Improving Healthspan Through Lifestyle Choices and Preventive Health Measures

Disease prevention 0:33 0
“Dr. AA goes systematically through the seven major causes of death worldwide beginning with cardiovascular disease and cerebral vascular disease, also cancer, also accident related deaths, dementia, deaths of despair, and in every case explains the three or four major levers that one can employ in order to offset that is to prevent those major causes of death.”

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Mental health 1:37 0
“Emotional health has everything to do with our physical health and vice versa.”

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Substances 6:04 0
“I found that by taking Ketone IQ which we know increases blood ketones I can achieve much better focus for longer periods of time for any kind of cognitive work and much greater energy levels for exercise especially if I'm going into that exercise fasted and find myself a little bit hungry when I start that exercise.”

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Longevity 7:48 0
“So it involves some bifurcation between lifespan and healthspan uh lifespan is very easy for people to understand it is binary you are alive or you are not alive and uh clearly part of longevity is about how long you live uh now I think for a lot of people that tends to be where the discussion ends that tends to be the focus of it right it's sort of like you know longevity somehow implies living for you know 100 years 120 years some something like to that extent we talk a lot about maximum lifespan um even in laboratory experiments with mice that's sort of one of the metrics that's that's discussed is what what what's maximal lifespan of the animals um but there's an equally if not slightly I think potentially more important part of longevity which is Health span and health span is squishier and I think it requires some definition now the the medical definition of Health span is the period of time uh by which you are free from disability and disease uh I find that to be a not particularly helpful definition because by that definition you and I have the same Health…”

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Disease prevention 12:28 0
“globally it's enormous we're talking about 18 to 19 million people a year that are dying of atherosclerotic cardiovascular disease in the world whereas number two is cancer at about 11 million”

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Disease prevention 14:35 0
“the majority of these are embolic however so don't quote me on this exactly but call it four or five to one Strokes result from an embolic phenomenon as opposed to um a hemorrhagic phenomenon”

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Disease prevention 15:58 0
“hypertension is hands down the leading driver of hemorrhagic stroke phenomenon”

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Disease prevention 16:37 0
“the more aggressively you manage blood pressure to be within the 120 over 80 range the better”

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Disease prevention 17:29 0
“there are too many people walking around with high blood pressure who don't know it”

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Disease prevention 17:57 0
“the right way to measure a person's blood pressure the person has to be sitting like this for 5 minutes doing nothing”

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Disease prevention 18:20 0
“a manual cuff is better than an automated cuff but not enough people use manual blood pressure”

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Disease prevention 18:51 0
“I'm pretty relentless about checking my blood pressure and so I'll do side to side manual versus automated every day and there's easily a 10 to 15 point difference between them”

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Disease prevention 20:36 0
“we're not checking blood pressure often enough on people we're overly relying on blood pressures in the doctor's office which are not being done correctly”

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Disease prevention 23:29 0
“there's three big ones that stand out you know top and center and then there's kind of a fourth one that I think is the foundational piece so the three big ones we've talked about one blood pressure so if your blood pressure is 120 over 80 or better that's important”

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Disease prevention 23:48 0
“the second is not smoking so it turns out that smoking and blood pressure are both devastating for arteries uh but for different reasons right so smoking is devastating from a chemical perspective so it's completely irritating to the endothelium”

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Disease prevention 26:53 0
“I don't think vaping is a good idea my the last time I looked at the data on this it was surprisingly sparse but to me the only Advantage I could see to vaping was if it was the only way a person would stop smoking”

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Toxin exposure 28:59 0
“the chemical constituents of The Vape and what people are inhaling are terrible for people and are loaded with carcinogens and a bunch of other stuff many of which cross the blood-brain barrier”

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Air quality 30:27 0
“the PM 2.5 data is pretty good I think once you so particulates that are less than 2.5 microns are are getting straight into the body”

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Air quality 30:55 0
“more people are dying from the particulate matters in air that result from burning coal than are ever going to die from the CO2 emissions that result from that”

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Genetics 34:59 0
“so if you cannot synthesize cholesterol you can't live you you'll die in utero so there are rare genetic conditions that prevent the successful synthesis of cholesterol uh you know embryos that have those mutations do not survive”

