Aggressively manage ApoB levels as early as possible to minimize the cumulative burden and significantly reduce atherosclerosis risk over a lifetime. Aim for an ApoB level below 30 mg/dL, as this range is associated with an inability to develop atherosclerosis.
Dedicate 80% of cardio training time to Zone 2 (low intensity) and 20% to VO2 max (high intensity) to maximize metabolic flexibility and cardiorespiratory fitness. This approach builds both mitochondrial efficiency and peak capacity.
Prioritize getting approximately 7.5 to 8 hours of sleep per night by maintaining a consistent bedtime and wake-up time. This optimizes sleep quality and overall physiological function.
Actively pursue early and aggressive cancer screening to detect cancers at their most treatable stages, significantly improving outcomes. Be aware of the economic costs and emotional toll of potential false positives.
Aim for a blood pressure of 120/80 mmHg or better to significantly reduce cardiovascular risk. Utilize lifestyle interventions like weight loss and regular exercise as primary strategies.
Evaluate hormone replacement therapy (HRT) for managing menopausal symptoms and long-term health. Initiating HRT at the onset of menopause can reduce the risk of heart disease and dementia, and preserve bone mineral density.
Assess low testosterone (Low T) based on a combination of symptoms (reduced libido, energy, mood, muscle mass, recovery, insulin resistance) and plausible lab levels. Consider TRT if total testosterone is below the 30th-40th percentile and symptoms are present.
Lower triglyceride levels, which are a proxy for insulin sensitivity, to effectively reduce ApoB burden and atherosclerosis risk. Restrict refined and starchy carbohydrates as this is the most effective dietary tool for triglyceride reduction.
Engage in Zone 2 exercise (e.g., cycling, running) for 30-45 minutes to enhance mitochondrial efficiency and the ability to utilize fatty acids for energy. Use the ’talk test’ as a guide: you should be able to speak in full sentences but it feels uncomfortable.
Refrain from engaging with emails, social media, or other stimulating activities for a couple of hours before bedtime to promote relaxation. This helps in turning down the nervous system before sleep.
Prioritize avoiding junk food as a fundamental principle for a healthy diet. Focus on maintaining energy balance and ensuring adequate protein intake.
Acknowledge that there is no biochemical benefit to alcohol at any dose, and limit intake to minimize potential negative health impacts. If consuming alcohol, do so earlier in the evening (e.g., with dinner) to prevent it from disrupting sleep quality.
Utilize multiple screening tests (e.g., mammogram with ultrasound or MRI) to increase the accuracy (positive and negative predictive value) of cancer detection. Do not rely on any one test in isolation.
Implement weight loss and regular exercise, especially cardio, as primary interventions to manage and lower blood pressure. Consider hot tubs/sauna, nitrate-rich foods (e.g., green shakes), and cocoa flavanols as natural aids.
Track FSH and estradiol levels on Day 5 of the menstrual cycle to identify the perimenopausal transition and guide HRT initiation. Start HRT when a woman becomes symptomatic during perimenopause.
When initiating TRT in men, aim to increase free testosterone to the higher end of the physiological range (e.g., 20 ng/dL) to assess symptomatic improvement. Prefer twice-weekly testosterone injections for more consistent levels.
Be mindful of saturated fat consumption, as it can increase ApoB by impacting cholesterol synthesis and inhibiting LDL receptor production. If ApoB levels are high, consider replacing saturated fats with monounsaturated fats (e.g., olive oil).
Include VO2 max training with intervals of 3 to 8 minutes at high intensity, followed by equal rest periods, to build cardiorespiratory engine peak capacity. This complements Zone 2 training for overall fitness.
Consider a sauna session followed by a shower before bed as a routine to facilitate sleep. This can be a productive sleep trick to wind down the body.
Aim for 40-50 grams of protein, four times a day, to support energy balance and anabolic structure. This is a key focus for conscious dietary effort.
Consider starting colonoscopies at age 45, or even 40 if risk factors are present, and repeat every three years depending on findings. This is crucial for early detection of colon cancer.
Use an automated cuff and follow a strict protocol: sit for 5 minutes without stimulation, then take three measurements 5 minutes apart, ensuring the cuff is correctly placed (2 inches above elbow, at heart level). Track twice daily for two weeks for an accurate average.
Opt for bioidentical estrogens (estradiol and/or estriol) for HRT, and prefer transdermal estrogen (e.g., patch) over oral forms to avoid increased risk of hypercoagulability. Combine with bioidentical progesterone if a uterus is present.
Be aware that testosterone replacement therapy (TRT) does not increase prostate cancer risk but may potentially increase prostate size (BPH). Address other health issues, such as high blood pressure, before initiating TRT.
If taking statins, especially with APOE4 or family history of AD/dementia, monitor desmosterol levels. Consider discontinuing statins if levels fall below 0.8 mg/dL to mitigate potential dementia risk.
Allocate half of your total weekly exercise time to strength and stability training to build muscle mass and bone density. This is a foundational pillar of a comprehensive exercise routine.
Finish eating at least three hours before bedtime to improve sleep quality. Going to bed slightly hungry can lead to better rest.
Actively educate yourself and be a thoughtful consumer of your own healthcare information. Take personal responsibility for your health and seek advanced preventative care.
For women, consider annual mammograms combined with ultrasounds every six months (staggered) starting at age 40, especially if at higher risk. Do not avoid mammograms due to radiation fears, as the radiation is very low.
Integrate mental health practices such as therapy (e.g., dialectical behavioral therapy) and journaling to improve distress tolerance and overall quality of life. This creates a wider buffer zone around distress.
Explore non-statin lipid-lowering drugs like Ezetimibe, PCSK9 inhibitors, or Bempedoic acid, especially if statins cause side effects or are contraindicated. These offer effective ApoB reduction without impacting brain cholesterol synthesis.
Explore supplements like Glycine, Ashwagandha, Magnesium L-Threonate, and Magnesium Oxide to aid sleep. Use melatonin or phosphatidylserine only when experiencing jet lag.
Consider incorporating liquid biopsies (e.g., Grail test) into screening protocols for early cancer detection. These tests can identify aggressive cancers and potentially pinpoint the tissue of origin.
Explore low-dose testosterone replacement for women experiencing sexual dysfunction (reduced libido, arousal, orgasmic function) post-menopause. Aim to restore levels to those typically seen in their 30s and 40s.