Hi Reader,

Usually, conference swag is junk. T-shirts, stress balls, and socks that end up in the hotel trash.

But after spending the last week conference-hopping from the ivory towers of the Buck Institute (deep longevity science) to the neon chaos of A4M Vegas (commercial reality), I realized something while unpacking.

The swag isn't random. It’s a roadmap.

These samples represent where the biggest longevity companies are spending their marketing dollars right now. They are the bridge between the unpublished data I heard in the lecture halls and the products your patients will be asking for in six months.

I analyzed the 16 items that made it into my carry-on (it was so heavy 😅). There was too much "alpha" for one email, so I’m splitting this into a two-part series.

Today, in Part 1, we cover "The Plumbing"—the physical infrastructure that keeps you alive. Because if blood doesn't flow, nothing else matters.

The TL;DR:

If you only have 30 seconds, here are the protocols hitting the mainstream in 2026:

• 🫀 Vascular: It’s not just about beets. The new standard is "Fuel + Efficiency" (Nitrates + low-dose Tadalafil) to reduce dementia risk.
• 💇🏻‍♀️ Hair: Why the longevity industry is obsessed with hair loss other than for aesthetics (hint: it's a microcirculation biomarker).
• 🦷 Oral Health: 60% of Black and Hispanic adults have periodontitis (vs 39% of White adults). For high-risk groups, oral care is a survival intervention.

👀 Next Week: We cover the Engine (Mitochondria) and the Processor (Brain).

If you're interested in a full list of the exhibitors and the swag I brought home, I created a spreadsheet here (just request permission and I'll send it over!).

🫀 The Big Theme: Vascular Health (Fuel vs. Efficiency)

I came home with THREE different nitric oxide (NO) products. That’s not a coincidence—it’s a signal. But these supplements only tell half the story.

To understand vascular longevity, you have to understand the difference between Fuel and Efficiency.

1. The “Fuel” (Nitrates) Products like Berkeley Life and N.O. Beetz provide the raw materials. They use dietary nitrates or citrulline to help your body produce Nitric Oxide.

• Who needs this most: Everyone over ~40, but specifically African Americans. Research shows this demographic often has reduced NO bioavailability due to higher baseline oxidative stress. The “fuel tank” runs low faster.

2. The “Efficiency” (PDE5 Inhibitors) This is where the pharmaceutical side (Tadalafil/Cialis) comes in. Once your body produces NO, an enzyme called PDE5 degrades it. Tadalafil inhibits PDE5, essentially "plugging the leak" and keeping vessels dilated.

Why Longevity Clinics Are Prescribing ED Meds Off-Label

Doctors used to think of Tadalafil strictly for erectile dysfunction. We were wrong. In longevity medicine, we now view low-dose Tadalafil (2.5mg–5mg daily) as a systemic microcirculation enhancer.

Recent data has forced us to pay attention:

• A 2024 study in Neurology analyzing over 250,000 men found that PDE5 inhibitor initiation was associated with an 18% reduction in Alzheimer’s risk (with the strongest effect seen in those with the most tadalafil prescriptions).
• Retrospective analyses have shown that men taking PDE5 inhibitors have lower rates of major adverse cardiovascular events (MACE) and overall mortality compared to controls.

Is this for women? Yes. While the dementia studies skew male, the mechanism is universal. Longevity physicians frequently use this in women to treat Raynaud's Phenomenon (cold hands/feet) and to compensate for the loss of estrogen-mediated vascular protection post-menopause.​

How You Might Actually Feel

• The “Extremity Warmth”: Patients with perpetually cold hands/feet often report feeling warmer within 3-5 days.
• The “Gym Pump”: You may notice significantly improved vascularity and muscle fullness during workouts.
• The “Brain Fog Lift”: Improved cerebral perfusion often manifests as better sustained focus in the afternoon.

What to Actually Do:

• The Baseline: Eat your arugula and beets. This is your fuel.
• The Upgrade: Discuss low-dose daily Tadalafil (2.5mg - 5mg) with your physician.

⚠️ Safety Note: Do NOT combine with organic nitrates (like nitroglycerin – this can lead to dangerous hypotension and falls). Check your medication list.

