Longevity Command Center
Single-pane view of biomarkers, diagnoses, protocols, surveillance, and emerging therapies — updated continuously.
Patient: Bambos Kaisharis
Age: 48 (DOB 25 Feb 1978)
Weight: 74.4 kg
Location: Palo Alto, CA
Last refresh: 1 Jun 2026
Next auto-refresh: Mon 8 Jun (weekly)
Top of Mind
Order fasting ferritin + iron + TIBC — this week
Two-year-overdue investigation. Your 3-yr persistent GGT elevation + carrier status for the HFE H63D iron-absorption gene point to mild iron overload. Easy test ($50, no physician order), simple fix if positive (therapeutic blood donation).
questhealth.com →
Once done, dismiss this banner and the underlying
Module 11 action item will close automatically.
Module 11 action item will close automatically.
Module 01
Snapshot
Cardiovascular Profile
Discordant monitor
High harmful-particle count but zero calcified plaque. Risk is soft-plaque accumulation, not late-stage damage.
Hormonal Profile
High-T, binding-protein ↑ watch
Strong total testosterone (913 ng/dL) but elevated SHBG binds too much of it, reducing usable hormone.
Metabolic Profile
HbA1c 5.6% edge of normal
Excellent insulin sensitivity but blood sugar creeping toward prediabetes range over 2 years.
Active Peptide Protocol
CJC/Ipa Wk ~4 in titration
Started Apr 2026. IGF-1 response check due ~22 May.
Watch list (most-recent values · hover for definitions)
ApoB
108 mg/dL
↑ rising — target <80
Lp(a)
90 nmol/L
elevated · ref <75
HbA1c
5.6 %
↑ 5.3→5.6 over 2 yr
SHBG
67 nmol/L
high · ref 16–56
GGT
94 IU/L
3 yr isolated ↑ · HFE H63D?
Creatinine
1.09 mg/dL
recovered from 1.34 artifact
CAC Score
0
0th percentile (Aug 2024)
Module 02
Biomarker Trends (2022 → 2026)
Atherogenic Particles
ApoB · LDL-C · non-HDL — target zone shaded green
Glycemic Control
HbA1c trending into upper-normal · insulin still excellent
Renal Function
Creatinine spike Jan 2026 was creatine-supp artifact (recovered)
Androgen Axis
Total T strong · SHBG above range suppressing bioavailable T
Liver — GGT
Persistent 3-year elevation · isolated · HFE H63D suspected
Hematology — Hgb/Hct
Hct 46% (Jan) was borderline — monitor on CJC/Ipa
Module 03
Active Diagnoses & Surveillance
Tip: Hover any underlined term for a plain-language definition.
Discordant Atherogenic Lipid Phenotype active
Your blood lipid (fat-and-cholesterol) profile shows a mismatch between two different ways of measuring heart risk:
- Your ApoB is 108 mg/dL (ideal <80) and your Lp(a) is 90 nmol/L (ideal <75) — both elevated. These count the actual number of harmful particles in your blood.
- But your CAC score is 0 (best possible) — meaning there's no calcified hardening in your heart arteries yet.
What this means
Particles capable of damaging arteries are circulating in higher numbers than ideal, but your arteries haven't yet shown evidence of late-stage damage (calcification). The risk isn't "you've already got plaque blocking things" — it's "you're accumulating risk that will show up later if untreated." The danger is in soft (non-calcified) plaque, which can rupture and cause heart attacks before it ever shows on a CAC scan.
Why it matters for you
Your driver isn't lifestyle (you're lean, fit, low inflammation) — it's primarily genetic Lp(a), which is heritable and only really addressable by an emerging class of injectable gene-silencing drugs (covered in your Lp(a) tracker). Repatha (an existing injectable that lowers cholesterol) drops Lp(a) by ~25–30% — meaningful but not enough. The real fix is in the next-generation pipeline.
Next action: Consider a CCTA with plaque characterization to see whether soft plaque is actually accumulating. Track ApoB and Lp(a) quarterly. Discuss adding psyllium + plant stanols (see Module 6).
