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When should you consider starting statins? A risk benefit analysis 👇

@DrAdamBat kicking off Tech Week at Alkindi Club London yesterday. Great turn out and thanks for everyone who showed up! #LondonTechWeek

The classic “annual check up” hasn’t changed much in about 40 years! If we started from scratch and reimagined what an annual preventative check up would look like with what we know today using the tech that exists now, it would look very different I talked about this at Alahsa Primary Care Conference in Saudi Arabia last week who are modernising the primary care model in the kingdom Main themes I covered: - More biomarkers: we now have a large number of biomarkers that are independent risk factors for chronic disease that are not covered in rhe standard check up. This needs to change. We owe people this knowledge. - Optimal vs normal: for preventative health biomarkers, the standard “normal range” is often misleading. - The “10 years risk” model is outdated: we need better risk calculators with longer time horizons and lower thresholds for intervention - Utilisation of continuous monitoring: biowearables can pick up a significant percentage of high risk individuals who would otherwise be missed if we only rely on single snapshots of health done in a typical annual check up

Inflammation is a crucial part of our immune response. But at times, it goes haywire. This is often the case as we age. Molecules called 'resolvins' may offer a solution. buff.ly/3vlyYeJ

How to make 2024 the healthiest year of your life: 1- Book 2 blood tests in advance: One for January and one for 6 months after. Put it in your calendar, it will motivate you to improve your markers (see list of tests to do at the end of this thread) 2- Get a weighing scale If you don’t have one, get one and place it in your bathroom. Then write your target weight on your scales with a sharpie A 2015 study showed that daily weighing improves weight loss and adoption of weight control behaviours (ref: PMID 4380831) 3- Book 3 personal trainer sessions in advance Ask them to coach you on your form and improve your exercise schedule Even if you don’t continue with a regular PT, having a few good sessions can boost your long term performance by improving form, setting a benchmark to aspire to, and educating you on the best ways to exercise to reach your goals Studies show that one-on-one coaching is effective in changing attitudes towards exercise (ref: PMID 24616604) 4- Consider stocking up on these supplements and taking them every day: Creatine (3 grams daily): helps preserve muscle mass and strength Acetyl-L-Carnitine (1-2 grams daily): improves exercise performance if you exercise a lot Vitamin D if your blood level is below 50 nmol/L If you’re older than 45, consider NAC + Glycine 1.5 grams daily Psyllium husk (especially if you don’t eat much fiber): 5 grams once daily with meals, this will improve your bowel motions and is associated with some improved triglyceride levels 5- Create a list of foods you like that contain 30 grams of protein Then make these foods a part of every main meal you have Here’s a 30g protein cheat sheet that I’ve found useful: 5 Whole Eggs 5oz Wild Caught Salmon 5oz Chicken Breast 6oz Chicken Thigh 5oz Grass-fed Ribeye 5oz Wild Caught Shrimp 1 1/2 cups Greek Yogurt 1 cup Cottage Cheese 4.7oz Tempeh 6- Invest in blackout blinds that fit your bedroom window If any light enters your bedroom in the early morning, I suggest you do this. This is critical for good sleep 7- Stop eating/drinking any fluid 2-3 hour before bed Can help with better sleep and less waling up to go to the bathroom at night 8- Buy a blood pressure monitor Blood pressure is an extremely important market of health. The earlier you optimise the better I recommend the M3 Omron monitor (no affiliation) 9- Add this isometric exercise to your routine: especially if your BP is on the high side Protocol: 90 degree wall sit for 2 minutes, rest 1-2 minutes, repeat 4 times, 5 times a week Why? A recent study showed that isometric exercise is the best for lowering blood pressure even in people with normal levels (ref: PMID 37491419) 10- If you smoke or vape, stop trying to quit on your own There are services and professional interventions that are very successful in helping with successful smoking cessation This might be the most important thing you can do for your health. It is 100% worth prioritising These substances are highly addictive and difficult to stop. Get help List of blood tests: Lipid panel including ApoB Fasting glucose HbA1c Fasting insulin HOMA-IR hsCRP Homocysteine Uric acid Testosterone Oestrogen Omega 3 index/Omega 6:3 ratio Liver function test Kidney function test PSA

