This is an evidence-based update on what we know about health and longevity, and what you can do now to stay healthier longer. You can find the supplements I recommend below on my stack page, and go to the store page to get the books and other goodies you need. Forget all the small stuff. This is the big stuff that matters, and it’s in order of importance to your longevity.
Caption: I’m 65, and I’m in the gym every day.
Smoking
Know your A1c number
If you’re even a little overweight, you should read Why We Get Sick, by Ben Bikman. You should know your A1c number, which is a quick measure of insulin resistance. A1c measures how many glucose molecules are stuck to hemoglobin, which gives a running three-month average of your insulin resistance. If that number is 5.7 or higher, you should work on your diet to lower it. Cut sugar, cut alcohol, cut carbs. 5.5 and below you are insulin sensitive, which is the safe zone – stay in it. Insulin resistance is more likely to kill you than heart disease is.
Here’s how I think of it now: Cut sugar and alcohol out of your diet. If your A1c is 5.6 or less, you have room to eat pizza, pasta, Mediterranean diet, etc. But if the number goes up over 5.6, you need to reduce carb intake. Two very similar looking people, or husband and wife, will have completely different metabolic reactions to the same diet, so one diet does not work for everyone. But just because you’re an athlete doesn’t mean you should be on a high-carb diet – your A1c number will tell you that. Measure your A1c every 6 months if you aren’t 5.5 or below. If you’re in the safe zone, sweets should be seen as a once-or-twice-a-month treat.
Fat
When you gain weight, you create new fat cells. When you lose weight, you do NOT lose fat cells. Any fat cells you make will be with you forever, and if you lose fat those cells will want the fat back. Fat cells are like balloons that prefer to stay filled up. Help your kids by not letting them get fat in the first place. If you are ten pounds overweight, that should be a red flag that things are going in the wrong direction.
Losing fat isn’t that hard, just reduce your calories. Keeping fat off is hard, and most people don’t do it. If you built up 30 extra pounds over 30 years, it’s not going to magically melt away in 6 months and never come back. Losing weight is about 30 percent of the job; keeping it off is 70 percent. Diet and exercise are tools – use them intelligently.
Hormone replacement therapy
HRT is so beneficial to so many women, I recommend it for all my clients, and I have a partner doctor you can use to order everything online. You’d need a good reason not to go on it. Here’s a video conversation with my client Kathleen on this topic. For men, it’s more complicated.
Get enough protein
The older we get, the more protein we need. You should be trying to get 1 gram of protein for every pound of lean-mass bodyweight daily. It’s not easy. I don’t have time to go into all of it, but you’ll find a lot on my website, especially the videos.
What’s up with LDL cholesterol?
The evidence connecting LDL cholesterol with heart attacks and stroke is very mixed. I hope to have a thorough update on this topic at some point. But what to do about it is quite straightforward. We know that soft plaque is far more dangerous than hard plaque. You can undo it by reducing insulin resistance and hard exercise.
Should you take statins?
I think most people will benefit from taking statins. Few people have side effects (if you do, stop taking them or switch the kind of statin). And the lowest dose is generally best. If you’re on 20 mg, ask your doctor about going to 10. If you’re on 40, ask about going to 20. If you don’t like the idea, try red rice yeast, it’s pretty much the same.
Build bone
If you’re not building bone, you’re losing it. You can’t build bone by walking and doing yoga. Runners and cyclists, even mountain bikers, don’t have strong hips and spines. Everyone over 70 has a 25% risk of a fall each year, and 50 percent of falls result in a permanent reduction in the quality of life, leading to death. You build bone through resistance training and impact training. Read The Osteoporosis Breakthrough to understand the basics. Resistance is pushing or carrying heavy weight, and impact is jumping and landing fairly hard. Two people in the world have an advanced bone-building program, and I’m one of them. I’ll make a better video, but for now you can watch my very blurry video that goes into some of this.
Build muscle
Yes. I love Peter Attia and want everyone to read his book, Outlive. He talks about the value of zone-2 exercise, which I agree with. But I can’t emphasize the value of zone-3 and zone-4 exercise enough, even if you’re in your 80s. This means going as hard as you can for 2-4 minutes in the pool, on the track, rowing machine, or even jumping up and down in your living room (YouTube videos are great for this). Hard. Like you can’t do any more, and the last 30 seconds are very very challenging, and it takes several minutes to recover.
It’s very important not to get hurt, and that’s why you want a longevity coach, not a gym trainer. You need to prevent injuries. A few of us know how to do this — to keep you under your injury threshold yet still performing at the highest capacity that your system will allow. It starts gently but progresses, because stressing your bones, muscles, and heart are the best way to fight aging.
Use a stopwatch. If you ride a bike, pick a hill and always start at the same place and measure your time to the top, then keep trying to beat that time. In the pool or on a machine, it’s easy. Always keep trying to beat your previous best time. I also like 2-4km of rowing – how fast can I row 4km at the hardest setting?
