How to get into A+ health

The results of listening to every health podcast made in 2023

Unclear if he’s skipping leg day

‘Tis the season of promising ourselves we’re going to get healthier. While this newsletter normally focuses on emotional intelligence and cultural hot takes, “health” is ~50% of manosphere hot takes (the other 50% being “wealth”) - so it’s worth sussing out the b.s. And even though I’m what folks would consider a generally healthy guy, early deaths in my family have made me sensitive to two things:

1. The older I get, the more sensitive I am to genetic risks (in my case, heart disease)

2. The last decade of many Americans’ lives are spent in pain and without the ability to do basic tasks like getting out of chairs and carrying groceries. 

#2 is especially tough to face. I did not appreciate how shitty most of our lives will be towards the end until my father passed away in 2021 and I started researching longevity. The average American man lives 73 years (it was 79 before COVID). 73 is low. But even worse is America’s healthspan, or the amount of time we feel good and capable. There’s no single quantitative number for that, but 60% of Americans have at least one chronic disease such as diabetes or heart disease. 40% have two or more. If we did have one number for healthspan in America, it would not inspire confidence.

And so I spent 2023 listening to every health podcast that had something interesting to say.¹ I have way too much information to keep to myself. This is part 1 of a 3 part series on physical health. This issue focuses on the question: what does it take to get into A+ health?

Here’s what I mean by that. My goal is to live into my 80s. Until the day I die, I want to be cognitively “with it,” to be able to get out a chair (and ideally a pool), and to carry groceries. When my time is up, I want that to be relatively swift as opposed to the long, slow declines most people experience and what our healthcare system is set up to support. At least for the time being, this is considered A+ health. How does one do this?

There is a mountain of highly opinionated people with answers to this. I sought out the most anal retentive and obsessive among them. Due to the level of pseudoscience and disagreement in this arena, this post focuses on what’s generally agreed upon. We start with a summary of the takeaways, and then we go deep into exercise and nutrition protocols. I spent 12 months slurping up everything the Internet could give me on this, so this post is loooooooong. It is meant as a reference when you want certain information as opposed to being consumed all in one go (although all at once is cool too). 

The 80/20 of how to get into A+ health

According to Dr. Peter Attia, there are four major causes of shortened healthspans for Americans:

1. Atherosclerotic disease, which is comprised of cardiovascular disease and cerebrovascular disease

2. Cancer

3. Neurodegenerative disease - the most common form being Alzheimer’s disease

4. Type 2 diabetes and related metabolic dysfunction (hyperinsulinemia, insulin resistance, fatty liver disease)

We should avoid these. How does one do that? When it comes to habitual behavior, the answers are surprisingly simple. 

1. Exercise. Workout at least five days a week (2.5 hours cardio, 2.5 hours strength training). 

2. Sleep. Get 8 hours of sleep a day. Then get 5 - 10 minutes of sunshine within an hour of waking up. 15 - 20 minutes if it’s cloudy.

3. Eat 35 - 50 grams of fiber a day and .8 - 1g of protein for every lb of bodyweight a day 

4. Don’t smoke or drink alcohol.

I want to note that these steps are head and shoulders more work than what normal people do. Working out 5 days a week is a ton. 8 hours of sleep is just not a thing unless you’re retired. Eating that much fiber and protein is nowhere close to even your average healthy diet. Why is the bar so high? A big reason is that with every decade after our 40s, we lose significant strength and cognitive functioning, so you want to set the bar as high as possible as early as possible. If you want to carry groceries when you’re 80, become a jacked and juiced health freak now. 

I should note that everything in this post, including the summary above, largely comes from the publishings of the following sources:

• Dr. Peter Attia. He’s one of the most expensive personal physicians on the planet and his book Outlive lays out the bulk of the takeaways of this post. For a 50 year old man, he also looks fantastic which is weirdly not a thing for most physicians. 

• Andy Galpin, PhD. He’s a fitness coach for athletes and Founder/Director of the Biochemistry and Molecular Exercise Physiology Laboratory at Cal State Fullerton. Huge fitness nerd. His 6 part exercise series with Huberman were some of the most popular Huberman did in 2023, which is saying something because that’s like 18 hours of material right there. 

• Dr. Layne Norton: He has a PhD in nutritional sciences and is an International Powerlifting World Champion. Powerful combo right there. He’s also a stickler for good study design and calls out nutritionists who spreads b.s. on Instagram. 

• Andrew Huberman, PhD: Stanford neuroscientist with the world’s most popular podcast devoted to science based protocols to enhance daily performance. Also his homie leaked a shirtless video of him two months ago and at least a thousand dudes had their first publicly gay moment in the comments section.

The rest of this article goes into detail. I recommend skimming and checking out the sections / bolded terms that interest you.