💇🏻‍♀️ The Canary in the Coal Mine: Hair as a Vital Sign

If vascular health is the "Plumbing," your hair is the pressure gauge.

I counted over 15 different companies on the expo floor dedicated to hair restoration (Nutrafol, Capillus, KeraFactor, LaserCap). Why is the longevity sector obsessed with hair? It’s not just vanity.

The Science: Hair follicles are mini-organs with massive energy demands. However, they are supplied by tiny capillaries. When your systemic endothelial function (vascular health) declines, these peripheral capillaries are the first to constrict to save blood for vital organs.

• The Translation: Hair loss is often an early warning sign of systemic microvascular dysfunction—long before it shows up as a heart attack.

The "Stack" I Saw Everywhere: The industry has moved beyond just Minoxidil. The new standard of care combines Energy + Blood Flow.

1. Photobiomodulation (Red Light Caps): Companies like Capillus use laser diodes to stimulate mitochondrial energy in the follicle.
2. Growth Factors: Products like KeraFactor are using biosynthetic growth factors to signal dormant follicles to wake up.

​

What to Actually Do (The Longevity Hair Stack):

The days of “just try Rogaine” are over. The new standard is a multi-modal stack that addresses Soil, Signal, and Energy. Review with your health provider before trying any new interventions!

The “Soil” (Internal)

• The Product: Xtressé.
• Why: This is the new gummy line challenger to Nutrafol, and it tells me the industry is finally acknowledging cortisol. High stress pushes follicles into the resting phase (telogen effluvium). You cannot grow hair on a stressed-out scalp.
• Action: Use an adaptogen-heavy formula like this to fix the internal environment (lower cortisol) before you worry about topicals.

The “Signal” (Topical)

• The Upgrade (Growth Factors): KeraFactor. Unlike PRP (which varies by patient health), this uses bio-identical growth factors wrapped in nanoliposomes to “tell” the follicle to grow.
• The Upgrade (Genetics): Roots by Genetic Arts. Stop guessing. Their pharmacogenetic test tells you if you even have the enzyme (SULT1A1) needed to process Minoxidil. If you don’t, standard Rogaine will never work for you.

The “Energy” (Device)

• The Product: Capillus or LaserCap
• Why: Red light therapy (LLLT) stimulates the mitochondria in the follicle.
• Action: Combine this with the Vascular Protocol above (Tadalafil) to maximize delivery of nutrients to the scalp.

🦷 The Sleeper: Oral Microbiome

The Product: Dentalcidin (Biocidin Botanicals) — A toothpaste with an 18-botanical antimicrobial blend.

This seems random until you realize that in longevity medicine, the mouth is not Las Vegas: What happens here does not stay here.

The "Leaky Gum" Problem: You may have heard of "Leaky Gut," where bacteria escape the gut and into the rest of your body, causing bad inflammation. The same pathology happens in your mouth. When you have periodontitis, the epithelial barrier breaks down, turning your gums into an open door for pathogens to enter your bloodstream (bacteremia) and travel to distant organs.

The Science (It’s horrifying):

• In the Brain: Studies show that Porphyromonas gingivalis (the primary gum disease pathogen) increases permeability of the blood-brain barrier, plus the bacteria and its toxic enzymes (gingipains) have been found inside the brains of Alzheimer's patients.
• In the Heart: The American Heart Association has long acknowledged the link between periodontal disease and atherosclerotic cardiovascular disease (ASCVD). DNA from oral bacteria is frequently found inside the plaque clogging coronary arteries.

The "Mouthwash Paradox" (Crucial for Vascular Health): If bacteria are the problem, shouldn't we nuke them with Listerine? NO.

• As we discussed in Section 1, your body relies on specific oral bacteria to convert dietary nitrates (from beets/arugula) into Nitric Oxide.
• The Data: Research shows that using antiseptic/alcohol-based mouthwash kills these good bacteria, effectively shutting down your Nitric Oxide production and raising blood pressure within hours.

The Demographic Reality: Aging is not an equal opportunity process. If you treat patients in these demographics, you must be aggressive about oral systemic health.

What to Actually Do for Smart Mouth Health

You need to modulate the microbiome, not sterilize it.

