I’ve been trying to explain something for years and never quite found the right shape for it.

Health isn’t one single topic. It’s ten, maybe more, all running at the same time, and most of us are only paying attention to one or two of them. We focus on diet, going hard on workouts, but something else gives way. Then you have to reassess what to improve, how to re-balance. Then you go deep into your sleep tracking, but later realise you have never once checked your ApoB. You might be lifting heavy three times a week and you start to wonder about your cortisol. Nobody’s fault; there’s just too much ground to cover, and most health content picks one lane and stays in it.

So I built a map for all the things I’ve been writing about, and all the things I’m planning to write about; organized neatly in a way that may make sense to some.

Literally. It started as a whiteboard a while back, and it’s turned into something closer to a London Underground map: ten lines, each one a different part of health (sleep, nutrition, hormones, gut health, exercise, mental health, and so on), with stations along each line that are specific topics. Click a station and you get the essentials: what it is, why it matters, what the evidence actually says. The deep dive will follow at some point!

It’s not exhaustive. It’s not meant to replace a doctor, a coach, or a proper deep-dive. Think of it as the 101 as you start to think about what aspects you wish to learn about and improve. A way to see the whole board at once, figure out where you’re strong, and notice a blind spot you didn’t know you had. A few lines cross each other too, on purpose, because that’s how health actually works. Your sleep line runs into your hormones line runs into how you feel emotionally, and none of it sits in isolation the way most content treats it.

Here’s how it is intended: don’t read it top to bottom. Pick the line you think you know best and see if there’s a station on it you’ve never actually looked into. Then pick the line you know least: for most people that’s Gut Health, Hormones, or Mental Frameworks, and start there instead.

Some stations are live already, with a full piece behind them. Most say “coming soon” on purpose. This is going to grow station by station, issue by issue, as Young Centenarians comes back properly. If there’s a station you want written first, tell me. That’s basically how the whole thing gets prioritized from here.

Enjoy -

Young Centenarians

A huge THANK YOU to each and every one of our readers who took anything from a few seconds, to minutes, to hours reading our posts and providing feedback on what works or doesn’t - for them. We plan to make this newsletter, more actionable, more relevant, more accurate, more fun…and potentially shorter!

What would you like to achieve for your health in 2026? Where are the key barriers in getting there? What would you wish we wrote about in future posts? Have any feedback for us? Leave a comment to let us know.

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Healthy..2025..wrap…get it?

Young Centenarians Newsletter

I translate science into easy strategies and tools for creating healthy longevity habits, for people who struggle to stay on track, and show you how to 2x your health and quality of life long term

By Manos Mastorakis PhD

High Risk, High Returns (Biotech Investing Newsletter)

Biotech Investing Newsletter: 2x your money, one biotech catalyst at a time A biotech analyst (ex-Deutsche Bank, ex-consulting, PhD) dissects biotech catalysts worth investing in!

By Manos Mastorakis PhD

List of our published articles

• Taking care of that heart of yours: 5 LESSONS from a cardio medical conference in London (CVRM UK) — 26 Nov 2025​

• Announcing ‘XX innovation’: A Women’s Health ecosystem — 10 Nov 2025​

• Acetaminophen (paracetamol) & autism risk: a complex (unfortunately politicised) topic concerning most of us — 9 Oct 2025​

• Health Optimization Summit 2025 – Day 2 re-cap: Highlights and Full Notes! — 14 Sept 2025​

• Health Optimization Summit 2025 – Day 1: Sessions Recap/Notes + Key Takeaways! — 13 Sept 2025​

• Health Optimization Summit: What we’re excited about, full agenda and tips for 1st timers! — 12 Sept 2025​

• Inside the GLP-1 Boom: What a Biotech Analyst and PhD/Nutritionist Thinks — 7 Aug 2025​

• Why willpower alone is not enough in becoming healthier — 14 Jul 2025​

• Setting health GOALS, picking a clear STRATEGY and the right TOOLS: a full guide for all ages and levels — 11 Jun 2025​

• Young Centenarians, still on track... — 10 Jun 2025​

• Intermittent fasting: a tool with many uses, but not a ‘magic health bullet’ — 17 May 2025​

• Personalized Nutrition: We are not there yet; and we’ve gone too far — 8 May 2025​

• Your Blood Tests Should Look Like This If You Wish To Be 100+ years old — 7 May 2025​

• Science-Based Hydration Strategies for Better Living & Performance You Didn’t Know — 5 May 2025​

• What You Need to Know on your Journey to Healthspan & Lifespan — 4 May 2025​

• What’s in-store for the Future of ‘Young Centenarians’ newsletter — 3 May 2025​

• Every Family Should Hire Their Own Health Coach. Here’s why! — 2 May 2025​

• 5 Lifestyle Factors For A Younger Heart — 2 May 2025​

• Diets Decoded: The Rules for Healthy Eating (and a Brief History & Biology of Nutrition) — 1 May 2025​

• The simplest guide to understand your blood results — 29 Apr 2025​

• The 6 most common mistakes when tracking your weight — 28 Apr 2025​

• 11 simple STEPS for weight control — 27 Apr 2025​

• Blood Tests: Take this Exact List with You Next Time — 26 Apr 2025​

• Day 1 of ‘getting healthier’. Where do I even begin? Blood tests… — 25 Apr 2025

• The 3 Types of Hunger — 24 Apr 2025​

• Consequences of Obesity on Health & Wellbeing — 23 Apr 2025​

Top performing posts

There’s always 1 or 2 posts that stand out in terms of driving new subscribers. For our newsletter, those were the two-part articles covering the Health Optimization Summit in September. Health Optimization Summit 2025 – Day 1: Sessions Recap/Notes + Key Takeaways! — 13 Sept 2025, and​ Health Optimization Summit: What we’re excited about, full agenda and tips for 1st timers! — 12 Sept 2025. I believe people who attended the summit found our conference planner particularly handy and our Day 1 session coverage a life-saver as they didn’t manage to attend as many sessions as we did, or even take good notes of these sessions, as we did!

Our audience grew…to 232 strong, from all corners of the world!

Two recent personal stories prompted me to write about two topics that have never been paired together, but I found that they should, because they have one crucial element in common: oxygen physiology!

• Story 1: A family member recently suffered a leg fracture and the doctor suggested that the recovery would be smooth - within a few weeks, my family member would be once again be walking comfortably, as long as they rested properly. A week later, upon further examination, the doctor was not as hopeful as at the start and suggested that surgery would now be more likely to be needed. In search of higher confidence in the diagnosis and treatment plan, my family member sought the opinion of a second doctor who advised them to initiate hyperbaric oxygen therapy (HBOT) to support and speed up recovery. And even though I had previously heard and read about HBOT, I was unaware of the potential use of it in speeding up recovery of broken bones. So, that got me thinking about how HBOT works at that level…

• Story 2: Last weekend my wife and I visited Tenerife, a Spanish island off the coast of West Africa. A beautiful island, which I always regarded a destination known for its beaches and partying, but this is no longer the case. Tenerife is a beautiful island, with tropical xerophytes (that’s plants like cacti, that can withstand lack of water), amazing sceneries, great road infrastructure and also home to a volcano - Mt Teide - which at 3,500meters houses a breath taking view. We only managed to ascend to 2,000meters where the air was noticeably cleaner, colder and somewhat thinner as we felt only ever-so-slightly lightheaded. Googling what a safe level of high altitude is, I reminded myself of the human biology of adapting to high altitudes, with which I bored my wife over dinner. While driving up the mountain, I also wondered whether high altitude (lower pressure of O2) and HBOT (higher pressure of O2) work in the exact opposite way to each other, and if so, how can both result in some health benefits, whether in the long or short term, respectively?

And that’s how the idea for this article was sparked…(also thanks to my precious mother for asking me questions on how HBOT works, which I felt embarrassed not to know in enough detail…)

I also wondered about a theoretical experiment: given pressure decreases the higher up you go, could you - by the same logic - find a place on Earth below sea level that could simulate HBOT-like high pressures? The answer is, no. It appears that this is not technically possible, but even if it were able to build a chamber empty of water, but thousands of meters below the sea level, you would only be able to reach a +5% increase in oxygen pressure as opposed to the 100-300% increase generated in an HBOT chamber.

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Source: Shutterstock - Showing Mount Teide’s peak in Tenerife (Spain) at 3,718 meters

Source: Personal Video from our trip earlier this weekend in Tenerife. We only ascended to c2,000 meters.

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So basically these two stories relate to hyberbaric oxygen therapy (aka HBOT) and high altitude exposure. What are they exactly?

• HBOT is a man-made environment inside a relatively large device (see below), which creates a unique atmosphere of highly pressurized, 100%-oxygen air (vs. normal air, which contains only about 21% oxygen at 1 atmosphere of pressure). By increasing both pressure and oxygen concentration, HBOT exposes the body to an oxygen load that cannot occur anywhere naturally on Earth unless you go underwater.

• High altitude is the exact opposite. High altitude refers to any environment where the barometric pressure decreases enough that the partial pressure of oxygen (PO₂) drops significantly—even though the oxygen percentage in the air remains unchanged at ~21% (unlike most people saying that oxygen is too low in high altitude places).

HBOT vs. High Altitude: The Physiology of Opposites

What oxygen extremes teach us about healing, performance, and human adaptation

TL;DR

Most people think oxygen is either there or not. But oxygen isn’t binary — it’s a pressure gradient, a sliding scale your body interprets as information.

Hyperbaric oxygen therapy (HBOT) lives on one end of that scale: super-physiological oxygen abundance. High altitude lives on the other: oxygen scarcity.

One heals the body. One changes the body. Both teach us something profound about human biology.

In other words:

• HBOT = high-pressure oxygen → healing, anti-inflammatory, tissue repair, stem cell mobilization

• High altitude = low-pressure oxygen → EPO surge, more RBCs, mitochondrial remodeling, endurance adaptations

• They are not substitutes; they trigger opposite gene programs

• Oxygen levels shape biology more like a hormone than a nutrient

1. HBOT: Controlled Hyperoxia (meaning higher amounts of oxygen)

HBOT places you in a chamber where:

• atmospheric pressure rises to ~1.5–3 ATA

• oxygen concentration rises to 100%

• oxygen dissolves into blood plasma much more easily (i.e. at levels impossible at sea level).

*note that accessing HBOT sessions can be somewhat expensive depending on where you live.

Mechanism: Henry’s Law applied to biology

More pressure → more oxygen dissolved → more oxygen delivered to hypoxic tissue.

A simple way to think about this is:

When inside an HBOT Chamber
+ Increased Pressure
+ 100% O2 (oxygen)
-------------------
= Plasma becomes an oxygen delivery system. It's not just hemoglobin doing the work

This oxygen flood results in:

• Angiogenesis (new blood vessels)

• Fibroblast activation (collagen repair)

• Stem cell release

• Reduced edema & inflammation

• Enhanced immune activity

Note that HBOT is not believed to cause any long-term adaptations. It’s not “training.” It’s short-term therapeutic overload.

2. High Altitude: Adaptation Through Deficit

At altitude, oxygen concentration stays ~21%, but the partial pressure drops.

This is why climbers, skiers, and mountaineers start to notice:

• Faster breathing

• Tachycardia

• Brain fog

• Decreased sleep quality

• Reduced exercise capacity

• Risk of altitude sickness (AMS, HAPE, HACE)

At very high and extreme altitudes, these effects become pronounced and unavoidable unless you descend or use supplemental oxygen.

⚠️ What’s “dangerously high”?

• Above 3,500 m: acclimatization becomes necessary

• Above 5,500 m: prolonged exposure is unsafe

• Above 8,000 m (“death zone”): human life cannot be sustained without oxygen; the body begins to deteriorate rapidly

Most elite mountaineers limit time above 8,000 m to hours, not days. Imagine oxygen molecules being pulled farther apart:

You can visualize oxygen inside the air at sea and high-altitude (mountain) as follows: 

Sea Level Air        High-Altitude Air
O O O O O O O          O    O     O

This reduces oxygen’s driving force into your blood.

Long-term adaptations (if you stay >10–14 days):

• EPO surges → more RBCs

• Higher hematocrit (blood becomes more oxygen-rich)

• More capillaries

• Mitochondrial optimization

• Improved oxygen unloading from hemoglobin

Altitude teaches your body to become an oxygen-efficient machine.

3. The Physiology of Opposites

   HBOT                         High Altitude
==================        ========================
Pressure:  High           Pressure:  Low
Oxygen:    Flooded        Oxygen:    Scarce
State:     Hyperoxia      State:     Hypoxia
Outcome:   Healing        Outcome:   Adaptation
Blood:     ↓ EPO          Blood:     ↑ EPO, ↑ RBCs
Mitochondria: More ROS    Mitochondria: More efficient

HBOT = short-term flood
Altitude = long-term adaptation

One restores you, the other one strengthens you.

4. The “Negative Altitude” Paradox

Could we simulate HBOT below sea level on dry land?

Theoretically, yes. The deeper the basin, the higher the atmospheric pressure.

But Earth offers only:

• Dead Sea (~−430 m): +5% pressure increase (not enough)

HBOT requires:

• +50% to +200% pressure increase

To achieve this naturally, you’d need:

• A 1,000–2,000 meter deep dry basin

• That somehow doesn’t fill with water

• With atmosphere thick enough to increase pressure

In reality? It’s impossible without engineering something closer to a science-fiction megastructure. Human-made HBOT exists because nature cannot create these conditions for us on land.

5. How Does It All Work?

A. Reactive Oxygen Species (ROS)

• HBOT → more ROS, but mostly in a controlled, hormetic burst. This activates repair pathways but not chronic oxidative damage.

• Altitude → less oxygen, fewer ROS → mitochondria compensate by improving efficiency.

Here’s the great paradox:

• Hyperoxia increases ROS but heals

• Hypoxia decreases ROS but strengthens mitochondria

B. HIF-1α (Hypoxia-Inducible Factor-1 Alpha)

Altitude stabilizes HIF-1α, triggering:

• EPO production

• New blood vessels

• Glycolytic pathways

• Survival signaling

HBOT suppresses HIF-1α — the opposite signal.

C. Nitric Oxide (NO)

In high altitude → increases NO production → vasodilation → better blood flow in low O₂.
Inside a HBOT chamber → oxygen saturation rises → NO signaling shifts → improved microvascular perfusion.

D. Immune modulation

HBOT boosts neutrophil killing via oxygen-dependent mechanisms, whereas high altitude suppresses certain immune pathways (temporary immunosuppression is common in mountaineers).

6. Practical Takeaways for Readers

For readers interested in specific health benefits, such as improving their VO2 max, accelerating recovery or reducing inflammation, read below:

If you’re considering HBOT

Expect:

• improved recovery

• better wound healing

• anti-inflammatory effects

• help with brain injury recovery

• increased tissue oxygenation

Do not expect:

• endurance gains

• higher VO₂ max

• altitude-style adaptation

If you’re interested in altitude physiology

Expect:

• increased RBC mass

• improved aerobic capacity

• higher VO₂ max at sea level

• better mitochondrial function

Do not expect:

• faster healing

• anti-inflammatory benefits

• better immune function

7. Oxygen Is a Signal

HBOT and high altitude reveal something crucial about human physiology:

Your body does not respond to oxygen like fuel. It responds to oxygen like information.

Hyperoxia (when oxygen is in abundance):

Heal now. Repair tissues. Mobilize stem cells.

Hypoxia (when oxygen is low):

Adapt. Become more efficient. Build new systems.

Health and performance live in the oscillation between those extremes.

Thank you for reading -

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Interested in more detail? Scroll down to the detailed notes section from the cardiology conference…

For more insights on managing weight, improving fitness and working towards your longevity goals, refer to previous posts of our YOUNG CENTENARIANS newsletter.

Before we start, here’s an AI party trick to impress your friends: Ask ChatGPT (or any other AI) to guess one number between 1 and 50. Scroll to the bottom to see which number you probably got!

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Image taken from this week’s Economist article on ‘Good and Bad Cholesterol’.

Summary

In my life, I have attended multiple conferences and I am often impressed (and overwhelmed) by the abundance of life-changing insights on the latest word of Science and Medicine. I have also always enjoyed the sense of community that conferences help create between people with a common goal: extending life and improving the quality of life. In other words:

Today’s conference revealed a healthcare transformation is underway, but facing challenges getting the message across: cardio, lung, and metabolic diseases are being recognized as one interconnected system rather than separate diseases; yet most doctors out there, treat them as such...

