Chapter 1 – The Long Game: From Fast Death to Slow Death

• Odds are overwhelming that you will die as a result of one of the chronic diseases of aging that I call the Four Horsemen: heart disease, cancer, neurodegenerative disease, or type 2 diabetes and related metabolic dysfunction.
• Longevity has two components.  The first is how LONG you live, your chronological lifespan, but the second and equally important part is how WELL you live – the quality of your years (HEALTHSPAN)
• Nutritional biochemistry – how the combinations of nutrients that you eat affect your own metabolism and physiology, and how to use data and technology to come up with the best eating pattern for you
• One macronutrient, in particular, demands more of our attention than most people realize: not carbs, not fat, but PROTEIN becomes critically important as we age.
• Exercise is by far the most potent longevity “drug”
• Emotional suffering can decimate our health on all fronts, and it must be addressed.
• Longevity demands a paradigm-shifting approach to medicine, one that directs our efforts toward preventing chronic diseases and improving our healthspan – and doing it now rather than waiting until disease has taken hold or until our cognitive and physical function has already declined. It’s not “preventative” medicine, it’s PROACTIVE medicine.

Chapter 2 – Medicine 3.0: Rethinking Medicine for the Age of Chronic Disease

• Medicine 1.0 – conclusions were based on direct observation (pure guesswork).
• Medicine 2.0 – advent of germ theory of disease – created the scientific method.  This represented a philosophical shift from observing and guessing to observing and then forming a hypothesis.  
• Medicine 3.0 – focuses on prevention than treatment, considers the patient as a unique individual, and the starting point is the honest assessment and acceptance of risk – including the risk of doing nothing. Pays more attention to maintaining healthspan.
• Medicine 3.0 demands much more from you, the patient: You must be well-informed, medically literature to a reasonable degree, clear-eyed about your goals, and cognizant of the true nature of risk.

Chapter 3 – Objective, Strategy, Tactics: A Road Map for Reading This Book

Strategy without tactics is the slowest route to victory. Tactics without strategy is the nose before defeat

Sun Tzu

• Objective > Strategy > Tactics. To achieve our objectives, we first need to have a strategy: an approach, a conceptual scaffolding or mental model that is informed by science, is tailored to our goals, and give us options. Our specific tactics flow from our strategy, and the strategy derives from our objectives. We know what the object is, but the strategy is the key to victory.

Three Areas of Healthspan Decline:

• 1. Cognitive Decline – our processing speed slows down.  Our memory begins to fade.
• 2. Physical Body Decline – lose muscle mass and strength, along with bone density, stamina, stability, and balance.  Assess what “activities of daily living”, a checklist used to access health and functionality of elderly people.  
• 3. Emotional Health – as important as physical health

Tactics fall into 5 broad domains:

• 1. Exercise – strength, stability, aerobic efficiency, and peak aerobic capacity – increasing limits in each of these areas is necessary if you are hoping to reach your limit of lifespan and healthspan.
• 2. Nutrition – focus more on how much you eat: how many calories you take into your body (rather than what you eat).
• 3. Sleep – poor sleeptriggers a cascade of negative downstream consequences, from insulin resistance to cognitive decline, as well as mental health issues.
• 4. Emotional Health – “Why would you want to live longer if you’re so unhappy” – Ester Perel
• 5. Exogenous molecules, meaning drugs, hormones, or supplements.

Chapter 4 – Centenarians: The Older You Get, the Healthier You Have Been

• Study of Scandinavian twins have found that genes may be responsible for only about 20-30% of the overall variation in human lifespan.
• Need to understand detailed family history – when your relatives died and why?
• Centenarian genes have brought them a phase shift in time – that is, their entire lifespan and healthspan curve has been shifted a decade or two (or three!) to the right. Not only do they live longer, but these are people who have been healthier than their peers and biologically younger than them, for virtually their entire lives.
• The e2 variant of APOE, on the other hand, seems to protect its carriers against dementia.
• CETP and APOC3 (two other cholesterol-related genes) are correlated with extreme longevity (and may explain why centenarians rarely die from heart disease).
• In the end, I think that the centenarian’s secret comes down to one word: resilience.  They are able to resist and avoid cancer and cardiovascular disease, even when they have smoked for decades. They are able to maintain ideal metabolic health, often despite a lousy diet.