The lowdown on exercise

The #1 longevity and health thing is exercise. Not smoking, diet, etc are important, but still not as important as exercising 3 to 6 days a week when it comes to long term health. Huberman, Galpin, and Attia all advocate exercising 5 or 6 days a week. Here’s how they recommend breaking it down:

Building Aerobic capacity

• Attia thinks of aerobic capacity as a pyramid. The peak is defined by high intensity (going for max heart rate) training. The base is defined by time spent in Zone 2, or low intensity training. The higher the heart rate of the intensity trainings and the longer the time spent in Zone 2, the bigger the pyramid gets, which is a good thing. 

• Zone 2 cardio. Most folks define Zone 2 as cardio (biking, swimming, running etc) at a level where you can still have a conversation, but the other person would know you’re exerting yourself. Andy Galpin recommends performing all Zone 2 cardio should be performed while nasal breathing, as that’s somehow better for air quality and facial muscles. He recommends getting at least 150 minutes per week, although this can be accomplished by playing sports and other “active” activities like hiking. Peter Attia has a much more specific definition. Zone 2 for him is the highest metabolic output/work that you can sustain while keeping your lactate level below two millimole per liter. This requires using a lactate meter periodically (he recommends 1x/month) immediately after workouts to see if you’re in range. Attia recommends 180 - 210 minutes of this a week.

• Max heart rate training. This is just going as hard as you can in short sprints. Andy Galpin recommends warming up for about 10 minutes, then going fast for 2 minutes then resting for 2 minutes, and repeating 3x. I like doing this with ellipticals, stationary bikes, or treadmills, although treadmills can be risky given they don’t slow down when you get tired. Galpin and Attia recommend doing this 1x/week at least, or twice if you can swing it. 

Strength / physical therapy training 

• The key principle is progressive overload. This is where you’re slowly adding more strain to the muscles which then adapt over time by becoming larger. Every week, you want to do a bit more weight or reps than the week before. Galpin recommends adding 10% more weights or reps each week. After six weeks, he recommends down shifting by 30% to give muscles a rest, then slowly going up again. Eventually, you get strong as hell. 

• Tracking progress. To keep track of strength training lbs and reps, I find the “Strong” app to be affordable and simple.

• Focus on full extension and compound movements. Compound exercises use multiple muscle groups, such as a bench press. This is in contrast to isolation exercises, such as a bicep curl, which focus on a particular muscle. Do each exercise full extension to ensure your muscles retain full range of motion. So if you’re doing pushups, touch the floor with your chest and then extend until your elbows are straight. If you’re doing a squat, go all the way down before extending into standup position. 

• Building a workout routine. Galpin recommends only focusing on 3 - 5 strength exercises in a particular day, and not changing those exercises for 2 to 3 months, to ensure you’re maxing out on each one and slowly progressing. Regarding how much to do for each exercise, Galpin’s rule of thumb based on studies is 3 sets of 3 - 5 reps if you’re optimizing for strength. If you’re optimizing for hypertrophy, 3 sets of 8 - 12 sets.

• For following a particular routine, Jeff Cavaliere at Athlean-X is popular for weights. I really like his Beginner Workout, which is a 3x/week program and has three difficulty tiers for each type of foundational exercise. On each strength training day, I also add exercises from one of two sources:

  • Knees Over Toes Guy because he’s all about building knee/leg strength, and I have previous knee injuries. He’s incredibly earnest and nerdy about knee strength, which I find endearing. He has an app ($50 / month) that I’ve used but there are Youtube videos of people explaining his basics, which is a program he calls “Knee Ability Zero.” 

  • Jeff Cavaliere’s Posture Restoration Exercises because my posture is crap as well. 

The lowdown on nutrition

Protein. A reminder: our 80 year old selves need our younger selves to be jacked. To accomplish this, Peter Attia and Layne Norton recommend .8 - 1g of protein for 1 lb of body weight per day. This is a lot and hard to eat honestly. Attia estimates the max per sitting is around 50g (more than that and it’ll get shit out). I aim for around 115 grams / day and that’s with 26g of protein isolate a day - doing more is just too much eating and diet optimization for me. If you want to read more about it I recommend looking up Layne Norton’s materials.

If you’re aiming for the .8 - 1g of protein / 1lb of body weight target, you’ll likely need to supplement with some kind of protein powder. I recommend whey protein isolate as opposed to whey protein concentrate. Whey protein concentrate has sugar alcohols which can give folks tremendous farts. I don’t think it matters much what brand you get as long as it’s made in a GMP (good manufacturing practices certified) facility. I get is this one for the price (and no, I don’t get a cut from any product or Youtube links referenced here). 