!!! Here are my 5 actionable insights and takeaways that you can follow to improve your heart health, beyond the usual lifestyle advice that you will often hear. TIME TO ACT NOW: Whether you are 25 35 or 75 years old, take this to your GP or your heart doctor and discuss it !!!

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1. Your Lungs and Heart Are Linked—Your Chronic Cough Might Signal Heart Issues and Vice Versa

• COPD (chronic obstructive pulmonary disease aka a chronic lung disease) and cardiovascular disease share the same inflammatory pathways. 40% of COPD flare-ups are driven by undiagnosed heart problems, not just lung issues. When you have a sudden flare-up, your cardiovascular event risk spikes within days—but hospitals still treat lungs and hearts separately.

YOUR ACTION: If you have COPD, recurrent coughs, or shortness of breath, ask your doctor for an NT-proBNP blood test (a heart stress marker) and a thorough assessment of your heart health. Levels above 587 pg/mL during exacerbations signal hidden cardiovascular stress. Don’t wait for obvious heart symptoms; get screened proactively.

2. Your Cholesterol Medication Alone May Not Be Enough. 80% of People Need Combination Therapy

• Statins (the most common drug for managing LDL levels) only achieve 20-30% LDL reduction even at maximum doses. But new combination therapies are actually more effective. Further increasing statin dose is not an effective approach. Instead, new drugs and combinations (such as NUSTENDI (bempedoic acid + ezetimibe)) can achieve stronger LDL reduction on top of statins—whilst delivering further heart protection in high-risk patients

YOUR ACTION: If you’re on a statin (simvastatin, rosuvastatin etc) but your cholesterol (LDL) isn’t going down or your target isn’t being hit, don’t accept “that’s the best we can do.” Ask about adding ezetimibe, bempedoic acid or even explore a PCSK9i inhibitor (inclisiran, LEQVIO).

3. LDL Cholesterol Should Be Targeted More Aggressively and Earlier than Previously Thought

Why do we care about reducing cholesterol? Because the evidence that it contributes to heart-related events such as stroke, heart attacks etc is very strong. Older guidelines aimed for LDL ~70-100 mg/dL. New evidence shows “lower is better”; the greater the LDL reduction, the greater the heart benefits reduction. For people with multiple cardiovascular events or genetic risk factors, targets drop to <55 mg/dL or lower.

YOUR ACTION: Do you know your LDL level? If not, get your LDL measured. If it’s above 100 mg/dL and you have any cardiovascular risk factors (family history, prior events, diabetes, kidney disease), work closely with your doctor and nutritionist. This is no longer optional management—it’s foundational.

4. You Must Test For Your Lipoprotein(a) (Lp(a)) Levels; Few People Understand how Important it is, and Yet 1 out of 5 are affected. Diet Won’t Change It, But Knowing It Can Save Lives

Roughly 20% of the population have higher than normal Lipoprotein(a) (Lp(a)), a cholesterol particle that’s 5x more ‘sticky’ than regular LDL and directly triggers heart disease and stroke. It’s genetically determined (diet can’t change it), but most doctors routinely ignore it. ESC 2022 guidelines recommend checking it at least once in your lifetime.

YOUR ACTION: Request an Lp(a) test at your next checkup (you only need to do this once in your lifetime!), especially if you have family history of early heart attacks or strokes. Normal Lp(a) is <50 nmol/L; if you’re elevated, you need to intensify LDL and blood pressure management even more aggressively, since there are no Lp(a)-lowering drugs at the moment (there may be in the coming years). Until then, we have tools to manage all other heart-related risk factors such as LDL cholesterol, inflammation and blood pressure.

5. High (and Stubborn) Blood Pressure Needs Aggressive and Early Management. Most People Struggle because they Just Don’t Take Their Meds

The breakthrough: The most “resistant” high blood pressure cases resolve when patients actually take all their medications consistently. For true resistant cases, new targets like CETP inhibitors and baxdrostat are emerging to lower pressure through novel pathways.

YOUR ACTION: If you’re labeled “resistant,” audit your medication adherence with brutal honesty. Set phone reminders, use pill organizers, or ask family to help. If you truly have resistance after maximal adherence, ask about clinical trials or rare-disease specialists—breakthroughs are coming, but they’re not yet mainstream.

Interested in the detail? Read further below…

Detailed Notes from the cardiology conference (CVRM UK) in London, earlier today:

*CVRM stands for cardio-vascular, renal and metabolic and refers to diseases of the cardiovascular system (heart failure, stroke etc), kidneys (chronic kidney disease etc) and metabolism (diabetes etc).

Welcome Session: Kevin Fernando (Intro):

• Tremendous advances in CVRM including SGLT2 and GLP1 among others.

• Rethinking how we conduct trials when these treatments have life altering benefits. (Refer to Graphical Abstract – “Approaches to clinical trial design for CV, kidney and metabolic diseases” (Eur Heart J).

• Suggesting that basket trial designs looking at multiple comorbidities is important (including MASL, CKD, HF).

• *MASLD is a metabolic, not a liver disease primarily.

• TRIUMPH-Outcomes study is the retatrutide outcomes study (next gen incretin – triple agonist) and includes multiple different populations looking at the benefit in different populations with different comorbidities.

• Breaking down barriers in trial design.

Respiratory Disease and CVRM risk: Beverley Bostock, PCCS President Elect, Advanced Nurse Practitioner and Professor Chris Gale, Prof of Cardiovascular Medicine.

• Primary care physicians do not have the advantage of saying they specialise in any disease. COPD and CVD link is clear.

• Case study of a 54 year old lady who smoked since 12 and now vapes. Recurrent cough, breathless on exertion and treated with a dual bronchodilator, comfort eats, drinking alcohol, 2 exacerbations this winter. Did not change lung function (not commonly seen in COPD). Daily life is really impacted.

• Aims of COPD are to prevent further disease progression, relieve symptoms, improve exercise tolerance and health status, prevent and treat complications and exacerbations, minimise side effects and reduce mortality. Mortality is more cardiovascular than respiratory.

• Comorbdities of COPD patients:

  • 

• Interventions include supported self management and education, smoking cessation, pulmonary rehab, flu/pneumonia/coronavirus vaccinations, bronchodilators, inhaled CS, mucolytics (going out of fasion), chest clearance (UK is not great at using these devices)

• 

• Prognosis is dire with 40% dying after x years

• Cause of death differs by COPD serverity. In the late stages, the deaths are driven by cardiovascular.

• CV diseases and risk factors are many (hyperlipidemia, hypertension, PAD, CVA, CAD, CHF, AF)

• Cardiopulmonary events in COPD include: COPD exacerbation, myocardial infarction, stroke, heart failure decompensation, arrhythmia, death due to any of these events. Hence start to include Major Adverse Cardio Respiratory Events

• Often asymptomatic until exacerbation occurs. CV latent effects and complications occur.

• COPD patients who exacerbate (come to hospital and get treated with antibiotics, etc) you do not see the immediate CV complications, and this can happen in the first few days of exacerbation. It is siloed by the thought process of doctors and the treatment journey (e.g. PCPs will not look for it). Risk of CV events increases with more exacerbations. The worse your exacerbation the higher your risk of CV.

• ICRA (International CV and Respiratory Alliance) – free to join. Global alliance including patient advocacy, HCP education, original research and more.

• How to identify and manage cardiopulmonary risk in COPD? Assess CV risk profile against COPD risk profile. Then, identify COPD in people living with CV disease. Have an index of suspicion in patients who have regular colds, smoke etc.

• Management of COPD in people living with CV: evaluate lung disease severity beyond spirometry. Tailored chronic disease management strategy, follow COPD guidelines, minimise beta2 agonist bronchodilators

• Identifying these patients: if patients are coming through you need to understand that COPD is a systemic disease beyond the lungs, and CV is important.

• Management of CV disease in people living with COPD. Perform primary CP assessment. If you suspect heart failure you do NT-proBNP. Do history and examination, observations and scores, blood panel

• CP actions: management and optimization through lifestyle advice and treatment options

• QRISK algorithm massively underestimates CV risk, but QR4 includes COPD as an independent risk factor for CVD much better

• 

• 2026 GOLD Report: Cahpter on CV disease and chapter on therapeutic interventions that reduce mortality. Should COPD be considered a CVD risk equivalent? We should not see cardio and respiratory as separate as there is a large overlap.

• Think outside the box: score 10% or more? Relative risk increased? Ask about menopause?

• Smoking cessation: treatments more likely to succeed are cytisine, varenicline, dual NRT

• Triple inhaled therapy: Trimbow, Trixeo, Trelegy. Trixeo developing a new version that is as good as Trimbow for the environment.

• AECOPD means: assess CVD risk, educate about the link, cholesterol management, optimise inhalers, pulmonary rehab

• Mental health issues are significantly higher

• Case study approach: discussed current concerns in a person-focused way, assessment of physical and psychological well being, management of COPD/CVD risk factors

• Patient and clinician understanding of the COPD and CV link is essential

  

AI in CVRM: Professor David Strain, Associate Prof in CM Health at University of Exeter Medical School. AI in healthcare: enhancing patient outcomes.

The rate of doubling knowledge is accelerating extremely fast. It now takes roughly 30 days to double our current medical knowledge. AI is seen by many as a tool to make things a little bit quicker. Multidisciplanary approach – doing things differently systematically, and foundationally. Not just about doing things quicker. Transformative potential of AI.

• AI in clinical admin: staff rostering and capacity planning, automated clinical documentation etc

• AI in radiology: widely used for image recognition, helps detect tumors, fractures, hemorrhages, assists radiologists in interpreting X-rays, CTs, and MRIs

• AI in ophthalmology: screening for diabetic retinopathy and glaucoma, AI analyses retinal images for early intervention, used in community screening programs.

Black box issue: today’s medical students may learn with AI but not with the traditional trial-and-error method, which means when AI messes up, they may not be able to spot that vs today’s doctors trained 20 years ago with the traditional tools

• AI in cardiometabolic disease: CGMs analysis

• Digital twins to test personalisation: virtual patient to see how they will fair in every clinical trial there’s been to see which drug is the best to give them

• Obstacles: legacy IT systems, data interoperability, culture and expertise, investment, privacy, ethics, regulatory hurdles

• The need for caution: not all AI tools are clinically validated, data bias can worsen inequalities, errors may be harder to detect, AI can influence decision-making without transparency.

Horizon scanning in CBRM: What’s around the corner by Nadia Malik

• Incretins are reshaping CVRM. Multiple molecules in the pipeline. GLP1, GIPR, Amylin and others. Reduce weight to help with glucose, inflammation and more. From a glucose centric approach to weight centric. The net of diseases being explored is becoming wider and wider (e.g. Novo’s negative result with semaglutide in Alzheimer’s earlier this week). One medication to treat lots of conditions.

• 

• MOONRAKER and THUNDERBALL programs by Bayer in HF and CKD. Siloing and box structuring in NHS and different specialties, a key hurdle on . New targets coming out: cagrisema, retatrutide, baxdrostat, combination therapy, Lp(a), CETP.

  

• Most resistant hypertension is people who do not take some of their medication.

• Rethink how we look at our patients. It’s not about a single score for risk, in a single disease context for a single disease. Need to think broadly, polypharmacy and multi-disease context. As the basket trials come out you can see that this is becoming more true, whereby, multi-/combination approach is helping address most or all risk factors at once.

• Frustration about the system, but people working on the ground are willing to find ways to overcome these hurdles on a daily basis. They are willing to take risks.

Looking into the future: normal to feel overwhelmed, lots is going to be coming through all at once. Focus on the patient and what they tell you. Make small achievable goals.

Lipid management by Mike Cummings

• To reduce a killer in diabetes, it’s cholesterol and blood pressure that have a better CV risk reduction, vs hyperglycemia.

• 

• The greater the LDL reduction the greater the CV events reduction

• It’s about intensive LDL reduction and longer duration

• Q-risk calculator is very useful and dynamic for lifetime risk prediction

• Combined long term risk factor improvement leads to considerable reduction in risk for CVD and mortality

• SANTORINI study, showed how well different EU countries are addressing lipid parameters. UK has the best introduction of statin therapy but we know that a large % will need combination therapy and that’s where the UK are the worst right now.

• The rule of 6: doubling the dose of statins does not double the LDL-C reduction.

• What tools are available to reduce cholesterol values: statins, ezetimibe, bempedoic acid (NILEMDO and NUSTENDI)

• NUSTENDI is an oral non-statin that can help patients reach target LDL

• Combines the complementary mechanisms of action of bempedoic acid and ezetimibe

• Less cholesterol in the liver, so the liver expresses more receptors to mop up cholesterol (Once daily preparation)

• It fits in the paradigm after those who have reached max dose of statins and ezetimibe alone.

• Significant LDL-C reductions on top of maximally tolerated statins vs placebo and vs ezetimibe. Noted CVOT data with both ezetimibe and bempedoic acid. Risk of gout is flagged, especially higher in those with pre-existing gout.

• CLEAR Outcomes study (NEJM): 14K patients with high CV risk and had either bempedoic acid or placebo. Primary endpoint of MACE-4. Event driven study. 13% (HR 0.87) on MACE-4 reduction

• Non statin therapies increasingly being used.

• Audience question challenged whether bempedoic acid is the best choice for those with slightly elevated cholesterol that will gain minimal benefit from bempedoic but not significant, but that would make them ineligible for inclisiran (PCSK9i).

Lipid management workshop

• CV death in the UK had levelled off but now starting to rise and that is not due to covid alone

• elevated Ldl and loa levels are a dominant risk factor contributing to plaque and inflammation

• Need to get LDL levels down and as early as possible

• 

• NHS has very conservative targets in secondary prevention, instead the ESC guidelines which are not affordability based should be preferred

• ⁠For patients with more than one event and polyvascular disease, target LDL is even lower. In that population, no LDL low amount is low enough.

• Case study of 47 year old with fatal MI and no recorder history

• Familial hypercholesterolemia: excess CVD can be eliminated with 8% of people
  - ⁠ask about family history of MI, ideally do DNA testing for apoB100 or PCSK9 mutation

• if under 40 a very pronounced corneal arcua lipidus and xanthoma tendonitus

• 100% of men with fh and 75% of women have an event by 70.

• always try for a definitive diagnosis; ensure referral

• results were polygenic hypercholesterolemia and one variant found for Lpa.

• PH can be almost as damaging as FH

• 2 FH and 17 PH out of 100 people with MI.

• combining Qrisk with genetic score doubles the risk

• Lp(a): 20% have raised levels in a Caucasian polulation. Mainly genetically determined. Diet has no effect. Independent causal factor. Consists of LDL like particle and it is 5 times stickier than LDL particle.

• 

  Despite managing LDL, there is remaining (residual) risk stemming from Lp(a), another lipoprotein similar to LDL.

  

  

  

  • proatherogenic; proinflammatory and prothrombotic

  • in the UK nothing is being done about it.

  • In ESC 2022 consensus statement said thst we should measure it at least once in an adult life.

  

  • Even if no direct medication for it the other factors should be managed actively.

  • heart UK consensus advised to test for it and especially in the presence of first degree relative with higher than 200 LPa

  • focus on blood pressure management, nonHDL management

  • currently lipoprotein apheresis, Cetp inhibitors, statins may increase levels but no increase of events

  

  CVRM stands for cardiovascular, renal and metabolic diseases and these are related in many more ways than we previously thought. Treatment is thus now considered in the context of all these.

  

  The sooner you can intervene to improve kidney function, the better the outcomes

  

AI party trick answer: Did you get ‘27’? Thought so…

• Health & Longevity (Young Centenarians) and,

• Biotech Investing (High Risk, High Returns)

These two newsletters are part of my evolving efforts to bridge science, health and investing across a range of thematics. Women’s Health is a thematic that has received inadequate amounts of attention and capital long enough, by health systems, researchers, pharma/biotech and investors. My involvement in this new venture, therefore, aims to address that!

Introducing XX innovation

Today marks the beginning of XX innovation—a platform built by ambitious problem-solvers, united by a single purpose: to reimagine and improve the future of women’s health. For months, we’ve been working behind the scenes, shaping ideas that address real challenges faced by half the population.

Why “XX”?

What’s Next?

This website is only the beginning. In the coming months, you can expect stories, educational resources, and fresh perspectives spanning hormones, pain, misconceptions, mental health, and more. Our mission is to drive real conversation and action, addressing gaps and pushing boundaries in women’s health.