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Hormone balance 36:01 0
“the second thing that makes cholesterol so important it is the precursor to some of the most important hormones in our body so our sex hormones testosterone estrogen progesterone in addition to glucocorticoids”

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Metabolic health 36:30 0
“the cholesterol that you eat in food largely irrelevant it's aerified cholesterol so it means it has an Esther side chain it's too bulky to absorb in the gut so most cholesterol that you eat in food just goes out your GI trct”

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Disease prevention 41:36 0
“most important fact in all of this is that the apobs are atherogenic”

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Metabolic health 42:24 0
“could somebody have relatively High um LDL maybe even higher than um sort of highend of chart or even um above high-end apob but there's some sort of demand metabolic demand or or there they're weight training a lot or they're running marathons and so they need a lot of LDL”

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Mental health 45:18 0
“cholesterol is a critical component of the synaptogenesis process the for the formation of connections between neurons in the developing brain”

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Metabolic health 46:51 0
“cholesterol basically serum cholesterol levels rise basically monotonically throughout life”

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Metabolic health 47:21 0
“what you measure in the serum is but a fraction of the total body pool of cholesterol”

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Disease prevention 49:10 0
“the number of particles is much more predictive of risk than the amount of cholesterol contained within them”

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Disease prevention 51:22 0
“if your objective is to not die from heart disease and only to die with it then you want apob as low as possible”

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Disease prevention 53:11 0
“if you believe that smoking is causally related to lung cancer then smoking cessation reduces the probability of lung cancer that is a logical equivalency there can be no debate about that.”

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Disease prevention 54:52 0
“there is no ambiguity that a OB is causally related to atherosclerosis.”

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Disease prevention 57:59 0
“if a risk is causal and it is modifiable it should be modified regardless of the risk Tale in duration.”

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Nutrition 1:01:37 0
“usually we want to see how far we can get with nutrition so fixing insulin resistance in an insulin resistant person will bring this down.”

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Nutrition 1:03:05 0
“lowering dietary fat no actually it's most easily accomplished through carbohydrate restriction.”

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Exercise 1:03:38 0
“where does exercise come um play a role minimal role for improving insulin sensitivity no no no I'm sorry for improving uh lipids in general yeah but it can improve in uh absolutely especially combinations of resistance training and cardiovascular exercise correct.”

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Disease prevention 1:06:07 0
“there's a checkpoint inside the bar that basically says do we have too much cholesterol if so spit it out and there's another door that acts more like The Bouncer and he's called the ATP binding cassette G5 G8 and he spits excess cholesterol out and if that system is working fine everything is great but in a lot of people that ATP binding cassette doesn't work very well and it can't properly regulate the total body pool of cholesterol”

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Disease prevention 1:07:35 0
“statins uh do have side effects so 5% of people genuinely and legitimately get a muscle soreness uh that can be debilitating”

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Disease prevention 1:08:25 0
“there's a narrower subset of people that um do do do get brain fog and do experience brain frog from statins and and we don't really understand the why there”

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Disease prevention 1:09:30 0
“insulin resistance so it really and this is one of the I think one of the benefits of at least having periotic CGM tracking is we'll see this you know we had a patient who happened to be wearing CGM in general and then we started him on you know 10 milligrams of rzua Statin which is probably the Workhorse Statin right now it's a that's generic NM for store um and he pings us like a couple weeks later and he's like man my glucose is like 10 points up consistently from where it has normally been”

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Genetics 1:11:30 0
“she discovered this mutation in uh a gene for pcsk9 that codes for a protein that degrades LDL receptors so these people had hyperfunctioning pcsk9 genes so their genes were just chopping down all the LDL receptors in the liver so these people weren't clearing LDL”

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Disease prevention 1:11:59 0
“these people had hypofunctioning pcsk9 they had virtually unmeasurable these people had LDL cholesterol levels of 10 to 20 milligrams per deciliter and not surprisingly they had no heart disease”

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Substances 1:12:12 0
“I take one of these drugs I've been taking one of these drugs for I don't I probably started in 2015 so it's an injectable drug I take it every two weeks and it's a called a pcsk9 inhibitor”

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Genetics 1:17:04 0
“I know my apob numbers and it I might be that guy who's up in the you know above a hundred so I'm going to get this treated uh that's a promise to myself.”

