Roadmap - How To Look Young & Feel Strong

Starting a fitness journey is as much about mindset as it is about physical activity. Understand that transformative results don't manifest overnight. Instead, it's the consistent, small actions taken daily that compound over time. As emphasized in the book "Atomic Habits" by James Clear, it's about making 1% improvements every day. These "atomic" changes, though seemingly minor, accumulate to produce significant results. 

Pacing yourself is crucial. While the allure of intense workouts might be tempting, beginning slowly and gradually increasing intensity is vital. This approach not only fosters a sustainable exercise habit but also minimizes the risk of injury. Remember, it's about longevity and consistency, not just intensity.

Focus on the journey, not just the destination. Instead of being fixated on specific outcomes, concentrate on building and reinforcing the habits that will lead you there. By integrating exercise into your daily routine, you lay the foundation for lasting success.

1. The Power of Habit

Before diving into specific exercises, recognize the significance of habit formation. Dedicate a specific time each day to fitness, be it post-waking, during lunch, or pre-bedtime. This daily consistency helps cement your new routine.

2. Workday Walking Routine

If you own a smartwatch, monitor your daily steps and weave walking into your routine:

• Morning: Park your car further away from your workplace, allowing for a 10-minute walk to your office.
• Lunch: Before settling down to eat, take a 5-minute walk away from your workplace and then walk back. This not only adds to your daily step count but also provides a mental break.
• Evening: End your day with the same 10-minute walk back to your car. By following this routine, you'll easily achieve the minimum recommended daily exercise without feeling overwhelmed.

3. Home Workouts

Starting your fitness journey doesn't require a gym membership or expensive equipment. In fact, your home offers plenty of opportunities to get active. One approach to ease into regular physical activity is through "exercise snacks" – short, frequent bouts of activity that can be just as beneficial as longer, structured workouts. These mini-exercises can be seamlessly integrated into your day, making it easier to stay active without feeling overwhelmed.

Exercise snacks and at-home workout ideas:

• Kneeling Push-Ups: Start in a plank position but with your knees on the ground. Lower your body towards the floor, keeping your elbows close to your sides, then push back up. This exercise targets your chest, arms, and core.
• Squats: Stand with your feet shoulder-width apart. Lower your body as if you're sitting in a chair, keeping your back straight and knees over your toes. Push through your heels to return to the starting position. This works your legs, glutes, and core.
• Lunges: Take a step forward and lower your body until both knees are bent at a 90-degree angle. Push back up and repeat with the other leg. This is great for leg strength, balance, and flexibility.
• Glute Bridges: Lie on your back with your knees bent and feet flat on the floor. Lift your hips off the ground until your body forms a straight line from your shoulders to your knees. Squeeze your glutes at the top, then lower back down. This targets the glutes and lower back.
• Plank: Start in a push-up position but keep your weight on your forearms instead of your hands. Ensure your body forms a straight line from head to heels. Hold this position, engaging your core, for as long as you can. This exercise strengthens the entire core region.
• Wall Sit: Lean against a wall with your feet shoulder-width apart. Slide down until your knees are at a 90-degree angle and hold. This is an excellent exercise for building endurance in the legs.
• Standing Calf Raises: Stand upright and push through the balls of both feet to raise your body upward. Keep your abdominal muscles pulled in so that you move straight upward, rather than shifting your body forward or backward. This targets the calf muscles.
• Arm Circles: Extend your arms out to the side at shoulder height. Move your arms in small circles, about a foot in diameter. Do this for about 30 seconds, then reverse the direction. This exercise is great for shoulder mobility and endurance.

Remember, the key is consistency. Start with a few repetitions of each exercise and gradually increase as you become more comfortable.

4. Gradual Running or Exercycle

Starting a running routine can be a fantastic way to build cardiovascular health, but it's essential to begin slowly to minimize the risk of injury. If running isn't suitable for you, using an exercycle can be an excellent low-impact alternative.

Running:

• Week 1-2: Begin with brisk walking for 10 minutes daily. This helps condition your body for more intense activity.
• Week 3-4: Incorporate short bursts of jogging into your walks. For example, walk for 4 minutes, then jog for 1 minute. Repeat this cycle for a total of 20 minutes.
• Week 5 onwards: Gradually increase the jogging intervals and decrease the walking intervals until you can jog continuously for 20 minutes.

At-home Exercycling (Alternative to Running): If running isn't feasible due to joint issues or personal preferences, consider using a cheap, second-hand exercycle as an alternative.

• Week 1-2: Start with 10 minutes of gentle cycling daily, focusing on maintaining a steady pace.
• Week 3-4: Increase your cycling time to 15 minutes and try to incorporate short bursts of faster pedaling.
• Week 5 onwards: Aim for 20-30 minutes of continuous cycling, adjusting your speed and resistance as you become more comfortable.

Whether you choose running or cycling, the key is to listen to your body. If you feel pain (not to be confused with the typical discomfort of exercise), it's essential to rest and consult a healthcare professional if necessary. Remember, the goal is to build a sustainable exercise habit, so it's okay to adjust your pace and approach based on your individual needs.

5. Stay Accountable

Share your fitness journey:

• Buddy System: Find a friend with similar fitness goals. Working out together can be motivating and make the process more enjoyable.
• Track Progress: Use a journal or fitness app to log your activities. Celebrate milestones, no matter how small!

Intermediate Exercise Guide:

As you transition from a beginner to an intermediate exerciser, the focus shifts from establishing a routine to optimizing and diversifying your workouts. Here's a comprehensive guide to help you navigate this stage:

Continue the Active Lifestyle and Exercise Snacks:

As you advance in your fitness journey, remember the foundational habits set in the beginner's phase. Continue to weave exercise into the fabric of your daily life. Monitor your steps, opt for stairs over elevators, and park a bit farther from destinations to incorporate walking. The exercise snacks and at-home movements you've learned are not just beginner tools; they're lifelong habits. Integrate them throughout your day to keep your body active and your momentum going.

Aerobic Activity:

Now that you have built up to 20-minute jogs, we want to build upon this foundation by aiming for at least 180 minutes of ‘Zone 2’ aerobic activity weekly, ideally spread across five days.

What is Zone 2 Training?

Zone 2 training refers to exercising at a heart rate that corresponds to 60-70% of your maximum heart rate (MHR). This zone is often described as a "conversational pace," meaning you should be able to maintain a conversation while exercising without feeling overly breathless.

Benefits of Zone 2 Training:

• Builds Aerobic Base: Training in Zone 2 helps in building a strong aerobic foundation, which is essential for improving endurance and overall fitness.
• Fat Utilization: Exercising in this zone encourages your body to use fat as its primary fuel source, which can be beneficial for those looking to reduce body fat.
• Recovery: Zone 2 workouts are less taxing on the body, making them ideal for active recovery days.
• Preparation for Higher Intensities: A strong aerobic base established through Zone 2 training can better prepare you for higher intensity workouts in the future.