How to Get Involved

• Visit the website: https://xxinnovation.com/

• Follow us on Instagram: https://www.instagram.com/xxinnovation/

• Read our articles (new ones every week), share your experiences and join the conversation—your voice matters and will help shape what comes next.

Join us as we help rewrite the story of women’s health—together.

With excitement and gratitude,

The XX innovation Team

Disclaimer: I am not a medical doctor and anything included in this newsletter should not be considered as personalized medical advice. Please consult your physician for advice on this subject.

A personal story on autism –

As a pharmaceutical consultant I spent thousands of hours researching and analysing which companies develop which drugs for which diseases or disorders. It’s an important step to understand what the competition is doing, where the opportunities lie and which drugs are likely to be the future blockbusters. Thus, in the early stages of my career, starting out as a consultant supporting mostly big pharma clients, I was placed in a project focused on autism. For almost three years I worked with one of the largest pharmaceutical companies developing a drug that was meant to be a future treatment for autism (spoiler: it didn’t make it through Phase 2!).

Through this project I had the privilege to travel to different parts of the world to attend conferences focused on autism. INSAR (International Society for Autism Research) is the largest of them and takes place every year, with an unfathomable amount of research presented on this topic driving our understanding of this complex disorder forward.

My goal was to understand the full landscape of “competitors” my client would be facing if their drug were to make it to the market a few years down the line, and a conference like that was the perfect opportunity to see all the latest developments coming from academia and big pharma. Like that, I developed a very detailed understanding of what autism really is, and what pharmaceutical approaches were being pursued by big pharma or smaller biotech companies in hopes to tackle a highly lucrative market that was at the time valued at $4bn+, considering 1 in 42 people is believed to meet ASD criteria.

What is autism or ASD?

Autism spectrum disorder (ASD) is a complex neurodevelopmental condition that begins in early childhood and is characterized by persistent differences in social communication and interaction, as well as restricted, repetitive patterns of behavior, interests, or activities. The symptoms and support needs can range widely, and some individuals require significant help while others live independently. Autism is understood to result from differences in brain development, with genetic factors playing a major role and environmental factors having a smaller influence. Social communication and repetitive behaviours are the core symptoms, with peripheral/associated symptoms expressed in some but not all patients.

Luckily I was able to dig up a slide (that I made at the time…) of what the clinical landscape of this disease looked like almost 8 years ago.

You can see many big names in the ‘race’ such as Roche, JNJ and Takeda, but also smaller players/biotech companies. You can also see molecules with different mechanisms of action and with the potential (!) to treat autism (or parts of autism) targeting different parts of the human biology.

Targeting the oxytocin and vasopressin pathways were the ‘hottest’ approaches at the time. Other approaches involved: targeting the electrolyte imbalance in the synapses, whereas the most bizarre approach at the time (when microbiome research was not as popular and the importance of the gut brain-axis was still not in the consensus thinking) was using faecal transplant to improve ASD symptoms (CM-AT in the image).

Though I’ve stayed a bit out of touch with the autism landscape, and wouldn’t be able to tell you the ‘who is who’ of autism pharmacology research, what I do know as an analyst of the pharmaceutical space for the past 10 years is that I am still waiting to hear about a drug with meaningful data and clinical evidence in improving the lives of autistic patients. That’s how challenging and complicated this disorder is (remember this point…!).

Regardless, 8 years ago, when I was attending autism conferences as part of my job, I could see there was hope on the rise. More academic groups, more biotech companies and more big pharma companies were starting to invest their resources into ASD. I recall my first INSAR conference in 2017, had included only one session covering pharmaceutical approaches towards tackling autism, featuring clinical trials (with half of the presentations including trials in chimps, not humans!) in progress or completed with results, which the next year increased to multiple sessions involving clinical trial data, suggesting there was more investment and interest in this space!

My first INSAR conference, however, is the most memorable one of all; but not for a very hopeful reason…

At the time (in 2017), the two prevailing, experimental approaches for treating autism were focused on (1) oxytocin pathway (aka the “love” or “cuddle” hormone), and (2) vasopressin pathway (aka anti-diuretic hormone). The principal investigators of the respective approaches, coming from different institutions (academic and pharma), presented data from their studies, although neither of them seemed to be convincing enough as the next big cure for autism.

Looking back, it is clear to me each presenter had an agenda and personal ego, which possibly led to a reluctance of acknowledging each other’s approach. Autism research had been compromised by money, politics and personal ego.

This is to show that even within the highly educated and sophisticated scientific community, there is the temptation to put ego, political or financial interests first. This ultimately forms a barrier to interpreting data without bias, uncovering the truth and advancing Science.

Fast forward to today, barriers to understanding the truth on Science and Health continue to exist (within the scientific community, and in politics alike), causing confusion and frustration in decisions related to people’s health. Since politics is not my forte, I think I am better qualified to at least say that it is a human trait to not think scientifically and to fall into common traps of misinterpreting information.

Context: Trump, Tylenol and Autism warning

On September 22, 2025, the Trump administration issued a press release announcing major initiatives focused on autism, including a warning that acetaminophen (Tylenol, aka paracetamol or acetaminophen) use during pregnancy may be linked to increased autism risk in children. The administration called on the FDA to revise drug labeling and advised physicians to avoid recommending acetaminophen to pregnant women unless absolutely necessary.

The announcement sparked controversy across the medical and scientific communities. Autism researchers and professional groups disputed the claims, emphasizing that the evidence cited by the administration is based on limited and conflicting observational studies, not on robust clinical or epidemiological data. Experts warned that such statements risk misleading families and undermining evidence-based medical practice.

This matters because acetaminophen is widely viewed as the safest option for pain and fever relief during pregnancy, and changing its recommended use could leave pregnant women without safe treatment alternatives while increasing unnecessary fear. The evidence for the administration’s statement came primarily from a handful of observational cohort studies and reviews, but the largest and most rigorous analyses, including sibling-control studies, have found no causal link between acetaminophen use during pregnancy and childhood autism. Most medical authorities continue to recommend acetaminophen as appropriate when medically indicated during pregnancy, highlighting that genetics and other factors play a far greater role in autism risk

The below is therefore a summarised collection of insights throughout my reading and podcast listening and summarised for simplicity! The key point is that for many reasons, as important as it is to find an answer on this topic, it is extremely difficult to dissect the impact of a single pain-relief drug on the rates of autism, when autism itself is such a complicated disorder, mostly driven by genetics (and/or epigenetics), and with multiple other environmental parameters having shown a much larger effect size and stronger evidence for a causal link. Despite what the evidence shows, however, everyone could still consider exercising caution and acting with a risk-benefit framework in mind when it comes to using paracetamol during or around pregnancy. See below for more detail.

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Evidence from the largest studies we have

• Autism rates have increased nearly five-fold over the past generation, but evidence strongly shows no single environmental factor—including acetaminophen—is responsible for this rise; rather, expanded diagnostic criteria and increased awareness account for most (about 60-90%) of the change.

• The claims connecting acetaminophen use in pregnancy to autism stem largely from observational studies. A systematic review in 2024 summarised prior data, finding a small association, but the evidence is inconsistent and often vanishes with rigorous controls, such as sibling comparisons or more complete statistical adjustment.

• The largest studies from Sweden (2.5 million children) and Japan (220,000 children) both showed, after sibling control, that any association between prenatal acetaminophen and autism disappears—suggesting non-causality.

• Small single-site studies have many methodological flaws, such as poor measurement of true exposure and strong bias from participant selection, making them far less reliable as evidence.

Interpreting Risk and Causality: not an easy task

• The estimated effect size in the pooled data is a 5% relative risk increase (hazard ratio: 1.05), which translates to an absolute increase of less than 0.1%—a vanishingly small number that all but disappears with rigorous statistical scrutiny.

• Genetics account for 80-90% of autism risk (strong heritability component), far outweighing any observed environmental factors, and the most relevant modifiable contributors, such as advanced parental age, maternal obesity, and infections - carry much stronger associations than medication use like acetaminophen.

Practical considerations on paracetamol use

• FDA pregnancy safety categorization places acetaminophen in Category B, implying that, based on human and animal studies, Tylenol is generally considered safe for use in pregnancy, especially compared to alternatives like NSAIDs, which are riskier, especially in later trimesters.

• For minor aches, pains, or low-grade fevers, it may be prudent to minimize medication use in pregnancy. However, for high fever or when pain threatens maternal health or wellbeing, acetaminophen remains the preferred option, as untreated maternal fever itself poses much greater risks to the developing fetus than acetaminophen exposure.

• In the absence of definitive randomized controlled trial data (which is unattainable for ethical reasons - because you cannot select a group of pregnant women and give half of them a potentially risky drug and others a placebo), epidemiology must be interpreted with caution, using frameworks and not simply headlines.

Final, practical thoughts: think in ‘risk-reward’

• The probability that using acetaminophen in pregnancy causes autism is very low based on current evidence; if a risk exists at all, it is trivial next to genetic and other established factors.

• Decisions about medication in pregnancy require balanced judgment, weighing not just theoretical risks from the medication but also the risks of leaving conditions untreated.

• The greatest increase in autism diagnoses is explained by genetics, diagnostic expansion, and awareness—not by medications like paracetamol.

If you are new to this newsletter, make sure to check previous content such as:

• Inside the GLP-1 Boom: What a Biotech Analyst and PhD/Nutritionist Thinks

• Why willpower alone is not enough in becoming healthier

• Setting health GOALS, picking a clear STRATEGY and the right TOOLS: a full guide for all ages and levels

• Your Blood Tests Should Look Like This If You Wish To Be 100+ years old

• The simplest guide to understand your blood results

And if you’re here for HOS’25 content, make sure to check our Day 1 summary and stay tuned for more HOS’25 coverage later this week!

• Health Optimization Summit 2025 – Day 1: Sessions Recap/Notes + Key Takeaways!

• Health Optimization Summit: What we're excited about, full agenda and tips for 1st timers!

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Key Takeaways & Recurring Themes

Quotes and actionable insights that stayed with me!

• “If business is your priority, it will lead your life.”

• Just 7k steps a day gives you half the mortality benefit of 15k.

• Early calories = better digestion; movement > exercise.

• Spirituality matters: connect to something bigger, not just your molecules.

• Faith, not fear, is the ultimate medicine—not just for you, but your community.

• “Don’t be the doctor who doesn’t listen”—to patients or to yourself!

What’s your n=1 breakthrough? What small daily practice will you commit to?

Full Notes from Today’s Key Sessions

Ben Greenfield / Tim Gray

10:00am - 10:40am - (Power Plate Stage) Ben Greenfield & Tim Gray

• Creatine and NAD discussed in the context of thoracic mobility.

• Thoracic mobility exercises:
   - Exercise 1: World’s greatest stretch
   - Exercise 2: Thoracic expansion from a crawl
  - Exercise 3: Deep squat with rotation

  
   - Recommend sprinkling these exercises throughout the day.

• GLP-1:
   - Standard advice: eat plenty of protein and lift weights.
   - Reality: it’s really hard to have an appetite for enough protein while on GLP-1.
   - Smaller doses can help with lipid management and have neurological benefits.

• Ketones:
   - Emerging research; BHB (beta hydroxybutyrate): D configuration for the brain, L for fatty acid synthesis and fat burning.
   - Ketone Lab (D/L): doesn’t taste good, but is cutting-edge biohacking for neurological benefits.
   - Preferred fuel for the brain, liver, and thoracic muscles.

• DHM/Synbiotics:
   - Incredible if you’ve been drinking and are concerned about liver enzymes—best “mop-up” post-drinking.

• Role of religion:
   - Strong belief in objective morality and Christianity; conquest of meaning and faith in a higher power.

• Priorities:
   - “If business is your priority, it will lead your life.”

• Morning routine:
   - Reading the Bible and creating a positive mindset for the day.
   - “There will be time during the day for biohacking and business; but if you can find some time in the morning for yourself and God, it will be very useful.”

• Purpose & mindset:
   - The bigger purpose and mindset matter most.

• Bio-spirituality:
   - It’s possible to lose the sense of connection to God when “high,” but it’s not about breaking rules; spirituality can be enhanced, but ideally, reach it without molecules.

• Leading by example:
   - Especially in the family setting.

• Book:
   - “Stillness is the Key” by Ryan Holiday recommended – practice 5–10 minutes of silence with yourself.

  

• Why would he return to HOS’25 each year?
   - Community passion fuels him; his mission is to help people become healthier and find their purpose.

Dr. Karan Rajan

11:00am - 11:40am - (Power Plate Stage) Medical Myths Busted - Dr Karan Rajan

• UK doctor; had health adventures that changed his approach.

• Theme: n=1!

• What’s normal in blood testing?

  

• NMN, NAD:
   - Not always in the guidelines, but what’s good for population data may not benefit the individual.

• Gut health and microbiome: his major passion.

• Missed bowel cancers:
   - 50% get missed due to different fecal blood test cut-offs by country.

• “When you hear hooves, think horses, not zebras”:
   - Medical training prioritizes efficiency, not always accuracy.

• Endometriosis:
   - Gut symptoms can mask systemic conditions; common misdiagnosis.

• Belief systems:
   - We must keep updating our beliefs.

  

• Normal labs ≠ healthy:
   - NHS and WHO have different diabetes cut-offs.

• Gut microbiota:
   - Hadza, Italians, USA all vastly different microbiomes; sleep, community, movement, fiber are commonalities.

• Movement > exercise:
   - Blue zones emphasize movement.

• 7k steps/day:
   - Approaches 50% reduction in all-cause mortality, nearly as beneficial as 15k steps.

• Walking:
   - Keeps LDL moving, blood vessels evolved for constant low-level stress/movement. Walking is unmatched.

• Social isolation:
   - Major risk for dementia; key death nail.

• Obesity:
   - Not lack of willpower; it’s very complex and multifactorial.

  

  

• Gut health:
   - Knowledge has exploded in the last 10 years. Gut = everything.

• Nutrition research:
   - Red meat alone isn't linked to poor outcomes; studies often misrepresent. Moderation and context are key.

• Meal timing:
   - Earlier caloric intake is better for digestion.

• Supplements:
   - Valuable role; omega-3 shown beneficial unless eating fatty fish constantly.

• Radical idea:
   - What if everyone got a standard vitamin, omega-3, and creatine package?

Barbara O’Neill

• Truth and freedom:
   - These are linked; “The truth shall make you free.”

• Fear and faith:
   - Complete opposites—major theme!

• Be your own doctor:
   - Listen to your body, use common sense.

• Advice to patients:
   - “Don’t be the doctor who doesn’t listen.” Herbs are for humanity.

• Cayenne pepper:
   - Stops bleeding and is a vasodilator.

• Respect others' opinions:
   - “Thank you for your opinion” you can say to your doctor - and keep looking for answers

• Symptoms:
   - Body’s way of saying “Can you do something about it?”

• Red blood cells:
   - Carry nutrients, oxygen, waste.

• SUSTAIN-ME principles:
   - Sunshine: Use Aloe Vera gel instead of sunscreen, time your exposure, melanin is protective, cholesterol converts to vitamin D. Sunlight can reset body clock and jet lag. Vitamin D helps calcium and minerals enter the body; magnesium brings water into cells. If tired in the afternoon, consider (Celtic) salt. Thirst and hunger can be confused; sip water with a little salt.
   - Water: Hydrate early; the brain needs it. Get that after-cold-plunge feeling. Save morning coffee for after you move.
   - Sleep: Melatonin made 9pm–2am, crucial for regeneration. Comes from gut flora; most powerful antioxidant. Drugs must be eased off slowly. Sleep early, ideally 2 hours before midnight.
   - Work/play: 8 hours each for work, sleep, play. Work and play with kids, go to bed early!

• Self-healing:
   - Have faith in your body.

• Drugs:
   - Don’t cure, only shift the disease’s format/location.

• Method:
   - Give it time, ask questions, abstain.

• Alcohol:
   - No safe dose; eliminate toxins.

• Inhale/Breathing:
   - Inhaling through your nose purifies/humidifies/pressurizes air. Mouth is for speaking/eating. Nose optimizes gas levels.

• Nutrition:
   - Legumes are nutrient-dense; wheat now over-bred, gluten allergy/new wheat structure linked to diseases. Drugs hurt gut flora—restore with yogurt, kefir, fiber. Start fermented foods in small doses. Protein, fiber, and fats essential. Ditch cheap seed oils (use coconut/olive).