The Protocol:

• Stop "Nuking": Throw away the blue alcohol mouthwash. It is destroying your vascular health.
• Mechanical Defense: Flossing is non-negotiable. It is the only way to physically disrupt the biofilm that houses P. gingivalis.
• Botanical Support: Use a liposomal or botanical toothpaste (like Dentalcidin) that targets pathogens while supporting the healthy flora needed for Nitric Oxide production.
• Test (Don't Guess): If you have a family history of dementia or heart disease, ask your dentist for a salivary pathogen test (like OralDNA) to see if you carry high loads of high-risk pathogens.

⚡ Longevity Quick Hits

💀 The senolytics field just lost its flagship company. Unity Biotechnology officially dissolved after their lead drug (UBX1325) failed to beat standard treatment for diabetic eye disease in Phase 2b. This doesn't mean senolytics are dead — it means the "kill all senescent cells" approach may be too blunt. The field is pivoting toward more targeted strategies.

🧠 Meanwhile, BioAge posted promising Phase 1 data for BGE-102, an NLRP3 inflammasome inhibitor. The key finding: significant brain penetration, with drug levels in cerebrospinal fluid exceeding what's needed for 90% inhibition. This is exactly the "dual-target" approach (metabolic aging + neuroinflammation) that Unity lacked.

🔬 Mayo Clinic developed synthetic molecules (aptamers) that can tag senescent cells in living tissue. This solves a huge problem — we've had trouble detecting senescent cells without toxic antibodies or genetic modification. Non-invasive detection could be a game-changer for validating senolytic therapies.

🍫 Dark chocolate gets more scientific support. An analysis of two large cohorts found higher circulating theobromine levels were associated with a slower epigenetic clock. Nutrigeroscience continues to validate some of our favorite indulgences.

🧪 A pee test for biological age? Researchers published a urinary microRNA clock that predicts biological age from extracellular vesicles in urine. No blood draw required. If validated, this could enable cheap, frequent, at-home aging monitoring.

💊 Noom enters longevity medicine. The weight loss app is expanding into the longevity space — another signal that consumer wellness and clinical longevity are converging fast.

🇫🇷 The "Function Health of Europe" just raised $8.5M. France's Lucis combines biannual 180-biomarker panels with wearable data. They've completed 500K tests across four countries in one year. The Personal Health OS category is going global.

What I'm Thinking About This Week

The wellness market hit $6.8 trillion this year — up 35% since 2019. That's equivalent to 60% of global healthcare spending.

Longevity is the next evolution of wellness and, in my opinion, the bigger and better version, with clinical and scientific backing.

The translation speed is accelerating. Which means the curation problem — figuring out what's real vs. what's marketing — is only getting harder.

That's what I'm here for!

Where You Can Find Me

LinkedIn Live with Dr. Hillary Lin & Dr. Anant Vinjamoori – I'm joining fellow longevity doctor Anant on a LinkedIn live the week of Jan 6! I'll send more details soon. Get started by following me here.

Physician Creator Trends – VSP Innovation Center & Matter Fireside Chat (Virtual) – Jan 28 @ 1PM EST link TBD. So excited about this topic!

👱🏻‍♀️👩🏻‍🦰👩🏻👧🏽👧🏾 Livelong Women’s Health Summit – April 17-18, 2026, SF, CA. Delighted to join 50 other thought leaders in speaking on women's longevity!​

Support The Longevity Letter via your longevity purchases

​NeuroAgeTx is offering the most comprehensive and science-backed brain aging package to The Longevity Letter readers at up to 61% off (affiliate link here)

​Timeline offers the patented Urolithin A for scientifically proven mitochondrial support. Their MitoImmune trial just published showing reversal of immune cell exhaustion in 28 days. (Code CARECORE for 10% off).

​GlycanAge measures your immune system's biological age, offering an easy way to detect "inflammaging" and recommend how to fix it.

Hillary Lin, MD

Co-Founder & CEO

​Care Core​

​

Follow me for more longevity insights: YouTube | LinkedIn | Instagram | TikTok​

Want to turn your wellness brand into a full-service health destination? Learn about Care Core's platform or Get Started Here​