Chapter 5 – Eat Less, Live Longer: The Science of Hunger and Health

• mTOR – mechanistic target of rapamycin – one of the most important mediators of longevity at the cellular level
• Rapamycin tends to slow down the process of cellular growth and division.  Lowering mTOR – reduces division and slows down aging
• Rapamycin boosted mice’s remaining if expectancy by 28% for males and 38% for females. Rapamycin might extend lifespan “by postponing death from cancer, by retarding mechanisms of aging or both”
• Caloric restriction (CR)- can be found to length the lifespan of a mouse or rat by anywhere between 15 to 45 percent.
• AMP activated protein kinase (AMPK) works to inhibit the activity of mTOR, the cellular growth regulator. Instead of making new proteins and undergoing cell division, the cell goes into a more fuel-efficient and stress-resistant mode, activity an important cellular recycling process called autophagy, which means “self-eating” (or better yet, “self-devouring”).
• By cleansing our cells of damaged proteins and other cellular junk, autophagy allows our cells to run more cleanly and efficiently and helps make them more resistant to stress. But as we get older, autophagy declines.  Impaired autophagy is thought to be an important driver of numerous aging-related phenotypes and ailments, such as neurodegeneration and osteoarthritis.
• A small but growing number of people, including me and a handful of my patients, already take rapamycin off-label for its potential geroprotective benefits. 

Chapter 6 – The Crisis of Abundance: Can Our Ancient Genes Cope with Our Modern Diet

• “Normal” is not the same as “healthy.” The reference ranges for these lab tests are based on current percentiles, but as the population in general becomes less healthy, the average may diverge from optimal.  Average is not necessarily optimal.
• Not everyone who is obese is metabolically unhealthy, and not everyone who is metabolically unhealthy is obese.

Metabolic syndrome (or MetSyn) is defined as:

• 1. High blood pressure (>130/85)
• 2. High triglycerides (>150 mg/dL)
• 3. Low HDL cholesterol (<40 mg/dL in men or <50 mg/dL in women)
• 4. Central adiposity (wase circumference (>40 inches in men or >35 in women)
• 5. Elevated fasting glucose (>110 mg/dL)
• If you meet three or more of these criteria, then you have the metabolic syndrome.
• Nearly 10 million Americans are normal weight (BML 19-24.9) but metabolically unhealthy.

• I insist my patients undergo a DEXA scan annually – and I am far more interested in their visceral fat than their total body fat.  You can have 20% body fat (maybe 50^th percentile), but 4.5 pounds of visceral fat and would be considered exceptionally high risk for cardiovascular disease and type 2 diabetes.
• While in may be in vogue to vilify high-fructose corn syrup, which is 55% fructose and 45% glucose, it’s worth pointing out that good old table sugar (sucrose) is about the same, consisting of 50% fructose and 50% glucose. So, there’s really not much of a difference between the two. 
• But the first thing I look for, the canary in the coal mine of metabolic disorder, is elevated insulin.
• Studies have found that insulin resistance itself is associated with huge increases in one’s risk of cancer (up to twelvefold), Alzheimer’s disease (fivefold), and death from cardiovascular disease (almost sixfold) – all of which underscores why addressing, and ideally preventing metabolic dysfunction is a cornerstone of my approach to longevity.

Chapter 7 – The Ticker: Confronting and Preventing Heart Disease, the Deadliest Killer on Our Planet