• Movement:
   - Move in the morning for all-day benefits.

• Miscellaneous:
   - RFK Jr. got thimerosal out of the flu vaccine.

That’s it folks…thanks for reading!

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Whether you attended HOS’25 or missed it, don’t worry! We covered the meeting in great detail and share our notes from the most important sessions we managed to attend! Read the key themes and health takeaways of the first day and scroll further down to read our notes! Look forward to tomorrow’s conference wrap! Stay tuned -

Key Themes & Viral Takeaways

1. Biohacking Is About Agency—But Don’t Lose the Plot

• Biohacking is about individuals reclaiming their health—taking power back from systems built around averages and giving it back to the unique “n=1” in all of us. The heart of biohacking: “I can do something about my problem.” But beware—chasing perfection has a cost. If Optimization means sacrificing community, compassion, or joy, it's time to rethink what health is really for. Data’s cool, but trust and self-compassion are the real superfoods.

2. The Mind-Body Link: Stress & Forgiveness Are Medicine

• Chronic stress and lack of forgiveness aren’t just metaphors—they show up as high blood sugar, even autoimmunity and cancer. Radical ownership of mindset, learning not to take offence, rituals of solitude, and simply keeping a promise to oneself are some of the most powerful forms of health optimization.

3. Personalization Is the New Prescription

• From bloodwork to tongue diagnosis, the future of health isn’t one-size-fits-all. Your mitochondria, your microbiome, and even your ideal exercise (racquet sports rule!) are unique—biohacking is realizing this before “blanket protocol” medicine does. Whether avoiding the dirty dozen, filtering your shower water, or dialing in your fasting, it’s about what your body needs today.

4. Killing Chronic Disease Starts with the Basics

• No secret: toxin overload, chronic stress, poor nutrition, sleep deficiency, and sedentary habits are most modern disease's root cause. New tech (CGMs, DNA clocks, plasma exchange) offers promise, but the baseline is still “move more, eat real, sleep a lot.”

5. Longevity Revolution: Health Is Becoming an Engineering Problem

• Aging as an engineering challenge? That’s the bet—from Moore’s law in medicine to Yamanaka factors and AI-powered biology. The next decades will be about tracking and hacking the “hallmarks of aging” as if lifespan were an app—spit kits for cell-free DNA, wristwear for mitochondria.

6. Nature Still Wins—But Now We Can Measure It

• From red light to hydrogen water, ancient modalities are getting their molecular close-up. If mitochondria (powered by photobiomodulation, hydrogen, and nature) can turn back the clock, and practices like grounding and sunshine nourish the immune system, the Hippocrates adage returns: “Let food be thy medicine…and maybe photons too.”

My actionable health recommendations from HOS’25 Day 1

Make one promise to yourself daily—and keep it.

Filter your water, eat your veggies, and call your friends.

Measure less, move more, delete guilt.

Tidy up your morning routine and stick to it: it carries a lot of power for how your day unfolds

If you want to shrink your problems, grow your purpose.

The next big trend: exercise compassion with yourself and your circle

Notes Summary

Tim Gray – Opening Remarks

• “If you want to shrink your problems, grow your purpose.” – Tim Gray

• Today, there are 4,250 attendees.

• Austin, Texas HOS’25 Summit had 2,600 people.

• “We love being healthy. We love helping others. The space is growing.”

• Retreat in Corfu, Greece, announced with more details to follow.

Dr. Rangan Chatterjee and Tim Gray

10:45am - 11:40am (Power Plate Stage): Dr vs Biohacker: Where we align (and Clash) - Dr R. Chatterjee, Tim Gray

What has the biohacking world got right?

• Biohacking is about agency and empowerment; when medicine goes wrong, it’s about dependency and disempowerment.

• At its core, biohacking says, “I can do something about my problem.”

• N=1 approach: “what’s going to work for me”. Medicine relies on population data and blanket protocols.

• Typical NHS consultations for diabetes don’t empower patients to control their condition.

• Dr. Chatterjee: CGM is the “best tool” for behaviour change in diabetes—real-time feedback about what works for you.

• Wearables are helpful when used for (1) a certain period, (2) a certain purpose, (3) learning something new about yourself.

• Kipchoge uses his Oura ring, but never looks at it on race morning.

• Ask yourself: “What is your relationship with your wearable?” It should be that you own the data, not the data owning you.

• Key learnings from CGM: stress significantly affects blood sugar levels; diabetes is not just a dietary disease.

• Chronic stress is a strong influencer of blood sugar.

What has the biohacking world got wrong?

• People get obsessed with health data; need to be aware of the costs of decisions/actions.

• Chasing perfect metrics can lead you to give up time with family and community.

• Biohacking can go to extremes: “What are you optimizing your health for?”

• Compassion pill: the most important thing is relationships, not metrics.

• “Not everything that can be measured matters, and not everything that matters can be measured.”

• Difficulty with forgiveness can be linked to autoimmune issues or cancer.

• Internal world matters: studies tie forgiveness with lower blood pressure.

Managing your internal and external world

• The four pillars: food, movement, sleep, stress.

• Stress can be both internal and external.

• Words are not inherently stressful—reaction comes from within.

• Learning not to take offence is key to health.

• “The greatest prison is inside your mind.”

• Nightly practice: review moments where you got triggered; radical ownership of mind/emotions.

• “Be impeccable with your work, don’t take anything personally.”

• Ask: “How could I have done better yesterday?”

• Behaviours often respond to other problems.

Biggest health advice

• Community is crucial, but so is solitude—be comfortable with quiet.

• Embrace micro-moments of silence.

• Mindfulness, movement, and mindset—make habits easy enough to stick to daily.

• Miracle Morning book recommended.

• Most “toxic” thing: breaking promises to yourself breaks self-trust.

• Make a small daily promise and execute it.

Personal story:

• After his father’s death, his back pain disappeared—something deeper, a weight of responsibility was lifted.

Dr. Josh Axe

12:00pm - 12:40pm (Power Plate Stage): How to Reverse ‘Incurable’ Diseases - Dr Josh Axe

How to Reverse Irreversible Conditions?

• Story of herniated disc/spinal infection; lost 40 kg.

• Used: hyperbaric chamber, IVs, peptides, methylene blue, stem cells; year-long recovery.

• Another person had to have discs fused.

• The body has a strong capacity to heal.

• Different organs have different biological ages.

• Ability to live to 120, but we do 40+ years of damage.

4 Keys to Healing and Longevity

1. Reduce toxicity.

2. Optimize nutrients.

3. Increase cellular energy.

4. Personalize diet and medicine.

• Personalization: Chinese medicine/Ayurveda reads the body.

• Toxin overload: PFAS and glyphosate exposure are widespread.

• Sugar is hidden everywhere.

Toxins:

• Metabolic: sugar, seed oils, artificial sweeteners.

• Pathogenic: mold, parasites, viruses, bacteria.

• Environmental: pesticides, additives, skincare, metals.

• Mind: negative mindset, childhood trauma, addiction.

Top 5 Ways to Reduce Toxin Exposure:

• Filter water (reverse osmosis or carbon block); add a shower filter.

• Avoid conventional meat/dairy—choose organic or grass-fed.

• Switch to non-toxic cleaners/personal care.

• Ditch plastics—use glass/stainless; never microwave in plastic.

• Eat organic “dirty dozen”—wash produce well.

• Baking soda reduces pesticide residue.

• Avoid pork/shellfish due to parasites (cancer risk).

• Beef bacon is a good swap.

Fasting:

• Powerful for many, but sick people should fast one day a week, not daily.

• Women with hormonal issues need regular meals.

Mold:

• Vinegar may help remediation.

Nutrient Deficiency:

• 40-75% fewer nutrients now versus 100 years ago.

• Buy local.

Fatigue:

• Mitochondrial depletion (“cells’ batteries”).

Supplements and Superfoods:

• Ashwagandha relieves stress and helps with Yang.

• Pomegranates, Urolithin A.

• Organ meats, probiotic foods, holy basil.

Personalize Your Plan:

• Tongue diagnosis: ridges = weak digestion, coat = digestive issues, redness = emotional stress.

Stress, Sleep, Spiritual Growth:

• 80% of doctor visits are stress-related.

• We sleep 30 min less than before—lack of sleep raises disease risk.

• Faith, mindset, emotions, positive thinking are all important.

• Tips: Write down memories that bother or bring peace; read for enjoyment; allow healing time.

Exercise and Cardiovascular Health:

• Best longevity sport: racquet sports (social + cardiovascular).

• Cycling, swimming, weights, jogging.

• Cardiovascular foods: fatty fish, meat, greens, berries, beets, tomatoes, walnuts, olive oil.

• Supplements: CoQ10, omega-3s, garlic, hawthorn, ginkgo, magnesium, heart gland.

• Activities: aerobic, interval, meditation, strength training.

Immune System (“Inflammaging”):

• Lack of oxytocin (deep connection) weakens heart.

• Eat: chicken broth, miso, pears, yogurt, onions, garlic, ginger.

• Herbs: astragalus, elderberry, echinacea.

• Exercise outdoors.

Metabolic/Digestive, Detox, Hormonal: (see slides).

Hormonal:

• Men: high protein, grass-fed beef, bone broth, cruciferous veg, pumpkin seeds, fatty fish, zinc, Mg, rhodiola, cordyceps, fenugreek, vitamin D; strength, VO2 max, good sleep, stress management.

• Women: flaxseed, fatty fish, sweet potatoes, beans, avocado, goji berries, ashwagandha, holy basil, methylated B complex; need to feel safe, often low in Yin (moisture/cooling).

Resources:

• The Biblio Diet book.

• The Dr. Axe Show.

Garry Lineham

14:00pm - 14:25pm (Power Plate Stage): Release Stress & Regulate your Nervous System in Minutes - Garry Lineham

Dr. Shah

14:30 - 15:10 (Oxyhelp Stage): The Future of Medicine: What all doctors should be doing to optimise healthspan - Darshan Shah MD

Personal Story:

• In 2016 weighed 235 lbs, high BP, joint pain, autoimmune.

• Med school didn’t teach him how to keep himself healthy.

• Used functional medicine—went from 12 pills to 2.

• Founded clinic: NEXT HEALTH optimization & longevity centers.

Frailty:

• Increases risk for falls, immobility, delirium, incontinence, medication side effects.

Healthspan vs Lifespan; Medicine 4.0:

• Lifestyle, preventative, functional, longevity medicine.

Goal 1: Get Basics Right

• Nutrition, movement, sleep.

• Pareto (80/20 principle): avoid ultraprocessed foods, any diet works; avoid sedentary, any movement works.

• “Exercise snacks” (move every 45 min).

• Identify what works for you (n=1).

Goal 2: Eliminate Chronic Disease

• Inspired by Peter Attia: top 10 killers/diseases.

• Be hyper-preventative; don’t wait till too late.

• New tech: know when to use it.

Heart Disease

• 50% of heart attacks are fatal.

• Cholesterol alone not a great predictor; coronary CT scan at 40 checks plaque.

• ApoB is also important.

Cancer

• New diagnostics: cell-free tumor DNA (e.g., Grail’s GALERI). Getting cheaper.

Brain

• Alzheimer’s: pTau 217, amyloid ratio.

Goal 3: Stop Disease at Its Root Cause

• Dr. Jeffrey Bland’s work: inflammation, hormone deficiency, gut dysbiosis, chronic stress, insulin resistance, toxins, mitochondrial dysfunction, oxidative stress.

Goal 4: Longevity

• Moore’s law: exponential growth in anti-aging tech.

• AI applied to biology will make it a computational engineering problem—stop disease, reverse aging.

• Sam Altman’s project with 4 Yamanaka factors.

• Hallmarks of Ageing (Cell paper), plasma exchange, DNA age clocks (Horvath clock).

• Where to start: mindset first.

• “A healthy person wants a thousand things, a sick person only wants one.” – Confucius

• The age of medicine: predictive, personalized, preventative, participatory.

• First shift: stop blaming/depending on the system, take ownership.

• Build your own health system: coaches, experts, support group.

• Be CEO of your own health: measure blood pressure quarterly (aim for 120/70), track grip strength, use CGM for diabetes risk.

• Glucose Revolution book recommended.

• Build the “health mindset.”

Habit Formation Books:

• Miracle Morning, The Power of Habit, Atomic Habits.

Free Guide:

• www.drshah.com/biomarkers

James Caroll

15:30pm - 15:50pm (CELLER8 Stage) - Red Light Therapy Protocols for Optimal Recovery: How to improve HRV, VO2 max and sleep - James Caroll

• Inventor of NovoThor; 120 academic papers, 40 clinical trials.

• Goal: make red light therapy a recovery cornerstone.

• Red light therapy = photobiomodulation (PBM).

• 1,762 clinical trials, 757 dental/oral RCTs, 99 brain RCTs, 5,000 lab studies.

How can one treatment address so many issues?

• Works on mitochondria: crucial for energy, reactive oxygen species (ROS).

• Light absorption causes shifts in energy and ROS balance.

• Increases blood flow (critical for oxygen delivery), anti-inflammatory.

• Dose-response is key—not too much, not too little.

Medical Uses:

• Oral mucositis, dermatitis, xerostomia: >60% reduction in patients needing morphine for oral mucositis.

• Fibromyalgia: 12 treatments in triple-blind RCT improved endpoints.

• AMD (age-related macular degeneration): device study in 100 patients showed sustained benefit.

How clinically significant are these results compared to biologics?

Sleep/RHR/HRV and Sleep Time:

• Study in female athletes using Oura ring; used twice per month—less need for sleep, reduced resting heart rate, improved HRV.

• Single dose increased VO2 max by 7%.

Dr Vonda Wright

16:30pm - 17:10pm (Power Plate Stage): Become Unbreakable: A Woman’s Ultimate Guide to Ageing with Power - Dr Vonda Wright

Gary Brecka

17:40pm - 18:40pm (Power Plate Stage): Unlocking Optimal Health & Longevity Through Optimising Genetics and Supplementation - Gary Brecka

• Most people aren’t healthier/happier due to modifiable risk factors.

• Wants to build an “army” of health optimizers.

• “The presence of oxygen is the absence of disease.” – Gary Brecka

• Ensuring all tissues get enough oxygen is key.

• Longevity: global experts agree that “immuno-fatigue” is a universal driver.

• Immune system as the body’s principal guardian.

• Leading research uses the best of nature: vitamin D3, sunlight, grounding, whole foods.

• Nature is medicine; so is food and movement.

• Methylation pathway: every cell undergoes trillions of methylation events.

Why don’t we ask: Does the body have the raw materials?

• Example: dopamine gene (tyrosine to dopamine); deficiencies here may drive addiction.

• Anxiety: rise in catecholamines = excitement, increased heart rate, fear.

• Homocysteine: high levels cause hypertension; not just familial, but modifiable.

• 30% of blood pumped by heart, 70% in microvascular system.

• Very rarely do multiple systems fail at once; usually one domino falls first.

• If you find and fix the “one thing,” you can help heal the whole.

Molecular Hydrogen:

• Historical: too much oxidation is bad, but too little is also harmful—need RE-DOX homeostasis.

• Hydrogen’s role in oxidative stress, vascular health, anti-cancer.

• NRF2 pathway: regulates RE-DOX via DNA, manages homeostasis.

• Hydrogen water—6-month study in 70-year-olds showed cognitive improvements.

• Deep sleep crucial for lymphatic drainage and detox.

• Hydrogen gas improves supplement absorption.

• After hyperbaric oxygen sessions, hydrogen is needed.

Keep scrolling to see:

• Tips & Logistics

• The full agenda

• What we’ll cover

Logistics & Tips for 1st timers to enjoy the experience to the fullest!

• 📱App! Download the Bizzabo app for access to the full schedule and companies/products that will be in the exhibition stage with a booth

• 🗓️Agenda and planning! Most sessions are running in parallel to each other, which means you will inevitably have to miss some talks. Spend 15’ in advance of the summit to prepare which sessions you want to prioritize and prepare a planner for yourself (see below for screenshots of the entire agenda)

• 📍Location! Business Design Center (2 Upper St, London N1 0QH)

• 🎫 Badge collection! Arrive super early (9:00am or before) to avoid standing in long queues to collect your badge, IF you wish to watch the first sessions. Arrive after 10:30 to collect your badge, IF you are in a more relaxed schedule. Bring an ID just in case! No need to print the ticket, just show the QR code or ticket receipt.