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Disease prevention 1:18:22 0
“we covered um the three major risk factors which were um blood pressure um keeping that in check don't smoke um and apob and we've now talked about the things to adjust apob levels.”

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Exercise 1:19:56 0
“if we could get a person to lose 10 pounds and exercise every day we see great effects with zone two stuff right so kind of the low intensity cardio.”

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Sleep 1:20:24 0
“sleep is an important piece um so get get the sleep right get the exercise right if you if you're if you're overnourished let's correct that problem.”

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Disease prevention 1:22:29 0
“The hazard ratio of all cause mortality associated with compromised kidney function is even greater than that of heart disease once you cross that threshold.”

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Disease prevention 1:22:44 0
“Your risk of death is higher than that of someone with high blood pressure, smoking, even someone who has cancer.”

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Disease prevention 1:22:56 0
“The kidney is so sensitive to blood pressure, this is a tiny organ that on every pump of your heart is getting 20 to 25% of your blood.”

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Disease prevention 1:25:42 0
“There is no dose of ethanol that is healthy.”

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Sleep 1:28:30 0
“I think the impact of sleep on cardiovascular stov vascular disease is profound and I do think that the impact of ethanol on sleep is underappreciated.”

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Sleep 1:28:59 0
“I think Matt really deserves most of the credit for alerting people to these issues around not getting enough sleep.”

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Disease prevention 1:32:21 0
“Prostate cancer colon cancer are Cancers that no one should ever die from because they are so easy to screen for, they are so easy to treat when they are in their infancy.”

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Genetics 1:33:54 0
“your germ line and my germ line are set when we were born our germ line mutations uh any mutations we have in germline genes are inherited from our parents it they're non-negotiable non-negotiable you got those things.”

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Genetics 1:34:18 0
“less than 5% of cancer results from those types of genetic mutations.”

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Body weight 1:35:41 0
“obesity is now the second most prevalent environmental driver of cancer.”

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Body weight 1:35:52 0
“I don't think it's obesity per se I think obesity is just a masquerading proxy what is obesity obesity simply is defined by body mass index.”

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Metabolic health 1:37:42 0
“I think it's two things that come with obesity insulin resistance which is you know 2/3 to 3/4 of obese individuals are insulin resistant and inflammation.”

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Toxin exposure 1:38:26 0
“we understand that people who have exposure to asbestos have a much higher risk of certain types of lung Cancers.”

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Disease prevention 1:40:55 0
“to my knowledge there is not a single example of a cancer that is more effectively treated when the burden of cancer cells in the body is higher than when it is lower.”

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Disease prevention 1:41:50 0
“if you take a person with stage three colon cancer... 80% of those people are alive in five years.”

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Disease prevention 1:42:52 0
“the first line of screening is Imaging is is is is is a sort of visualization.”

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Toxin exposure 1:48:54 0
“when I was a graduate student I worked with fixative so paraph Maldive parap Malahide excuse me um gluto alide we know that these are mutagens they mutate cells not good you do some molecular biology in the lab you use DNA intercalating die those little bands and gels the reason they label is because they get between the DNA not good if for to get into your own uh DNA”

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Toxin exposure 1:49:28 0
“most people I think uh will be exposed to pesticides um they'll put um stuff on their lawn or they'll have um paint thinners and things of that sort”

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Toxin exposure 1:51:09 0
“I don't know that the asbest in the ceiling you know four layers up is really a problem but if they had to come in here and rip this ceiling apart I don't know that i' want to be in here either.”

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Toxin exposure 1:51:25 0
“post 911 a lot of the workers at the World Trade Center pits developed cancers probably from exposure to those kinds of things.”

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Genetics 1:52:17 0
“I can't control my genes anymore, they are what they are. I got whatever predisposing cancer genes I'm going to get.”

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Disease prevention 1:54:00 0
“colon cancer is not just the third leading cause of cancer death, it's 100% preventable. Every colon cancer comes from a polyp and every polyp can be seen on a colonoscopy.”

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Cognitive stimulation 1:58:56 0
“everyone experiences some age related cognitive decline so we all get less uh uh proficient at Focus memory um complex context dependent task switching all that stuff as we get older but it's the slope of that line that really can be controlled to some extent and that Alzheimer's dementia represents just a steep acceleration downward uh acceleration of of all of that.”