Candidal Intertrigo (Yeast Skinfold Infection) resolving
A persistent yeast infection in warm/moist skinfolds (groin and armpits) that was misdiagnosed for months as common "jock itch."
Why the previous treatment failed
There are two main types of fungal skin infections that look similar but require different drugs. The first attempt used terbinafine (a topical antifungal) — which works for dermatophyte molds (true jock itch, Trichophyton). But your infection was actually Candida (a yeast), which terbinafine barely touches. Distinguishing features that pointed to Candida: scrotal involvement (rare in dermatophyte), satellite pustules around the main rash, both armpits involved, and stubborn failure to clear over months.
The fix
Fluconazole (oral azole-class antifungal) prescribed April 2026. It blocks the enzyme yeast needs to build its cell membrane and reaches high concentrations in skin and sweat. Standard course: 150 mg weekly × 4–6 weeks. Good clinical response so far.
Next action: Confirm full clearance. For recurrence-prevention: ketoconazole 2% cream daily + miconazole antifungal powder after every shower (moisture control is critical). Treat feet concurrently — they're a fungal reservoir.
Resected Colon Polyp (Tubular Adenoma) surveillance
A small benign-but-precancerous polyp was found and removed during your 2024 screening colonoscopy. Located at the "hepatic flexure" — the bend in the colon near the liver.
What an adenoma is
Most colorectal cancers begin as adenomatous polyps that grow over 10–15 years from benign → dysplastic → cancerous. Removing an adenoma at this stage essentially prevents that cancer pathway entirely. Yours was a "tubular adenoma" (the most common, lowest-risk subtype), 3 mm (small), and with no high-grade abnormal cells under the microscope.
Surveillance schedule
Per US Multi-Society Task Force guidelines: a single small low-risk adenoma → repeat colonoscopy in 3 years. If clean again, the interval extends. Your colorectal cancer polygenic risk score is exactly average — so this surveillance is the correct schedule, no genetic upgrade needed.
Next colonoscopy due: ~June 2027. Book by Q1 2027.
Recurrent Left Varicocele monitor
A varicocele is essentially a varicose vein in the scrotum — the small veins that drain blood from the testicle become dilated and tortuous. Almost always on the left side (anatomical reasons: the left testicular vein joins the renal vein at a sharp angle, creating higher pressure).
Yours was surgically repaired in ~2008 but has recurred. Examiner noted the right testicle feels slightly smaller. Ultrasound confirmed both testes are normal in size, mildly heterogeneous tissue, no masses. A small (5 mm) benign cyst in the left epididymal head — common incidental finding, not concerning.
Why it matters
Varicoceles can affect testosterone production and sperm quality if symptomatic, but many men live with them without intervention. Given your Total Testosterone is high-normal (913 ng/dL) and you have no fertility concerns at this stage, surgical re-intervention isn't indicated. The factor worth tracking: if your SHBG-driven low free testosterone gets worse, or you develop scrotal pain, urology consultation makes sense.
Next action: Watchful waiting. Re-consult urology only if symptoms (pain, dragging sensation) or if fertility becomes a goal.
Persistently Elevated Liver Enzyme (GGT) workup
GGT is a liver enzyme that's been mildly elevated in every test for 3+ years (~50% above the upper limit). What makes this notable: your other liver enzymes — ALT and AST — are completely normal. Isolated GGT elevation without ALT/AST rise is a specific pattern that points away from classic hepatitis or fatty liver and toward something else.
The leading hypothesis: iron-driven oxidative stress
Your Nucleus genome shows you carry one copy of an HFE H63D variant — a common gene tweak that makes you absorb slightly more iron than average. Excess iron in the liver drives oxidative stress (Fenton chemistry: iron + hydrogen peroxide → hydroxyl radicals → membrane damage), and GGT is one of the most sensitive markers of that. Two other clues line up: your alcohol-dependence genetic risk is below average (so it's probably not booze), and your APOE e3/e3 genotype + normal ALT/AST argue against fatty liver.