Fiber. Layne Norton recommends getting at least 35 grams of fiber for a 2,500 calorie diet, although he also states that the more fiber a day, the better for longevity. I aim for 50g of fiber a day. A review article came out (over 1 million subjects reviewed) showing that for every 10g increase in fiber, there was a 10% reduction in risk of mortality. That’s miracle drug level crazy. I can’t think of another dietary intervention that comes close to that. Layne cites the study and states it’s not well understood why fiber is so well correlated with long term health and longevity, but Attia mentions it improves glucose and ApoB levels - two of the most important factors for monitoring atherosclerotic disease and diabetes (read how to test for those things here). As a note, Norton cautions against relying on fiber for curing hunger when dieting here, as it can impede performance.

As Dr. Peter Attia explains in this AMA, it’s important to get both soluble and insoluble fiber in a sitting. There’s a big caveat though - if you supplement with too much fiber out the gate - and especially insoluble fiber - you can get some weapons-grade level gas. I say this from personal experience. 

I include 10g of fiber into a protein shake everyday on the recommendation of Gillett Health, a concierge medicine practice I’ve used for personal health plans and questions around the protocols in this document. I do a mixture of psyllium husk and inulin, which is the best bang for your buck when it comes to fiber per gram ratios. 

Fish oil.  DHA and EPA are two Omega 3 Fatty Acids in fish oil that have been shown to have a lot of cognitive and cardiovascular benefits, including longevity. This includes protection against neurodegeneration (e.g. Alzheimer's) and improving cardiovascular function (thereby preventing heart failures and related issues). Here’s how to get the benefits of DHA and EPA:

1. eat fatty fish such as salmon, tinned sardines or mackerel with the skin on 

2. take at least 1 gram of EPA derived from fish oil each day, or 2 grams of EPA if you’re not a fish eater. 

The most cost effective way of supplementing that I’ve found is Carlson’s fish oil (which actually goes down super smooth with a light lemon taste - I put it in the protein shake every morning). The most cost effective source that I can use while traveling is Nordic Naturals Ultimate Omega. Keep the bottle refrigerated if possible as room temperature will degrade the potency of the EPA + DHA, and if the bottle gets hot it can go rancid.

The expert on fish oil I follow is Dr. Rhonda Patrick. Here’s her site with way more info on fish oil than you ever bargained for. 

Creatine. This started out as a bodybuilder supplement but is now recommended for pretty much everyone, as it turns out to have lots of cognitive benefits as well. A recent study came out showing that creatine supplementation helped old ladies strengthen their hips, decreasing their probability of falling and breaking a bone (a primary cause of death for senior citizens). 

For creatine you want creatine monohydrate. There are other more expensive creatines out there but none have been shown to perform better and none have been tested as thoroughly as creatine monohydrate for muscle and cognitive improvements. Brand also doesn’t matter but this is the one I get. Folks under 180 lbs should shoot for 5g/day, everyday. Heavier folks often supplement up to 10g/day. The expert I follow for creatine advice is Dr. Layne Norton. 

Alcohol. After all that back and forth about whether red wine is good for us, it turns out all alcohol is poison - including red wine. It causes neurological decline, damages the gut microbiome, and increases stress levels when we’re not drinking. Folks interpret the literature a bit differently. Huberman advises against drinking more than 2 drinks a week (with 0 being ideal). Attia advises the limit is up to 7. Either way this is a huge bummer for folks like me. Both Huberman and Attia agree that anything over 2 drinks a day is supremely no bueno.

Other protocols for improving health

Early morning sunshine. Get 5 - 10 minutes of sunlight within 1 hour of waking up. This kick starts the circadian rhythm and regulates hormones, making it easier to sleep. If it’s cloudy out, or you skipped sunlight yesterday, get 15 - 20 minutes. Source is Huberman.

Nasal breathing. Breath through your nose as opposed to your mouth as much as possible. Research shows nasal breathing creates a healthier facial structure. Some folks go so far as to tape their mouths shut when they go to sleep to train themselves to nasal breath during sleep. I did this for a while and it helped, as I struggle with congestion / nasal breathing. Source is Huberman.

Coffee intake timing. Delay drinking coffee until 90 minutes after you wake up. It will last longer and prevent crashes. Source is Huberman.

Water intake. Hydration rule of thumb: Throughout the day, drink half your bodyweight (in pounds) in ounces per day. So, 200 pounds → 100 ounces of water. Distribute this throughout the day. Source is Huberman’s interview with Andy Galpin, PhD.

Go to bed at the same time every night. Recent evidence suggests that in addition to getting 8 hours of sleep every night, going to bed at the same time is necessary for the body to naturally produce human growth hormone while you sleep. HGH increases metabolism and helps tissue repair, slowing aging. Even going to bed 30 minutes off every night can inhibit the release of growth hormone at night. Source is Huberman’s interview with Gina Poe. 

And that’s it! Next issue I’ll discuss answers to the question: “How do I know if I’m healthy?”

1. This is my extremely accurate, albeit subjective, approximation.