• Autopsy data from young people who died from accidents, homicides, or other non-cardiovascular causes have revealed that as many as a third of sixteen-twenty-year-olds already had actual atherosclerotic lesions or plaques in their coronary arteries when they tied. As teenagers.
• Should get a CT angiogram – can identify the noncalcified or “soft” plaque that precedes calcification.  Calcium scans only show calcified plaque, while CT angiogram shows “soft” plaque too.
• If you have a history of premature heart attacks in your family, you should definitely ask for an Lp(a) test.
• The only real treatment for elevated Lp(a) right now is aggressive management of apoB overall.
• When I look at a patient’s blood panel for the first time, my eyes immediately dart to two numbers: apoB and Lp(a).
  • ApoB not only tells me the concentration of LDL particles (which is more predictive of disease than the concentration of cholesterol found within LDL particles, LDL-C), but it also captures the concentration of VLDL particles, which as members of the apoB family can also contribute to atherosclerosis. Even someone whose apoB is low can still have a dangerously elevated Lp(a).
• High quantities of extra virgin olive oil, macadamia nuts, and avocados (among other foods) promote better cholesterol.
• The sooner we lower apoB exposure, thus lowering risk, the more the benefits compound over time – and the greater our overall risk reduction.

Chapter 8 – The Runaway Cell: New Ways to Address the Killer That is Cancer

Three-part strategy to dealing with cancer:

1. Prevention: the associated between obesity, diabetes, and cancer is primarily driven by inflammation and growth factors such as insulin. Need to avoid being insulin resistant to type 2 diabetes, where our cancer risk is clearly elevated.  Getting our metabolic health in order is essential to our anticancer strategy.

2. New Treatments: Use newer and smarter treatments (e.g. CAR-T) to help treat cancers.

3. Early Detection: Most important tool in our anticancer arsenal is early, aggressive screening.

• Out of dozens of different types of cancers, we have agreed upon reliable screening methods for only five: lung (for smokers), breast, prostate, colorectal, and cervical.
• In my practice, we typically encourage average-risk individuals to get a colonoscopy by age forty – and even sooner if anything is their history suggests that they may be at higher risk.  Why? Out of all the major cancers, colorectal cancer is one of the easiest to detect, with the greatest payoff in terms of risk reduction.
• My bottom line is that it is far better to screen early than risk doing it too late. Think asymmetric risk: It’s possible that NOT screening early and frequently enough is the most dangerous option.
• The pap spear for cervical cancer is another well-established, minimally invasive test that I recommend my patients do yearly.
• Out of the Horsemen, cancer is probably the hardest to prevent. The only modifiable risks that really stand out in the data are smoking, insulin resistance, and obesity (all to be avoided)
• If the first rule of cancer is “Don’t get cancer”, the second rule is “catch it as soon as possible.”

Chapter 9 – Chasing Memory: Unlocking Alzheimer’s Disease and Other Neurodegenerative Diseases

• I always check in patients is their APOE genotype, the gene related to Alzheimer’s disease (e4 allele – higher risk of Alzheimer’s; e4/e4 can have up to twelve times greater risk).
• Developing complex skills such as speaking a foreign language or playing a musical instrument, the more resistant to cognitive decline we tend to be. 
• People with better movement patterns, and a long history of moving their bodies (athletes) tend to resist or slow the progression of Parkinson’s compared to sedentary people. Boxing is a primary treatment/prevention strategy for Parkinson’s.
• Robust blood flow seemed to be critical to maintaining brain health. Alzheimer’s is more likely to be diagnosed in patients who have suffered a stroke which blocks blood flow to specific regions of the brain.
• Having type 2 diabetes doubles or triples your risk of developing Alzheimer’s disease

To reduce Alzheimer’s:

• Address metabolic issues (improve glucose metabolism, inflammation, and oxidative stress).  Switch to mediterranean-style diet, relying on more monounsaturated fats and fewer refined carbohydrates, in addition to regular consumption of fatty fish and possibly supplementation with omega-3 fatty acid DHA (found in fish oil). Cut out added sugar, refined carbohydrates, and alcohol. 
• The single most important item in our preventative toolkit is exercise, which has a two-pronged impact on Alzheimer’s disease risk: it helps maintain glucose homeostasis, and it improve the health of our vasculature.  Focus on steady endurance exercise to improve her mitochondria efficiency.
• The greater someone’s grip strength, the lower their risk of dementia.
• Sleep is also a very powerful tool against Alzheimer’s disease.
• Sauna – at least four sessions per week, of at least twenty minutes per session at 179 degrees Fahrenheit or hotter seems to be the sweet spot to reduce the risk of Alzheimer’s by about 65% (and the risk of ASCVD by 50%).