• 🚶‍♀️Queuing up for sessions! “First-come, first-serve”. Popular sessions can fill in very quickly with long queues outside the corresponding rooms. If you really want to watch a talk live, get in there early!

• 🏢 Exhibitors! Browse the exhibitors list in the Bizzabo app to find interesting products, and think about signing up for slots offered to try out their products and services (slots fill up quickly!)

• 💬 Community! In your itinerary email, you will have received a link to join the Whatsapp group for all attendees. Useful for Q&As and more!

• 🎉 Enjoy! Take in the entire experience, connect with people, take photos, explore the booths, products and freebies!

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Agenda

Saturday, 13th September 2025

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Sunday, 14th September 2025

Sessions we will be EXTRA interested in, this weekend!

Saturday:

• 10:45am - 11:40am (Power Plate Stage): Dr vs Biohacker: Where we align (and Clash) - Dr R. Chatterjee, Tim Gray

  • OR…11:00 - 11:40 (Oxyhelp Stage): How to Use Hyperbaric Oxygen for Optimal Performance Recovery and Brain Health, Hagen Thiers

• 12:00pm - 12:40pm (Power Plate Stage): How to Reverse ‘Incurable’ Diseases - Dr Josh Axe

• Exploring Exhibition Booths (and break!)

• 14:00pm - 14:25pm (Power Plate Stage): Release Stress & Regulate your Nervous System in Minutes - Garry Lineham

• 14:30pm - 15:10pm (Power Plate Stage): Biggest Health Lessons and Best Hacks from my Toughest Year Yet - Tim Gray

  • OR…14:30 - 15:10 (Oxyhelp Stage): The Future of Medicine: What all doctors should be doing to optimise healthspan - Darshan Shah MD

• 15:30pm - 16:15pm (Human Garage Workshop Area): Relieve Pain and Reprogram Your Body Through Fascia - Aisha Rodrigue Lopez, Jason Van Blerk

  • OR…15:30pm - 15:50pm (CELLER8 Stage) - Red Light Therapy Protocols for Optimal Recovery: How to improve HRV, VO2 max and sleep - James Caroll

• 16:30pm - 17:10pm (Power Plate Stage): Become Unbreakable: A Woman’s Ultimate Guide to Ageing with Power - Dr Vonda Wright

• 17:40pm - 18:40pm (Power Plate Stage): Unlocking Optimal Health & Longevity Through Optimising Genetics and Supplementation - Gary Brecka

Sunday:

• Exploring Exhibition Booths

• 10:00am - 10:40am - (Power Plate Stage) Ben Greenfield & Tim Gray

• 11:00am - 11:40am - (Power Plate Stage) Medical Myths Busted - Dr Karan Rajan

• 12:00pm - 12:40pm - (Power Plate Stage) Finding Freedom - Peter Crone

• Exploring Exhibition Booths

• 14:00pm - 15:00pm (Human Garage) - Relieve Pain and Reprogram Your body through Fascia

• Science enthusiasts

• Pharma/biotech consultants, analysts

• Investors in the life science space

• Doctors, nutritionists, health coaches, fitness coaches

• People considering or already on weight loss medication

• Longevity enthusiasts

I help you:

• Understand what weight loss medications are

• Get a list of the key obesity players in the pharma/biotech space

• Understand lifestyle strategies to get the best outcomes out of GLP1s

Free Resources included:

• Obesity development landscape and launch timelines

• Weight loss data from key drugs in development

Comment ‘Health’ and I will share a US market model template to help you forecast weight loss drug sales yourself

See inside for disclosure

Intro to Weight Loss Medications (WLMs)

Unless you are living under a rock, the words “GLP1”, “Ozempic”, “Wegovy”, “Mounjaro”, “weight-loss medication” must not be new to you. Weight loss, heart protection, kidney protection and more recently brain protection…and of course, anti-ageing - the long (and growing list) of benefits of the drugs pumped out by Danish Pharma, Novo Nordisk and US Pharma, Lilly.

• Should you take a weight loss medication?

• If you take it, what should you expect?

• If you take it, what lifestyle changes should you apply?

• What other drugs will become available in the future?

• What are the risks and benefits?

🚧 Quick disclosure - as a pharmaceutical and biotech equity research analyst at one of the largest banks for the past 5 years, I spent lots of time analyzing one of the two companies mentioned above, which means I was partly responsible for our team’s view of which pharma companies presented a good investment opportunity for institutional investors who were our clients and had access to our research. I no longer have any affiliation with the bank and therefore I aim to derive a facts-based analysis, whilst any views expressed here do not represent investment advice or the views of my former employer. My current views are expressed in the context of independent and un-conflicted analysis and should be taken as such. I welcome all types of feedback and constructive discussion to improve my content.

Glad that’s out of the way…so let’s continue!

What happened all of a sudden and everyone is talking (or taking) weight loss medications?

Well, to begin with, the population’s weight is going up. See below.

Figure 1: Obesity rates on the rise in the US

Why? I’ll leave that for another post. For now, we better focus on the ‘so what?’.

The ‘so what’ of the story is that with an increasing weight, most aspects of our health are at a higher risk. In more clinical terms, obesity has multiple comorbidities. For example, obesity and diabetes are connected to diseases of other organs as shown below, such as:

• liver disease or MASH (metabolic associated steatohepatitis) affecting 250 million people globally,

• CVD (cardiovascular disease) affecting >500 million globally,

• HF (heart failure) affecting >60 million globally,

• PAD (peripheral artery disease) affecting 200 million people globally and,

• AD (Alzheimer’s Disease) affecting 70 million people globally.

Figure 2: Diseases associated with obesity and global numbers (Source: Novo)

Thankfully, these can (to some extent) be addressed through losing weight. For example, we know that people who lose weight through lifestyle changes or weight loss medications, see an improvement in a variety of health aspects. Also read: Consequences of Obesity on Health & Wellbeing (23/04/25)

How do they work?

Weight loss medications have existed for a while, but they tended to be associated with limited weight loss results and problematic side effects, which did not allow for a wide-spread adoption by the masses.

GLP-1 agonists were originally designed to treat Type 2 diabetes.

• These medications imitate the natural hormone GLP-1 (glucagon-like peptide-1), which prompts the pancreas to release insulin.

• This action is especially important for people with Type 2 diabetes, whose pancreas does not produce enough insulin. Managing Type 2 diabetes often involves boosting insulin secretion and enhancing the body’s sensitivity to insulin, allowing glucose to be absorbed more easily by the liver and muscles.

• Initially, GLP-1 agonists were used mainly to lower blood sugar levels and hemoglobin A1c in diabetic patients. However, newer versions of these drugs—such as semaglutide (Ozempic, Wegovy) and tirzepatide (Mounjaro, Zepbound)—have been shown to significantly reduce both weight and hemoglobin A1c.

In simple terms, these drugs ‘curb hunger’, so you don’t eat as much, calorie intake falls below the required amount of calories to maintain your weight (i.e. calorie deficit) and thus weight loss and reduced HbA1c ensue (along with the improvement of other biomarkers). Also read: The 3 Types of Hunger (24/04/25)

My take on this is that, in some way, this could be considered as ‘outsourced discipline’, allowing people to control their food intake without going through the mental, physical and social challenges of controlling one’s intake through willpower alone (see the most recent post on willpower: Why willpower alone is not enough in becoming healthier (14/07/25)). As a nutritionist, I understand that all tools in our toolkit that could help people achieve their desired goal should be welcome and assessed for its benefits and risks. Weight loss medications are no different, especially when the potential health benefits are so large.

In more scientific terms, these drugs have multiple modes of action, including:

• in the pancreas (insulin secretion goes up, glucagon secretion goes down to lower blood sugar levels; stomach emptying and gut motility go down to give you a longer feeling of fullness),

• in the liver (reduced glucose production; similar to metformin, a popular and cheap diabetic drug),

• in the brain (activates your feeling of fullness)

• in the muscles (increases their ability to ‘burn’ glucose and produce energy)

• in the fat tissue (boost lipolysis through glucose uptake)

Figure 3: Multiple organs impact by weight loss drugs

Hence, a new era of marketing these ‘anti-diabetic’ drugs also as ‘anti-obesity’ began a few years ago, with different drugs targeting one or more of these hunger hormones that play a role in the regulation of appetite, sugar levels and overall metabolism.

Figure 4: Different hunger hormones that are being targeted by Pharma companies for drug development

What’s coming next?

A wave of drugs is currently in development to capture a market that is expected to be north of $100bn in size. At least in the US, the numbers are truly staggering with c 44% of people belonging in the obese or overweight group, which could increase to 53% by the end of the decade. Of these, a significant proportion are also diabetic. This represents a huge population (in the US alone) for companies to consider as a lucrative opportunity for a type of drug that only 3-4 years ago was not even in the picture - for the treatment of overweight or obesity, which was burdened with a huge ‘taboo’.

Now that we understand how central to our health, having extra weight is, and the potential of improving health outcomes (heart disease, cancer, brain disease, kidney disease, liver disease etc) through the reduction of weight, the path is wide open for pharma and biotech companies to develop and market such drugs.

Figure 5: Overlap of obesity and diabetes

With Lilly and Novo Nordisk currently the only two companies with approved weight loss medications in the US and international markets, the companies generated a combined $32bn in the US market last year alone and almost another $10bn outside the US.

Table 1: Total GLP-1-drug sales (US, $m)

I’ve crunched the numbers and I think there is a big opportunity here for the obesity market but perhaps not as big as people think. To summarize, on one hand the modest upwards trajectory of the obese and diabetic population provides a fertile ground for Pharma companies to sell more for the years to come, however, downside risks remain, including: pricing, compounders and overall competition, which will make it hard for companies like Novo and Lilly to maintain their growth.

🆓 Reach out directly to receive my obesity market model template.

Figure 6: Projected obese, overweight, diabetic and otherwise healthy population in the US (proprietary analysis; ask for my model)

Novo, Lilly…who else is next?

Below is a summary (definitely not exhaustive) for the landscape of weight loss drugs in development (including company name and formulation, dosing and mechanism), showing my estimation of when these could launch and become available for patients. I include my interpretation of what is the likely differentiation point for each new drug.

Note that there are drugs in development as sub-cutaneous (SC) administration (like current Ozempic, Wegovy, Zepbound, Mounjaro), whilst we won’t need to wait to long for the oral versions of these drugs to come out (next 6-12 months).

Another interesting class of drugs includes myostatin inhibitors, whose role is to help preserve muscle mass, which in alone or in combination with weight loss medications could help improve overall body composition, metabolism and health.

Figure 7: Obesity development landscape. Future drugs to reach the market. (Proprietary analysis based on public information)

Compounders in the picture (investor’s take)

“The explosive rise of compounded GLP-1 drugs has shaken up the weight loss industry, but is this disruption a passing fad—or a sign of an irreversible change?”

Compounding pharmacies sometimes combine GLP-1 drugs with other substances like vitamin B12 or Vitamin D to navigate regulatory rules. However, because compounded drugs can vary in form and quality, the medical stance is that patients should be cautious and only use reputable compounding pharmacies that follow strict standards to ensure safety and effectiveness. However, these rules tend to relax when there is a shortage of a specific drug.

Over the past year, companies like Hims & Hers significantly changed the weight loss medication market through aggressive adoption and promotion of compounded GLP-1 agonists. . Hims & Hers quickly pivoted to selling cheaper, compounded alternatives (such as vials rather than pens) to meet consumer demand and to work around drug shortages and high prices of the original drugs. This move allowed them build a strong subscriber base with a noticeable reduction in the price.

This shift had major financial repercussions for industry leaders like Novo Nordisk and Eli Lilly. In 2025, Novo Nordisk was pushed to cut its sales forecasts for Wegovy, explicitly blaming the rise in compounded alternatives for lost revenue and a sharp decline in its share price. Eli Lilly faced similar competitive pressure, prompting the company to launch its own vials of tirzepatide at much lower prices.

For Hims & Hers and related compounders, this has been a double-edged sword: while Hims’ shares soared earlier in the year, they experienced harsh corrections amid regulatory uncertainty, as partnerships with drugmakers were suddenly terminated and as the FDA resolved drug shortages, threatening the legal viability of compounded offerings. We know that compounded medications filled a critical gap during shortages, both Novo and Eli Lilly are now ramping up manufacturing and online distribution, which is likely to squeeze compounders’ market share going forward.

That’s why I believe companies like HIMS and HERS (in the US), Numan (UK) and others may be in a good position to capitalize on this and any other opportunity that emerges (think: peptides, testosterone replacement therapy and more), although regulation remains a massive risk for the time being.

🤠 Ok, taking my biotech investor hat off now, and putting on my nutrition coach hat…!

Just started my weight loss medication (WLM): what to expect & tips on maximising benefits from GLP-1s

The first thing I would say to anyone who is on a WLM or thinking about it, is ‘well done’, and that it is exciting to be on the journey of improving your health, your looks and how you feel.

There is a lot of noise when it comes to these medications, however, with people ending up scared, and others expecting miracles out of them only to end up with disappointment.

I’m going to break it down and help you:

• How to use nutrition, exercise and sleep to get the best results from the medication

• Whether WLMs are a short or long term solution

⚖️ Weight loss effect to expect

Studies across different drugs and in different populations (obese, diabetics) have shown that weight loss can be significant. For the approved drugs, the following table summarizes the data from clinical trials on weight loss and how long it may take to get there. Note: these are averages, suggesting that some patients did not lose as much weight, whilst others exceeded these numbers.

Table 2: Expected weight loss over time

Even more potent drugs are in development. The following interactive chart (credits to BayBridge Bio) gives a more detailed picture of those future drugs and their weight loss potential! Lilly’s retatrutide (triple agonist targeting GLP1, GIP and glucagon) promises to be the most potent of all.

Figure Source: Bay Bridge Bio - Link

⏱️ What happens in 6 and 12 months from first dose?

Weight loss could happen as early as few weeks in, for many, but people on WLMs should play the long game, regardless of results. Let me explain!

Picture yourself in 1 year, 2 years and 3 years or longer. Even if you have the slowest progress possible, you could be at -15% of your starting weight in two years from now! That would be impressive and powerful for your overall health, even if it takes longer than you would wish or expect!

Based on what your doctor recommends and how you progress, you could should consider taking blood tests roughly every 3 months to monitor progress in key blood biomarkers and how they are improving. Of course, during that time you will track your weight and that will also inform how well the medication is working.

At 6 or 12 months, depending on the progress made, the doctor might recommend keeping the same dose if there is no slowing of the weight loss, or if there is no further improvement for some time, so you may be switched to a higher dose.

People who are on semaglutide (Novo’s Ozempic or Novo’s Wegovy) could consider switching to tirzepatide (Lilly’s Mounjaro or Lilly’s Zepbound). Lilly’s versions have recorded a more powerful weight loss effect, believed to be due to a dual-action on two hormones (GLP-1 and GIP).

🫀 Other health benefits to expect:

Now that so many people have taken Ozempic and other weight loss medications for long periods, we know very well what the overall health benefits are!

• For example, as a result of the weight loss and the regulation of sugar, you should also see your HbA1c (blood sugar), blood pressure and cholesterol/triglycerides improve. This means that your heart and overall health will benefit greatly from this.

• Some results show that sleep quality also improves as weight loss progresses in the desired direction.

• Studies also have shown that kidney function (the organ the filters the blood and helps control blood pressure) can improve as well

• Heart disease risk also is known to improve. The SELECT study on Novo’s Wegovy showed a c20% reduction in the risk of heart disease (heart attack, stroke or cardiovascular death) when taken for 5 years, compared to those who did not. Also read: 5 Lifestyle Factors For A Younger Heart (02/05/25)

• Neuroprotection is another area where benefits of using GLP1s are starting to generate evidence, specifically lower risk of Alzheimer’s, although data is still early. NOVO and LLY both are conducting large studies to demonstrate whether that’s true for their respective drugs.

🙃 Potential side effects (short-term)

Some of the potential unwanted effects from taking the medicine, mostly in the first few weeks, which tend to occur in most people taking WLMs at this dose are shown below.

Note that these were people with serious diabetes diagnosis, so it would be expected your chances of any of the above would be lower. Regardless, these are all resolved quite quickly in most people. See below to learn what you can do to manage those issues.

Nausea: some dizziness, nausea may occur as a result of your body trying to adjust to the reduced appetite and reduced food intake. In some cases, some vomiting or other GI issues might occur. Not to worry, but do discuss with the doctor!

🙃 Potential side effects (long-term?)