Why this matters
Mild persistent iron overload, left untreated for years, can progress to liver fibrosis and increase cardiovascular risk. The test to settle this is straightforward: check ferritin (iron storage marker) and transferrin saturation (how loaded your iron transport is). If ferritin >200 µg/L or saturation >45%, the diagnosis is essentially confirmed and treatment is simple — therapeutic phlebotomy (regular blood donation) drops iron stores quickly.
Next action: Order fasting ferritin + iron + total iron binding capacity (TIBC) immediately. Available via questhealth.com without physician order. This is the single highest-priority gap in your current workup.
2 mm Non-Calcified Lung Nodule no follow-up
When you got your heart-calcium scan, the radiologist noticed a tiny 2 mm spot in the lung (lingula area). Incidental lung findings on chest CT are very common.
Why this doesn't need follow-up
The Fleischner Society (international thoracic radiology guidelines) sets the imaging surveillance rules for incidental lung nodules. For solid nodules <3 mm in a low-risk patient (non-smoker, no family history), no follow-up imaging is required. Yours is at that threshold. Statistically the probability that a nodule this small is anything significant is <0.1%.
Next action: None required. Note this baseline measurement for comparison if you have future chest imaging.
Presbyopia + Mild Astigmatism corrected
Age-related decline in the lens's ability to focus on close objects (presbyopia — universal by mid-40s) combined with a slight irregular curvature of the cornea (astigmatism). Both common; both correctable with glasses.
Prescription: both eyes +1.25 / -0.50 × 085. Reading and computer glasses prescribed.
Why annual eye exams still matter for you
Your AMD (age-related macular degeneration) polygenic risk score is above average. Annual ophthalmology exams with macular OCT (optical coherence tomography — a non-invasive scan of retinal layers) catch early macular changes years before symptoms.
Next action: Annual ophthalmology exam ~Feb 2027. Request macular OCT given AMD genetic risk.
Undescended Left Testicle at Birth resolved
A condition where one testicle hasn't moved into the scrotum at birth. Either descended on its own in early childhood or was surgically positioned. Current ultrasound (Mar 2026) confirms both testes are normal size with no concerning features.
Historical context worth knowing
Men with a history of cryptorchidism (undescended testicle) have a modestly elevated lifetime risk of testicular cancer in the affected side — though absolute risk is still low. Standard advice: monthly self-exam (familiarity with your normal anatomy = faster detection of any change). Your current ultrasound was reassuring.
Next action: Routine testicular self-exam monthly. No additional imaging needed unless palpable change.
Module 04
Screening & Imaging Schedule
| Screen / Test | Last Done | Cadence | Next Due | Status | Rationale |
|---|---|---|---|---|---|
| Lipid + ApoB + Lp(a) | 17 Mar 2026 | Quarterly (active workup) | ~Jun 2026 | on track | Lp(a) requires LC-MS or isoform-indep assay in nmol/L; reflex at draw |
| Comprehensive Hormone Panel | 17 Mar 2026 | 3-month on CJC/Ipa | ~17 Jul 2026 | on track | SHBG, Free T, LH, E2, IGF-1, DHEA-S, PSA |
| IGF-1 (early on-cycle check) | 17 Mar 2026 (pre-cycle) | 4–6 wk after start | ~22 May 2026 | due now | Confirm response; stop if >300 ng/mL. Order via questhealth.com |
| Fasting Ferritin + Iron/TIBC | Never | Baseline → annual if normal | Immediately | overdue | HFE H63D carrier + 3-yr GGT elevation; HIGH priority |
