evidence is still, do we do it? Do we not do it? If you can get it from food, amazing. And if it’s a clean food source, double, you know, A+ then to you. Magnesium, you can get that from a lot of seeds, selenium, you know, Brazil nuts. There are so many wonderful ways how you actually can strategize your nutrition without really breaking the bank.

Nick Urban [00:44:55]:
And I think also depending on the lifestyle and the other interventions, the things that people are doing, for example, if you’re going in the sauna or you live somewhere where it’s very hot and you’re sweating for big periods of the day, or you’re sweating profusely, that’s going to change the rate at which your body burns through different nutrients. And as a result, it’s going to become harder and harder under certain circumstances to get that through diet alone. And then supplementation can make a lot of sense just so you’re getting back to base level. That’s not even necessarily to go to optimal. That’s just to get back to what you’re already depleting.

Adrijana Kekic [00:45:27]:
That’s exactly right. So, if you’re going to sauna and you’re experiencing muscle cramps, maybe headache, maybe tiredness, that absolutely could be the very first sign that you’re dehydrated. And plus, you’re losing some of those very potent elements in your body, sodium, potassium, of course, minerals, and so on. So, I 100% agree with you. And there’s such simple strategies that you can do. If you go to to a sauna, make sure that you hydrate before, make sure you hydrate if you need it throughout, but also afterwards. Men and women have slightly different experiences to significant temperature changes, be it sauna, be it cold plunging. But overall, I think sauna is what most of us, most of us can do well with.

Adrijana Kekic [00:46:13]:
And of course, strategies about how not to lose your precious minerals.

Nick Urban [00:46:18]:
Yeah. And so, when you were building out dataset behind Futureome and also in your work in practice, how big of differences were you seeing between your female and male clients, especially as it relates to certain data? Like, the study was done on, say, a male population and it looked really cool and promising, but then when you try to apply it to women, it has a completely different effect. And the example I was just thinking of is cold plunging. Like, men and women respond fairly differently to cold plunging, especially depending on like life stage. And I’m assuming that applies across the board to a lot of other things as well.

Adrijana Kekic [00:46:55]:
It sure does. The 2 biggest things that I see is going to be the temperature, extreme temperature interventions, be it sauna, be it cold plunging. And the second thing that I see significant difference between men and women is also medical fasting or fasting. So, let me unpack really quickly both. A lot of women, and especially women also who come to see me, may have, I don’t know, Endometriosis, Ehlers-Danlos syndrome, which is a connective tissue disorder. There are 13 different types right now, but hypermobility Ehlers-Danlos is one of those types. And we don’t really have good genetic testing to determine it. So it’s really a clinical diagnosis.

Adrijana Kekic [00:47:33]:
Like, can I bend? Am I bendy? Am I very flexible? So, and then those women oftentimes will have also POTS, postural orthostatic tachycardia syndrome, which is a form of dysautonomia. How do you know if you may have that? Well, Well, if you’re in a seated or laying position and you get up, especially if you get up promptly, you may get lightheaded and dizzy. That sometimes is an indication that you may actually, especially if you’re flexible or hyperflexible, that you may have a form of dysautonomia. And then there is also what I see with men and women, but especially with women who have dysautonomia, hypermobility, is they have mast cell activation syndrome. Mast cells are part of our immune system. They will release histamines. And oftentimes, this is what I see with women who report being really sensitive to almost anything, a deodorant, a perfume, a new car scent, a new food, new supplement, or even old supplement that they used to take before. Larger doses of medications don’t really work well for them, meaning they make them quite sensitive to them, and so on and so on.

Adrijana Kekic [00:48:38]:
So those women oftentimes will have both difficulty with sauna, Yeah. So they need to ease themselves into that. Ease themselves into it could be 1 to 3 minutes, just to trial how they do with that, making sure that they have water and electrolytes in that water. The biggest problem that I see is when they start cold plunging. I had 2 of my previous clients who passed out in the cold plunge, and they all had these conditions that I’m describing. So understanding that there are sex-based differences here is really important, knowing what do you do for For yourself. The fasting part is, and there are mechanisms around this that we still don’t fully understand, but it has to do something with these conditions. The second part for a lot of women, especially women who are in perimenopause or maybe are gearing up for pregnancy and so on, fasting, you have to be careful how you fast.