In the recent history of GLP1 development and in light of millions of people who have used them for a long period of time, concerns for long-term side effects have made news headlines several times, however, large studies and long term follow-up of users have not revealed any definitive long term risks

💪 Maintaining muscle and losing more fat - step-by-step guide.

We know that on average, for every 1kg people lost whilst on Wegovy, approximately 0.3kg was muscle, and 0.7kg was fat. However, we can improve the odds of maintaining more muscle and losing more fat, if we do the following:

• 🏋️ Focus on strengthening exercises, for example, work with weights to build muscle. Increase the weights or number of repetitions over time as you get stronger.

• 🚶‍♀️ Walking: this will help with the fat burning and to enhance the appetite suppression effect.

• ⬆️ 🧀 ⬇️ 🍕 There is evidence (see this study) the ketogenic diets (think: low in carbohydrates), and higher in protein and fats can be beneficial.

• 🍌 🥕 Increase intake of vegetables and fruits. This is because we want good nutrients coming in to avoid losing nourishment as your body will ‘ask’ for less food than usual and the risk could be that you intake less nourishment than you need. Protein + vitamins/minerals = nourishment. Though no specific study can be referenced to suggest that higher intake of vegetables and fruits can help, we know that a generally less processed, higher fiber diet (As in Mediteranean-type diets) can help with overall health and function and long term health outcomes, such that its importance should not be diminished or forgotten whilst on WLMs.

• 🧂 Take some salt (add it to your fruit, or your water, or your veggies) when you feel low on energy. It is possible you will feel low on energy as your calorie intake has reduced, especially in the first few weeks, with the temptation to look for sugary options making it more likely that you will indulge in less nutritious, processed, calorie-dense foods.

• 💤 Sleep will be important in this process. Ensure you get adequate rest at night and during the day.

• 💦 Water and hydration - with some salt from time to time will help for better hydration. Staying hydrated will keep your metabolism running well. At night you can take some magnesium if you are feeling fatigue. Also read: Science-Based Hydration Strategies for Better Living & Performance You Didn’t Know (05/05/25)

Longevity community couldn’t resist GLP1s…

Given our newsletter’s core focus is on longevity itself, we couldn’t help but give the perspective of the longevity community on GLP-1s and other WLMs. Long story short:

• Weight loss medications are increasingly being “microdosed,” meaning they’re taken at much lower-than-standard doses, not just for weight management but also for their emerging reputation as anti-aging therapies. See recent WSJ article here

• Enthusiasts (biohackers?) and some longevity-focused clinicians believe that microdosing these drugs offers benefits beyond weight loss, such as improved metabolic health, glycemic control, reduced systemic inflammation, and potentially even a lower risk of age-related diseases.

• This has led to a surge of interest in using GLP-1s as so-called “anti-ageing miracles,” with proponents suggesting that their positive effects on blood sugar, appetite regulation, and cardiovascular health may help promote healthier ageing.

• Early clinical and anecdotal reports are promising, yet robust long-term evidence for their anti-aging claims is still limited, and experts caution that these medications should be used thoughtfully, under medical guidance, until more research confirms their safety and effectiveness for this purpose.

“Never say I ‘i can’t’. Only say ‘i don’t want to’”

That’s a phrase I grew up hearing from teachers, elders, trainers.

One interpretation was: “don’t tell yourself you are unable to do something, rather just admit you just haven’t found the way - yet!”

Another one is: “you don’t want it enough; once you really want something, you will figure out how to get it”

In other words, willpower is all you need.

That phrase has always stuck with me as a mantra.

A little “voice” to everything I did, or didn’t do.

Not getting high grades? You don’t want it hard enough

Didn’t score a penalty? You didn’t want it hard enough

This little “voice” in my ear helped me to keep pushing

To look inwards and question whether I am giving it my best. Whether I want that “something” badly enough.

Sounds like tough love, but looking back, I’m thankful for this little “voice”, which told me to look for what is in my control.

Not to focus on excuses, on how the referee screwed us, on how my teammates didn’t step up.

This voice of “willpower” continues to follow me throughout adulthood in my career, my fitness, my family and my approach when helping people achieve their health goals.

But things have started to change.

When helping people create positive change and form new, healthier habits, I’ve had to learn and understand that willpower and willingness, as well as powering through difficult situations, are not enough.

I’ve had to become more sensitive and understanding to the fact that people usually fail, not just because they don’t want something hard enough, but they also lack the right tools, or systems.

A quote by James Clear (author of Atomic Habits) says: “You do not rise to the level of your goals. You fall to the level of your systems.”

Willpower is not enough. You need good systems and tools in place.

Willpower alone will not fix society’s health problems

Our society’s inability to understand this is why we have failed for the past two decades to tackle key health issues such as obesity, simply labelling it as a matter of having the ‘willpower’ to exercise more and eat less.

That thinking, whilst technically correct, has failed to catch up with the reality and the complexities of human psychology, the complex biology of hunger (read: The 3 Types of Hunger) and metabolism.

The past few years have led to a dramatically enhanced understanding of we can tackle obesity, and more broadly how we can more effectively create change for a healthier living, more holistically.

We’ve learned that we need more than willpower and willingness. We need to be ready and capable as well.

A better framework for introducing health change

In the space of health and nutrition, the framework used for that is called: “willing and ready”

In order to achieve change, one ought to ask themselves:

• Am i willing? (How open am I to the idea of it?)

• Am I ready? (Do I have the skills, knowledge and tools to do it?)

Why does this matter?

• Being willing: as a coach helping people introduce changes to their lives to achieve certain health goals, I often see that not everyone is open to following any recommendation given. For example, a 65 year old client was initially very closed to the idea of doing strength training, and only wanted to focus on walking. In that case, after discussion it became clearer that the barrier was mainly awareness as to why strength training will be beneficial and how it will help them achieve their goal.

• Being ready: It was also a matter of comfort, and being reluctant to try a completely new style of workout. That does not mean the client was not capable, just they didn’t feel ready! And that’s the key: the perception that one is not ready can change! How? The client was otherwise healthy, albeit a beginner in the fitness space, but in most ways, technically ‘ready’ to follow a step-by-step guide on how to a new type of workout they had never done before.

It was clear that we needed to ‘educate’ the client to shift their mindset from ‘not willing’ to ‘willing’, by providing a clearer understanding of the benefits of strength training (build muscle, improve metabolism, help lose weight etc), and from not ready to ready by showing what the workouts would look like.

To address this, we headed to the gym together with the client and walked them through a set of full body exercises, starting small and simple. We took notes on weights, reps, sets and proper form. Clear instructions on warm-up and stretching were given. At the end of the one hour session, everything was clear. The client had now seen first hand what a strength training workout involves.

It didn’t involve ‘crazy lifts’, or ‘fancy movements’.

Just a simple set of movements the body is familiar with, but with an addition of extra weight to increase the level of difficulty.

Mindset changed.

Gone from ‘not willing’ to ‘willing’ and from ‘not ready’ to ‘ready’!

New habit formed and now on their way to achieving their weight loss goal and overall fitness goal.

The key takeaway is that people need to be both willing and ready before embarking on a path of change, as this is more likely to result in an effective adoption of a new habit and eventual improvement.

How to help yourself create positive change and start a new healthy habit?

Research tells us that if you want to learn something or help yourself, first try it on someone else.

So, here’s a framework way to help a friend, client, family member or colleague, with bringing a positive change to their life, when something seems to be signalling that they are not willing or ready.

Then, apply it to yourself! Think what healthy habit or change are you hoping to introduce to your life.

Are you willing? Are you ready?

Follow the framework, and see where the bottlenecks are. Then tackle those bottlenecks relentlessly or pick another strategy until you are once again ready.

Remember that this is just one tool of many and that you should work with someone who knows how to help you with a structured plan to achieve your personal health goals (Setting health GOALS, picking a clear STRATEGY and the right TOOLS: a full guide for all ages and levels)

Thank you for reading -

It’s been a while…

When I started this newsletter, my goal was to bring information that I come across everyday in the world of health, and package it into helpful, reasonable and realistic actions for my friends and family.

After 2+ years of incubating the idea of a ‘Young Centenarians Newsletter’, along with the strategy and the content that would be part of it, the first post was made in late April.

That was followed by a series of daily posts for 2+ weeks straight. That was a good start.

But, as we all know from experience, life gets in the way of our goals, our priorities shift around temporarily, and habits that took a long time to form, fall behind.

This was true with my newsletter writing habit, and it’s often true with people’s journey to keeping healthy.

The important thing to remember when you deviate from the path, is to always find a way to come back on track and keep trying.

As long as we keep coming back with a renewed effort, energy and determination, the chances of meeting our objectives, will never be zero.

From there, one needs to have a good PLAN in place, to ensure their efforts are not a waste of time.

A good PLAN usually needs to have:

🎯 a clear GOAL,

♟️ driven by a clear STRATEGY,

🔨 made of effective TOOLS.

That’s why today’s article, will give an introduction on:

1. setting personal, realistic and meaningful health GOALS for ourselves,

2. defining a clear and effective STRATEGY and

3. choosing the most appropriate TOOLS to help us execute this strategy and succeed,

…even when life gets in the way!

In summary (…if you’re busy to read the article in-full), remember the following:

• Whilst setting your GOALS, think about what you’d like to be able to do in ‘x’ number of months or years, and work backwards to understand where you are now and how much better you should be at this task TODAY to ensure, as the years go by and your abilities (naturally) decline, you end up at a comfortable level of ability or skill to perform the task when that future ‘deadline’ arrives. For example, your GOAL could be “to be able to go on long walks with my grandchildren when I’m 80 years old”.

• Whilst defining your STRATEGY to achieve the above goal, remember, to first pinpoint the current limitations you are facing. For example, it could be that your legs are currently too weak to carry you through more than a 3km walk. The strategy employed in that case would be to “strengthen my legs and build lower body muscle”. You can stack additional strategies on top of each other. For example, a second strategy could be to “build a strong foundation of heart and lung capacity through cardio-based training”.

• Whilst picking your TOOLS to execute the above strategies, remember to choose tools that work for your lifestyle, personal preferences, budget and other factors, as long as you can remain consistent in using those tools week-after-week for a long time, and as long as you have easy access and does not pose injury risk. For example, a beginner athlete whose strategy is to “strengthen my legs through weigh lifting”, the appropriate tool in that case could be, “doing gym weights 2x a week”, instead of “doing crossfit classes 2x a week”, as the second option could result in injuries for someone who is not used to high intensity style training like crossfit.

Read below for more detail and scroll to the end to download your free goal setting template.

🎯Let’s start with your GOAL…

The challenge of today’s healthcare system is that people and doctors will tackle a health issue once it becomes a problem, and typically treatments are not long term solutions to the real problem. For example, lowering cholesterol by starting a treatment of statins (a very common approach of most doctors today and for the past couple of decades), does not address the core issue, which in most patients may be the fact that they are eating more than they need to and moving less than they should, resulting in weight gain.

In order to avoid this whack-a-mole approach in getting healthier, we may need to flip the conversation with our doctor.

What if, next time you visit the doctor and get a recommendation for a medical treatment, take a moment to ask them: “What is the objective here, doc. What are we trying to do, long term?”. The aim is to help start a conversation, which could help your doctor provide you with a bigger picture plan in remaining healthy for as long as possible. It is, however, a lot to ask from your doctor, to create an objective for you when they have a limited amount of time in their hands, and 10 more patients waiting for them in their lobby.

That’s why the future of health relies heavily on people taking full ownership of their own health as a first step, which would mean, thinking about their own health objectives.

Here are some example objectives:

“I wish to be able to carry my groceries from the car to my kitchen, at the age of 75, without help”

“I wish to be able to play a 60’ football match, with my old friends, until the age of 50”

“I wish to be able to go on long walks with my grandchildren, and keep up with their pace, even when I’m 80”

“I wish to be able to get up from the chair, unassisted, at the age of 90”

“I wish to eliminate my risk of heart disease (given my family history and current lab results) and live heart-disease-free into my 70s”

📍 (I would be interested in hearing your objectives, so feel free to write them in the comments, or if shy, write them in a sheet of paper, or share them with a loved one. Then, keep reading to see how you can turn your objective to a strategy)

The reason for framing an objective in the above way serves (at least) 2 purposes:

1. 👁️ It gives you a clear and visible goal. When you write something down, it gets one step closer to becoming a reality. It helps you visualize what you are aiming for.

2. 🔢 By giving a clear metric, with a clear deadline, you can now work backwards to the present day to understand what is your starting point and how much gap you need to cover to get to your goal.

For example, in the case of objective number 1 (”i wish to be able to carry my groceries from the car to my kitchen, at the age of 75, without help”), for someone who is now age 55, this could possibly mean:

• Being able to carry groceries that weigh approximately 5kg on each side, for a distance of 20meters (i.e. from the car to the kitchen) at the age of 75, means…

• …Being able to carry a little bit more than that (perhaps 7.5kg on each side?) at the age of 70, which means…

• …Being able to carry a little bit more than that (perhaps 10kg on each side?) at the age of 65, which means…

• …Being able to carry a little bit more than that (perhaps 12.5kg on each side?) at the age of 60, which means…

• …Being able to carry a little bit more than that (perhaps 15kg on each side?) at my current age of 55!

Doing this quick mental exercise of backwards extrapolation, you can quickly see that in order to maintain a specific ability 20 years from now, you ABSOLUTELY need to be significantly more capable TODAY!

The reason is simply that over time, people lose approximately 1% of their muscle every year, and along with that their strength, balance and overall capacity to perform otherwise simple tasks.

In other words, “use it or lose it”….

What this tells us is that the person who wants to be able to carry their groceries of 5kg on each side in 20 years from now, should go to the gym TODAY, and perform simple ‘farmer carries’ with a significantly larger weight on each side and check the level of difficulty.

Training in this way, will enable them to have the necessary strength and balance when they need to, 20 years from now.

🚧 A word of caution: setting objectives needs to be realistic. Expecting to be a competitive skier after retirement, when you haven’t really been to the mountains in the past couple of years, probably sets you up for failure and likely injuries.

Similarly, expecting to lose 15kg (or 33 pounds) by the end of the year, when your starting weight is 90kg, might be for most people almost impossible unless you are willing and ready, and have the right strategy and tools to achieve such an ambitious goal! (see below chart for target % fat for males and females, as well as different types of weight loss you can expect within a span of 1 year, depending on how consistency of executing a plan).

A few tips on GOAL setting!

Tip 1: Choose a Priority Goal!

When setting goals, people often try to change too many habits at once - starting a diet, working out, sleeping more, and meditating, all beginning January 1st. Taking on multiple goals simultaneously typically leads to failing at all of them. Instead, set a priority goal by asking: What is the one goal I can dedicate proper time and energy to right now?

Tip 2: Choose an ambitious Goal!

Your goal should be ambitious enough to stretch you. Basic, easy goals won't create the mental engagement and productive stress needed to drive real growth and learning. So aim high with your target.

Tip 3: Define Specific Actions with metrics

Dont’ just say: “get fit,” “write a book” or “walk more”. Break down your desired outcome into specific action & steps to. For example, commit to “walking three times per week, each time a minimum of 8k steps”.

Tip 4: Make Time and Put it in your Calendar

I often find that planning my upcoming week on a Sunday, prepares me for the worst, if life gets in the way. I start with booking specific time slots for my workouts, and labelling these workouts. This ensures that I have no excuses when the time comes, my workout clothes are ready, I’ve fuelled my body with sufficient food and water and I’m mentally prepared for the challenge.

Tip 5: Don’t Tell the World about your goal (tell them how they can help you, instead)!

Psychology research has shown that people who share their big goals with a wider group of friends may be more likely to give up on their goals. The reason is that the positive encouragement from friends and family may be perceived by the brain as a reward, but without having yet put in the hard work. This eventually reduces motivation to continue pursuing the goal. So, for some people, keeping your goal to yourself may be better. For others, including friends and family in the process may become helpful, for example, explaining to your friends what you are trying to achieve and how they can help you, may serve you well long term.

****♟️Now, let’s think about building the STRATEGY…

A mistake most people make is that they often have a clear GOAL (let’s say, I want to gain 2kg of muscle and lose 5kg of fat, by next year), but skip the STRATEGY and go straight to “ok, now just tell me what to eat and how many hours to exercise”. And that’s almost always a recipe for failure, especially when the GOAL is somewhat long term and somewhat more complex or ambitious.