Not all midlife crises are bad

This body type is inevitable for most men after age 40. This isn’t fashion advice but knowing this will help you look better regardless of what you wear. This body type is often called “skinny fat”. This man’s weight may be within “normal range” but it doesn’t reflect that his body composition is likely not ideal. He has: 1) high fat percentage as evidenced by mild gynaecomastia (man boobs) 2) increased waist circumference indicating increased visceral fat which is the worse type of fat due to its high correlation with heart disease and metabolic dysfunction 3) Low muscle mass indicated by his disproportionate upper body compared to waist (upper chest and shoulders) Why is it inevitable for most people? Because all these elements accumulate over time and only get more difficult to reverse with age 1- Fat percentage increases as we age 2- we lose muscle faster with age 3- building muscle becomes more difficult with age 4- Testosterone decreases with age making it more difficult to maintain body composition 5- visceral fat predictably increases with age as a percentage of overall body fat This body shape can be part of a bigger pattern of health called metabolic syndrome which includes things like high blood cholesterol and triglycerides, high blood pressure, insulin resistance. If you want to prevent this from inevitably happening, you need to work hard on: - consuming the right amount of protein (1.8 grams of protein kg of body weight is a good goal for most people, higher if you exercise a lot). Increasing protein intake is associated with lower visceral fat and higher muscle mass. You can get this from natural sources such as chicken, eggs, red meat, fish, legumes… etc and you can supplement with whey isolate protein (or 70:30 pea:rice for vegans) - focusing on resistance training: aim to train every major muscle group twice a week. Reach near failure to stimulate growth. - not over eating: choose whatever diet you like but ultimately you will gain fat if you consume more calories than you need. - measure your testosterone. It’s not uncommon for men to have a drop in testosterone after 40 requiring medical intervention. The earlier you know, the better. Always be guided by a medical professional. - The gold standard for measuring your body composition and visceral fat is a scan called a DEXA scan. This is a scan that uses a small x-ray dose and can measure fat tissue, lean mass and bone density. A more advanced but unnecessary scan is the AMRA MRI which can provide even more accurate results. - aim for >8,000 steps a day. Higher step count (and faster walking) is associated with less likelihood of developing metabolic syndrome. - other important factors that can help you improve visceral fat: good sleep, stress management, stopping alcohol and smoking, lowering processed foods.

@DigitaLPhilly1 @robinyoungfun Hi, are you in the UK? Numenor is the leading Longevity practice in the UK with a focus on longevity medications. Book a free call at wwe.numenor.health

Lowering my dose to 3mgs with grapefruit juice today. Last time felt like just a little too much.

Crucial idea to understand when measuring your health over time: area under the curve Person 1 and Person 2 in the figure below have the same blood test at age 58 But their risk of disease is not the same. Why? Because they differ in the area under the curve for that biomarker. It reflects the cumulative load of that biomarker or the duration of exposure to high levels of it Someone who has longer exposure to high blood pressure, for example, will have a higher disease risk than a shorter duration of exposure This is why early intervention is extremely important in most aspects of health Examples: Cumulative BP is a better predictor of end organ damage than mean lnkd.in/e_zeEjSz Cumulative LDL cholesterol is more important than absolute level alone lnkd.in/eKXYbntp Cumulative exposure to impaired fasting glucose predicts future risk of type 2 diabetes mellitus lnkd.in/ejEcADwk

Before you address these: - LDL/HDL cholesterol - Apolipoprotein B - Blood pressure - Fasting blood glucose Don’t even talk to me about improving your “epigenetic age” or any other “biological age” test

Interesting article from @AlexLJanin in @WSJ today about the use of Metformin for longevity As I say in the article, many of my patients ask Metformin for longevity. I think there is potential for use under medical supervision if you monitor and target the right health markers

Longevity seekers are rethinking their use of metformin to fight aging on.wsj.com/3Uftuuv

One of the biggest mistakes I see in people who start getting interested in improving their health and longevity is that they want to measure/improve everything all at once Focusing on one part of your health at a time is more sustainable and productive