| Vitamin D 25-OH | 09 Apr 2024 (28.9 ng/mL, low) | Annual | Overdue (2 yr) | overdue | Was deficient; supplementing 3000 IU/day; need to verify response |
| Methylation Panel (Hcy, MMA, B12, Folate RBC) Quest codes: #70328 (Hcy) · #17557 (MMA) · #927 (B12) · #934 (Folate RBC) |
Never | One-off baseline | Next draw | pending | MTHFR A1298C homozygous; gates 5-MTHF dosing decision |
| Cystatin C | Never | One-off | Next draw | pending | True GFR — not confounded by muscle/creatine |
| Surveillance Colonoscopy | 06 Jun 2024 (adenoma resected) | Every 3 yr (post-adenoma) | ~Jun 2027 | scheduled-ready | 3-year protocol — book by Q1 2027 |
| Cardiac CAC Scan | 07 Aug 2024 (score = 0) | Every 3–5 yr | 2027–2029 | on track | Score = 0 = low yield short-term. Consider CCTA instead next cycle. |
| CCTA (Coronary CT Angiography) | Never | Once, then as needed | Consider in 2026 | discussion | Your CAC = 0 is reassuring but doesn't see soft plaque (which Lp(a) drives). CCTA shows the full picture. Also helps clarify trial eligibility. |
| Full Body Derm Exam | Unknown / overdue | Annual | ASAP | verify | Standard for 48-yo male; not in current records |
| Ophthalmology (incl. macular OCT) | ~Feb 2026 (Rx visit) | Annual | ~Feb 2027 | on track | AMD PRS Z=1.91 above-average — OCT for early macular changes |
| DEXA scan (body composition + bone density) | Never | Every 2 yr | Consider 2026 | discussion | Establishes pre-CJC baseline for body composition tracking; also bone density check given your above-average osteoarthritis genetic risk. |
| VO₂max / CPET test | Never | Annual | 2026 | discussion | The strongest single predictor of all-cause mortality. No Zone 2 or VO₂ data on file currently. |
| Sleep Study (if Hct rises further) | Never | PRN | PRN | conditional | Trigger: Hct >48% or symptomatic sleep disturbance |
Module 05
Peptide & Pharmaceutical Stack
CJC-1295 / Ipamorelin active
Two injectable peptides that work together to boost your body's natural growth hormone production
On-cycle
Wk ~4 of 12
How it works (plain language)
CJC-1295 mimics the brain hormone (GHRH) that signals your pituitary to release growth hormone. Ipamorelin mimics ghrelin (the "hunger" hormone) but specifically the part that also stimulates growth hormone release through a different receptor. The two together produce a stronger, more natural pulse than either alone — and critically, your body's own GH machinery does the work, so the natural pulsatility (the rhythm) is preserved. Unlike injecting synthetic GH directly, this approach doesn't suppress your own production.
Vendor
Peptide Partners
Batch CJIP202602 · 99.92% pure (third-party verified)
Current dose (wk 3–4)
150 mcg each
4.5 units on standard insulin syringe
Schedule
5 on / 2 off
Bedtime, ≥2 h after last meal, injected just under skin of abdomen
Cycling
12 wk on · 4 wk off
The 4-week break lets pituitary receptors reset so the drug doesn't lose potency
Goals: Energy, libido, body composition. The mechanism for the libido/energy benefit: as GH rises, SHBG tends to fall, releasing more bioavailable testosterone. Plus deeper sleep architecture (more slow-wave sleep) within 2–4 weeks.
Baseline IGF-1: 113 ng/mL (Mar 2026 — pre-treatment). Target: 150–220 ng/mL. Stop if >300 (supraphysiologic — increases prostate/colon proliferation signal).
Titration plan: Wk 1–2: 100 mcg → Wk 3–4: 150 mcg → Wk 5–6: 200 mcg → Wk 7–12: 250–300 mcg of each peptide.
Baseline IGF-1: 113 ng/mL (Mar 2026 — pre-treatment). Target: 150–220 ng/mL. Stop if >300 (supraphysiologic — increases prostate/colon proliferation signal).
Titration plan: Wk 1–2: 100 mcg → Wk 3–4: 150 mcg → Wk 5–6: 200 mcg → Wk 7–12: 250–300 mcg of each peptide.