Summary:

• What’s good for the heart is good for the brain.  That is, vascular health (meaning low apoB, low inflammation, and low oxidative stress) is crucial to brain health.
• What’s good for the liver (and pancreas) is good for the brain.  Metabolic health is crucial to brain health.
• Time is Key. We need to think about prevention early, and the more the deck is stacked against you genetically, the harder you need to work and the sooner you need to start. As with cardiovascular disease, we need to play a very long game.
• Our most powerful tool for preventing cognitive decline is exercise. We’ve talked a lot about diet and metabolism, but exercise appears to act in multiple ways (metabolic, vascular) to preserve brain health.  Exercise is the foundation of our Alzheimer’s prevention program.

Chapter 10 – Thinking Tactically: Building a Framework of Principles That Work for You

• Five tactical domains to alter someone’s health: exercise (most potent domain of its impact on both lifespan and health; VO2 max), diet, sleep, emotional health, and drugs / supplements / hormones.

Chapter 11 – Exercise: The Most Powerful Longevity Drug

• If you adopt only one new set of habits based on reading this book, it must be in the realm of exercise.
• Peak aerobic cardiorespiratory fitness, measured in terms of VO2 max, is perhaps the single most powerful marker for longevity. VO2 max represents the maximum rate at which a person can utilize oxygen.
• The fitter I am, the more oxygen I can consume to make ATP, and the faster I can run up that hill.
• An average 45 year old man will have a VO2 max around 40 ml/kg/mi, while an elite endurance athlete will likely score in the high 60s and above.
• Muscle may be almost as powerfully correlated with living longer (in addition to cardiorespiratory fitness and longevity).  It’s not the mere muscle mass that matters, but the strength of those muscles, their ability to generate force.
• Falls are by far the leading cause of accidental deaths in those ages 65+.  Someone with more muscle mass is less likely to fall and injure themselves, while those who are less likely to fall for other reasons (better balance, more body awareness) will also have an easier time maintaining muscle mass.
• Just as with VO2 max, it is important to maintain muscle mass at all costs. This is why I place such an emphasis on weight training – and doing it now, no matter your age.
• Therefore, I find a way to lift heavy weights in some way, shape or form four times per week, no matter what else I am doing  or where I may be traveling.
• The Centenarian Decathlon – framework of the most important physical tasks you want to be able to do for the rest of your life (e.g. get up off the floor under your own power, using a maximum of one arm for support, pick up a young child from the floor, life a 20 lb, suitcase in the overhead compartment of a plane, have sex, do five pull ups, dead hang for one minute, etc.).
  • So if you want to pick up that 30 lb. grandkid when you’re 80, you’re going to have to be able to lift 50-55 lbs. now.

Chapter 12 – Training 101: How to Prepare for the Centenarian Decathlon

Three dimensions in which we want to optimize our fitness are aerobic endurance and efficiency (aka cardio), strength, and stability.

Cardio: long, steady endurance work, such as jogging, or cycling, or swimming, where we are training in what physiologists call zone 2, and maximal aerobic efforts, where VO2 max comes into play.

• Zone 2: going at a speed slow enough that one can still maintain a conversation but fast enough that the conversation might be a little strained. It translates to aerobic activity at a place somewhere between easy and moderate. If you can’t speak in complete sentences, you’re likely in zone 3. If you can comfortably converse, you’re likely in zone 1.
• If you know your maximum heart rate, the highest number you’ve ever seen on a heart rate monitor, your zone 2 will correspond to approximately 80% to 85% of that peak number, depending on your fitness levels.
• Four times a week, I will spend about an hour riding my stationary bike at my zone 2 threshold.
• Benchmark for a reasonably fit person – take weight in kg (160 lbs = 72.7 kg * 2 = 145 output)
• Ideally, I want to target the “elite” range for their age and sex (roughly the top 2%). If they achieve that level, I say good job – now let’s reach for that elite level for your sex, but two decades younger.

