Illustrative Longevity Medicine Case Study With Karen Darke

We are delighted to present to you a case study with British paralympic cyclist, Karen Darke, that will demonstrate an example patient journey using one of our longevity medicine pathways. This very unique insight will hopefully answer a lot of questions about how this area of medicine works both logistically, as well as clinically; providing you with an opportunity to take a peek into what our treatment plans can look like for patients when they come to see us.

In recent years innovative, and forward thinking practitioners, scientists and researchers have begun to shift their focus towards understanding what determines healthy ageing, healthspan, and more importantly, how we can best utilise this new science to change our approach to healthcare. For those new to the longevity space, ‘healthspan’ is a relatively new term, and one that refers to the amount of years in your life where you feel in good health. Our longevity medicine consultations are medically-led by expert doctors that specialise in early detection and prevention of age-related decline; and we use a proactive approach to health instead of the traditional reactive healthcare model.

We hope that by presenting this case study we are able to inspire you to learn more about the importance of longevity medicine, healthspan and taking proactive steps to age well, so that you can find a place for healthy ageing within your own life.

Patient introduction

Meet Karen Darke, a British paralympic cyclist, paratriathlete, adventurer and author. Karen began her working life as a geologist in the Bolivian Andes, researching gold, but a life-changing accident left her paralysed from the chest down. She then moved away from being a ‘rock-doctor’ to exploring both outside as well as within. A keen adventure, she has travelled extensively, writing about her adventures for others to enjoy and gain inspiration.

We connected with Karen as she has a keen interest in longevity medicine, and she is specifically interested in helping to find ways to support others that have a spinal cord injury. We are inspired by Karen’s sense of adventure, curiosity and desire to help others.

Karen is very interested in placing the power back with the patient, matching our own philosophy of helping the body to help itself. After a discussion with Karen we learned that she is keen to focus on the longer-term health issues that arise for those with a spinal cord injury. Those that are paralysed will inevitably have health considerations that differ from those without this type of injury. Longevity medicine at its very core is precision-based medicine, that places the individual at the centre. We hope that by addressing longer term health concerns for those that have had a spinal cord injury, that we can begin to show what patients can do using longevity medicine to support their health.

Karen’s case study goals

To obtain personalised insight about how best to support with healthy ageing
Learning where best to place her focus with regards to the varying longevity medicine practices
Would like to learn and then highlight about the longer-term health concerns that are specific to those with a spinal cord injury

We will follow Karen’s journey with us as she completes a longevity medicine Comprehensive Consultation pathway which will look to address her current health concerns and symptoms, as well as optimise her health, healthspan and longevity!

Initial Longevity Comprehensive Consultation | June 2024

Who?
Female, 53 years old, paralympic athlete

Patient goals

Interested in being more proactive about her health
Concerned about recent high blood calcium
Would like to optimise energy levels
Address recurring migraines
Curious about her hormone health

Initial consultation observations

Paralysed from the chest down following an accident, aged 21
Has a permanent urinary catheter

Complaints and concerns

Occasional migraines
Reported high blood calcium levels (already under investigation)
Frequent antibiotic use for UTI (urinary tract infection)
Menopausal
Asymptomatic Syringomyelia
Feels as though she holds tension in jaw and neck
Mindful of skin sores
Slow gastric motility

Past History

History of candida overgrowth – reduced dietary sugars and implemented supplement regime
Previously low in vitamin D and anaemia
Kidney stones
Previous bloating – now is better

Current habits

Taking low dose oestrogen in patch form
Daily exercise using weights and completes cardio 1-4 hours per day currently
Medium coffee intake
History of elevated stress
Sleep is generally good – less so in past couple of years
Diet is low in carbohydrates and processed foods
Fresh vegetables daily and meat 3 times per week
Eats fish once per week
Tends not to have dairy – replaced with oat milk
Very low alcohol consumption
Addresses diet to to reduce incidence of UTI
Non-smoker