Monitoring while on cycle:
- IGF-1 at 4–6 weeks (~22 May 2026) — confirms peptide is working, prevents overshoot
- HbA1c every 3 months — growth hormone counteracts insulin, so blood sugar can drift up. Yours is already at the upper edge of normal.
- PSA every 6 months — IGF-1 stimulates the PI3K/Akt/mTOR proliferation pathway in prostate tissue
- Hematocrit with next CBC — yours was borderline 46% in Jan; growth hormone can mildly raise it
- SHBG / Free T at 3-month panel — measure whether the testosterone-availability benefit materialized
FluconazoleOral antifungal — blocks ergosterol synthesis in yeast cell membranes
Dose150 mg weekly × 4–6 wk
StartedApr 2026
active
ForCandidal intertrigo — good response
Repatha (evolocumab)Injectable monoclonal antibody · blocks PCSK9 · injected under skin every 2 or 4 weeks
Effect~27% Lp(a) drop · ~60% LDL drop
StatusDiscussion / pending
pending
ForBridge therapy until gene-silencing Lp(a) drugs arrive (see Lp(a) tracker)
PT-141 (Bremelanotide)Targets brain pathway for sexual desire (MC4R agonist) · injected as-needed
Dose0.5–2 mg, 45–60 min before desired effect
WhenAfter 3-mo CJC panel
future
IfLibido still suboptimal even after SHBG/Free T improves on CJC
Module 06
Supplement Stack
| Supplement | Dose | Evidence | Status | Mechanism / Rationale | Monitoring |
|---|---|---|---|---|---|
| Psyllium Husk NOW Foods or Yerba Prima — unflavored |
10 g/day (titrate from 5 g) | strong | ADD — high priority | Forms a gel in your gut that grabs bile acids and pulls them out via stool. Your liver responds by pulling cholesterol out of blood to make new bile acids → ApoB drops. Bonus: slows sugar absorption (HbA1c down 0.2–0.4%), counteracting the blood-sugar rise that GH peptides can cause. Take pre-meal with ≥250 mL water; separate from other meds by 2 h. | ApoB, LDL, HbA1c at 8 wk |
| Plant Stanols (sitostanol esters) Benecol capsules · stanols preferred over sterols (no oxidation) |
2 g/day with largest meal | strong (109 RCTs, EAS endorsed) | ADD — recommended | Structurally mimics cholesterol — physically displaces dietary cholesterol from being absorbed in the gut. Combines with psyllium for a 26% boost in liver LDL receptors (more cholesterol clearance from blood). ~10% LDL drop, 5–8% ApoB drop, small Lp(a) signal too. Population study (n=213,992): modest CAD risk reduction. Your ABCG5/G8 genes = wild-type. Bump Vit D to 4–5k IU. See deep dive. | ApoB, LDL, Lp(a), HbA1c at 12 wk |
| Creatine Monohydrate | 5 g/day (reduced from 10 g) | strong | keep | Cellular energy buffer that improves strength, power output, cognition, and possibly mood. 5 g/day fully saturates muscle stores — the 10 g you were on was inflating your kidney function blood test (creatinine) without any extra benefit. | Creatinine (artifact resolved) |
| Magnesium Bisglycinate CA Gold TRAACS |
200 mg/day | strong | keep | Cofactor for ~300 enzymes including those involved in insulin signaling, sleep regulation, and heart rhythm. The bisglycinate form is well-absorbed and gentle on the gut. Especially relevant given your HbA1c trending upward. | HbA1c, fasting glucose |
| Vitamin D3 CA Gold + fish-oil D |
~3,000 IU/day total | strong | keep | Critical for bone health, immune regulation, mood, and lipid metabolism. Your last test (Apr 2024) showed deficiency at 28.9 ng/mL. Now 2+ years old — needs re-checking to confirm supplementation is working. | 25-OH Vit D — OVERDUE |
| B-Complex Plus (active forms) Seeking Health · Quatrefolic 5-MTHF + methylcobalamin |
1 cap/day | moderate | keep | You're homozygous for MTHFR A1298C, a common gene variant that makes it harder to activate folate from food. Active forms (5-MTHF instead of folic acid; methylcobalamin instead of cyanocobalamin) bypass the bottleneck entirely. | Methylation panel pending |