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Disease prevention 2:00:33 0
“Alzheimer's disease is both the most prevalent form of dementia and the most prevalent neurodegenerative disease so it occupies that unique spot uh we're talking about roughly six million people in the United States have Alzheimer's disease that's one in uh well let's see I mean Haven checked about two% of the total population.”

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Genetics 2:03:21 0
“maybe folks understand we have two copies of every Gene so for Gene X you have copy that you got from your mom and copy that you got from your dad and the apoe gene is kind of a unique Gene and that it really it has three different isoforms that are all considered normal none of them are mutations so you have the E2 isopor the E3 isopor and the E4 isopor”

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Genetics 2:03:58 0
“the E4 isopor offered a lot of advantages back in the day it's a bit of a pro-inflammatory um isopor and it certainly offered protection against infections especially parastic infections in the CNS which would have been a really important thing to select for 200,000 years ago”

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Genetics 2:04:52 0
“today we realize that there's a clear stratification of risk when it comes to Alzheimer's disease that tracks with those isoforms”

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Genetics 2:05:51 0
“there are at least three deterministic genes in Alzheimer's disease uh one is called psn1 another one is called pn2 and another one is called AP those genes collectively make up about 1% of cases of people with Alzheimer's disease so they're fortunately very rare genes but sadly they are deterministic meaning if you have those geneses you do get Alzheimer's disease”

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Cognitive stimulation 2:09:35 0
“are completely healthy and have died with no cognitive impairment and they're chalk full of amalo so what we don't fully understand is exactly what does removing amalo do”

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Disease prevention 2:10:35 0
“the link between AP and whether or not one develops genes for related to AP and whether or not it's cleaved at one site or another is just what you were describing and and risk for Alzheimer's so it's basically a CLE it's a cleavage question right so AP people with the AP mutation I think have one extra cleavage site”

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Disease prevention 2:12:21 0
“the field is probably in in a bit of a crisis because there have been so many bets placed on anti- ameloid therapies and ameloid biomarkers and ameloid everything and we just haven't seen efficacy right so contrast that with cardiovascular disease”

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Sleep 2:14:16 0
“the unequivocally true things for brain health are sleep matters”

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Exercise 2:14:53 0
“the fourth one that is unequivocally clear is exercise matters”

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Exercise 2:15:40 0
“if your brain really matters to you do more one hour of interval training is no joke no because you're going to spread that out over probably at least two workouts.”

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Disease prevention 2:17:05 0
“the best thing to do if you get a head injury is to not get another one.”

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Substances 2:20:35 0
“there's tons of supplements that I think about when it comes to brain health you know what about thumin what about magnesium with L3 and8 the transporter um what about methylated vitamins that lower homocysteine what about EPA and DHA.”

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Exercise 1:41:18 0
“exercise exercise sleep insulin sensitivity um and lipid management”

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Sleep 1:41:18 0
“exercise exercise sleep insulin sensitivity um and lipid management”

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Metabolic health 1:41:18 0
“exercise exercise sleep insulin sensitivity um and lipid management”

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Toxin exposure 2:27:09 0
“where the majority of this is making its way into the into The Accidental poisonings is through illicit counterfeit pills”

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Disease prevention 2:28:35 0
“I don't care which friend of yours it is I don't care how much she's amazing if she tells you to try this sleeping pill because she took it the night before and it was really helpful or this will help you study better or this will help you do anything I'm like just come to us we got a better pill for you right like in other words I you can't trust anything because you don't know where she got it”

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Exercise 2:31:33 0
“people's ability to jump and land seems to be highly correlated with one's ability to not fall or at least fall and control the fall in a way that leads to no or less severe injury”

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Exercise 2:33:27 0
“you cannot age well if you are not doing the type of training that is there to strengthen and delay or minimize the hypertrophy of your type two fibers”

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Exercise 2:34:07 0
“one of the pillars of strength training is Ecentric strength which is breaks”

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Exercise 2:35:10 0
“I always want to make sure I can broad jump six feet that's kind of my arbitrary number that I've chosen and the reason is on the takeoff that's a very explosive movement but the landing is just as important if I can't stick that Landing it means I don't have the braks”

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Exercise 2:38:20 0
“you're actually going to have a wide narrow aerobic base so think about just maximizing the area of that triangle widest tallest stability and strength stability of course encompasses everything we're talking about in terms of reactivity.”