How to Determine Your Zone 2:

Typically, Zone 2 exercise is characterized by a pace at which you can comfortably hold a conversation during the activity. If you prefer a more precise approach, you can determine your Zone 2 using heart rate measurements with the following calculation:

1. To find your Zone 2 heart rate, first, estimate your maximum heart rate using the formula: 220 minus your age.
2. Then, calculate 60-70% of this number. For instance, if you're 30 years old, your estimated maximum heart rate would be 190 beats per minute (bpm).
3. Your Zone 2 would then be between 114 and 133 bpm.

This can be achieved through activities like brisk walking, light jogging, using an exercycle, or swimming.

Zone 2 training options:

Traditional methods:

• Light Jogging: A steady-paced jog where you can still hold a conversation is a classic way to stay in Zone 2. The aim is not speed but maintaining a consistent pace.
• Swimming: Swimming at a moderate pace, where you're not racing but still moving consistently, can be an excellent full-body Zone 2 workout.
• Exercycle: Aim for a rhythm where you feel the effort but can still breathe comfortably,

Incorporating into Daily Life:

• Brisk Walking: As emphasized earlier, consider parking a bit farther from your workplace. A brisk 10-minute walk both to and from your office easily adds up to 20 minutes of Zone 2 exercise daily!
• Netflix and Cycle: Needing to catch up on a show? Hop on your cheap, second hand exercycle bike as you indulge in your favorite episodes.
• Cycle Desks: If you're desk-bound for most of the day, a cycle desk can be a game-changer. It allows you to maintain a Zone 2 pace while working, merging productivity with physical activity.

Strength Training

Muscular strength was inversely and independently associated with all-cause death rates.[30] Therefore, to prevent or delay muscle wasting (known as sarcopenia), the aim is to maximise muscle in youth and young adulthood, maintain muscle in middle age and minimise loss in older age.[31]

So congratulations on building a solid foundation in the beginner's phase using the at-home exercises! As you transition to the intermediate stage, you'll be introduced to more advanced techniques and routines. This phase will challenge you, but remember, every step you take is a progression towards a fitter, healthier you.

Transitioning to the Gym: If you've primarily been working out at home, stepping into a gym can be both exciting and a tad overwhelming. Remember, everyone was new at some point.

Personalized Program: For the best results, consider having a personal trainer create a tailored program for you. Regular monthly, or three-monthly check-ins can ensure you're on track, your exercise technique/form is good, and making safe progress. 

Here are some guiding principles for a well structured strength protocol:

1. Frequency: Include strength training exercises at least twice a week. For optimal results, consider four to five sessions weekly. This can involve weights, resistance bands, or bodyweight exercises.
2. Warm-Up and Cool-Down: Always start and conclude your workouts with a 5-10 minute warm-up and cool-down phase to prepare your body and aid recovery.
3. Progressive overload: Understanding progressive overload is essential for effective strength training. This principle involves gradually increasing the stress on your body as you become stronger. Here's a safe approach:
   1. Opt for weights that allow 15-20 repetitions before reaching failure.
   2. Conclude your set 1-2 reps before reaching this point to minimize injury risk.
   3. As you progress, adjust the weight to maintain the 15-rep threshold.
   4. Aim for 2-3 sets per exercise for optimal strength gains, ensuring at least a 2-minute rest between sets.[32]
   5. Engage in exercises with a full range of motion for maximum benefits.
4. Opposing Muscle Group Training: Balance your workouts by training both pushing and pulling muscle groups. This ensures even strength and flexibility development across your body, promoting good posture, functional fitness, and reduced injury risk.
5. Balance and Flexibility: Incorporate balance and flexibility exercises into your routine. Yoga and Tai Chi can improve your balance and flexibility, and they can also be good for stress reduction. You can also do some stretching in between exercise sets.
6. Mix It Up: Variety in your exercise routine can keep it interesting and help you work out different muscle groups. Personal trainers are fantastic at incorporating new movements into your workout routine
7. Listen to Your Body: Rest when you need to and don't push yourself too hard. If you feel pain, shortness of breath, dizziness, or nausea, stop and rest.
8. Nutrition and Hydration: Fuel your workouts with a balanced diet and ensure you stay hydrated before, during, and after exercise.
9. Scheduled Rest Days: While it's essential to push yourself, it's equally crucial to allow your muscles to recover. Ensure you have at least two rest days in a week, especially if you're training intensely.
10. Compound vs. Isolation Exercises: As you progress, incorporate compound exercises like squats, deadlifts, and bench presses that work multiple muscle groups.

Advanced – Exercise Guide 

Welcome to the pinnacle of fitness training. As you transition into the advanced stage, you're no longer just exercising; you're honing your body like a finely-tuned instrument. This stage is about mastery, precision, and pushing the boundaries of what you thought possible.

Having built a robust foundation in the beginner and intermediate phases, you're now equipped to tackle more complex training methodologies. The advanced stage is characterized by strategic variations in your workout regimen, ensuring that your body continues to adapt and grow without plateauing. It's not just about lifting heavier weights or running faster; it's about understanding the intricate balance between pushing your limits and allowing adequate recovery, between strength and flexibility, power and endurance.

In this section, we'll delve deep into advanced training techniques, from periodization strategies to high-intensity workouts, plyometrics, and beyond. We'll explore the science behind each method, ensuring you not only execute each movement effectively but also understand the 'why' behind it.

However, as you ascend to these advanced heights, it's crucial to remember the bedrock principles that got you here. Don't forget about the foundations of an active lifestyle: incorporating exercise snacks, Zone 2 training, and the other habits you've cultivated in the earlier stages. These remain essential components of a holistic fitness approach, no matter how advanced you become.

Remember, with greater challenges come greater responsibilities. Always prioritize safety, listen to your body, and don't hesitate to seek expert advice when needed.

1. High-Intensity Interval Training (HIIT):

High-Intensity Interval Training, commonly known as HIIT, is a dynamic workout regimen that alternates between intense bursts of activity and periods of lower intensity or rest. While Zone 2 training lays the foundation for aerobic endurance, HIIT takes your cardiovascular and muscular systems to the next level, targeting both aerobic and anaerobic fitness.

A standout feature of HIIT is its emphasis on training the fast-twitch muscle fibers. These fibers are responsible for explosive, powerful movements and are crucial for activities that require sudden bursts of strength or speed.

Examples of HIIT Workouts:

• Sprints: After a warm-up, sprint at maximum effort for 30 seconds, followed by a 2-minute walk or jog. Repeat for 2-3 cycles.
• Jump Rope Intervals: Jump rope as fast as possible for 40 seconds, then rest or do low-intensity hopping for 20 seconds.
• Burpee Intervals: Perform burpees for 45 seconds, aiming for maximum repetitions, followed by a 1-2 minute rest.
• Cycling Intervals: On a stationary bike, pedal at maximum intensity for 30 seconds, then slow down for a 2-minute recovery. Repeat 2-3 times
• Tabata Protocol: Choose an exercise (e.g., push-ups, squats, or kettlebell swings). Perform it at maximum intensity for 20 seconds, rest for 10 seconds, and repeat for a total of 8 cycles.