| N-Acetylcysteine (NAC) Nutricost |
600 mg evening only | moderate | conditional | Precursor to glutathione, your body's main antioxidant. Particularly relevant given your HFE iron-absorption variant. Take ≥6–8 hours after workouts — antioxidants taken right around exercise blunt the muscle-building signal. | GGT, ferritin |
| Omega-3 Fish Oil NOW Ultra · 600 EPA / 300 DHA |
~900 mg combined | subtherapeutic | restructure | The cardiovascular benefit of fish oil shows up at 2–4 g/day of EPA — you're at about a quarter of that. Triglycerides (the main fish-oil target) are already excellent for you. Decision: either increase to ≥4 g EPA daily for genuine CV effect, or drop it as currently subtherapeutic. | Omega-3 index (not measured) |
| DHEA 50 mg | — | moderate | stop now | DHEA converts partly to estrogen. Stacking with CJC/Ipa risks pushing estrogen too high. Pause until 3-month hormone panel; only restart if DHEA-S drops below 200 µg/dL. | DHEA-S, E2 |
| Boron 10 mg | — | weak (single small study) | finish bottle, drop | The case for boron lowering SHBG comes from a single 8-person study — very thin evidence. CJC/Ipa addresses SHBG through a much stronger mechanism (JAK-STAT signaling from growth hormone receptors). Boron becomes redundant. | SHBG |
| TUDCA 500 mg Tauroursodeoxycholic acid — bile acid derivative |
— | moderate | pause pending ferritin | Supports liver bile flow and may reduce hepatic stress. But if your GGT elevation is iron-mediated (which is most likely), TUDCA treats the symptom not the cause. Hold off until ferritin result clarifies the underlying mechanism. | GGT, ferritin |
| 5-MTHF standalone + Methylcobalamin SL | — | — | do not add yet | Wait for methylation panel — need to see homocysteine, MMA, B12, and Folate (red blood cell) levels first. Only add standalones if you're functionally deficient despite the active-form B-complex. | — |
Module 07
Genomic Risk Map
Nucleus WGS v1.4.7 · sample NU-XFHH-4942 · released 10 Apr 2026. 0 pathogenic variants across 2,147 conditions. APOE = e3/e3 (lowest-risk Alzheimer's genotype). 6 carrier variants (partner-screen relevant only, except HFE which is clinically actionable for you).
Elevated Polygenic Risk (Z > 1)
Z-score = how many standard deviations above average
Clinically Actionable
HFE H63D heterozygous carrier — iron over-absorption risk. The best mechanistic explanation for your 3-year persistent GGT elevation. Action: ferritin + transferrin saturation blood test immediately.
APOE e3/e3 confirmed — lowest-risk Alzheimer's genotype. Your lifetime Alzheimer's risk is 8.8% (vs 13.8% for typical population). Substantially reassuring — you don't carry the e4 variant that drives most genetic Alzheimer's risk.
T2D risk 30.1% — your genetic predisposition is modestly elevated AND your blood sugar (HbA1c 5.6%) is already at the upper edge of normal. Since CJC/Ipa raises blood sugar mildly (growth hormone opposes insulin), this combo warrants checking HbA1c every 3 months.
Carrier Variants (heterozygous · partner-screen only)
GJB2 · AR deafness 1A
UPB1 · β-ureidopropionase deficiency
FANCI · Fanconi anemia group I
SPG7 · Spastic paraplegia type 7
USH2A · Usher syndrome type 2A
HFE H63D · Hemochromatosis (see above — clinically actionable)
UPB1 · β-ureidopropionase deficiency
FANCI · Fanconi anemia group I
SPG7 · Spastic paraplegia type 7
USH2A · Usher syndrome type 2A
HFE H63D · Hemochromatosis (see above — clinically actionable)
Evaluated → Cleared (18 May 2026): ABCG5 / ABCG8 sitosterolemia variants. Direct VCF query: wild-type at D19H (rs11887534), G574R, W361X, R419H, R446X. Plant sterol absorption phenotype = population-typical; no atherogenicity contraindication.