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Exercise 2:40:23 0
“today for example I finished my today was a cardio Zone 2 day so I did my cardio Zone 2 and I you know had it extra 10 minutes before I needed to kind of get moving and so all I did was step ups for 10 minutes I just did single leg very slow step up and insanely slow step Downs off a box in a gym so 2 second up 4 second Down 2 second up 4 second down with you know and I would do them with ipsilateral loads controlateral loads all sorts of different things and you know basically that's just a stability game for me it's like I'm building that concentric strength in um in a movement where it's easy to cheat um but can I do it without cheating.”

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Mental health 2:41:27 0
“emotional health if you could just share with us a bit of what inspired you to include that section was this uh for instance um based on communication with your patience to what extent it was based on your own life experience and then um maybe we can drill a little bit deeper into what's contained in those chapters and what really constitutes emotional health.”

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Mental health 1:45:51 0
“but the top thing on my list is actually emotional health that's the one that is the hardest for me to manage and it's the easiest to get out of balance and it creates the most pain in my life”

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Social connection 2:47:49 0
“connectivity with others just seems to be an inescapable part of this so the ability to maintain healthy relationships and attachments to other people”

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Purpose 2:48:06 0
“having a sense of purpose”

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Circadian rhythm 2:49:00 0
“I'm very often predisposed with thoughts about the future occasionally thoughts about the past but it's much more often kind of thoughts about the future and planning and thinking about what I need to do and what do I want to do next and never really being satisfied with anything that's happening the moment”

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Purpose 2:55:51 0
“I think for most people that's that's that's what I hope this chapter does is it it is it sort of allows more people to kind of take an appraisal of that and ask that question which is before too late am I living my life more for my resume virtues or for my eulogy virtues to borrow from uh David Brooks's work the road to character which I I I talk about as being kind of one of the many aha moments that I had during this journey.”

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Mental health 2:56:30 0
“I mean I had a very clear list of daily things I needed to do and so so at that point for about six months following getting out of that stint of rehab I mean I was I mean God the list of behaviors I was doing every single day I mean twice a day standing in front of the mirror reading my list of affirmations writing in my journal every single day I had therapy every single day I mean all of that stuff was highly regimented.”

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Social connection 2:57:12 0
“perhaps the most important thing that does come up every day is um being mindful of and acting on as quickly as possible every time I uh do something damaging to a relationship.”

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Mental health 3:06:27 0
“I still one to two times a week I'm still working with a therapist I have to kind of try to figure it out on my own and then usually bounce it off a therapist and say well I think this is why I'm upset about this.”

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Mental health 3:07:32 0
“I would just feel anger in response to every interaction but what I didn't realize was that anger was really just another emotion that was superimposed on top of hurt or superimposed on top of fear or superimposed on top of shame or superimposed on top of something else but I didn't know how to articulate any of those other emotions so the only thing I could really articulate was anger.”

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Social connection 3:05:12 0
“so I think I always try to ask myself this question when I'm having some interpersonal conflict which is what am I optimizing for.”

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Mental health 3:08:52 0
“most of the time we have no idea how other people feel even though we think we do and most of the time we don't even know how we feel. Our ability to really know what we're really feeling is terrible.”

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Mental health 3:11:30 0
“I learned that people like me can be overly analytical and that hyper analytical nature can lead you astray when you think that your intellect is giving you a fact-based explanation for a set of circumstances and you rationalize them away.”

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Mental health 3:15:01 0
“if I know one thing for sure and make it very clear I'm not a clinician but is that the brain doesn't um discard of any circuitry we repurpose the same circuitry we used as children as as adults and so the ability to go back to that and to and to par but as you as you point out not from a um from an intellectual stand standpoint but from an emotional standpoint seems to be the the really hard work”

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Mental health 3:16:09 0
“I use a system called dcal behavioral therapy that is a regular part of the therapy that I do um but I don't have to go back to my childhood I don't have to go back to uncovering and re-exploring a lot of that stuff um I I I've I've I've learned the lessons and now it's really about practicing the skills I know I know what I want now and I and I know you know you talk about plasticity”

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Mental health 2:02:19 0
“it only took about four months to get rid of Bobby Knight like you know again we we had kind of a mental model for what this looked like which was Bobby Knight was the chairman of the board he sat in the boardroom and nobody else got to talk”

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Mental health 2:03:40 0
“I'm just not beating myself up like I used to and I think by extension I'm beating other people up a lot less.”