When incorporating HIIT into your routine, it's essential to ensure proper form during those high-intensity intervals to prevent injury. Given the demanding nature of HIIT, it's also crucial to allow adequate recovery time between sessions. Aim for 1-3 HIIT sessions a week in addition to your Zone 2 training.

Remember, the goal of HIIT is not just to complete the intervals but to push yourself during those high-intensity bursts.

2. Periodization

For seasoned practitioners, "periodization" is a strategic approach to organize training over time, maximizing gains and minimizing overtraining risks. This method helps prevent plateaus, reduces overtraining risks, and optimizes performance peaks.

For instance, a 12-week program could be: 

• Weeks 1-4 (Hypertrophy Phase): Focus on muscle growth with lighter weights and higher reps (e.g., 3 sets of 15-20).
• Weeks 5-8 (Strength Phase): Prioritize maximal strength with heavier weights and fewer reps (e.g., 3 sets of 8-12).
• Weeks 9-12 (Power Phase): Incorporate explosive movements with even higher intensity (e.g., 3 sets of 1-5 reps).

3. Plyometric Training:

Plyometric training, often referred to as "jump training" or "plyos," involves exercises that harness rapid and explosive movements to build power, speed, and strength. These exercises are designed to allow a muscle to reach maximal force in the shortest possible time, making them particularly effective for training fast-twitch muscle fibers. Fast-twitch fibers are essential for activities that require sudden bursts of energy, such as sprinting or jumping.

The essence of plyometrics lies in the stretch-shortening cycle. When a muscle is rapidly lengthened (stretched), it's followed by an immediate shortening (contraction) of that same muscle. This action, when done explosively, trains the muscles and nervous system to generate a large amount of force quickly.

Examples of Plyometric Exercises:

• Box Jumps: Start in a squat position and explosively jump onto a raised platform or box, landing softly in a squat. Step down and repeat.
• Burpees: From a standing position, drop into a squat, place your hands on the ground, kick your feet back into a plank position, perform a push-up, jump your feet back to the squat position, and then explosively jump into the air.
• Plyo Push-Ups: Begin in a standard push-up position. Lower yourself and then explosively push off the ground, allowing your hands to leave the floor. Land softly and repeat.
• Bounding: Take exaggerated leaps forward, propelling yourself as far as possible with each jump. Use your arms to gain momentum.
• Depth Jumps: Stand on a platform or box, step off (don't jump off), and as soon as you touch the ground, explosively jump as high as you can, reaching your arms overhead. 

Safety Considerations:

Plyometric exercises are high-impact and can be hard on the joints, so it's essential to ensure proper form and technique. Always start with a thorough warm-up and begin with lower-intensity plyometrics before progressing to more advanced moves. It's also crucial to have a solid strength base before incorporating a lot of plyometric work into your routine. Ensure you're landing softly to absorb impact and protect your joints.

Incorporating plyometric training into your routine can significantly enhance your athletic performance, especially in sports or activities that require quick bursts of power. However, due to their intensity, plyometric sessions should be spaced out, allowing adequate recovery time between them.

4. Overtraining and the Importance of Rest & Recovery:

Understanding Overtraining:

Overtraining, often referred to as overtraining syndrome (OTS), occurs when there's an imbalance between training and recovery — when the training intensity and/or volume exceeds the body's ability to recover. It can lead to prolonged fatigue, decreased performance, increased risk of injury, and other health issues.

Signs of Overtraining:

• Persistent fatigue and lack of energy
• Decreased performance and strength
• Increased perceived effort during workouts
• Persistent muscle soreness
• Sleep disturbances
• Increased susceptibility to illnesses and infections
• Mood changes, irritability, and heightened feelings of stress
• Decreased motivation and enthusiasm for training

The Importance of Rest & Recovery:

Recovery is when the body heals and gets stronger. It's a crucial component of the training process, and neglecting it can hinder progress and lead to overtraining.

• Active Recovery: This involves low-intensity, low-impact exercises that promote blood flow to the muscles, aiding in nutrient delivery and waste product removal. Examples include light cycling, walking, or even yoga.
• Stretching and Mobility Work: Regular stretching can improve flexibility, enhance circulation, and reduce muscle tightness. Mobility exercises help improve the range of motion around joints.
• Foam Rolling and Massage: These can help in breaking down scar tissue, improving blood flow, and reducing muscle tightness. Regular massages can also help in identifying tight areas that need extra attention.
• Rest Days: Incorporate at least two full rest days or light activity days in your weekly routine. These days are crucial for muscle repair and glycogen replenishment. 

Preventing Overtraining:

• Listen to Your Body: If you're feeling particularly fatigued or notice a decrease in performance, consider taking extra rest days.
• Periodize Your Training: As mentioned earlier, structuring your training into cycles with built-in easy weeks can prevent continuous high-stress loads on the body.
• Stay Hydrated and Well-Nourished: Ensure you're consuming enough calories and staying hydrated, especially during intense training periods.
• Consult Professionals: Regularly check in with trainers or physiotherapists who can provide guidance on training loads and identify early signs of overtraining.

Remember, while pushing your limits can lead to growth and improvement, it's equally essential to give your body the time and resources it needs to recover and thrive.

 

Sleep

Sleep is a vital part of maintaining and improving health. Good sleep hygiene can significantly enhance the quality of your sleep and, in turn, your overall health. Here are some sleep hygiene tips that can help you improve your sleep:

• Establish a Regular Sleep Schedule: Aim to go to bed and wake up at the same time every day, even on weekends and days off. This regular rhythm will help your body establish a healthy sleep pattern.
• Soak Up the Sun: Aim for at least 30 minutes of natural sunlight per day, particularly early morning sunlight, to help regulate your sleep patterns.
• Sleep When Sleepy: Only try to sleep when you actually feel tired or sleepy, rather than spending too much time awake in bed.
• If You Can't Sleep, Get Up: If you haven’t been able to get to sleep after about 20 minutes, get up and do something calming or boring until you feel sleepy, then return to bed and try again.
• Limit Stimulants and Screen Time: Avoid caffeine or energy drinks past 9:30am and limit screen time before bed. Both caffeine and the blue light emitted by screens can interfere with your ability to fall asleep.
• Limit Alcohol: Avoid alcohol for at least 4-6 hours before going to bed (ideally though, no alcohol at all). Although many people believe that alcohol helps them to get to sleep, it can actually interrupt the quality of your sleep.
• Reserve Your Bed for Sleep and Sex: Try not to use your bed for anything other than sleeping and sex, so that your body comes to associate bed with sleep.
• Avoid Naps: Try to avoid taking naps during the day to ensure that you are tired at bedtime. If you must nap, make sure it is for less than an hour and before 3pm.
• Develop Sleep Rituals: Establish your own rituals that signal to your body that it's time to sleep, such as doing relaxing stretches or breathing exercises for 15 minutes before bed each night.
• Consider a Bath/Shower Before Bed: Having a hot bath 1-2 hours before bedtime can be useful, as it will raise your body temperature, causing you to feel sleepy as your body temperature drops again.
• Keep a Sleep Diary: This can be a useful way of making sure you have the right facts about your sleep, rather than making assumptions.
• Exercise Regularly and Eat Right: Regular exercise and a healthy, balanced diet will help you to sleep well. However, try not to do strenuous exercise in the 2 hours before bedtime and avoid large meals close to bedtime.
• Create a Sleep-Friendly Environment: Keep your bedroom cool and dark. A cooler temperature (around 18-20 degrees Celsius) is conducive to better sleep. Use blackout curtains or an eye mask to block out light.
• Maintain Your Daytime Routine: Even if you have a bad night's sleep and are tired, try to keep your daytime activities the same as you had planned. Don't avoid activities because you feel tired as this can reinforce the insomnia.
• Manage Worries: Try to resolve your worries or concerns before bedtime. If you can't resolve them, try writing them down and setting them aside for tomorrow.
• Check Your Mattress and Pillows: The foundation of good sleep is a comfortable bed. The life expectancy of a mattress is about 9 or 10 years for most good quality mattresses. Pillows only last around 2 years, as they start to accumulate dust mites.
• Use a Sleep App or Recorder: If you suspect you might have a sleep disorder like sleep apnea, consider using a sleep app or a simple audio recorder on your phone to monitor your sleep. These tools can help you track your sleep patterns and record any noises you make in your sleep, such as snoring or gasping for air, which are common signs of sleep apnea. Remember, these tools can't diagnose sleep apnea, but they can provide information that you can share with a healthcare provider. If you have symptoms like excessive daytime sleepiness, loud snoring, or you stop breathing during sleep, it's important to consult a healthcare provider for a proper diagnosis and treatment.

