Jake Kelly MD

Most 80-year-olds can’t walk up a hill without stopping. My 80-year-old mom is in the top ~1–2% VO₂ max for her age. No lifelong athletics. No supplements. Just consistency, walking, and light strength. Cardiovascular fitness doesn’t fade with age; it fades with inactivity.

@hjluks Appropriate stress at the appropriate time. I love learning from your deep expertise and experience @hjluks

Cardiac imaging catches disease. But...by the time you're imaging, the process has been underway for years. ApoB-driven plaque doesn't start at 50. It starts at 20. The question isn't when to image. It's when to intervene on the exposure.

GLP-1s lead to lean mass loss at ~ same ratio as calorie restriction alone ~ 26% Tirzepatide, 25% Diet-only @drwilliamwallac

@feelthebyrn1 I hope your dead hang instruction on extended reach in the pool works for me. Looking forward to incorporating more. Thoughts on duration? 30”, longer?

A simple way to add plyometrics to your program A little goes a long way with these exercises Jumps & Bar Hangs > Scrolling

@Alan_Couzens I love watching this in real time with @JohnGoldman. Thanks for reinforcing the principles of training, health & life @Alan_Couzens

My latest on Season Planning is live...👇 Most athletes don’t fail because they didn’t train enough. They fail because they never gave their training time to work! Fitness doesn't happen right away. And, if you just keep adding more and more load, you interrupt the whole process. Give your fitness time to grow! 🌱

A normal fasting glucose 🚫 metabolism is healthy. Insulin ↗️for years before glucose ↗️. By the time glucose rises, your body has been compensating in silence. Fasting insulin. TG/HDL ratio. Waist circumference. The early signals aren't on your standard panel.

@doctorinigo Such a great perspective, post and article. Must read!

🚨New Substack Article: VO₂max vs Lactate VO₂max represents cardiorespiratory adaptations and measures oxygen delivery. Lactate reflects cellular and mitochondrial adaptations key for metabolic health. Over the past decades, elite sport moved beyond VO₂max and focused on metabolism. That shift changed how we interpret physiology, how we train and how we define performance Longevity and metabolic health are now arriving at the same crossroads. Because improving how we deliver oxygen is only part of the equation. Understanding how our cells use it is what ultimately determines metabolic health 👇 inigosanmillan.substack.com/p/vomax-vs-lac…

VO₂max tells you how much oxygen your heart can deliver (engine). Lactate tells you what your cells actually do with oxygen (highway). Engine 🚫 highway. Metabolic health = how well your engine runs. Elite sport figured this out years ago @doctorinigo.

Your LDL cholesterol can be normal. Your risk can still be high. LDL-C measures cholesterol mass. ApoB counts the particles carrying it. It's the particles that enter the arterial wall. If you've only checked LDL-C, you've checked the passenger. Not the driver.

@TheSGEM @CAEP_Docs Thank you to our ER staff for always keeping the light on.

I chose EM because I wanted to be the light in the house of medicine, always on and seeing anyone, anytime, for anything. The ED is a place where science, uncertainty & critical thinking come together in real time to help patients when they need it most. ⁦⁦@CAEP_Docs⁩

@louisanicola_ There is something special about Sauna. Finally pulled the trigger for home Sauna and it just “feels” better in all aspects of my life now.

What if one of the simplest longevity tools isn’t a pill or a protocol… But sitting in a hot room for 20 minutes? New research is doubling down on sauna use as a serious longevity lever. Here’s what the latest science actually says 👇

@Ashwinreads I look forward to following this story @Ashwinreads . This could be very impactful on overall health and show us what is possible in other countries with improved access to GLP-1s

glp-1s will decimate the fast food vendors in india because when semaglutide goes off patent next week, prices will plummet by at least 90%! this means all of a sudden, the average indian WILL be able to afford these meds and the appetite suppressant effects along with changes in taste buds is going to cause a blood bath for fast food places AND e-commerce food delivery businesses like swiggy/zomato.

@ted_ryce Great post @ted_ryce - I check theee routinely in my practice but it is fairly uncommon in routine practice. I’m writing further about this Tuesday. Keep teaching!

Client's blood work came back. Everything looked "normal" according to their doctor. But here's what wasn't tested: Apolipoprotein B (heart disease risk) LP(a) (genetic heart disease marker) Fasting insulin (insulin resistance) "Normal" blood work doesn't mean optimal health. It means you're not sick yet.

@forgedmedicine @Alan_Couzens I try to use 10k lux light when I read/write/think at 5 am but often I head out to run or downstairs to ride first thing.

@jakekellymd @Alan_Couzens Yeah this is the part people don’t always account for. I’m trying, but morning light isn’t happening with my schedule…lunch is usually my first shot. Still counts.

I don't think most athletes understand the magnitude of this. I recently pulled training response (k1) data across athletes I’ve coached. Range: -0.06 → 0.30 Let that sink in… Some athletes got worse with more training. Both the athletes who got better and the athletes who got worse did the work. The difference? Life stress. Chaos. Poor recovery capacity. Before you add more load… 👉 Get your life in order!

@doctorinigo I can't wait to read what is brewing from @doctorinigo . Thanks for sharing and teaching such valuable insights!

Working on a new article for my Substack. Those of us working with elite athletes have relied on our good old friend VO₂max for decades. It’s essential, but it’s not the full picture. Now that VO₂max has re-emerged in the world of longevity, it’s worth remembering that physiology has evolved tremendously… and so should how we think about performance and metabolic health. New article tomorrow. inigosanmillan.substack.com

@forgedmedicine @Alan_Couzens I really love this - still working on my light @forgedmedicine. I suspect you are too this time of year (it is coming though). Reduce stress, good sleep, recover. Watch for true signals!

@Alan_Couzens This is the part people miss. The body isn’t just responding to training… it’s responding to everything. Light. Stress. Sleep. Timing. Training load is just the loudest signal…not the only one.

@Alan_Couzens Yes @Alan_Couzens - I had plateaued for years: 12-15x100+ hour work weeks a year over the last 9 years. I stopped January 31. In the last 6 weeks, my HRV has climbed to new levels, I'm lifting more than ever, I'm sleeping great and I feel great. Thanks for the push @Alan_Couzens

My patient Jeff was a state finalist in cross country. 29 years ago. He's 47. 225 lbs. New Garmin on his wrist. His first run back? A 13-minute mile at 133 BPM. That's not failure. That's the foundation. 4 zones. 1 to skip.

@drpablocorral CAC is a tool. Over-utilized. I infrequently order as a cardiologist as I can typically get patients to their personalized goals without it.

👉CAC score 1.CAC=0 doesn’t mean no atherosclerosis A CAC score of 0 indicates the absence of detectable calcified plaque, but it doesn’t rule out non-calcified plaques, which can still pose risks. Non-calcified plaques are common in younger patients or those with early-stage atherosclerosis. 2.CAC=0 doesn’t mean low risk While CAC=0 is associated with a lower risk of major adverse cardiovascular events in the short term, it doesn’t guarantee long-term low risk, especially in patients with other high-risk features like diabetes, smoking, or a family history of premature atherosclerotic cardiovascular disease (ASCVD). 3.CAC is not a risk factor, it’s just a tool CAC itself is not a pathophysiologic driver of disease but rather a surrogate marker. It helps refine risk assessment, especially in intermediate-risk patients where the decision to intensify therapy might be unclear.