Testing

Hormone blood test panel (blood draw)
Nutrient Core DNA (cheek swab)
GutID – Core Gut Insights (stool test)

Doctor’s initial opinion prior to receiving test results

Potential for longer term skin and bladder issues which are of key concern
For bladder issues – this is currently out of our remit; but there is a case of helping the body help itself here too. We can help to improve immunity so that the patient can fight infections better
For skin issues – this is likely to be an ongoing issue which will always require care and management. This will be resource heavy, and by resource, I mean the things that our body needs to expedite healing. Nutrients play a crucial role here, and instead of simply taking supplements I would like to target this further by looking at her individual needs for nutrients with a DNA nutrient test. From personal experience, I know that this can significantly change things and it will likely save money in the longer run as we are more targeted in our management
Recurrent antibiotic use, which at present, does not seem to impact her but it would be good to explore her gut diversity
Decrease the amount of exercise or be more aware of the amount of exercise completed. It is my belief that there is likely overuse contributing to other symptoms such as migraines and headaches. I’m also curious as to why there’s a need to spend so much time exercising – something I would like to explore more in our follow up consultation
Stress management needs more targeted management

Update | July 2024

Testing has been ordered by our specialist patient care team, and once results are back, we will review them and adjust Karen’s treatment plan accordingly.

Update | November 2024

Karen’s test results are back with us, reviewed, and a comprehensive longevity medicine report is finalised by Dr. Harpal Bains.

Hormone blood test results

Oestrogen: Levels remain extremely low despite HRT. Higher doses may not be suitable if there is difficulty in clearing oestrogen metabolites, which is suspected to be an issue.
Progesterone: Levels are also very low.
Testosterone: Levels have room for improvement.
DHEA: Levels are within the normal range.
Thyroid: Levels are low-normal but likely adequate for the body’s needs.
Vitamin D: Levels are excellent, indicating a sufficient pro-hormone status.

Gut test results

Overall gut health: While diversity is good, there is room for improvement. Given the history of annual antibiotic use, the gut microbiome is notably resilient but still slightly below average compared to the general population.
Beneficial bacteria: Some important species, particularly Lactobacillus, are very low.
Rare bacteria: Elevated levels of uncommon species, including one resembling E. coli, were identified. While not currently causing issues, a preventative approach to enhance diversity and balance would be beneficial.

Nutrient DNA testing results

Key focus areas: Vitamin K, B vitamins (especially folate and B12), and glutathione.
B vitamins: Poor absorption of folate and B12 due to reduced MTHFR activity. Supplementation is advised.
Vitamin K: Higher-than-average requirements indicate the need for supplementation.
Glutathione: A GSTM1 gene defect reduces detoxification efficiency. While there are no current toxin overload symptoms, optimizing detox pathways with measures like an infrared sauna or IV glutathione is recommended.
Inflammatory response: Genetic predisposition to heightened inflammation, likely exacerbated by a high exercise load and possibly linked to post-Paralympic burnout.
Blood pressure: A genetic predisposition to higher blood pressure suggests regular monitoring (2-4 times per year), even if it is not currently an issue.

Summary of Karen’s personalised longevity medicine plan:

Please note: These recommendations have been made based on Karen’s individual history, goals and test result. This advice should not be followed by anyone else.

1. Gut health

Follow a targeted 3-month gut supplement protocol to optimise gut health and microbiome diversity.
Increase fibre intake and diversify food sources to support gut health.

2. Hormonal support

Continue with the current dose of HRT but transition to Evorel (oestrogen-only patches) at the same dose. This allows progesterone to be taken as an oral supplement, which has different absorption and benefits compared to the topical form.
Add oral progesterone (Utrogestan 100mg) to gain systemic benefits beyond uterine support.

3. Detoxification and antioxidant pathways

Introduce a glutathione supplement paired with vitamin C to enhance antioxidant and detoxification capacity.
Include sulforaphane supplements to support effective oestrogen metabolism.