 

Mindfulness & Meditation

Mindfulness is the practice of focusing your attention on the present moment and accepting it without judgment. It's about being fully engaged in whatever is happening around and within you, without being distracted or overwhelmed by what's going on. Mindfulness can be practiced in any moment of the day, whether you're eating, walking, or even doing chores.

Practicing mindfulness has been shown to reduce stress, improve focus, regulate emotions, increase self-awareness, and enhance mental health. It can also help reduce negative thinking patterns, improve relationship satisfaction, and increase resilience to adversity.

Meditation, on the other hand, is a more formal practice where you dedicate specific time to cultivate mindfulness or other mental qualities. There are many forms of meditation, including concentration meditation, loving-kindness meditation, body scan or progressive relaxation, and mindfulness meditation.

Regular meditation practice has been shown to have numerous benefits, including:

• Reduced Stress: Meditation can decrease the levels of the stress hormone cortisol, leading to a more relaxed state of mind and body.
• Improved Emotional Well-being: Regular meditation can lead to an improved self-image and a more positive outlook on life.
• Enhanced Self-awareness: Certain types of meditation can help you develop a stronger understanding of yourself, helping you grow into your best self.
• Increased Attention Span: Focused-attention meditation is like weight lifting for your attention span. It helps increase the strength and endurance of your attention.
• Improved Sleep: A variety of meditation techniques can help you relax and control the "runaway" thoughts that can interfere with sleep. This can be particularly helpful for insomnia.
• Decreased Blood Pressure: Meditation can also improve physical health by reducing strain on the heart.[33] Over time, high blood pressure makes the heart work harder to pump blood, which can lead to poor heart function.

Remember, mindfulness and meditation are skills that take time to develop. Start with just a few minutes each day and gradually increase the time as you get more comfortable with the practice. There are numerous resources available, including apps and online courses, that can guide you through different mindfulness and meditation techniques.

Incorporating mindfulness and meditation into your daily routine can be a powerful way to improve your mental health and overall well-being. It's a simple, cost-effective tool that can make a big difference in your quality of life.

 

Young Skin

The skin, our body's largest organ, serves as a protective barrier against environmental threats, including harmful UV radiation from the sun. Advances in skincare science have provided effective means to prevent and even reverse signs of skin aging, such as wrinkles.

Step 1: Moisturizer with Ceramides and Nicotinamide (Vitamin B3)

Maintaining a robust skin barrier is crucial for youthful, vibrant skin. Ceramides, often described as the 'glue' holding skin cells together, are essential for an intact skin barrier. A notable 2019 study, utilizing a split-site, double-blinded, randomized, and controlled approach, demonstrated that moisturizers with ceramides can significantly diminish wrinkles compared to those lacking ceramides.[34]

Nicotinamide, known as Vitamin B3, is a powerhouse ingredient for skin health. It enhances the skin's barrier function, leading to improved hydration, and plays a role in reducing pigmentation, blotchiness, and redness associated with aging skin.[35, 36]

Recommended Product: CeraVe Facial Moisturizing Lotion

Step 2: Sunscreen

Protecting the skin from excessive sun exposure is essential to prevent premature aging, hyperpigmentation, and skin cancer. Studies even suggest that sunscreen can reverse some aging signs. [37, 38] However, no sunscreen offers complete UV protection, so it's crucial to complement it with sun-protective clothing, seeking shade, and avoiding peak sun hours. Sunscreen should be applied after moisturizer.

Types of Sunscreens:

• Chemical Sunscreens: These absorb UV radiation. Despite some reservations, current research affirms their safety (https://www.aad.org/media/stats-sunscreen).
• Mineral Sunscreens: Containing ingredients like titanium dioxide and zinc oxide, these sunscreens reflect UV radiation. They're recognized as safe but might not shield as extensively as chemical versions and can be difficult to apply. 

Product Options:

• Mineral Sunscreen: EltaMD
• Chemical sunscreen: When shopping, seek out sunscreens listing Bemotrizinol (bis-ethylhexyloxyphenol methoxyphenyl triazine) as an active ingredient. Bemotrizinol’s best quality is its size. At a molecular mass of 628 Da, it doesn’t absorb through the skin or penetrate cells.

Step 3: Collagen Peptide and Hyaluronic Acid supplements

Collagen is a vital protein that provides structure and elasticity to the skin, however it's estimated that adults over 80 years have 75% less dermal collagen in sun-protected skin than young adults.[39] Supplementing with 10-15g of hydrolyzed collagen can help rebuild it.[40, 41]

Similarly, Hyaluronic Acid is essential for skin health and decreases as we age. Fortunately, just like collagen, we can rebuild Hyaluronic Acid. Multiple human randomized controlled trials, including a non-sponsored, conflict-free study in 2021, have shown significant improvements in skin health with Hyaluronic Acid supplementation, including an 18.8% decrease in skin wrinkle depth.[42]

MicroVitamin contains 200mg of Hyaluronic Acid, which can be found here: https://drstanfield.com/products/microvitamin

Step 4: Retinoid Creams

Retinoid creams are a powerful tool in the fight against skin aging. They accelerate the skin-building process by stimulating cells to produce collagen fibres and improving blood supply and nutrition to the skin.[43]

There are two main types of retinoid creams: adapalene and tretinoin. A large study in 2018 found that both creams significantly improved wrinkles and other signs of skin aging, with no significant differences between the two.[44]

However, it's worth noting that adapalene is generally the least irritating topical retinoid, while tretinoin can be more irritating.