In other cases, when the GOAL is pretty clear and self-explanatory, for example, “I wish to establish a walking routine and maintain it for the next 6 months”, we can go straight to figuring out the TOOLS that will help you with forming this new habit, without much need for a STRATEGY.

In most cases, however, and for most people, there will be a time when a STRATEGY will be essential in order to achieve long term, challenging GOALS, such as “I wish to be able to go on long walks with my grandchildren, and keep up with their pace, even when I’m 80”.

So, we now need to think about helping this 50 year old person, develop the skills and functionality that by the time they are 80-years old, will be able to follow the rest of the family on long walks.

The STRATEGY in that case could potentially, be two-fold:

• (Part A) Build sufficient cardiovascular capacity 🫀

• (Part B) Build sufficient leg strength, stability and balance 💪

⛔ The first step would be to assess the root cause of the current issue or the limitations in reaching the goal. For example, let’s find out how long this person is able to walk right now at any given day.

• Can they walk 5km at comfortable pace? What about 10km? What about 15km?

• What seems to be the limiting factor when reaching their maximum distance? Is it a matter of leg strength, or the lungs and heart start to give way? Is it both?

This assessment can help us identify where the focus should be and what strategy we should focus on.

Part A: Example strategy to build sufficient cardiovascular capacity.

• Focus on improving breathing capacity and stamina under demanding conditions

Part B: Example strategy to build sufficient leg strength, stability and balance

• Focus on lifting heavy weights, especially lower body, to build more muscle

So, the STRATEGY must be tailored to your individual GOAL and needs to follow a particular logic, as explained above.

Other STRATEGIES could be:

• Improve triglycerides and cholesterol 🧪 —> 🩺 to reduce heart disease risk

• Improve blood pressure 🩸 —> 🫀 to reduce heart disease risk

• Improve mobility and flexibility 🧘‍♀️ —> 🤕 to reduce risk of injury while running

• Improve sleep and recovery 🛏️ —> 😩 to lower stress and help with body weight management

• Improve hormone balance 🧬 —> 👶 to increase chances of fertility

All of the above are example strategies, which need to be agreed upon with an expert, and which will inform your approach and lifestyle. But a strategy alone cannot be executed without using specific TOOLS & TACTICS.

🔧 Finally, let’s pick the right TOOLS for success…

We now have our GOAL and our STRATEGIES to accomplish our GOAL. What we need is to go a level deeper and pick the right TOOLS out of our toolbox.

Such tools could be related to nutrition, recovery, exercise, pharmacological treatment (supplements and/or medication), psychological therapy, stress management, physical therapy and so much more.

Peeling another layer of this ‘onion’, we can go even deeper and prepare a more detailed plan with a set of appropriate TOOLS.

In this case:

🎯 GOAL—> “I wish to be able to go on long walks with my grandchildren, and keep up with their pace, even when I’m 80

♟️ STRATEGY —>

• (Part A) Build sufficient cardiovascular capacity

• (Part B) Build sufficient leg strength, stability and balance

🔧 TOOLS —>

For building cardiovascular capacity:

• Swimming

• Running

• Walking

• Rowing

• Cycling

• Sauna

• Steps machine

• Breathing exercises

• Losing extra weight

For building strength, stability and balance:

• Gym

• Pilates

• High intensity interval training

• Sprinting

• Yoga

• Calisthenics

• High protein diet

..Sky is the limit in terms of the number of tools available to us, and these can be more than one! The important thing is to make them meaningful enough and personalized enough for you!

In most cases, a combination of nutrition, sleep, exercise, sometimes pharmacological treatment and other categories may be required (i.e. a holistic approach may be required).

Putting it all together, I have compiled a template which you can take away with you (copy to your notes, whatsapp, or print out) to help you define your own health PLAN, consisting of your own GOALS, STRATEGIES and TOOLS.

Free Template for GOAL, STRATEGY and TOOLS setting

✔️ Some final tips for success:

• You can have more than one GOAL, but pick your most important, high-priority GOAL

• These GOALS can be short, medium or long term

• You could (and probably should) find appropriate support in building your PLAN, including a nutritionist, trainer or doctor

• You can try, fail, miss some workouts, enjoy dessert, gain some weight, get injured, but remember to always come back to your initial GOAL, think about the STRATEGY and the TOOLS, what works, what doesn’t and modify accordingly! Then keep going…!

I know it’s been a long time, but our work here is far from over!

We’re just getting started!

Next topic will be on setting health OBJECTIVES, finding a STRATEGY and executing with the right TOOLS & TACTICS!

For those who are new, or need a reminder, here’s a summary of everything that we’ve talked about so far, and more content will be coming up soon.

The first article focused on the impact obesity can have on the different aspects of health (Consequences of Obesity on Health & Wellbeing (23/04/25)). Obesity and strategies for weight management will be a recurring topic given how many people are impacted and given the benefits of reducing weight on heart (5 Lifestyle Factors For A Younger Heart (02/05/25)), brain and overall health. We delved into the biology of eating with the second post on The 3 Types of Hunger (24/04/25), to understand what compels people to eat above or below their physiological needs, and which ultimately results in over- or under-nourishment. Day 1 of ‘getting healthier’. Where do I even begin? Blood tests…(25/04/25), focused on the first step someone should take when starting their journey to improve their health, and since that is in my view, doing a basic panel of blood tests, I shared a list of key tests (Blood Tests: Take this Exact List with You Next Time (26/04/25)), followed by a guide on how to interpret the results (The simplest guide to understand your blood results (29/04/25)). I also shared a basic list of healthy habits for easier weight control (11 simple STEPS for weight control (27/04/25)) and for better tracking of one’s weight (The 6 most common mistakes when tracking your weight (28/04/25)). Diets Decoded: The Rules for Healthy Eating (and a Brief History & Biology of Nutrition) (01/05/25) looked at the biology of eating, the history of nutrition and the basics of constructing a healthy diet from scratch, whether that’s vegetarian, vegan, paleo, keto or any kind of diet. The latest post explored the view that nutrition or health coaches should be more widely relied upon by families with along term strategy to improve the overall health of the entire family and prevent or delay disease (Every Family Should Hire Their Own Health Coach. Here's why! (02/05/25)). We also covered the healthspan vs lifespan debate here (**What You Need to Know on your Journey to Healthspan & Lifespan (04/05/25)) along with the key drivers of death, taking inspiration from the book ‘Outlive’. We pivoted to primer on hydration (Science-Based Hydration Strategies for Better Living & Performance You Didn’t Know (05/05/25)), before talking about the secrets of a centenarian’s blood (Your Blood Tests Should Look Like This If You Wish To Be 100+ years old (06/05/25)). We also touched on the topic of personalize nutrition, which appears to still need room for improvement before mass application (Personalized Nutrition: We are not there yet; and we’ve gone too far (07/05/25)). Our most recent article was focused on intermittent fasting, providing a guide for beginners considering implementing this tool (Intermittent fasting: a tool with many uses, but not a ‘magic health bullet’ (16/05/25)).**

Thank you for reading and stay tuned for more!

With apologies for the long hiatus from posting due to travelling, we’re back with a topic that often makes it to discussions amongst friends, often causes confusion and in my experience after following this practice for months, may have both benefits and risks. This guide is intended to help people (and their doctor’s or nutritionists) decide whether (1) intermittent fasting is for them, and; (2) how to best execute intermittent fasting to achieve optimal results!

What is IF?

Practiced for centuries as a ritual in many religions, intermittent fasting (IF) has recently surged in popularity as a weight loss and health-improvement tool. A 2024 survey found that as many as 13% of Americans followed an IF regimen in the previous year.

The most common form of IF is time-restricted eating (TRE), where individuals limit their eating to a 6–8-hour window, fasting for approximately 16–18 hours daily.

Evolution of IF and Modern-Day Eating 🙊

Humans evolved in an environment with intermittent food access, requiring them to function without constant meals. Long fasting periods were common and essential for survival.

In contrast, modern food abundance has shifted eating patterns toward frequent meals and snacks, contributing to overconsumption, insulin resistance, and obesity.

Different Types of Intermittent Fasting or TRE ⏰

• Time-Restricted Eating (TRE): e.g., the 16:8 method (16-hour fast, 8-hour eating window)

• 5:2 Diet: Eat normally 5 days a week, restrict intake to ~500–600 calories on 2 non-consecutive days

• Alternate-Day Fasting: Fast every other day

Effectiveness varies, but all approaches promote reduced energy intake and facilitate metabolic switching (e.g., from glucose to fat as fuel).

The key is finding a sustainable method that aligns with your lifestyle and goals.

Benefits and Risks Have Been Studied Reasonably Well 🧠 💗 🏃

Without diving too deep into scientific jargon, it's worth noting that thousands of studies have examined IF under different conditions and populations. The evidence suggests many potential benefits, but also risks and caveats—especially when IF is poorly implemented.

For instance, simple calorie restriction may be more appropriate than IF in some cases.

Risks could include losing muscle, developing nutrient deficiencies, lower athletic performance and others, which depends on how an IF protocol is executed.

The figure below shows how the number of studies with ‘intermittent fasting’ as the topic of focus have increased year after year in the past 25 years.

Reasons You May Want to Consider IF 💪

• Weight loss

• Improved insulin sensitivity and diabetes/pre-diabetes management

• Reduced inflammation

• Brain health and mental clarity

• Regulating dopamine and cravings

• Hormonal rebalancing (e.g., ghrelin, leptin)

• Gut microbiome benefits

• Reducing processed food intake

• Body recomposition (gain muscle, lose fat)

• Improved cholesterol

• Lower blood pressure

• And more...

🚧 Disclaimer: Not all of the above are guaranteed outcomes of IF.

There is some evidence supporting these benefits—but results depend on individual execution. Poorly implemented IF (e.g., prolonged fasting, under-eating, or low nutrient intake) can lead to suboptimal or even harmful outcomes.

🔧 Remember: IF is just one of many tools available to you to support your goals. It’s not a solution to all health problems, and most likely it’s not forever!

Ultimately, any consistent plan that creates a calorie deficit can yield results. IF is only effective if it works for you—your schedule, lifestyle, and preferences.

🎯 Building Your Goal & Strategy

1. Define your goal and how you’ll measure success (consult a doctor/nutritionist if needed).

2. Choose the duration of IF you’ll follow (1 week, 1 month, 2 months, etc.).

3. If new to fasting, build up gradually—start with a 12-hour fast and extend it by 1 hour every day or two.

4. Evaluate progress regularly: How do you feel? What’s working? What needs adjusting?

✅ Practical Tips for an Intermittent Faster

• [ ] Evaluate whether IF is right for your needs and health status

• [ ] Start slowly with shorter fasts and build gradually

• [ ] Ensure adequate protein intake

• [ ] Ensure adequate fiber intake

• [ ] Include strength training for muscle maintenance

• [ ] Avoid overtraining, especially during long fasts

• [ ] Prioritize sleep and recovery

• [ ] Stay hydrated—consider electrolytes during longer fasts

• [ ] Calories still matter even with IF

• [ ] Consider skipping dinner (instead of breakfast) to improve sleep

• [ ] Minimize external stress, since fasting is a stressor in itself

• [ ] Limit processed foods to improve nutrient density

• [ ] Make IF enjoyable and flexible—allow for social occasions and real-life demands

🧑‍⚕️ The Nutritionist’s / Doctor’s Guide

• [ ] Co-create a tailored nutrition and lifestyle plan based on client goals and baseline labs

• [ ] Check in during the first week to monitor response

• [ ] Schedule follow-ups to reassess weight, heart rate, BP, and labs if needed

• [ ] Discuss adherence and outcomes, then agree on adjustments or discontinuation

• [ ] Conduct a final evaluation after the trial period to determine long-term strategy

⚠️ A Word of Caution

IF is not suitable for everyone. Avoid in:

• Children and adolescents

• Pregnant or breastfeeding women

• Individuals with eating disorders

• Those with chronic illness or on medications, unless advised by a medical professional

🔮 What’s the “Magic” Behind IF? Hint: There Is No Magic

Some proposed mechanisms of the various benefits, include:

• Weight loss: IF naturally reduces caloric intake for many

• Fat burning: May enhance lipolysis and improve insulin sensitivity

• Energy during fasting: Ketones (from fat) may provide stable brain and muscle fuel

• Growth hormone (HGH): IF can boost HGH, but muscle growth requires sufficient calories

• Autophagy: Fasting may enhance cellular repair, though calorie restriction and exercise do this too

• Longevity: Animal studies suggest benefits, but no human trial has proven increased lifespan (yet)

Personalized nutrition is an approach beyond a one-size-fits-all approach to healthy eating using unique personal characteristics to inform diet choices and optimise health and wellbeing. Such characteristics may include a person’s:

• Genes & family history

• Microbiome

• Metabolism

• Proteome

• Lifestyle habits

• and so much more…

A new goldmine

Many companies have rushed to capitalize on the unique opportunity to offer ‘personalized nutrition’ guidance, using differentiated approaches, claiming a ‘personalized approach’.

For example, companies have recently launched continuous glucose monitors (CGMs), devices which continuously measure levels of glucose in the blood, with the promise that this data can inform better lifestyle and nutritional guidance for better management of diabetes or weight loss. With more companies pouring into the mix and providing different offerings, the scientific rigour of these claims comes into question, especially in the absence of regulated studies to prove these claims. The result is thousands of people who are not diabetics (admittedly even myself, once upon a time), have flocked to using CGMs for ‘improving their lifestyle’.

The idea is that you can observe and track how your glucose levels change in response to different foods and that multiple spikes in glucose levels can cause mean glucose levels to be raised, which could increase risks of diabetes and heart disease.

However, the benefit of focusing on glucose responses in people with no underlying health condition is controversial.

There is still a lack of sufficient research to show whether the use of CGM devices in healthy individuals can help in any meaningful way.

To prove this point: even when I used a CGM for myself and was able to see my glucose levels going up and down after waking up, after eating rice, after having a protein bar or after sipping coffee, I am still wondering, what really was the purpose of all that. What did I really learn for my long term health and long term lifestyle habits. Probably nothing.

The dangers are many. "Don't buy magic beans."

(1) Interpretation of the data by users could cause an incorrect understanding of which food or meals are causing spikes in glucose are could be mistakenly considered unhealthy and, in the same vein, foods that do not cause these variations are healthier.

That is simply wrong.

Metabolic health is much more than blood sugar levels. Sugar spikes are a natural part of the metabolism process and insulin spikes that follow have a large number of roles to play in overall health (e.g. muscle building).

"Extraordinary claims require extraordinary evidence."

(2) Companies that claim they can analyze a person’s microbiome (their gut bacteria) to arrive at personalized nutritional recommendations, are simply modern ‘snake-oil or magic-bean sellers’.

The scientific literature is far from having a complete understanding of the ways thousands of bacterial types that we host in our gut, affect us and how they are affected by the foods we eat.

(3) Unnecessary costs is another downside..

(4) Unnecessary anxiety over eating is yet another downside…

This is a long and complex topic that we’ll explore in the future, but the key message is that there is no way anyone can confidently say, in the case of microbiome-based nutrition, or CGM-based nutrition, or gene-based nutrition that..:

Nonsense (for now…)

Can we get there eventually? Yes, but till we get there "your body isn't a mystery to be solved by pseudoscience."

Currently, personalised nutrition services are not explicitly regulated globally.

As this sector evolves and research on metabolism, genetics, and the microbiome continues, thorough evaluation and monitoring of personalised nutrition companies’ claims from stakeholders is crucial.

"The original snake oil salesmen traveled by wagon. Now they use algorithms and AI"

Certainly AI will also help in the process and we may eventually get there at some point.

But we are currently not ready to blindly apply ‘personalized nutrition’ advice based on incomplete datasets, sold with the AI stamp.

What do I do with all this?

Given what we’ve discussed above, there are three things I would recommend:

1. "In a world of quick fixes, lasting health is built—not bought." —> so don’t look for easy solutions sold by smart marketers!

2. "Optimize your skepticism before your supplements." —> be critical with advice that sounds too good to be true, and do your research. Ask for a second or third opinion before committing to buying a product or service.

3. Stick to the basics (for weight control tips, see: 11 simple STEPS for weight control (27/04/25)), and stay consistent. Results will come.

4. Keep reading the ‘Young Centenarian’s Newsletter’ 😊

Thank you -

Although this is a philosophical question that may never have a straight answer, medicine has provided plenty of evidence that living a long and healthy lifespan can be attributed to both genetic and lifestyle factors.

