Shifting the Focus from Treating Disease to Preventing It

By Steve Spencer 

After receiving his PhD from MIT in 2002, followed by post-doctoral work at the University of Washington (UW), Matt Kaeberlein joined the UW faculty, where he focused his research on the biology of aging. Over time, he came to understand that most chronic diseases were associated with aging, and exacerbated by lifestyle, and after nearly 20 years in academia, he wanted to put his findings into practice.

“Our current healthcare system is largely reactive,” Kaeberlein said. “It’s good at fixing sick people. I wanted to work on something to keep people healthy in the first place.”

Kaeberlein met with Dave Sabey, the founder of Sabey Corporation, a large commercial real estate firm. Sabey had already helped found the P4 Medicine Institute which uses a model structured around personalized, preventative, predictive, and proactive healthcare. The two men spent time talking about the friction points in today’s healthcare system, thinking through the countless problems with the aim of using science-based practices to help people optimize their health.

With this in mind, in September 2023, they launched OptiSpan in Seattle. “We want to build an evidence-based, implementable toolkit that we can give to providers,” Kaeberlein said. “So we set up our own clinic, not so much to earn revenue, but rather to gain experience so that we could build the platform. We wanted to find out if there were interventions or modifications that could give us 80 percent of the benefit for 20 percent of the cost, which could be steps toward population-level proactive healthcare programs. And we’ve learned a lot.”

When a person joins the OptiSpan program, they come to the clinic for Gateway Day, which lasts about six hours. “We do broad comprehensive blood work,” Kaeberlein said. “There’s a metabolic collection, biomarkers of inflammation, of cardiovascular health, kidney health, liver health, toxins, and hormones.

Then we do an ultrasound for screening. It’s not a diagnostic tool, but it picks up things like significant plaque in the arteries, kidney or liver problems.

“The goal of our diagnostics is, first, to find out if the person has any serious problems that need immediate attention, and we often find things like pre-diabetes. Second, we want to establish their current health baseline.

“To get a detailed look at how someone is functioning physically, we do an exercise assessment that includes VO2 max, flexibility, and strength. We get a DEXA scan, which gives us information on muscle mass, fat mass, and bone density. Then we collect urine for urinalysis, and we do multi-genome sequencing.

“ We also do a cognitive assessment, and oral screening. We do this because oral health is both a predictor and a cause of other problems. We have a tool that can image the inside of a mouth, and we have a dentist who reads those images and can make recommendations if there’s any problem there.”

OptiSpan providers will also arrange a whole body MRI for people who want it. This helps with cancer detection, as well as quantitative brain imaging. Information on the size and volume of different parts of the brain can be predictive for cognitive impairment. If the team detects any problems from the workups, they’ll refer out for more in-depth procedures.

Gateway Day clients also spend several hours meeting with a physician. After that, they’ll meet with a coach to get information about the person’s lifestyle.

The OptiSpan program is structured around what they call the four pillars of health span. Eat – nutrition; move – exercise; sleep; connect - mindfulness and relationships. Kaeberlein and the team believe these components of health are all equally important.

“We use wearables to help with this,” Kaeberlein said. “Everyone gets a sleep tracker so we can assess the quality of their sleep. We also track heart rate variability. And everyone gets a continuous glucose monitor for at least their first 28 days with us. We do this in part to educate people. When someone sees in real time how certain foods and alcohol, as well as exercise and sleep affect their glucose metabolism, we hope that it will give them an incentive to remodel their behavior toward healthier habits.”

The movement component of the program isn’t as simple as saying that all exercise is good. “There are certain people for whom a particular type of exercise is most beneficial,” Kaeberlein said. “For example, we measure our clients’ flexibility, stability, and strength so depending on where you fall in these areas, you may focus more on one specific type of exercise.

“One thing that’s more common than expected is that there is a subset of middle-aged women who are extremely lean. Often they do a lot of cardiovascular exercise, and you assume they’re in great health. But when we do a body composition, we find that they are under-muscled, and often have a bit of visceral adipose which causes inflammation and metabolic disease. They might be eating a healthy diet, but a certain amount of muscle is needed for the body to regulate glucose, so these women are often pre-diabetic.

“So we give them a resistance training workout program, prescribe a little testosterone, and tell them to back off on the cardio, at least until you get the body composition where it needs to be. And we put them on a diet that has enough protein and calories to build muscle.

“We recently had a woman with this phenotype who looked healthy. But testing showed she had very high lipid levels. We found a history of micro strokes in her brain, not enough to impair cognitive function or brain health, but warning signs that if this did not get fixed, it was going to get serious quick. We put her on the resistance training program, coupled with testosterone, along with a lipid lowering therapy. We successfully lowered the lipids. So things are going in the right direction, but I don’t want to say she’s 100 percent out of the woods. It’s ongoing. We update clients’ biomarkers quarterly. For someone like this lady, we’ll do the DEXA every quarter.”

Ultimately, the OptiSpan team wants to promote longevity and optimize healthspan through proactive strategies rather than reactive treatments. They aim to redefine healthcare by shifting the focus from treating disease to preventing it entirely. 

The last century revolutionized global life expectancy through vaccines, antibiotics, and medical innovations. This century will be defined by optimizing healthspans for all people. The question isn’t just how long we can live, but how well.