The common concentrations of the creams are: tretinoin at a 0.05% concentration or adapalene at a 0.3% concentration.

Retinoid creams should be used at night. They can initially irritate the skin, so it's recommended to apply the cream every second or third night when you first start out, gradually increasing frequency as your skin adjusts.

Remember, always wear sunscreen when using retinoid creams as they can make your skin more sensitive to the sun. 

Lastly, be cautious with retinoid creams if you're pregnant or planning to become pregnant, as they can potentially cause harm to the developing fetus. Always consult with a healthcare provider before starting any new skincare regimen, especially if you're pregnant.

Step 5: Exfoliant with Lactic Acid, Glycolic Acid, and Salicylic Acid

Exfoliants are key to rejuvenating skin by promoting cell renewal and removing dead skin cells. This step focuses on hydroxy acids, which include alpha hydroxy acids (AHAs) like lactic and glycolic acid, and beta hydroxy acids (BHA), such as salicylic acid.

These hydroxy acids not only work on the surface for immediate skin smoothing but also have long-term benefits. With consistent use, they penetrate deeper skin layers, stimulating collagen and elastin production. This process helps in reducing the appearance of fine lines, giving your skin a more youthful look.

However, it's important to use hydroxy acids cautiously. They can increase your skin's sensitivity to the sun, so it's best to apply them at night. Also, avoid mixing them with retinoid creams (as discussed in Step 4). A practical approach could be to use hydroxy acid products on specific days, like Monday and Thursday nights, while applying retinoid creams on the other nights.

Product Recommendation: Consider trying Paula's Choice SKIN PERFECTING 8% AHA Gel Exfoliant & 2% BHA Liquid Duo

Other tools

• Lasers: Laser treatments stimulate collagen and elastin production, helping to reduce the appearance of wrinkles and improve skin elasticity.
• Photodynamic Therapy (PDT): A light-based treatment that targets and reduces fine lines, wrinkles, and age spots.
• Botox: An injectable treatment that temporarily paralyzes specific facial muscles, reducing the appearance of dynamic wrinkles.

 

Teeth

Maintaining good oral hygiene is essential not only for dental health but also for overall well-being. Here are some key practices to keep your teeth healthy:

• Brushing: Brush your teeth at least twice a day, preferably in the morning and before bed. This helps remove plaque and food particles that accumulate on your teeth and gums. Use a fluoride toothpaste, which helps strengthen tooth enamel and reduce the risk of decay.
• Electric Toothbrush: Consider using an electric toothbrush, such as the Philips Sonicare. Electric toothbrushes can be more effective at removing plaque and improving gum health compared to manual toothbrushes. The Sonicare Series, for instance, uses sonic technology to drive fluid between teeth, effectively cleaning those hard-to-reach areas.
• Flossing: Floss at least once a day to remove plaque and food particles that your toothbrush can't reach. Regular flossing can prevent gum disease and tooth decay. Make sure to floss before brushing your teeth. This helps the fluoride in the toothpaste to reach the pockets between your gums and teeth. 
• Regular Dental Check-ups and Cleanings: Visit your dentist or dental hygienist for a professional teeth cleaning every six months. Regular check-ups can help detect oral health problems early and keep your teeth and gums healthy.

 

Sunglasses

Protect your eyes from the sun's ultraviolet (UV) rays by wearing sunglasses that block out 99 to 100 percent of both UVA and UVB radiation. Overexposure to UV rays can lead to conditions like cataracts and macular degeneration.

However, it's beneficial to avoid wearing sunglasses in the very early morning. Exposure to morning light can help regulate your sleep/wake cycles and support overall health.

 

No Smoking and Limited (ideally no) Alcohol Consumption

Smoking and excessive alcohol consumption are two habits that can significantly impact your overall health, including your brain and sleep quality.

Smoking is harmful to almost every organ in your body, including your eyes. It is a leading cause of cancer and can damage your lungs, heart, and blood vessels. Smoking also decreases your body's ability to circulate blood effectively, leading to less oxygen and nutrients reaching your tissues and organs. This can result in premature aging and a host of other health problems.

Alcohol, even in moderate amounts, can have profound effects on your body and brain. It acts as a poison, leading to cellular stress and damage. It can negatively impact your gut microbiome, brain thickness, hormone balance, mood, and motivation. Alcohol also disrupts sleep, causing anxiety and headaches. Long-term alcohol consumption can lead to inflammation, stress, neurodegeneration, and an increased risk of cancer. It's also worth noting that alcohol can disrupt the balance of hormones in your body, including testosterone and estrogen.

 

Adult Vaccinations

https://www.cdc.gov/vaccines/schedules/hcp/imz/adult.html#table-age

 

Blood Pressure Below 120/80 At Home

Blood pressure is a critical aspect of overall health. It's the force that your heart uses to pump blood around your body, and maintaining it within a healthy range is vital for your wellbeing. High blood pressure, or hypertension, can lead to serious health issues, including strokes, heart attacks, vascular dementia, and kidney damage. 

Why Lower Blood Pressure?

Lowering blood pressure is important because it reduces the strain on your heart and arteries. This can significantly decrease the risk of life-threatening conditions such as:

• Strokes: High blood pressure can cause blood clots to form in the arteries leading to your brain, blocking blood flow and potentially causing a stroke.
• Heart Attacks: If high blood pressure is left untreated, it can lead to heart disease, which increases the risk of having a heart attack.
• Vascular Dementia: This condition, which causes problems with thinking, speaking, and memory, can be a complication of high blood pressure.
• Kidney Damage: The kidneys filter out waste from your blood using a network of tiny blood vessels. High blood pressure can damage this network, leading to kidney disease or failure.

Home Monitoring

Monitoring your blood pressure at home with an automated blood pressure kit is a good idea. It allows you to keep track of your blood pressure levels and notice any trends or changes. However, it's not necessary to check it excessively. Checking once every 2-4 weeks should be sufficient to get a trend.

For younger adults under 60, a relaxed, seated blood pressure reading should ideally be below 120/80 mmHg. In contrast, older adults might find a slightly higher reading of around 130/90 mmHg to be acceptable. This higher threshold balances the benefits of maintaining lower blood pressure with the potential risks, such as dizziness and falls, that can come with overly low readings.

Here is an example of an at-home blood pressure monitor: https://amzn.to/3YJjFax

Lifestyle Modifications

Achieving a healthy blood pressure can often be accomplished through lifestyle modifications, including:

• Healthy Diet: As mentioned in the diet section, a balanced, nutritious diet can significantly impact your blood pressure.
• Low-Salt Diet: Consuming too much salt can cause high blood pressure. Aim to limit your sodium intake.[33]
• Low or No Alcohol: Excessive alcohol consumption can raise your blood pressure, disrupt your sleep, and lead to other health problems. It's recommended to limit your alcohol intake or avoid it altogether.
• Regular Exercise: Regular physical activity can help lower your blood pressure and keep it at a healthy level.
• Good Sleep: Poor sleep or sleep disorders can contribute to high blood pressure.
• Stress Management: Techniques such as meditation and mindfulness can help manage stress, a common contributor to high blood pressure.
• Weight Control: Maintaining a healthy weight is crucial for blood pressure management. Newer GLP-1 therapies can help maintain a healthy weight if required.
• Meditation & Stress Management: Mindfulness based stress reduction programs have been shown to reduce blood pressure.[45]

For some people, these lifestyle modifications may not be enough to lower blood pressure to a safe level. In these cases, it's important to speak with a healthcare provider. They can help identify any underlying reasons for high blood pressure, such as kidney disease, hormonal disorders, or certain medications. If necessary, they can prescribe medications such as Angiotensin II receptor blockers (ARBs) to help manage your blood pressure.