Try ten flights of stairs (17 steps per flight is normal in a modern building) in under 90 seconds — without touching the handrails at all. Never touch handrails when doing stairs. Stairs are great, because you know exactly how far you’re going, you can do them in any weather, all you need is a building with 10 floors. I’m 65. My record for ten flights is 70 seconds, but that’s because I carry 50 pounds on my back up 13 flights three times a week. Can you beat me? If you’re older or not as strong, adjust but still push.
Caption: Doing a butterfly press.
Zone 4 is maximum output, like sprinting 100 meters as fast as you can. I’m sprinting 100m in 21 seconds; my goal is under 20. What’s yours?
Whatever you do, establish your best time and keep trying to beat it. Do this for the rest of your life. A breath trainer will help.
Don’t forget lifting heavy in the gym and rucking. If you’re not rucking, you should consider adding it to your routine. People who do a lot of walking, Pilates, and yoga don’t live longer than the rest of us. It’s the weightlifters and serious pushers who outlast everyone else. The average 70-year-old farmer will probably outlive the average 70-year-old citydweller by ten years or so.
Creatine
Creatine is a compound made from three amino acids that people think of as a bodybuilder supplement, but more and more research shows that creative a) is very safe, and b) has many other benefits, including brain health and even MS. It helps improve recovery time after exercise. The new recommended dose is ten grams per day. This video is a good overview, and the brand I recommend is on the stack page.
Calcium
Calcium is a critical mineral for bone building. The brand I like is called AlgaeCal Plus. It’s similar to getting your calcium from food. It includes magnesium, vitamin D and vitamin K. I think everyone over 40 should be taking it. Possibly everyone under 40 as well. And no, taking calcium has nothing to do with calcium build-up in your arteries, it is not bad for your cardiovascular system, so start taking AlgaeCal Plus today (I’m not affiliated with the company).
Vitamin D
Evidence is now stacking up that too much vitamin D is a bad thing, and most people who get outside don’t need to take a supplement. People over 50 should NOT be taking extra vitamin D above the 800 units they get in AlgaeCal Plus. People over 70 who live in temperate zones may need a bit more if they aren’t outside often. Stop taking your 2,000-unit vitamin D pills!
Collagen
If you have any joint pain at all, you should be taking collagen daily. See my stack page for details.
Fasting
Fasting is a bad way to lose weight, because you lose muscle as well, and muscle is hard to build back, while the fat comes back readily. Don’t fast more than 24 hours.
Fructose
No fructose. Fructose is bad for humans.
Caption: On the bench press.
Alcohol
The healthiest amount of alcohol is zero. If you really enjoy alcohol, drop all your junk drinking. That should be 50-70 percent of drinking you can simply give up and the quality of your life hardly changes. It’s easy to do and — assuming you don’t get hit by a bus later — will help you live longer. If you are planning to get hit by a bus, by all means enjoy your wine now!
What about GLP-1 agonists?
Everyone is getting injections, and many doctors are now on Ozempic/ Wegovy to lose weight and keep it off. Yet 70 percent are off the drugs within two years, and most of them are worse off. This is not going to turn out well. Stay away from fads and medicines and exercise harder.
Sleep
Do whatever it takes to get 7+ hours of sleep a night. Black out your windows. Drop the temperature. Create a routine that works. Measure your cycles using an app or a ring. Find patterns that give you good sleep. One suggestion: make your room as cold as you can possibly get it, like you’re winter camping. When you’re cold, you snuggle in and don’t move around. When it’s hot, you move and wake up more often. Drugs as a last resort, but you could look into patches.
Kidney stones
If you’ve ever seen a scanning electron microphotograph of a kidney stone, you understand why you don’t want one. First, drink plenty of water. Second, know your foods that have oxalic acid (spinach, almonds, almond milk, beets, beet greens, rhubarb, Swiss chard, sweet potatoes, chocolate, cocoa powder, black tea, navy beans, soybeans, raspberries) and eat them WITH calcium, so the calcium binds to the oxalate in the gut and gets taken out that way. What causes stones is when oxalates go to your kidneys and then bind with calcium there.
This is the dashboard I use for my clients:
Have I left anything out?
Yes, I’ve left a lot out. I could write much more about getting the big stuff right and forgetting about all the cute little supplements and vitamins and herbs and drips and procedures and fake experts and YouTube influencers.
Every one of my clients has pre-existing conditions. I always design a custom protocol for each person. This is just an overview.
Summary
Yes, I’ve left a lot out. I could write much more about getting the big stuff right and forgetting about all the fad supplements and vitamins and herbs and drips and procedures and fake experts and YouTube influencers. I work with clients around the world to lose fat, build bone and muscle, and add 10-20 years to their lives. Every one of my clients has pre-existing conditions. I always design a custom protocol for each person. This is just an overview. I hope it helps you add years to your life. Contact me if I can help.
David Siegel
The Infinite Game of Life