Adrijana Kekic [00:49:36]:
You cannot fast the same way as your male counterparts because we women make less carbohydrates, number one, almost half less than, excuse me, not carbohydrates, serotonin in our gut than men do, almost 50% less. And in some cases, it’s even more. And that’s determined by your genetics and your microbiome, by the way. So fasting, I would say, in the morning for most women should look like this. If you’re going to have a fasted workout, I would recommend that you don’t, ‘Cause actually having some protein and even a little light carb can regulate that cortisol system that is quite sensitive to these additional stressors that your body experiences, like exercise and even fasting as such. So you can fast, but maybe try to fast as opposed to in the morning prolonging not eating, Eat, and then maybe just skip your dinner or something along that line. And don’t be afraid of carbs. They’re really important for us.

Nick Urban [00:50:44]:
Interesting. Yeah, I’ve heard for many years that the fasting window that’s optimal for men and women is different. And it sounds like one of the big reasons is because of certain stress hormones, perhaps most prominently cortisol, but other glucagon and other like different levels of like epinephrine and stuff like that.

Adrijana Kekic [00:51:04]:
Yes, absolutely. And of course, keeping in mind that when we go through those hormonal changes, be it as we prepare for pregnancy, like when we’re in fertile stages or perimenopause, when we start to lose some of that, there is a signaling that’s happening between your gut, which makes some of those, you know, what I talked about, short-chain amino acids or fatty acids, excuse me, and other inflammatory markers. This directly can communicate to your cortisol. These 2 brains, the one in the gut and the one here, they communicate all the time. So that’s an additional layer.

Nick Urban [00:51:38]:
Yeah. In pharmacogenomics, I’m not sure, is the idea or understanding that the body is interconnected a popular idea? I know that in mainstream conventional Western medicine, it hasn’t been historically, at least in the more recent history, and that’s seeming to be changing. But, obviously, when you’re looking and you’re working on Futureome, you’re seeing the interconnectedness of everything and how one biomarker going out of balance here can affect another one over here. How did that show up in your professional career?

Adrijana Kekic [00:52:10]:
So, pharmacogenomics is a tool of personalized medicine, precision, so-called precision medicine. In precision medicine, we can use different tools, genomics, I don’t know, proteomics, metabolomics, and others. Pharmacogenomics is very targeted. It looks at your DNA, and specifically parts of your DNA that encode for genes, meaning they give instructions to make genes. There are 2 sets of pharmacogenes, pharmacokinetic and pharmacodynamic. And I know this is going a little granular here, but think of it simplistically like this. Pharmacokinetic genes will give instructions to your body to make essentially enzymes and proteins that will help you move things that you put in your body, medications, supplements, even foods, and so on. It’s all about kinetics, how that substance, whatever you put in, information, like a medication, travels through your body, absorption, distribution, metabolism, and so on, elimination.

Adrijana Kekic [00:53:06]:
Pharmacodynamic is really interesting because it’s not about just what you absorb, what your liver can metabolize, because majority of this is metabolized through your gut, liver, and kidneys. Majority, really liver. Most medications are metabolized through liver to various degrees. But it’s also once the liver transforms this into either something that your body can use or your body can expel out, what happens then? Why is it that we have such different experiences to pain medications, antidepressants, cancer drugs, a number of different, you know, cholesterol medications, a number of different things? And some of that has to do with these receptors. We all make these receptors. They’re like little docking stations that medication travels through and docks on, and then produces reactions. So if you take a pain medication, it gets metabolized through your liver, And eventually, your liver will do its job, and that medication will continue with the blood to travel and make do, meaning find that docking station, opioid receptor. And that opioid receptor, once it docks, it produces that pain relief.

Adrijana Kekic [00:54:17]:
That’s kind of the idea behind it. So, how we really use the pharmacogenomics is to understand the differences between Nick and Adriana in terms of how they metabolize and how they respond with those docking stations to meds. It’s not still very system layer approach. It’s more targeted genetic approach, but it is a tool of precision medicine. So I can see a future of pharmacogenomics where it becomes fully multi-omics. And what that means is we are thinking about what’s happening in your microbiome, in your gut, with other proteins in your body, how your genes are translated as opposed to just what did you inherit from your parents. That’s great, but it’s limiting still in terms of the actual Perfect.

Nick Urban [00:55:05]:
Well, Adriana, if people want to connect with you, where do you want to send them?

