The evidence is clear: aerobic fitness, muscle strength, optimal nutrition, quality sleep, and social connections represent powerful tools for extending both lifespan and healthspan.
Unlike many medical interventions, these strategies are largely under your control and can be implemented regardless of your current health status or age.
I don’t think I’ve ever seen such a clear and simple and powerful message on how to improve our quality of life as we get older. As a 59 year old man, this is just the message I need to see right now. All these strategies are really just a matter of choice and making better priorities. Thank you.
This is a really strong “healthspan-first” framing! The healthspan–lifespan gap you highlight (and the reality that many Americans spend a substantial stretch of late life with disability) is exactly why prevention after 50 has to be about preserving function, not just chasing lab targets. 
Clinically, what I find most motivating here is the implied takeaway: the biggest wins are often “boring fundamentals” done consistently (cardiorespiratory fitness, strength, sleep regularity, and social connection) because those are levers that build physiologic reserve. Your emphasis that moving from sedentary to “some activity” produces disproportionate benefit is spot-on and often underappreciated in real-world care. 
If there’s one mindset shift I’d add for readers: don’t aim for perfection, aim for repeatability. A plan that fits someone’s life at 70% adherence for years will outperform a “perfect” plan that lasts two weeks. Thanks for putting a hopeful, actionable lens on a topic that too often feels fatalistic!
I agree with your comment. Perfection is not needed. In fact the most naoticible improvement is achieved in the beginning of any intervention, later it slows down
Thank you for this well written, evidence based, and detailed outline of what we can all do to increase healthspan and lifespan.
I do wonder about the benefits of omega 3 supplementation. Most of the studies showing benefit are observational studies. These are subject to healthy user bias. That means taking supplements or eating lots of fish may have other healthy behaviors that confound the picture. We simply cannot account for all the potential confounders in observational studies.
When omega-3's have been put to the test through randomized control clinical trials for cardiovascular disease, most of these have turned out negative. One of the exceptions was the REDUCE-IT trial that you mentioned. In this study, people are given 4 G of pure EPA. This is a prescription and is much higher than what you can buy at the store. I'm not sure this applies to the average person taking omega-3 supplements.
I'm still not sure about the cardiovascular benefits of over the counter omega 3 supplementation for the average person. Curious what you recommend to patients.
Thank You for your kind words. I mostly agree with your summery of literature on omega 3. Many things in longevity field have studies showing associations and not causations. You have two choices. One is wait 5-10 years or never for a "Gold Standard" study (I don't have time for that, I am already in my 50s :).
The other is to have more practical approach. That would be answering the following questions:
1. Are there enough studies showing a favorable associations? 2. Is there plausible biological mechanism? 3. What is potential benefit in general and for particular individual's situation? 4. What is the risk of an intervention (the most important question to answer whenever uncertainty exists regarding positive outcomes)? 5. What is the cost? 6. What is somebody's preference after knowing potential benefits, risks and uncertainty of outcomes?
It should be the individual deciding not a doctor in situations like that. In medicine we doctors act or pretend to know everything while talking to patients, and in my opinion that is a mistake. I will stop here because, in near future I am planning a deep dive into the topic of omega 3s and seafood in diets.
The evidence is clear: aerobic fitness, muscle strength, optimal nutrition, quality sleep, and social connections represent powerful tools for extending both lifespan and healthspan.
Unlike many medical interventions, these strategies are largely under your control and can be implemented regardless of your current health status or age.
I don’t think I’ve ever seen such a clear and simple and powerful message on how to improve our quality of life as we get older. As a 59 year old man, this is just the message I need to see right now. All these strategies are really just a matter of choice and making better priorities. Thank you.
This is a really strong “healthspan-first” framing! The healthspan–lifespan gap you highlight (and the reality that many Americans spend a substantial stretch of late life with disability) is exactly why prevention after 50 has to be about preserving function, not just chasing lab targets. 
Clinically, what I find most motivating here is the implied takeaway: the biggest wins are often “boring fundamentals” done consistently (cardiorespiratory fitness, strength, sleep regularity, and social connection) because those are levers that build physiologic reserve. Your emphasis that moving from sedentary to “some activity” produces disproportionate benefit is spot-on and often underappreciated in real-world care. 
If there’s one mindset shift I’d add for readers: don’t aim for perfection, aim for repeatability. A plan that fits someone’s life at 70% adherence for years will outperform a “perfect” plan that lasts two weeks. Thanks for putting a hopeful, actionable lens on a topic that too often feels fatalistic!
I agree with your comment. Perfection is not needed. In fact the most naoticible improvement is achieved in the beginning of any intervention, later it slows down
Thank you for this well written, evidence based, and detailed outline of what we can all do to increase healthspan and lifespan.
I do wonder about the benefits of omega 3 supplementation. Most of the studies showing benefit are observational studies. These are subject to healthy user bias. That means taking supplements or eating lots of fish may have other healthy behaviors that confound the picture. We simply cannot account for all the potential confounders in observational studies.
When omega-3's have been put to the test through randomized control clinical trials for cardiovascular disease, most of these have turned out negative. One of the exceptions was the REDUCE-IT trial that you mentioned. In this study, people are given 4 G of pure EPA. This is a prescription and is much higher than what you can buy at the store. I'm not sure this applies to the average person taking omega-3 supplements.
I'm still not sure about the cardiovascular benefits of over the counter omega 3 supplementation for the average person. Curious what you recommend to patients.
Thank You for your kind words. I mostly agree with your summery of literature on omega 3. Many things in longevity field have studies showing associations and not causations. You have two choices. One is wait 5-10 years or never for a "Gold Standard" study (I don't have time for that, I am already in my 50s :).
The other is to have more practical approach. That would be answering the following questions:
1. Are there enough studies showing a favorable associations? 2. Is there plausible biological mechanism? 3. What is potential benefit in general and for particular individual's situation? 4. What is the risk of an intervention (the most important question to answer whenever uncertainty exists regarding positive outcomes)? 5. What is the cost? 6. What is somebody's preference after knowing potential benefits, risks and uncertainty of outcomes?
It should be the individual deciding not a doctor in situations like that. In medicine we doctors act or pretend to know everything while talking to patients, and in my opinion that is a mistake. I will stop here because, in near future I am planning a deep dive into the topic of omega 3s and seafood in diets.
Thanks for your thoughtful reply. I am eager to read your upcoming deep dive on omega 3's