Focus on achieving energy balance as the most important parameter for metabolic health, regardless of the specific diet chosen. Consuming even a ‘best’ diet in excess will lead to poor metabolic health.
Prioritize putting on as much muscle mass as possible before entering middle age (over 50) to avoid a muscle deficit. This is crucial for physical robustness in the marginal decade, as muscle is harder to maintain and build later.
Fixate on reducing or compressing the period of physical and cognitive frailty in the last decade of life (the ‘marginal decade’). Aim for physical robustness as a centenarian, rather than just adding years to life.
Take dramatic steps early in life (e.g., in your 30s) to prevent ASCVD by ensuring ApoB never exceeds 30-40 mg/dL. Also, avoid even one year of mild hypertension and always maintain metabolic health.
Be serious about using today’s tools for primary and secondary disease prevention and for optimizing lifespan and healthspan. This acts as a hedge against unlikely dramatic breakthroughs in extreme longevity.
When using any intervention (nutrition, exercise, drugs, supplements), identify and use biomarkers to know if you are doing it correctly, taking the right amount, and if it’s working. Without measurable feedback, it’s a guessing game.
Evaluate interventions (especially supplements) using a simple risk-reward matrix (low risk/high risk vs. low reward/high reward). Demand higher reward for higher risk interventions and be wary of high risk for no reward.
Aim for an ApoB target of 30-40 mg/dL, which often requires pharmacology, especially for those with genetic predisposition or high baseline ApoB. Consider a combination of drugs like PCSK9 inhibitors, bempedoic acid, and ezetimibe.
Use Continuous Glucose Monitors (CGMs) even as a non-diabetic to gain insights into metabolic health. Focus on lowering average blood glucose and reducing glucose variability (standard deviation), as these correlate with lower all-cause mortality.
Choose a manageable and sustainable diet that can be adhered to indefinitely, even if it’s not ‘perfect,’ over a perfect diet that cannot be sustained long-term. A 7/10 diet sustained indefinitely is better than a 10/10 diet for three months.
Aim for a high daily protein intake (e.g., 150-180 grams for Peter) to support muscle mass. Spread this intake out into multiple ‘hits’ (e.g., four times a day).
If statins are necessary, aim for the lowest effective dose (e.g., 5mg Rosuvastatin for 85% efficacy) to minimize side effects. Monitor for side effects like muscle aches, elevated liver enzymes, and insulin resistance.
Do not blindly follow someone else’s supplement list; understand the rationale, clinical history, and context. Regimens change over time based on new data and personal needs.
To lower ApoB without drugs, dramatically reduce carbohydrates (to lower triglycerides) and/or dramatically cut saturated fat (to upregulate LDL receptors). Acknowledge that this may not achieve optimal ApoB levels for everyone and sustainability is individual.
Avoid using the terms ‘good’ or ‘bad’ cholesterol; instead, refer to LDL-C and HDL-C. Understand that LDL transports cholesterol into artery walls while HDL does not, reflecting a more accurate understanding.
For patients with profound insulin resistance, carbohydrate restriction may be a more effective tool than general caloric or fat restriction to create a caloric deficit. This approach can help improve metabolic health.
When studying long-lived populations, consider all contributing factors (activity, sleep, stress, social connections, environment) beyond just diet. Diet alone may not explain their longevity, as diverse diets exist among such groups.
If engaging in long fasting protocols, be aware of potential costs (e.g., muscle loss) and consider re-evaluating their utility in the absence of clear, biomarker-driven benefits. Peter stopped his long fasts due to lack of clear benefit and logistical challenges.
Look forward to continuous blood pressure monitors (like the Actia device, available in Europe) becoming available in the US. These devices can provide frequent, objective blood pressure data to replace cumbersome ambulatory cuffs.
For individuals with high LP(a), be aware of an antisense oligonucleotide drug in phase three trials that obliterates LP(a). While initially for secondary prevention, it may eventually be available for primary prevention (potentially off-label or with future insurance coverage).
Consider using a device like Morpheus to get a daily readiness score and heart rate training zones for zone two workouts. This can help approximate optimal training intensity, especially for those less attuned to RPE or unwilling to measure lactate.
Express interest in continuous lactate monitoring during exercise to precisely understand metabolic breakdown and clearance during cardio and VO2 max training. This would offer a more accurate measure than heart rate or RPE.
Aim for about 1 gram of total elemental magnesium daily, using forms like SlowMag, magnesium L-threonate (Magtein), and magnesium oxide for slow and complete absorption. Peter takes some of these at night.
Consider taking methylfolate and methyl B12 (e.g., Gero brand, standard low dose) to keep homocysteine levels below 9. Adjust B6 intake (e.g., 50mg three times a week) to help with homocysteine while being careful not to overdo it due to neuropathy risk.
Consider supplementing EPA and DHA (fish oil) to achieve a red blood cell membrane concentration of about 12%, using a blood test as a biomarker. Peter takes approximately 2g EPA and 1.5g DHA daily.
Consider supplementing Vitamin D (e.g., 5,000 IU daily) due to its perceived insanely low risk, even if the exact reward is uncertain. Peter views it as potentially a $5 bill reward.
For younger individuals with low bleeding risk, a baby aspirin daily might be considered for potential cardiovascular benefits. Be aware the evidence is weak and benefits may be outweighed by bleeding risks in older individuals.
Consider taking 600mg of ashwagandha at night. Peter recently switched to the Solgar brand.
Consider taking 2 grams of glycine at night. Peter uses the Thorn brand.
For long flights or significant time zone changes, consider taking phosphatidylserine (e.g., 400mg). Peter uses Gero’s 100mg gel caps.
Consider incorporating a green drink like AG1 in the morning. Peter takes AG1 as his first consumption of the day.
Consider this probiotic, especially if aiming to improve glycemic markers, as it has shown promise in reducing A1C and postprandial glucose AUC in type 2 diabetics. Peter takes two in the morning with his AG1.