Adrijana Kekic [00:55:08]:
It’s simple. You can find us either on social, Futurome, or myself, Dr. Adriana Kejkić, or simply www.futurome.com, futurome.com.

Nick Urban [00:55:21]:
Perfect. I will put those, all those resources you mentioned, all those links in the show notes for this episode. I have a couple more questions for you before we wrap up today, and we will start with a rapid Okay.

Adrijana Kekic [00:55:33]:
I’m ready.

Nick Urban [00:55:35]:
What is a belief that you hold that most people in your field would disagree with?

Adrijana Kekic [00:55:40]:
I don’t know if they would disagree with this. Hmm. Everything is information, and that information does something to your body, and your body does something with that information. And we lack testing right now to help us act on that.

Nick Urban [00:55:56]:
What is one cheap, universally beneficial intervention with the biggest measurable payoff that most people aren’t currently doing or doing adequately?

Adrijana Kekic [00:56:05]:
Sleep, I would say. Sleep is probably one of the biggest levers that I see in people not prioritizing. If you can prioritize and optimize your sleep, it’s amazing the impact this has on immune system, cardiometabolic system, and everything else downstream.

Nick Urban [00:56:19]:
What’s something that the longevity crowd is obsessed with that you think is overrated?

Adrijana Kekic [00:56:24]:
This is going to be a double-edged sword that I feel like I’m going to end up like, you know, stabbing myself on. I think it’s peptides actually, because they hold enormous, enormous promise, but they are, I believe, in my view, they are also not used adequately. I think in order for us to use peptides adequately, we need to understand the system biology approach to health because they’re very important small molecules that are signaling continuously things in your body. This is one of the reasons why my clinical team and I have put together actually the peptide guide. It’s a PDF course guide that rests on the system biology approach, helping you how to reason through the peptides, not necessarily what’s the mechanism and what’s the next protocol that I need to follow. So, I would say that.

Nick Urban [00:57:16]:
Well, this sets me up perfectly. What is a peptide that’s on your personal radar that few people are talking about?

Adrijana Kekic [00:57:26]:
The peptide that I like is oxytocin. However, I will be frank with you. 2 reasons, actually. Oxytocin is a naturally producing peptide. It’s something that we release as humans and other animals as well when we bond. Let’s say like mom had a baby and she’s bonding right now with her child, or maybe you’re cuddling with somebody. These are beautiful molecules that also can bring down the stress levers, the indicators of the stress in your body. So they can help with memory, They can help lots of different things.

Adrijana Kekic [00:58:00]:
But notoriously, again, these peptides, they, in order for oxytocin to do that, it needs to cross blood-brain barrier. And the reason I’m saying oxytocin is I’m starting to see some really innovative technology as far as how we can address this blood-brain barrier crossover with these little nanoparticles that would basically act as a truck, like an Amazon truck, that basically you can load your peptide like oxytocin peptide, and that truck is so small that it can basically cross into blood-brain barrier, deliver your package, which would be like a peptide, be it oxytocin or another CNS peptide. I would love to see more work on that. So, that’s why I’m saying oxytocin. Cool.

Nick Urban [00:58:48]:
And, for people who have made it this far, what’s the final message you want to leave them here with?

Adrijana Kekic [00:58:54]:
My final message is this. Be at the driver’s seat of your health. Adjust the foundational elements of your health first, before you start thinking about more advanced interventions, be it, you know, peptides, stem cells, plasma exchanges, and even gene therapies, because I know there is quite a bit of interest about that. Nothing can replace sleep. Having really solid, healthy relationships in your life is as equally as important as eating cleanly, exercising regularly, and then of course, targeted, not a lot, but very targeted, precise supplementation or medications that can pinpoint point to the elements of your biology that need to be course-corrected.

Nick Urban [00:59:37]:
Perfect. Well, Dr. Adriana, thank you for joining the podcast today.

Adrijana Kekic [00:59:42]:
Thank you, Nick, for having me.

Nick Urban [00:59:43]:
And, thank you all for tuning in and sharing your time, your energy, and your attention with us today. And, until next time, be an outlier. Thanks for tuning in to High Performance Longevity. If you got value today, the best The best way to support the show is to leave a review or share it with someone who’s ready to upgrade their healthspan. You can find all the episodes, show notes, and resources mentioned at outlier.com. Until next time, stay energized, stay bioharmonized, and be an outlier.