You're seeing a 48-year-old woman for a cardiometabolic follow-up. You're reviewing her lipids, blood pressure, and the changes she's made since her last visit. She also has psoriasis. She's had it for 15 years, uses a topical, and feels her symptoms are well controlled.
How much does that history influence the rest of your visit?
We're glad her symptoms are well controlled. But she's had psoriasis for 15 years, and we'd want to understand what else might be showing up alongside that inflammatory history. Are there changes in her blood pressure or metabolic markers that deserve a closer look? Those earlier signals can help us decide how comprehensive her care needs to be.
That's the question we kept coming back to while reviewing a paper published September 9 in Frontiers in Immunology. It examines how sustained immune activity in psoriasis may affect the vasculature, and gives us a clinical question to dig into with AI.
What does the inflammatory history add?
The review brings together several mechanisms behind psoriasis's cardiovascular associations: IL-17-related signaling can alter vascular tissue, activated immune cells can interact with the endothelium, and bone-marrow responses can sustain inflammatory cell production.
The chronicity discussion is especially interesting. In experimental models, sustained inflammation can produce vascular changes that brief inflammatory episodes do not. Human observational research also links longer disease duration with cardiovascular events, including a 2017 study examining psoriasis duration and vascular inflammation.
That doesn't establish that duration always matters more than severity. It does give us a reason to understand the course of the disease. Has this patient's psoriasis always been manageable with topicals? Has she needed systemic treatment? Any joint symptoms? What has been happening with her metabolic health over that same period?
What information would help us care for her?
The 2026 ACC/AHA dyslipidemia guideline includes advanced psoriasis among inflammatory risk enhancers. There's already a basis for incorporating it into our assessment alongside blood pressure, lipids, glycemic status, smoking, and family history.
From there, we'd consider whether additional information could clarify a decision. Would hsCRP help refine the risk discussion? Would apoB help explain a lipid picture that doesn't quite fit the rest of her metabolic profile? If a treatment decision remains uncertain, is coronary calcium appropriate?
We're also curious about the systemic immune-inflammation index (SII) and systemic inflammation response index (SIRI), both calculated from a CBC with differential. They're accessible, which makes them appealing. But we still need to know what to do with the result.
In a 2026 study of patients receiving IL-23 inhibitors, neither index consistently tracked improvement in psoriasis severity. We'd keep them in the exploratory part of this discussion. They don't yet have the same role in cardiovascular risk assessment as hsCRP.
The same question applies to vascular assessments: what would the result change? Blood-pressure trends, calcified plaque burden, and endothelial function tell us different things. We want to be clear about which question we're trying to answer.
What could we influence?
This is where we'd ask AI to help investigate diet and lifestyle, fish oil, specialized pro-resolving mediators (SPMs), palmitoylethanolamide (PEA), and vitamin D. We'd want to know how each relates to the mechanisms, what has been studied in people, and which outcomes improved.
Diet gives us a useful example. In the 2025 MEDIPSO randomized trial, 38 adults with mild-to-moderate psoriasis continued stable topical treatment while receiving either an intensive Mediterranean diet intervention or low-fat dietary advice. At 16 weeks, 9 of 19 in the Mediterranean diet group achieved a 75% reduction in psoriasis severity, compared with none in the control group.
It's a small study, but it gives us something specific to discuss with patients. The intervention included dietary counseling, which matters when we think about implementation. The outcome was skin improvement; cardiovascular events weren't evaluated.
For the ingredients, we'd want the research to get just as specific. Which fish-oil formulation was studied? Do studies of oral SPM products support the benefits suggested by research on the body's own resolution pathways? How much of the rationale for PEA comes from direct human psoriasis evidence?
And we need room for findings that change our expectations. A vitamin D randomized trial found no significant improvement in psoriasis severity in patients with lower-range vitamin D levels. Addressing a deficiency may still be appropriate, but we'd explain the expected benefit accordingly.
This is the kind of work we want AI to help with: following a clinical question far enough that we can decide what belongs in care, what needs more investigation, and what isn't supported for the use we had in mind.
Try it with AI
Use an AI tool with web research enabled. Explore the full question or name one assessment or ingredient you'd like to investigate. No patient chart needed.
I'm a clinician investigating cardiometabolic assessment and adjunctive interventions in adults with psoriasis. Start with this review: https://www.frontiersin.org/journals/immunology/articles/10.3389/fimmu.2026.1923150/full
Connect the mechanisms to potentially useful assessments: blood pressure, lipids/apoB/Lp(a), glycemic measures, hsCRP, SII, SIRI, and vascular or physiologic assessments. Explain what each measures, whether it could change management, and whether its use is established, selective, or investigational.
Investigate diet and lifestyle, fish oil, SPMs, PEA, and vitamin D. Identify the studied population, formulation, dose, duration, outcomes, and key safety considerations. Separate skin improvement, biomarker changes, vascular effects, and cardiovascular events. Label extrapolations. Don't infer an ingredient indication from an elevated nonspecific inflammatory marker.
Use current guidelines and primary human studies, including null findings and older keystone studies where needed. Open and verify sources; flag inaccessible or unconfirmed details. Don't invent doses, cutoffs, or citations. Say when evidence is insufficient.