Remember, managing blood pressure is a long-term commitment. Regular monitoring, a healthy lifestyle, and if necessary, medication can help you maintain a healthy blood pressure and reduce the risk of serious health complications.

 

Screening Blood Tests for Optimal Health

Screening blood tests are a cornerstone of preventive medicine. They can identify potential health issues before they become severe, guiding both treatment and lifestyle modifications. However, it's essential to approach these tests judiciously. Not every test is necessary for every individual, and the concept of pre-test probability should guide decisions.

Pre-test Probability

Before ordering a test, it's crucial to consider the pre-test probability. This concept refers to the likelihood that a person has the disease or condition in question before any tests are done. If the pre-test probability is very low, even a positive result might still mean the person doesn't have the disease (false positive). Conversely, if the pre-test probability is very high, a negative test might not rule out the disease (false negative). Ordering tests with a low pre-test probability can lead to unnecessary treatments, anxiety, and costs.

Recommended Screening Algorithm

18-35 years:

• Full Blood Count (FBC)
  • Measures different components of the blood, detecting disorders like anemia, infection, and other diseases.
• Lp(a):
  • Elevated levels are associated with an increased risk of heart disease. Testing once in a lifetime is typically sufficient as the levels are primarily driven by genetics rather than lifestyle.[46]
  • Ideal level: <60nmol/L (<30mg/dL)
• Cholesterol Blood Panel
  • Essential for assessing cardiovascular risk.
  • Ideal level: LDL-c <70mg/dL (but lower for longer is best).
  • For further information, please see the dedicated Cholesterol section.
• ApoB:
  • Provides a more comprehensive view of heart disease risk.
  • Ideal level: <60mg/dL
• HbA1c: Measures average blood sugar over three months, diagnosing and monitoring diabetes.
• Creatinine: Assesses kidney function.
• Sodium & Potassium: Essential electrolytes indicating various conditions.

>35 years:

The tests are largely the same as for the younger age group, but with a frequency of every 5 years unless issues have been detected.

Additional Considerations:

Ferritin: While not routinely screened for every adult, it's essential for those at higher risk of iron deficiency. This includes premenopausal women, especially those with prior pregnancies or heavy menstrual periods, and individuals with conditions causing blood loss or iron malabsorption.

Hypothyroidism: Subclinical hypothyroidism is common, but most asymptomatic non-pregnant adults aren't routinely screened. However, individuals at increased risk for hypothyroidism, such as those with a goiter, history of autoimmune disease, previous radioactive iodine therapy, head and neck irradiation, family history of thyroid disease, or use of medications impairing thyroid function, should be screened.

Liver Function Tests: These aren't routinely screened unless there's a specific reason, such as alcoholism, obesity, family history of liver disease, autoimmune diseases, etc.

In conclusion, while screening blood tests are invaluable, it's essential to tailor them to individual needs, considering each person's unique health history, risk factors, and concerns. Regular consultations with healthcare providers ensure that the most appropriate tests are chosen, maximizing health benefits while minimizing unnecessary interventions.

 

Understanding Cholesterol: More Than Just a Number

Cholesterol's role in heart disease is vital yet often misunderstood in preventative care. Let's break it down.

Cholesterol's Essential Role

Cholesterol is indispensable. It forms the foundation of our cell walls, aids in hormone production, and performs several other crucial functions. In essence, without cholesterol, life as we know it wouldn't exist.

We’ve also known for decades that every cell in our body has the capability to produce its own cholesterol.[47] Organs like the liver can even produce extra cholesterol and dispatch it to other cells that might need a temporary boost. This cholesterol travels through our bloodstream, packaged neatly into spherical structures called lipoproteins. So the cholesterol that we measure in our blood only represents a minuscule fraction of the body's total cholesterol content.

The Catch with Cholesterol

During its journey, some cholesterol can get trapped in our blood vessel walls. This buildup can lead to blockages, a condition known as atherosclerosis.

Understanding Lipoproteins

Lipoproteins in our blood are mainly of two types: ApoA or ApoB. The ones we need to be wary of are the ApoB type, which includes all types of low-density-lipoproteins (LDL) and lipoprotein(a).[48] These are the culprits that contribute to blood vessel blockages.

The Importance of Managing LDL-c & ApoB Levels

Research has conclusively shown that actively lowering a person's LDL-cholesterol and ApoB levels can decrease their risk of heart attacks.[49] Moreover, recent studies suggest that using medications to lower LDL-cholesterol to very low levels (≤40 mg/dL) poses no significant risks.[50, 51] Importantly, these low cholesterol levels are not associated with cognitive impairment,[52] Alzheimer’s Disease,[53] or testosterone synthesis dysruption.[53] This aligns with the fact that our cells can make cholesterol on their own.

Guidelines on LDL-C Levels

The American Heart Association's 2018 guidelines suggest:

• While there's no universally ideal LDL-C level, the principle remains that lower is generally better.[54]
• An optimal total cholesterol level hovers around 150 mg/dL, with LDL-C at or below 100 mg/dL. Adults maintaining these levels tend to have reduced rates of heart disease and stroke.[54]
• For those at moderate heart disease risk (due to factors like a family history of premature heart attacks or conditions like diabetes), an LDL-C level below 70 mg/dL is recommended.[54]

Interestingly, the PESA (Progression of Early Subclinical Atherosclerosis) study demonstrated that even if other risk factors (such as blood pressure, blood sugar, insulin sensitivity, etc) are optimized, atherosclerosis still occurs above an LDL-cholesterol threshold of 60mg/dL.[55] Therefore, it is possible that future guidelines will suggest to reduce LDL-C below 60mg/dL. 

Achieving Targeted LDL-C and ApoB levels

A mix of a balanced diet, consistent exercise, and sometimes medications like Rosuvastatin, Ezetimibe, or PCSK9i can help hit these targets.