4. Supplementation

Add vitamin K to address higher-than-average requirements.
Incorporate B vitamins (especially folate and B12) to overcome absorption issues.

5. Inflammation and monitoring

Address the genetic inflammatory predisposition with lifestyle adjustments, particularly reducing exercise intensity if needed.
Regularly monitor blood pressure (2-4 times per year).

This bespoke plan aims to address identified imbalances and support Karen’s health and longevity goals through targeted interventions.

Nutritional therapy for healthy ageing

Karen also had a consultation with Victoria Marshall, our in-house nutritional therapist, who specialises in healthy ageing strategies to support patients in achieving their longevity goals.

Observations

Protein intake: Protein consumption is low overall, especially at breakfast, when it is most needed.
Carbohydrate intake: Carbohydrate intake is insufficient and not always optimally timed to support physical activity. Lunch, which precedes extended cardio sessions of 2+ hours, lacks adequate carbohydrates to fuel this performance.
Micronutrient richness: Karen’s diet is rich in micronutrients and antioxidants, providing a strong foundation for health which is great.
Morning routine: Consuming black coffee on an empty stomach elevates cortisol and disrupts blood sugar balance, which is suboptimal given her nutrient DNA panel which indicates an increased caffeine sensitivity.
Plant-based milks: Consumption of plant-based milks, such as oat milk, can lead to blood sugar spikes. Non-organic options also contain glyphosate, a widely used herbicide which is associated with potential health concerns.
Lifestyle and exercise: Karen’s cardio-heavy exercise routine is intense, which may potentially be placing excessive stress on the body. Without balanced macronutrient intake and proper timing, this could hinder recovery and amplify strain.

A summary of Karen’s initial nutrition strategy

Caffeine adjustment: Switch to decaffeinated coffee, especially when consuming it fasted, and avoid caffeinated coffee on an empty stomach to reduce cortisol spikes.

Protein intake: Begin to increase protein intake to 138g per day, aiming for at least 40g at breakfast. Incorporate high-quality protein powders, collagen, and savory options like eggs, salmon, mushrooms, and avocado. These choices also assist with introducing beneficial fats such as olive oil and avocado, which can offer anti-inflammatory properties.

Carbohydrate optimisation: Increase carbohydrate intake overall, especially at lunch to improve workout energy and performance. Suggested options include sourdough bread, quinoa, or sweet potato hash browns, to begin aiming for at least 120g of carbohydrates before 2.5 + hour workouts – especially if the sessions remain this length. Post-exercise, focus on fibre-rich carbs for steady energy release and continue bioavailable carbohydrate sources during your cycling sessions.

Inflammation management: Ensure daily supplementation with omega-3 due to her DNA profile indicating a predisposition to elevated inflammation markers (IFN-γ and TNF). Also prioritise gut health and microbiome diversity to assist with regulating inflammation and overall health. Upon returning to the UK, we suggest Karen considers using a food box service to introduce a wider variety of ingredients into her diet. Consider curcumin supplementation, both for anti-inflammatory components and its ever increasing association with longevity; this can be added later, once foundational dietary and supplementational routines are established.

Glutathione support: To enhance glutathione production, include two Brazil nuts daily to optimise selenium levels (an antioxidant and co-factor for glutathione activity) and consume cruciferous vegetables (e.g., broccoli, kale, cabbage) or garlic 1-2 times per day.

Exercise adjustments: Discuss with her personal trainer the possibility of reducing cardio sessions to incorporate more resistance and strength training. The goal would be a more balanced routine that avoids overtaxing the body and supports a sustainable longer-term fitness regime which also aligns better with the science around exercise tactics and longevity.

Spinal cord injury considerations: Although those with a spinal cord injury may require a reduced caloric and macronutrient intake, Karen’s high activity level and food diary indicate the unequivocal need to improve and maintain appropriate macronutrient intake to support her current demands effectively.

An Illustrative Longevity Medicine Case Study With Karen Darke