Module 08
Care Team
Dr. R Burns
Primary · Google Wellness Center, Mountain View
Dr. Kewmars Keyvani, MD
PCP/Internist · One Medical, Menlo Park
Dr. J Saya
Longevity/Hormone · Defy Medical LLC, Tampa FL
Dr. Iffath
Primary care contact (referenced)
Dr. Scott Soerries, MD
Ordering physician — Nucleus WGS
Specialists TBD
Hepatology · Urology · Ophthalmology
Module 09
Active Protocols & Performance Goals
Training
| Calisthenics (bodyweight strength) | ≥2×/week on |
| Yoga | Most days on |
| Zone 2 cardio | No data gap |
| VO₂max intervals | No data gap |
| Resistance training volume | Calisthenics-based verify |
Recommended longevity-focused targets: Zone 2 ≥180 min/week · 2× weekly 4-min interval sets at near-max effort · strength training 2–4×/week with progressive overload.
Nutrition / Sleep
| Protein | Target ≥1.6 g/kg = ~120 g/day |
| Pre-CJC fast | ≥2 h before bedtime injection |
| Alcohol | Minimal — GGT/HFE rationale |
| Sleep target | 7.5 h · consistent timing (Oura) |
| Lp(a) lever (diet) | Saturated fat <7% kcal |
CJC/Ipa typically improves deep-sleep architecture within 2–4 weeks — track Oura SWS to confirm.
Module 10
Emerging Treatments Hub
Deep-dive trackers for therapy classes most relevant to your phenotype. Each is independently auto-refreshed.
🧬
Lp(a)-Lowering Pipeline
7 therapies tracked: Pelacarsen, Olpasiran, Lepodisiran, Muvalaplin, Obicetrapib, Zerlasiran, Repatha. Bay Area trial sites. Built & live.
Open tracker →
🌿
Plant Sterols / Stanols Deep Dive
Recalibrated evidence review — 109 RCTs, NHS cohort (n=213k), EAS endorsement, Lp(a) data, ABCG5/8 status. Stanols vs sterols, product picks, stacking. Built & live.
Open deep dive →
✂️
Gene Therapy & Base Editing
NEW (25 May 2026): VERVE-102 Heart-2 Ph1b positive — single dose cut PCSK9 up to 88% and LDL-C up to 62%, durable to 18 mo, no serious AEs. Now Lilly-owned; Phase 2 to start by end-2026. A one-time fix for your ApoB/LDL phenotype. Also tracking EDIT-401, Intellia LNP.
Scaffold — build next →
💊
GLP-1 / Metabolic Pipeline
NEW (May 2026): Retatrutide TRIUMPH-1 Ph3 hit — 28.3% weight loss at 80 wk (30.3% at 104 wk), plus drops in non-HDL, TG, SBP, hsCRP. Regulatory filing expected 2026. Also tirzepatide, oral GLP-1s, amylin co-agonists. Relevant given HbA1c trajectory + T2D PRS.
Scaffold — build next →
⏳
Longevity / Senolytics
Rapamycin/mTOR, NAD+ pathway, senolytic CDs (dasatinib + quercetin), Klotho.
Scaffold — build next →
🧠
Peptides Watchlist
PT-141, BPC-157, TB-500, Tesamorelin, Epitalon, MOTS-c — evidence-tiered.
Scaffold — build next →
📊
Diagnostic Tech
Grail Galleri, Prenuvo whole-body MRI, Function Health, Cleerly CCTA AI.