Debunking Myths

A prevalent myth on social media claims that LDL-cholesterol doesn't contribute to blood vessel blockages, and that insulin resistance is the real culprit. This belief, popular in certain dietary communities, lacks evidence. As mentioned previously, the PESA study found a significant correlation between LDL-C levels and the presence of atherosclerosis, even when other risk factors, such as blood sugar levels, blood pressure, inflammation, and insulin resistance were at optimal levels.[55] Specifically, for every 10-mg/dL increase in LDL-C, there's an 18% increased chance of having atherosclerosis.[55]

This reinforces the idea that desirable LDL-C concentrations are probably much lower than those currently recommended, and suggest that atherosclerosis in both men and women develops above an LDL-C threshold concentration of approximately 50-60 mg/dL.[55]

For further evidence of LDL-C’s causal link to atherosclerosis, the European Atherosclerosis Society released a consensus statement on the mechanism explaining how LDL particles enter the blood vessel walls. They stated that LDL particles don’t just passively move across blood vessel walls. Instead, it uses a specific pathway involving various receptors:

“A considerable body of evidence in recent years has challenged the concept that movement of LDL occurs by passive filtration (i.e. as a function of particle size and concentration) across a compromised endothelium of high permeability. Studies have demonstrated that LDL transcytosis occurs through a vesicular pathway, involving caveolae, scavenger receptor B1 (SR-B1), activin receptor-like kinase 1 (ALK1), and the LDL receptor.”[56]

In Conclusion

Atherosclerosis can develop in individuals with LDL-cholesterol levels above 60mg/dL, even if they don't have insulin resistance. Addressing all heart disease risk factors, including LDL-cholesterol levels and insulin resistance, is the key to heart health.

 

Cancer Screening

Early detection of cancer can significantly improve the chances of successful treatment and survival. Screening tests are used to find cancer before a person has any symptoms.

The following is based on the American Cancer Society's guidelines:

Breast Cancer:

Age 40-44:

• Women have the option to start annual mammograms if they choose.

Age 45-54:

• Annual mammograms are recommended.

Age 55 and above:

• Women can either:
  • Continue with annual mammograms, or
  • Switch to mammograms every 2 years.
• Screening should continue as long as a woman is in good health and is expected to live 10 more years or longer.

Women should also know how their breasts normally look and feel and report any breast changes to a health care provider right away.

Some women – because of their family history, a genetic tendency, or certain other factors – should be screened with MRIs along with mammograms.

Cervical Cancer:

Under Age 25:

• Screening is not recommended as cervical cancer is rare in this age group.

Age 25-65:

• Every 3 years, women should undergo:
  • A Pap smear, and
  • A human papillomavirus (HPV) test.

Over Age 65:

• Women who have had regular cervical cancer testing with normal results in the past 10 years should stop testing.
• Once stopped, testing should not be resumed.
• However, those with a history of serious cervical pre-cancer should continue testing for at least 25 years after the diagnosis, even if it extends beyond age 65.

Colorectal Cancer:

Age 45-54:

• Begin regular screening at age 45, as recommended by the American Cancer Society.
• Opt for the stool-based FIT test.
• Repeat the FIT test every 2 years.

Age 55-75:

• Start getting a colonoscopy at age 55.
• Repeat the colonoscopy every 10 years.
• Continue regular screenings throughout this age range for optimal health.

Age 76-85:

• Discuss with your healthcare provider whether you should continue screenings.
• Your decision should consider your overall health, previous screening results, and personal preferences.

Age 86 and above:

• It's generally advised to discontinue colorectal cancer screenings.

Lung Cancer:

Age 50-80:

• Annual screening with a low-dose CT scan is recommended for individuals who:
  • Have a 20 pack-year smoking history, and
  • Currently smoke or have quit within the past 15 years.

If you quit smoking more than 15 years ago:

• Screening is not recommended.

After Age 80:

• Regular screenings are no longer recommended. 

Prostate Cancer:

Age 45-50:

• Routine screening is not recommended for most men.
• Men at high risk (e.g., those with a family history of prostate cancer or African American men) should discuss the potential benefits and risks of screening with their healthcare provider.

Age 50 and above:

• Discuss the potential benefits and risks of prostate cancer screening with your healthcare provider.
• If you decide to be tested, you should get a PSA blood test with or without a rectal exam. How often you’re tested will depend on your PSA level.

Additional notes

Multi-cancer Early Detection Tests:

Multi-cancer early detection (MCED) tests have the potential to detect more than one type of cancer from a single blood sample. The blood is tested for DNA or proteins from cancer cells. If found, it might indicate the presence of cancer and potentially identify its origin.

MCED tests, such as the GRAIL Galleri test, are currently available by prescription. They are not meant to replace existing screening tests but might supplement them.

These tests are still under evaluation, and more research is needed to determine their effectiveness and accuracy. More details here.

Whole-Body MRI Scans:

Whole-body scanning with techniques like MRI, CT, etc., is sometimes marketed for detecting undiagnosed cancers. However, there's no evidence suggesting these imaging studies improve survival or the likelihood of finding a tumor in asymptomatic patients.

The risk of false-positive findings can lead to unnecessary testing, exposure to radiation, and additional medical costs.

Medical professional societies do not recommend whole-body scanning for individuals without symptoms. More details here.

 

Other Health Screening

Osteoporosis Screening

Dual-energy x-ray absorptiometry (DXA) scan

Women:

• Age 50-65: Consider a DXA scan if risk factors for osteoporosis are present.
• Age 65 and older: All women should undergo a DXA scan.

Men:

• Age 50 and older: Consider a DXA scan if risk factors are present. Common risk factors include a previous fracture, smoking, excessive alcohol consumption, liver disease, and certain medications.

 

Supplements

Note: these are the supplements and medications that I take, and they might not always align with the standard primary care guidelines.

Creatine Monohydrate 5g

• The most effective ergogenic nutritional supplement currently available to athletes in terms of increasing high-intensity exercise capacity and lean body mass during training.[57]
• Possibly help enhance measures of memory performance.[58]
• Example brand: Optimum Nutrition

Omega-3 (DHA/EPA)

• Supplementation is associated with 13% reduced risk of heart attacks according to a 2021 Mayo Clinic meta-analysis, with high GRADE certainty.[59]
• Example brand: UnoCardio

 Low-dose Multivitamin & Mineral

• A low-dose multivitamin & mineral such as MicroVitamin can complement a healthy diet, and fill the gaps and support your nutritional needs when your diet falls short WITHOUT mega-dosing.
• Daily multivitamin-mineral (MVM) supplementation for 3 years improved global cognition, episodic memory, and executive function in older adults.[60]

Trimethylglycine 500mg

• Reduce homocysteine levels.[61]
  • High homocysteine levels are linked with Alzheimer’s disease, however it is currently unclear whether lowering homocysteine will reduce Alzheimer’s disease rates.[62]
• Possibly improve muscle performance during exercise.[63-65]
• Included in the multivitamin & mineral, MicroVitamin

Hyaluronic Acid 200mg

• Reduce skin wrinkles (by 18.8%) and the signs of skin aging.[42, 66-68]
• Included in the multivitamin & mineral, MicroVitamin

Collagen Peptides 10-15g

• Reduce skin wrinkles (by 8%) and the signs of skin aging.[40, 41]
  • There’s debate as to whether collagen peptides offer any further benefits for skin health compared to protein supplementation. In a 2020 trial of burn patients, one group had 36g of collagen daily while the other group had 35g of protein. The wound healing rate was significantly higher (Hazard ratio: 3.7) following supplementation with a hydrolyzed collagen-based supplement.[69] From that study, it appears that collagen peptide supplements have further benefits for skin beyond protein supplementation, however further research that specifically investigates skin wrinkles and the signs of skin aging is required.
• Example brand: Orgain

Psyllium Husk

• Reduce total cholesterol and blood pressure as per a 2016 Cochrane Review.[70]
• Example brand: Yerba Prima

Melatonin 300mcg (one hour before bed)

• Reduce the time it takes to fall asleep, and increase total sleep time.[71]

N-acetyl cysteine (NAC) 1g from the age of 45

• Glutathione is a powerful antioxidant, and a critical regulator of oxidative stress and immune function, however glutathione levels decline rapidly from the age of 45.[72]
• We have evidence from a human, placebo-controlled study that supplementing with the Glutathione precursors, Glycine & NAC, corrects the Glutathione deficiency in older adults and improved hand grip strength.[73]
• Collagen supplements already have significant quantities of Glycine, plus I already take Trimethylglycine (TMG), so I’m already getting all the glycine that I likely need. Therefore, when I reach 45 years of age, I’ll only add NAC to my supplement stack.

