So far, so good. 

Who wants to live longer?

American comedian Steven Wright once joked, "I plan to live forever." When asked how it was going he answered, "So far, so good."

I just read a book, Outlive by Peter Attia - (pronounced Ahh-tia) that recommends a healthy non-diabetic person should go out, purchase and use the kind of glucose monitoring system diabetics use all the time and monitor their blood glucose levels for two to three months. The idea behind it is sound. You will spend a month gathering and monitoring the data and the next month or two analyzing exactly what foods cause glucose spikes for you as an individual. Again, this is probably sound science and would be interesting to know. The point is to find out which foods affect you rather than relying on some general aggregated data about the general population. Good advice, but the same book argues that recommending very strict diets doesn't work because people can't stick to them, usually due to hunger or generally not feeling sated, like that feeling of having an apple and not feeling like you ate anything at all. Yet, the same book expects you to stick to a diabetic's level of glucose monitoring despite not having diabetes.

This is one of the problems with the book and its recommendations. You should eat healthily for you by finding out what foods affect you the most by carefully monitoring your glucose levels. You should exercise more, but very specifically training for strength, stability, flexibility and endurance by following peculiarly specific instructions. Attia gives very detailed data and instructions for following the data analysis, which is well beyond what anyone could do without a team normally reserved for professional athletes. Essentially he eschews taking a kind of moderate approach for something unusually complex, all to live longer and to better avoid the "four horsemen" of old age; cancer, heart disease, metabolic diseases such as diabetes and dementia from diseases like Alzheimers. Yet, while he recognizes that strict diet regimes don't work, he doesn't apply the same logic to other actions, namely exercise. Attia admits he has issues with being a data geek and an obsessive perfectionist, which probably explains all of this.

The author almost entirely ignores larger societal issues that make the problems of health difficult for any individual to overcome, particularly Americans and their excellent, but expensive and inaccessible healthcare. He discusses vehicular death as a problem we address with regulation and even admits to seeing the effects of gun violence in his time as an intern but only in the last chapter discusses mental health (an astounding number of gun deaths are suicides). In Canada we struggle to find a family physician never mind the sports medicine specialist, family practitioner, nutritionist, physiotherapist, sleep specialist, mental health therapist, and physical trainer you would be required to follow this, albeit sound and sage advice. His advice to practice "rucking", by walking an hour a day with weights in a backpack is particularly galling to me. Buddy, get rid of your car and try living any given day taking transit, walking or biking without your beloved "rucking". His blindness to all of these issues and concerns was highlighted to me by the increasingly simple health advice some journalists and activists are beginning to report.

The 7-minute workout and Michael Pollan's maxim to "Eat food. Not too much. Mostly plants.", are perfect examples. This morning on the Guardian Website I read this even simpler distillation of what we can all do to live better, healthier and longer lives:

The eight health measures named by the American Heart Association:

1. Eat a healthy diet
2. Be more active
3. Quit smoking
4. Get healthy sleep
5. Maintain a healthy weight
6. Control cholesterol
7. Watch blood sugar
8. Manage blood pressure

Again, the phrase "can slow ageing by up to six years" part comes down to some large data set and you should expect outcomes to differ for every single person. Each one of these comes with caveats and fairly simple guidelines. 

Eat a healthy diet: See Pollan's quote "Eat food. Not too much. Mostly Plants." Here Pollan means non-processed, real food, by the way. Simply avoiding things that are overly processed and have way too many ingredients goes a long way. Most people are fine with about 2000 calories a day, depending on your age, gender and size. Only full-time athletes need more. On the "mostly plants" bit, Attia disagrees a little saying most plant proteins come as fibre so they don't go towards building strength (which he sees as crucial), yet billions of humans live without animal proteins. Most experts will recommend sticking to chicken and fish for your proteins with moderate consumption of things like dairy and eggs but you can do pretty well with vegetables, pulses and beans or through alternatives like tofu which is also plant-derived. 

Be more active: See the 7-minute workout! Leaving the car and taking a walk regularly is also a good idea. I've spent most of my life trying to run, bike or swim farther but in truth, as you age, you should turn down "duration" and focus on "intensity and frequency", something to do with long cardio workouts raising cortisol levels and lowering testosterone making it more difficult to maintain muscle mass or something. Attia tells readers (overly prescriptively, I would add) to focus on strength first, flexibility, stability and endurance. In general, however you get your 150 minutes of activity a week, maybe think about adding stuff you may not be doing (like stretching and strength training for me). 

Quit smoking: No kidding. What is this, 1969? 

Get healthy sleep: This one is tough for me, but I have to admit that since the pandemic I've worked from home and often sleep until 8 AM and nap if needed which means I've slept better than I have in years. When needed I've leaned on using THC/CBD but it's not clear if that deep, dreamless sleep gives you the quality of sleep you need. Still, I try to maintain "sleep hygiene" and I'm up for putting my head down. 

Maintain a healthy weight: I'm working on it, always working on it, just like everyone else. What I have found is that what sort of appears like a normal weight to me puts me at about 2% body fat more than I should have and that's the number I'm following more than the pounds or kilograms. 

Control cholesterol: This still seems questionable to me. Is the association between cholesterol and heart disease correlation or causation? I read so many opposing things. The use of drugs like statins has lowered cholesterol but maybe hasn't significantly lowered heart disease as claimed. Some say populations that use statins over long periods have lower cholesterol but higher dementia while others report users on statins have a lower incidence of dementia and heart disease. Attia argues that high doses of statins isn't effective but at lower doses is and requires careful monitoring. Some foods, like almonds, reduce cholesterol but for others, almonds increase cholesterol. This would be tough to do without a lot of monitoring. 

Watch blood sugar: Short of using glucose monitoring I'm not sure what you can do other than be aware of how you "feel" when you don't eat or over-eat. 

Manage blood pressure: See all of the above. I mean, you hope by doing the first five steps, the next three steps will take care of themselves. If I see one of those machines in the pharmacy or gym, I'll give it a whirl and I've noticed until my heart rate settles down to sixty-ish, my blood pressure numbers are rubbish. Once my HR has "normalized", say after a workout, bike ride or walk, it seems like it is within the normal healthy range. 

My main problem with Attia's book, despite all its value, is how unreasonable much of it is, whereas the list from the American Heart Association is so simple and practical and assumes you can work out what it means for you. I remember a story from Tour de France winner Bradley Wiggins seeing Lance Armstrong calculate his caloric input and output levels for a day and using a kitchen scale to measure out two potato chips. Wiggins thought, "I'm not up for that!". As a competitor, Wiggins looked like a stick bug but since retirement he is now sporting a healthy "dad-bod". That tells me that Wiggins never had the obsessive nature to use the complex cheating strategy that Lance Armstrong, and his team of sports scientists, followed for years to attain seven Tour de France general classification "wins". Wiggins' sacrifice in the name of nutrition was to give up beer. That's my advice, be less of an Armstrong and more of a Wiggins. Keep it simple and hopefully, your health will stay good, so far.

PS. I am just slightly surprised there was no mention of giving up or moderating alcohol consumption as there's a fair amount of "live long" points to be gained from that.