Scaffold — build next →
Module 11
Open Decisions & Action Items
HIGH
Order fasting ferritin + iron + TIBC (Total Iron Binding Capacity). 2+ years overdue. Your HFE H63D carrier status plus 3-year persistent GGT elevation strongly suggest mild iron overload. If ferritin >200 µg/L or iron saturation >45%, refer to liver specialist for therapeutic blood donation. Cheap, no doctor needed.
questhealth.com
HIGH
IGF-1 blood test at week 4–6 of CJC/Ipa cycle. Due ~22 May 2026. This is your check that the peptide is working AND not overshooting. Stop or hold dose if >300 ng/mL (supraphysiologic); target zone is 150–220 ng/mL.
~22 May 2026
HIGH
Vitamin D (25-OH) retest. Last test (Apr 2024) was 28.9 ng/mL — deficient. You've been supplementing 3,000 IU/day since, but it's been 2 years with no recheck. Need to confirm it's now in target range (40–60 ng/mL).
next draw
HIGH
Watch for Pelacarsen Phase 3 readout (any week now). First-ever clinical outcome trial for an Lp(a)-lowering drug — results expected first half of 2026, currently pending. Positive readout would reshape the entire Lp(a) treatment conversation. Auto-monitored monthly.
auto-monitored
HIGH
Confirm CJC/Ipa dose with Dr. Saya before week 5. When he said "300–500 mcg," did he mean per peptide, or total combined? Standard clinical protocols cap at 300 mcg of each peptide. Clarify before titrating higher.
before wk 5
HIGH
Start psyllium husk titration this week. Begin 5 g/day for week 1, increase to 10 g/day by week 3. Take pre-meal with ≥250 mL water; separate from other medications by 2 hours. Drops ApoB and LDL while smoothing blood sugar (offsetting the mild HbA1c rise from CJC). Re-check ApoB + HbA1c at 8 weeks.
this week
MED
Consider CCTA (coronary CT angiography) with plaque characterization. Your CAC score = 0 is reassuring but doesn't rule out soft (non-calcified) plaque, which is what Lp(a) drives. CCTA visualizes both. Also would resolve "established cardiovascular disease" ambiguity for trial eligibility (e.g., the ACCLAIM-Lp(a) trial).
Q3 2026
MED
Order methylation panel. Four tests: homocysteine, MMA, vitamin B12, and red-blood-cell folate. Your MTHFR A1298C variant slows methylation; need to know if you're functionally deficient before adding standalone 5-MTHF.
next draw
MED
Order Cystatin C blood test. Settles whether your creatinine fluctuations are pure muscle/supplementation artifact or whether there's any underlying kidney signal. One-time check.
next draw
MED
Standing order: all future Lp(a) tests in nmol/L (not mg/dL). Clinical trial eligibility thresholds (≥175 nmol/L, ≥200 nmol/L) are specified in nmol/L only. Request an isoform-independent assay (LC-MS or equivalent) for accuracy.
standing order
MED
Restructure omega-3 supplementation. Your current dose (~900 mg combined EPA+DHA) is below the cardiovascular benefit threshold (need 2–4 g EPA daily). Triglycerides already excellent. Decision: increase to ≥4 g EPA/day for real CV effect, or discontinue.
this month
MED
Baseline VO₂max via CPET (cardiopulmonary exercise test). Better predictor of how long you'll live than any blood marker. No data on file currently. Available at most sports-medicine clinics; ~$300–500.
2026
LOW
Calendar reminder for Feb 2028: You turn 50, which makes you eligible for the OCEAN(a)-PreEvent trial — the only major Lp(a) outcomes trial specifically for primary prevention (people without prior heart attacks).
Feb 2028
LOW
Book surveillance colonoscopy by Q1 2027. Three-year follow-up after your June 2024 polyp removal. Standard protocol given your single small low-risk adenoma.
Q1 2027
LOW
Verify annual full-body skin (dermatology) exam is done. Standard preventive check for a 48-year-old male; not in your current records. Book if not already done in last 12 months.
ASAP
Module 12
Document Vault
Source files in your project folder. Click to open.