• To train VO max = supplement our zone 2 work with one or two VO2 max workouts per week (HIIT intervals).
• Intervals: four minutes at a maximum pace you can sustain for this amount of time – not an all-out sprint, but still a very hard effort.  Then ride or job for four minutes easy, which should be enough time for your heart rate to come back down to below about one hundred beats per minute.  Repeat this four to six times and cool down. Also, be sure to give yourself enough time to warm up and cool down from this intense effort.
• Ideal VO2 max pace is about 33% more than zone 2 pace. So if zone 2 pace represents an output of 150 watts, your VO2 max training pace should be about 200 watts for four minutes. If you know your functional threshold power (FTP), you should target 120% of this for 3 minutes and 106% of this for eight minute intervals and adjust for everything in between.

Strength – it takes much less time to lose muscle mass and strength than to gain it, particularly if we are sedentary. It is very difficult to put on muscle mass later in life.

• Track Bone Density (bone mineral density – BMD) – at least every few years. Optimize nutrition, focusing on protein and total energy needs and do heavy loading-bearing activities. Strength training, especially with heavy weights, stimulates growth of bone
• Rucking – basically means hiking of walking at a fast past with a loaded pack on your back. Three or four days a week, I’ll spend an hour rucking around my neighborhood, up and down hills.  A good goal is to be able to carry one quarter to one third of your body weight once you develop enough strength and stamina.

Strength Training:

1. Grip strength – There is an enormous body of literature linking better grip strength in midlife and beyond to decrease risk of overall mortality. If you have the strength to grab a railing, or a branch, and hold on, you may avoid a fall.
2. One of my favorite ways to train grip strength: farmers carry – where you walk for a minute or so with a loaded hex bar or dumbbell or kettlebell in each hand. One standard for males – carry half of their body weight in each hand (so total body weight in total) for at least one minute.
3. The most important tip is to keep your shoulder blades down and back, nut pulled up or hunched forward.
4. Another way to test your grip is by dead-hanging from a pull-up bar for as long as you can.  We like to see men hang for at least two minutes and women for at least ninety seconds at age 40.
5. Attention to both concentric and eccentric loading for all movements.  We need to be able to lift the weight up and put it back down, slowly and with control.  Focus on the “down’ phase of lifts ranging from pull ups to pull-downs to deadlifts to rows; rucking downhill, carrying a weighted pack is a great way to build both eccentric strength as well as spatial awareness and control.
6. Pulling Motions – at all angles form overhead to in front of you (pull-ups and rows)
7. Hip hinging movements, such as deadlift and squat, but also step ups, hip thrusters, and countless single leg variants of exercise that strength the legs, glutes, and lower back. Bend at the hips and not the spine!

Chapter 13 – The Gospel of Stability: Relearning How to Move to Prevent Injury

• Stability lets us create the most force in the safest manner possible. The goal is to be strong, fluid, flexible, and agile as you move through your world.
• Twice a week, I spend an hour doing dedicated stability training, based on the principles of DNS, PRI, and other practices, with 10-15 minutes per day on the other days.
• Stability training begins at the most basic level, with the breath.
• The idea behind breath training is that proper breathing affects so many other physical parameters: rib position, neck position, the shape of the spine, even our position of our feet on the ground.
• An ideal inhalation expands the entire rib cage front, sides, and back – while the belly expands at the same time, allowing the respiratory and pelvic diaphragm to descend.  Key is to inhale as quietly as possible.
• Toe Yoga – try to lift all toes off the ground and spread then as wide as you can. Now try to put your big toe back on the floor, while keeping your other toes lifted. Trickier than you’d think, right? Now do the opposite: keep four toes on the floor and lift only your big toe. Then lift all five toes, and try to drop them one by one, starting with your big toe.
• One key test in our movement assessment is to have our patients stand with one foot in front of the other and try to balance. Now close your eyes and see how long you can hold the position. Ten seconds is a respectable time; in fact, the ability to balance on one leg at age 50+ has been correlated with future longevity, just like grip strength.
• There is a strong correlation between having a weak rotator cuff (shoulder) and weak grip strength.
• I urge you to film yourself working out from time to time to compare what you think you are doing to what you are actually doing with your body.
• doing to what you are actually doing with your body.

Chapter 14 – Nutrition 3.0: You Say Potato, I say “Nutritional Biochemistry”

• There is one perfect diet that works for ever single person – is absolutely incorrect.