Return a concise one-page guide connecting mechanism, assessment, potential intervention, and clinical use, with no more than 10 verified references and links. Preserve standard psoriasis care and cardiovascular prevention. End with one unanswered question. If I name a narrower focus, apply this process only to that topic.
Open the source behind the finding you'd be most likely to use. Check who was studied, what they received, and what changed.
Which assessment or ingredient would you investigate first, and why?
Tell us in the comments. If you've already explored it, bring the paper you found. We'd love to hear what's been useful in your clinical thinking, or where you're still looking for a better answer. Please leave out identifiable patient details.
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This Friday: Dr. Kara Fitzgerald's "Functional Medicine Is Longevity Medicine" Masterclass
This Friday and Saturday, September 18 and 19, Dr. Kara Fitzgerald's online Masterclass runs under the theme that functional medicine is longevity medicine. Not as a trend, but as the most science-backed, clinically effective path to extending healthspan. Ultralight will be there, and we'll see you inside.
In the news
Apple Health now sells a $119 blood panel, drawn at Quest. As of Quest's September 9 announcement, US users will be able to order a 50-plus biomarker panel inside Apple Health, book the draw at one of roughly 2,000 Quest locations, and get results back in the app, with no clinician anywhere in the loop. Your patients will start arriving with these printouts, and the interpretation visit, the part Apple cannot ship, is yours.
Fisetin's human evidence just got its first serious audit. A review in Nutrients this week counted 34 registered clinical trials of the senolytic across age-related disease, of which six are complete and only four have posted results, with findings the authors call limited and heterogeneous. Patients are buying fisetin today, so this is the denominator to counsel with: promising biology, four human readouts, mixed.
The largest randomized trial of ambient AI scribes found modest, real gains. In NEJM AI's UCLA trial of 238 physicians across 72,000 encounters, published late last year and worth the look if you missed it, one scribe cut note time about 9.5 percent and both tools improved burnout scores roughly 7 percent, while AI-generated notes occasionally carried clinically significant omissions. The honest read for a practice shopping scribes: the well-being gain is real, the time savings are smaller than the marketing, and note review stays on you.
Upcoming Conferences & Events
Sept 18-19, Dr. Kara Fitzgerald Masterclass “Functional Medicine Is Longevity Medicine”· Online · Led by Kara Fitzgerald, this year’s Masterclass will continue under the theme that functional medicine is longevity medicine. Not as a trend, but as the most science-backed, clinically effective path to extending healthspan. Ultralight will be there!
Sept 22–23, MVMNT Longevity Medicine Summit · Coronado, CA · Evidence-graded longevity science, hands-on labs, and clinical frameworks you can implement the week after. Capped at 300 clinicians. Ultralight will be there!
Oct 8–10, A4M Women's Health Summit · San Antonio, TX · The best clinical education on hormone, metabolic, and midlife women's health you will see this year. The room to be in if you are growing the perimenopause and menopause side of your practice.
Oct 17-18, Roundtable of Longevity Clinics · Buck Institute, Novato, CA · Some 250 longevity clinic leaders, physicians, and researchers working toward shared standards for longevity testing and interventions. In-person and virtual tickets are open. Ultralight will be there!
Oct 21-23, DOC (Living Room Lab) · Sonoma, CA · Salon-style sessions on longevity science and medical AI with faculty from UCSF, Stanford, and the Buck, plus validated diagnostics in the Living Room Lab. Ultralight will be there!
Oct 21–24, NAMS Annual Meeting · San Diego, CA · The single most practice-changing meeting of the year for midlife women's health. Your protocols will look different after this one.
Nov 5–8, Eudēmonia Summit · West Palm Beach, FL · One of the most talked-about longevity gatherings in the U.S. With experientials, hands-on demos, and the best place to try the emerging frameworks your patients will ask you about next year. OvationLab and Ultralight will be there!
Nov 5-7, Private Physicians Alliance Annual Meeting · St. Petersburg, FL · The gathering for independent, cash-pay, and concierge physicians navigating practice independence. Practical and peer-driven. Ultralight will be there!
Nov 8-11, American College of Lifestyle Medicine Conference · Orlando, FL · Lifestyle medicine's main annual event — evidence-based approaches to behavior change, chronic disease, and healthspan. Growing overlap with the longevity medicine community.
Nov 10-13, Valley Forum 2026 · Napa Valley, CA · Invitation-only forum where healthcare leaders work through the industry's hard problems, AI's role in care among them. Ultralight will be there!
Dec 11–13, A4M Longevity Fest · Las Vegas, NV · The biggest longevity event in the U.S. The room spans clinicians, industry, founders, and the people building next year's platforms, and the connections from this one tend to compound through the rest of your year. OvationLab and Ultralight will be there!
Know of an event we should add? Reply and tell us.
Until next week
Her psoriasis is controlled, and now the next question is on the table: what else is that history telling us, and what would actually change her care? The prompt above is built to chase exactly that.
Know a clinician who would enjoy running this kind of investigation? Forward this to them.
Until next week, keep building the practice you imagined when you started.
— Dr. G and Sunita