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This comprehensive review of health and longevity spans multiple domains—disease prevention, mental and emotional well-being, metabolic health, exercise, sleep, toxin exposure, genetics, and broader lifestyle factors—offering both high-level perspectives and concrete, actionable insights.

1. Defining Longevity and Healthspan
Longevity isn’t just about adding years to life but ensuring those years are healthy. Lifespan (binary: alive or dead) must be balanced by healthspan—the years free of disability, maintaining strong physical, cognitive, and emotional function. Addressing all three dimensions is crucial for quality of life as we age.

2. The Horsemen of Death: Cardiovascular Disease, Cancer, and Beyond
Globally, atherosclerotic cardiovascular disease kills 18–19 million people annually, far outpacing cancer’s 11 million. Seven major causes—cardiovascular and cerebrovascular disease, cancer, accidents, dementia, “deaths of despair,” and others—can be prevented or delayed by focusing on a handful of modifiable risk factors.

  • Blood Pressure: Hypertension is the primary driver of hemorrhagic stroke. Aggressive management to keep blood pressure at or below 120/80 mmHg dramatically lowers heart attack and stroke risk. Proper measurement (sitting quietly for five minutes, manual cuff preferred) and frequent monitoring—beyond infrequent office checks—are essential.

  • Smoking and Vaping: Tobacco is chemically toxic to arteries and a proven lung-cancer risk; cessation unequivocally reduces cancer incidence. Vaping carries its own carcinogenic risks and should only be a last-resort quitting aid.

  • Cholesterol and ApoB: The number of atherogenic particles (apoB) predicts cardiovascular risk better than total cholesterol. Lowering apoB as much as possible—through diet, lifestyle, and medications like statins or PCSK9 inhibitors—is key. Carbohydrate restriction and improved insulin sensitivity can help manage triglycerides and apoB levels, while statins and PCSK9 inhibitors offer pharmaceutical avenues, albeit with potential side effects (muscle pain, insulin resistance, rare cognitive fog).

3. Nutrition, Metabolism, and Body Weight
Diet plays a foundational role: combating insulin resistance through dietary adjustments (especially carb restriction) can improve lipid profiles and reduce cardiovascular risk. While dietary cholesterol has minimal direct impact on serum cholesterol, overall metabolic health hinges on maintaining insulin sensitivity and balanced nutrient intake. Obesity—often a proxy for underlying inflammation and insulin resistance—ranks as the second most prevalent environmental driver of cancer.

4. Exercise and Physical Resilience
Regular physical activity supports both cardiovascular and cognitive health. Low-intensity “Zone 2” cardio and strength training (with emphasis on eccentric control and preserving fast-twitch fibers) bolster metabolic function, muscular power, balance, and fall prevention. Interval training and stability exercises (e.g., slow, controlled step-ups) further enhance brain health and reduce injury risk.

5. Sleep, Mental Health, and Emotional Well-Being
Adequate sleep is non-negotiable for cardiovascular and brain health, yet its importance is often underappreciated. Emotional health profoundly influences physical health; practices like therapy (DBT), journaling, affirmations, and mindful relationship repair support resilience. Cultivating social connections, a sense of purpose, and emotional self-awareness helps maintain balance, while professional support (ongoing therapy) anchors these efforts.

6. Genetics, Toxins, and Cancer Screening
Inherited factors—such as APOE isoforms affecting Alzheimer’s risk or PCSK9 mutations influencing LDL clearance—shape individual susceptibility but represent only a fraction of disease risk. Environmental toxins (PM2.5, asbestos, pesticides, counterfeit pills) carry significant cancer and neurological risks; mitigation involves avoidance, protective measures, and advocacy for clean air. Early detection (colonoscopies, imaging) remains the most powerful tool in preventing and treating cancers like colon and prostate, which are nearly 100 percent preventable when caught early.

7. A Holistic, Integrated Approach
Ultimately, proactive modification of causal, modifiable risks—through regular monitoring, lifestyle optimization, targeted supplementation, and medical interventions—is the cornerstone of extending both lifespan and healthspan. A structured, multidisciplinary strategy empowers individuals to live not just longer, but better.