Nutrition 3.0:

• 1. Are you undernourished or overnourished?
• 2. Are you undermuscled or adequately muscled?
• 3. Are you metabolically healthy or not?

Simple rules for nutrition: don’t eat too many calories, or too few; consume sufficient protein and essential fats; obtain the vitamins and minerals you need; and avoid pathogens like E. coli and toxins like mercury and lead.

Two issues around diet
1. Compliance – how well can you stick to the diet?
2. How a given diet affects you, your individual metabolism and other risk factors.

Chapter 15 – Putting Nutritional Biochemistry into Practice: How to Find the Right Eating Pattern for You

The farther away we get from the Standard American Diet (SAD), the better off we will be (e.g. junk food, processed foods)

Three strategies:

1. Caloric Restriction (CR) – eating less in total, but without attention to what is being eaten or when it’s being eaten. From the standpoint of pure efficacy, caloric restriction (CR) is the winner hands down. However, the catch is that you have to do it perfectly – tracking every single thing you eat, and not succumbing to cheat or snack or it doesn’t work.

2. Dietary Restriction (DR) – eating less of some particular element(s) within the diet (e.g. meat, sugar, fats). Conceptually simple: pick a type of food and then don’t eat that food.

3. Time Restriction (TR) – restricting eating to certain times (intermittent fasting), up to and including multiday fasting. One significant downside of this approach is that people who try it end up very protein deficient.

Caloric Restriction:

• Calorie counting is agnostic to food choices – you can eat whatever you want so long as you stay within your daily allowance.  But if you make too many poor decisions (e.g. eating snickers bars), you will be very hungry (as opposed to eating chicken breasts and broccoli).
• There appears to be a strong link between calories and cancer – CR monkeys had a 50% lower incidence of cancer.
• The quality of the food you eat could be as important as the quantity.  If you’re eating the SAD, then you should eat much less of it.

Dietary Restriction:

• Any form of DR that restricts protein is probably a bad idea for most people, because it likely also impairs the maintenance or growth of muscle.
• A more significant issue with DR is that everyone’s metabolism is different.  Some people will lose tremendous amounts of weight and improve their metabolic markers on a low-carb or ketogenic diet, while others will actually gain weight and see their lipid markers go haywire – on the exact same diet.

Alcohol:  my bottom line: if you drink, try to be mindful about it.  You’ll enjoy it more and suffer fewer consequences. I strongly urge my patients to limit alcohol to fewer than seven servings per week, and ideally no more than two on any given day.

Carbohydrates: Leverage a CGM (continuous glucose monitor) – my healthy patients need to use a CGM only for a month or two before they begin to understand what foods are spiking their glucose (and insulin) and how to adjust their eating pattern to obtain a more secure glucose curve. Once they have this knowledge, many of them no longer need CGM.

With a CGM, the first phase is the insight phase, where you learn how different foods, exercise, sleep (especially lack thereof), and stress affect your glucose readings in real time. This leads to the second phase, which is what I call the behavior phase. How are you going to respond by eating the bag of chips?

• CGM:  are patients’ blood glucose spiking above 160 mg/dL more than I would like? Overall, I like to keep average glucose at or below 100 mg/dL, with a standard deviation of less than 15 mg/dL.

Lessons from CGMs:

• Not all carbs are created equal (the more refined the carb, the faster and higher the glucose spike – e.g. chips). Less processed carbs are those with more fiber blunt the glucose impact (I try to eat more than 50 grams of fiber every day).
• Rice and oatmeal are surprisingly glycemic (meaning they cause a sharp rise in glucose levels), despite not being particularly refined; more surprisingly is that brown rice is only slightly less glycemic than long-grain white rice.
• Timing, duration, and intensity of exercise matter a lot. In general, aerobic exercise seems most efficacious at removing glucose from circulation
• A good vs. bad night of sleep makes a world of difference in terms of glucose control (sleeping just 5-6 hours vs 8 hours accounts for a 10-20 mg/dL jump in peak glucose.
• Non-starchy veggies such as spinach or broccoli have virtually no impact on blood sugar. Have at them.