 

Medications That I Take

Finasteride 1mg (for males only)

• Finasteride is a molecule that blocks the conversion of Testosterone to Dihydrotestosterone, and is used in clinical medicine to reduce male pattern baldness and shrink the size of the prostate.
• We have a long-term, placebo controlled trial showing that finasteride reduces prostate cancer rates, and a trend toward reduced mortality rates.[74] 

Rosuvastatin 5mg

• Rosuvastatin is a cholesterol-lowering medication, and is hydrophilic meaning that it doesn't get into places it shouldn't, namely muscle and fat.
• As explained in the cholesterol section, the desirable LDL-C concentrations are probably much lower than those currently recommended, and the PESA study showed that atherosclerosis in both men and women develops above an LDL-C threshold concentration of approximately 50-60 mg/dL.[55]
• Despite a great diet and regular exercise, my LDL-c levels were 73 mg/dL and ideally I'm targeting a level < 60 mg/dL. 

 

Supplements/Medications I’m Excited About & Awaiting More Data

Rapamycin

• When the Interventions Testing Program trials Rapamycin in genetically diverse mice, it extends both male and female lifespan.[75]
• Because of its mechanism of action, I’ve chose to set up a clinical trial combining regular exercise with either Rapamycin or Placebo to see if Rapamycin improves muscle performance.
• While I’m very excited about Rapamycin’s potential, I don’t think it should be used outside of clinical trials to assess that it’s both safe and effective.

17-Alpha Estradiol

• This is a “non-feminizing” type of estrogen that the Interventions Testing Program demonstrated a lifespan extension in males.[76] There’s also data showing an improvement in muscle strength.
• Similar to Rapamycin, I’m very excited about this molecule, however I don’t think that it should be used outside of clinical trials to assess both safety and efficacy.

 

Supplements That I Used To Take But Have Now Stopped

NMN/NR:

There’s interesting mice and single cell studies regarding NAD+ precursors, however the human data demonstrating a benefit is lacking. I focus on stopping my NAD from declining by using a small dose of Niacin, regular exercise, a great diet, periods of safe fasting, and restful sleep. 

Furthermore we don’t know the long-term effects of boosting NAD+ to very high levels.

Resveratrol/Pterostilbene:

The research around using molecules to activate sirtuin-1 is very conflicting. We may not need to further activate sirtuin-1 if we already exercise, sleep well, and have a great diet. 

Furthermore, it’s unlikely that resveratrol/pterostilbene directly activates sirtuin-1 anyway. There was a paper published in 2020 that used CRISPR technology that explored how resveratrol/pterostilbene work and the authors found the following:

“The ability of resveratrol to inhibit cell proliferation and S phase transit was independent of the histone deacetylase sirtuin 1, which has been implicated in lifespan extension by resveratrol. These results establish that a primary impact of resveratrol on human cell proliferation is the induction of low-level replicative stress.”[77]

Until there’s more compelling research, I’ve stopped taking both of these molecules.

Metformin/Berberine:

Metformin is a medication that I prescribe to my Type 2 Diabetic patients, and the initial data suggested that it could extend lifespan of non-diabetic patient as well.

However, when the Interventions Testing Program (ITP) trialed metformin in 2016, there was no lifespan benefit.[76]

Towards the end of 2021 a randomized, placebo-controlled, human trial that ran for 21 years was published. This trial took people at high risk of developing Type 2 Diabetes, and tested whether metformin would improve death rates, heart disease, and cancer when compared with placebo. Unfortunately, there was no benefit seen.[78]

Furthermore, there’s good data showing that metformin blunts the positive exercise effects.[79, 80]

This data has convinced me to stop taking metformin altogether. Crucial to note though that for pre-diabetics and Type 2 diabetics, metformin is a wonderful medication.

Quercetin/Fisetin:

The Interventions Testing Program trialed Fisetin, and unfortunately there was no healthspan, lifespan, or senolytic activity seen. Therefore in my opinion, the preclinical work does not support the use of Quercetin or Fisetin supplements.

There are a number of human studies ongoing, and until we have robust, published data showing a benefit, I’ve stopped taking both Quercetin & Fisetin. See this video here: https://youtu.be/Q3SX9B0QNWY 

Ashwagandha:

There is some human evidence to suggest that Ashwagandha can improve anxiety levels. Personally I didn’t notice a difference, and I made the decision to stop Ashwagandha to reduce my ‘pill-burden’. This is more of a personal, rather than evidence-based choice. 

Sulforaphane:

Sulforaphane is a potent activator of an enzyme called NRF2, the ‘master’ antioxidant switch. There are promising cell and mice studies, but at this stage the human data is lacking. Until this molecule is proven in humans, I’ve elected to simplify my supplement stack and stop sulforaphane. To support my anti-oxidant levels as I get older, I plan on taking Glycine & NAC from the age of 45.

Apigenin:

Apigenin is an inhibitor of an enzyme called CD38, and CD38 might be a reason why in some tissues, NAD+ levels go down as we age. There are exciting cell and mice studies that have used Apigenin, but much like Sulforaphane there is a lack of human data. To simplify my supplement stack, I’ve elected to stop Apigenin until more human studies are completed that prove a benefit.

 

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Changelog

• 20^th November 2023: re-wrote the Young Skin section and included information on exfoliants.
• 16^th October 2023: re-worded and expanded the cholesterol section.
• 2^nd October 2023: added melatonin, NAC, and medications.
• 18^th September 2023: Added salt and blood pressure references and images, mindfulness and blood pressure references, wording changes to Zone 2.
• 16^th September 2023: Wording changes to the expanded cholesterol section based on feedback from Gil Carvalho, MD. Link to his nutrition YouTube channel here: https://www.youtube.com/@NutritionMadeSimple
• 14^th September 2023: Added subsection on caffeine, changed the wording of the blood pressure section, expanded cholesterol section.
• 7^th September 2023: formatting fixes, minor wording improvements, added images to the diet and exercise sections.
• 31^st August 2023: re-wrote the exercise section into beginner, intermediate, and advanced sections and added significant extra details.
• 21^st August 2023: Initial write-up