Protein:

• I typically set 1.6 g/kg/day as the minimum, which is twice the recommended dietary amount in the US. For active people with normal kidney function, should be around 1 gram per pound of body weight per day (or 2.2 g/kg/day).
• If you weigh 165 lbs, you should aim for 120-165 grams of protein a day.
• Typically, I will consume a protein shake, a high-protein snack, and two protein meals.
• The overall quality of protein derived from plants is significantly lower than that from animal products.
• Whey protein isolate (from dairy) is richer in amino acids than soy protein isolate.

Fat:

• For most patients, the range we look for is between 8%-12% of red blood cell (RBC) membrane composed of EPA and DHA (marine source fats)
• Practice eating more olive oil and avocados and nuts, cutting back (but not necessarily eliminating things like butter and lad, and reducing the omega-6 rich corn, soybean, and sunflower oils, while also looking for ways to increase high-omega -3 marine PUFAs (polyunsaturated fats) from sources such as salmon and anchovies.
• I tell my patients: MUFAS are probably the fat that should make up most of our dietary fat mix, which means extra virgin olive oil and high-MUFA vegetable oils.
• Take EPA and DHA supplements in capsule or oil form.

Time Restriction:

• If you are following a fasting diet, it is worth thinking about whether prolonged fasting periods are making it harder to maintain muscle mass and physical activity levels, which are known to be very important factors for long-term health.

Conclusion:

• It is essential for older people who need to build or maintain muscle mass. But its power to leverage increased lifespan and healthspan is more limited. Bad nutrition can hurt us more than good nutrition can help us.
• In most cases, addressing the problem means reducing overall intake – cutting calories – but in a way that is sustained for the person. We also have to focus on eliminating those types of foods that raise blood glucose too much, but in a way that also does not compromise protein intake and lean body mass.

Chapter 16 – The Awakening: How to Learn to Love Sleep, the Best Medicine for Your Brain

• Good sleep is like a performance-enhancing drug.
• Endurance drops, VO2 max drops, and one-rep-max strength drops with poor sleep.

Low sleep can (6 hours a night):

• Make you older looking with flabbier skin
  Increase insulin resistance by up to a third.
• Increase cardiovascular disease by 6-26%.
• Increase risk of developing dementia. Thus, good sleep in middle age (40s-60s) appears to be especially important for maintaining cognitive health.

How to sleep better:

• Don’t drink any alcohol period. If you absolutely must, limit yourself to one drink before about 6pm.
• Don’t eat anything less than 3 hours before bedtime.
• Abstain from stimulating electronics, beginning two hours before bed.
• For at least one hour before bed, if not more, avoid doing anything that is anxiety producing or stimulating, such as reading work email or checking social media.
• Spend time in a sauna/hot tub/warm shower before bed. Once you get into the cool bed, your lowering body temperature will signal to your brain that it’s time to sleep.
• Give yourself enough time to sleep (at least 8 hours before you need to wake up)
• Fix your wake-up time and don’t deviate from it even on weekends.
• Exercise to cultivate sleep pressure, particularly sustained endurance exercise (e.g. zone 2), ideally not within 2-3 hours before bedtime.

Chapter 17 – Work in Progress: The High Price of Ignoring Emotional Health

Why would you want to live longer if you’re so unhappy

Ester Perel

• Living alone or feeling lonely is linked to a much higher risk of mortality
• Our Medicine 3.0 thesis is that if we address our emotional health, and do so early on, we will have a better chance of avoiding clinical mental health issues such as depression and chronic anxiety – and our overall health will benefit.
• “Reframing” – is the ability to look at a given situation from someone else’s point of view – literally reframing it. What does the situation look like through the other person’s eyes? How do they see it? And why is your time, your convenience, or your agenda any more important than theirs?
• Manage your inner dialogue – what does it sound like?  Is it kind and forgiving or is it harsh and judgmental? How would I speak to your best friend if they had performed exactly as I had done?
• Changing the behavior can change the mood. You do not need to wait for your mood to improve to make a behavior change.
• Therapist check-in: how am I feeling? How have I slept? Am I in physical pain? Am I in conflict? Then we dissect and discuss events and issues of the week in minute detail.