That is the reason this newsletter exists in the first place.

To identify and convince, then motivate and advise people on how they can - if they choose to - take control of their health and live better, longer.

Today we explore:

• A longevity study like no other

• What did the study aim to do?

• A longevity study like no other

• How did they do it?

• What types of blood tests did they do?

• So what’s in a centenarian’s blood?

• Should we be surprised by these findings?

• What can I do with this knowledge?

If you visited any of the Blue Zones (places with higher rates of centenarians), such as Okinawa, Nicoya, Sardina, or Ikaria, and asked those people what their secrets are, you’d probably get very different answers.

If you could look into their blood tests, what secrets would you find out?

That’s what a study in an exceptionally long-lived group of individuals asked, although in none of the Blue Zones above, but in Sweden.

Why?

Because the healthcare system of Sweden, dating back to a few decades ago, has a very rich record of health data (including blood tests) for a large number of people.

What did the study aim to do?

The study titled "Blood biomarker profiles and exceptional longevity: comparison of centenarians and non‑centenarians in a 35‑year follow‑up of the Swedish AMORIS cohort" compared blood results of people between the ages of 64 and 99, who eventually either lived to 100+ or had a shorter-lifespan.

How did they do it?

The researchers used a large dataset of 44,000 Swedish citizens who went through health assessments at ages 64-99. The participants were tracked for up to 35 years, with 1,224 (or 2.7%) of them living to be 100 years old.

A noteworthy statistic from the study is that 85% of the centenarians were female!

The key characteristics of the individuals upon entering the study (shown below) tell us that the group that eventually lived to 100+ were at the start generally less ‘troubled’ with the 4 most common diseases that result in people’s demise (see the relevant post from two days ago - What You Need to Know on your Journey to Healthspan & Lifespan (04/05/25)).

For example, they were 4 to 5 times less likely to have suffered a heart attack or heart failure, 5 times less likely to have been diagnosed with dementia, 50% fewer chances that they had cancer, and 6 times less likely to have had diabetes.

What types of blood tests did they do?

Twelve blood-based biomarkers related to inflammation and metabolic, liver, and kidney function as well as potential malnutrition and anemia were included (as a reminder, our recent posts on the recommended blood tests for a general health check, and how to interpret them at a basic level can be found here: The simplest guide to understand your blood results (29/04/25)

• For inflammation they used:

  • uric acid

• For metabolic function they used:

  • total cholesterol

  • glucose

• For liver function

  • alanine aminotransferase (ALAT)

  • aspartate aminotransferase (ASAT)

  • alkaline phosphatase (ALP)

  • lactate dehydrogenase (LD)

• For Kidney function

  • Creatinine

• For anemia

  • Iron

  • Total iron-binding capacity (TIBC)

• For nutrition

  • Albumin

So what’s in a centenarian’s blood?

Centenarians overall displayed rather homogenous biomarker profiles. Already from age 65 and onwards, centenarians displayed more favorable biomarker values in commonly available biomarkers than individuals dying before age 100. The differences in biomarker values between centenarians and noncentenarians more than one decade prior death suggest that genetic and/or possibly modifiable lifestyle factors reflected in these biomarker levels may play an important role for exceptional longevity.

More specifically, they found higher levels of

• total cholesterol —> intriguing! very low cholesterol may not always be better for a long life. There is a debate on this issue, which we will explore in the future.

• iron —> meaning improved oxygenation?

…and lower levels of…:

• glucose —> meaning lower chances of diabetes?

• creatinine —> meaning better kidney function?

• uric acid —> meaning lower levels of inflammation?

• aspartate aminotransferase —> meaning better liver, heart and muscle health?

• gamma-glutamyl transferase, alkaline phosphatase, lactate dehydrogenase —> meaning better liver function?

• total iron-binding capacity —> meaning improved oxygenation?

…were associated with reaching 100 years

Should we be surprised by these findings?

Whilst people may claim chance plays an important role in living a long and healthy life, other studies have shown that those who live longer tend to have fewer disabilities, comorbidities, hospitalizations and better cognitive function.

Lower inflammation, for example, has been shown to be a predictor of longer survival in a Japanese population. But these findings are unique because they provide a 35-year record of blood biomarkers, rather than a single measurement in time.

What do I do with this knowledge?

The entire healthcare system is mostly geared towards helping you live longer once you acquire disease. Prevention is not really the current goal of medicine. We discussed this here quite extensively and that Medicine 3.0 in the future may be able to solve this problem (Every Family Should Hire Their Own Health Coach. Here's why! (02/05/25))

• *With Alzheimer’s disease…*We have no drugs that can reverse the dementia or even slow its progression once it sets in

• *With cancer…*We’ve made very little progress in 50 years in regards to the long-term survival rate. With metastatic cancer, it’s about a 5% improvement we’ve made in 50 years

• *With cardiovascular disease…*It’s the one place where we’ve seen the most progress on managing a disease once it sets in. (5 Lifestyle Factors For A Younger Heart (02/05/25))

Yet, many people still do not pay enough attention on understanding their current state of health to understand their future risk of disease and overall quality and length of life.

And that’s a shame.

Because today we have a really good set of tools to get insight into key areas of health such as:

• Atherosclerotic disease

• Dementia risk

• Sex hormones

• Thyroid hormones

• Metabolism

…as well as the tools to fix (almost) anything that suggests risk:

• exercise

• weight loss

• nutrition

• supplements

• pharmacological agents

• surgery

• mental health support

• sleep tools

• etc

• etc

We will talk about all of these tools in the future and the actions each of us can take to improve their healthspan and lifespan.

For now, if you are only just beginning your journey, then you can start here: Day 1 of ‘getting healthier’. Where do I even begin? Blood tests…(25/04/25).

Get some tests done.

Have a chat with your doctor.

Agree on the desired blood profile for when you test again.

Adjust your lifestyle.

Stay consistent.

Enjoy the process.

thank you for reading,

Source:

• Blood biomarker profles and exceptional longevity: comparison of centenarians and non‑centenarians in a 35‑year follow‑up of the Swedish AMORIS cohort

Read below to learn about:

What are electrolytes

• Electrolytes: sodium, magnesium, potassium - these are the messengers carrying electrical signals inside our bodies, helping our muscles move, our heart beat and our brain think. Electrolytes are tiny particles that carry electric charges, which are essential for different parts of your body to work the way they should. These electric charges are responsible for many important functions in the body. For example, they help your muscles contract and relax. They also help your nerves send signals throughout your body.

Where Your Water Goes

Your body distributes fluids in a sophisticated way:

• 67% inside cells (critical for metabolism 🔥)

• 20% in interstitium (between cells; expands during illness 🤒)

• 8% in blood vessels (plasma volume = heart performance ❤️)

• 5% in specialized fluids (e.g., cerebrospinal fluid 🧠)

Dehydration vs loss of fluid volume 🎯

• Dehydration refers to water loss alone (e.g., breathing dry air ✈️).

• Loss of fluid volume is when both Water + electrolyte loss (e.g., sweating, diarrhea).

Why Hydration Matters

Every cell depends on this balance:

• Neurons need sodium to fire electrical signals ⚡.

• Heart function: As plasma volume loss goes down, so does the force with which the heart can contract and send blood throughout the body. As a result, the heart rate goes up, which can make us feel more tired, as more effort goes into heart beating 📈.

• Performance, as we know from studies, drops by 10–20% with just 2% dehydration 🏃.

• Metabolism can ‘slow down’ as water reserves go down. Water is an essential catalyst for most metabolic reactions. A key weight loss advice is to drink enough water, not only in order to maintain metabolism levels, but also as an appetite suppressant before meals

• Immunity: personally I have noticed I am more likely to fall sick after being dehydrated for a day or two

• Headaches are often caused by dehydration, whether lack of water or electrolytes. Consider hydration strategies before painkillers!

• Cramps, dizziness, confusion and subsequent falls can also be more serious consequences of dehydration.

Checking Hydration levels

❌ A common misbelief is that darker urine means dehydration

✅ Instead, a better metric includes:

• Urine output volume and frequency relative to usual output.

Hydration Strategies

Replenish electrolytes

• When resting: ~240mL for every hour (for the first 10 hours of the day), then less than that as fluid requirements go down towards the end of the day [1]

• When exercising: 2 mL/kg every 15–20 mins [2]

• Post-workout: find your preferred electrolyte brand or simply add a pinch of salt to your water🧂.

Minimize Fluid Loss

• Nose breathing, instead of mouth breathing: Cuts respiratory water loss (try mouth tape at night 😴).

Replenish fluid volume 🌊

• Pre-meal hydration: Drink 1 glass water 30 mins before heavy meals.

• Eat your water: Cucumber (96% water), watermelon (92%), celery (95%).

Watch out for these ⭕

• Air travel: Cabin air is drier than deserts → sip electrolyte drinks 🧂.

• Diuretics: Alcohol 🍷 blocks vasopressin (causing excess pee); caffeine ☕ has milder effects. Swap one coffee/beer for herbal tea or hydrate with fruits, or with a salt pinch ☕→🍵.

• Filtered water alone: Removes natural electrolytes; add a pinch of salt.

• Too much water-only consumption results in dilution of your body’s electrolytes

Hydration According to Exercise 🎯

• If working out <90 mins, then Water + electrolytes suffice (muscle glycogen covers energy 💪).

• If working out >90 mins/with or without high intensity consider also adding glucose (e.g., honey in water 🍯 or a commercial sports drink 🥤). [3]

Key Takeaways 🎯

1. Hydration = Water 💧 + Sodium 🧂 + Potassium 🍌 + Magnesium 🌿.

2. Urine volume is better than urine color for tracking 🚽.

3. Heart ❤️ and brain 🧠 suffer first when dehydrated, so remember to hydrate.

4. Some self-experimentation and tinkering with hydration strategies is always necessary to figure out what works for you!

Sources:

[1] Dr. Andrew Huberman

[2] Dr. Andy Galpin

[3] Dr. Peter Attia

Today’s post takes inspiration from the book ‘Outlive’ (the images inside are taken from this book)

I read this book last year as soon as it became available.

It is by Dr Peter Attia who hosts a podcast called ‘The Drive’.

A bit of background on the author and why I trust and enjoy his work:

I’ve been following Dr Peter Attia for at least a couple of years and would easily say he holds the top place on my list of experts that I trust when it comes to all things medical, health and fitness. The reason is that Dr Attia has a unique system of outlining problems, asking questions and arriving at conclusions. When interviewing other experts you quickly admire his skill of driving a conversation with incredible scientific detail, whilst making it somewhat easy for a generalist audience to follow. He is a medical doctor and cancer surgeon by training, who also spent some time as a McKinsey consultant, which resonates with me having myself spent half of my professional career in the consulting world and which tells me he takes a very systematic approach to solving problems and analysing complex problems. Dr Attia has since been focusing on his own medical practice where he has been developing the tools and methods to ensure his patients increase their lifespan and improve their healthspan. His book ‘Outlive’ came out in February 2023 and it quickly validated my expectations that it would be unlike any other ‘longevity’ (play)book. I have already gifted it to at least two people and remains amongst the most highly recommended books on my list. I’m sure anyone who reads it will have a newfound way of how one thinks about life duration, life quality and the various tools (under the umbrellas of exercise, nutrition, emotional health, sleep, supplements and more) everyone has access to, in order to improve both lifespan and healthspan.

The healthspan vs lifespan debate…can’t we just have both?

Healthspan defined as the period of life when you are free from disability or disease is too simplistic as it does not account for the difference between a 20-year old without disease or a 40-year old without disease. The book highlights that the key question for everyone should really be:

• ‘Where am I headed from here’, and

• ‘What’s my future trajectory?’

Then, one can create a better future for themselves by setting themselves on a better trajectory and by thinking about it and taking action now.

That’s where Medicine 3.0 comes in.

Medicine 3.0 seeks to “square” your longevity curve, by paying as much attention to healthspan as it does to lifespan. This way (as the picture below shows), you spend less time alive with health issues.

That’s because, as the book argues, Modern Medicine (or Medicine 2.0 - as discussed in previous note - Every Family Should Hire Their Own Health Coach. Here's why! (02/05/25)) is “far more effective against fast death than slow death. It is better suited at fixing broken bones, infections with powerful antibiotics, but has limited or no emphasis on preventing disease and sustainably improving quality of life. Whilst in cardiovascular disease, we have managed cut mortality rates by two thirds in about 60 years of medical progress, on the other hand death rates from cancer have hardly changed in the 50 years since the War on Cancer was declared. Type 2 diabetes is also on the rise and a “raging public health crisis” with Alzheimer’s also a looming threat to the ageing population”.

Delaying or avoiding these 4 preventable diseases is the KEY for healthspan and lifespan for most people!

The book also spends time to define these top four chronic diseases of ageing as the ‘Four Horsemen’, in other words the 4 key drivers of death and main source of disability in the modern era, including:

1. Heart Disease (for example, high blood pressure, stroke):

2. Cancer (for example, breast, lung, prostate, colorectal)

3. neurodegenerative disease (for example, dementia, Alzheimer’s),

4. type 2 diabetes.

We look into these four below and in a future post, we’ll look to what can be done to ensure these are addressed proactively or reactively.

💘 Heart Disease: What to watch out for…

Cardiovascular disease (CVD) remains the leading global cause of death, claiming 17.9 million lives annually (WHO). Behind this staggering statistic lies a big, yet silent crisis: atherosclerosis, the progressive hardening of arteries driven by invisible killers, such as:

1. High apoB Lipoproteins (reminder that in my previous notes on blood testing, I included the testing for apoB levels - The simplest guide to understand your blood results (29/04/25); Blood Tests: Take this Exact List with You Next Time (26/04/25); Day 1 of ‘getting healthier’. Where do I even begin? Blood tests…(25/04/25))

   • apoB-carrying particles (LDL, VLDL) are the primary drivers of arterial plaque (hardening and calcification of the artery walls).

   • Each 1 mmol/L (39 mg/dL) increase in LDL translates to a 22% higher CVD risk.

2. Hypertension (or high blood pressure)

   • Sustained high blood pressure damages vessel walls, accelerating plaque rupture risk.

   • Affects 1.3 billion adults globally; only 1 in 5 have it controlled.

3. Chronic Inflammation

   • Elevated CRP (C-reactive protein) doubles CVD risk, independent of cholesterol.

   • Poor sleep, stress, and ultra-processed foods amplify inflammatory pathways.

♋ Cancer: What to watch out for…

Cancer remains one of humanity's greatest health challenges, responsible for nearly 10 million deaths annually worldwide and a huge economic burden. Both genetic/family factors and environment/lifestyle factors are important.

1. Genetic Predisposition

   • 5-10% of cancers are directly inherited (e.g., BRCA mutations increase breast cancer risk 45-65%)

   • But even high-risk genes often require environmental "triggers" to activate

2. Family History Red Flags

   • 1 first-degree relative with cancer = 2x average risk

   • 2+ relatives = 3-5x increased risk (American Cancer Society)

3. Environmental Accelerators

   • Tobacco: Causes 30% of cancer deaths (90% of lung cancers)

   • Diet: Processed meats increase colorectal cancer risk 18% per 50g daily

   • Carcinogens: Asbestos (mesothelioma), UV radiation (melanoma), and pollution drive 15-20% of cases

Cancer is an ageing problem, with higher chances of getting a diagnosis as the life progresses.

🧠 Neurodegenerative disease: What to watch out for…

Alzheimer's and Parkinson's diseases don't strike suddenly—they're the devastating sum of decades of silent neurological/nerve damage. Emerging research reveals that: 50 million people worldwide live with dementia (Alzheimer's represents 60-70% of cases) and Parkinson's prevalence has doubled since 1990 to over 8.5 million cases. The following factors are the likely reasons:

1. Metabolic issues

   • Insulin resistance doubles Alzheimer's risk

   • Type 2 diabetics develop neurodegeneration 5-7 years earlier

2. Vascular (blood circulation) issues

   • Hypertension increases dementia risk by 60%

   • 1 in 3 Alzheimer's cases show significant vascular pathology

3. Sleep Deprivation

   • Chronic poor sleep triples amyloid plaque accumulation

🍯 Type 2 diabetes

Type 2 diabetes and metabolic dysfunction are one of modern medicine's greatest paradoxes - they're among the most preventable chronic diseases, but at the same time affect 1 in 10 adults globally (536 million people) and are projected to rise to 783 million by 2045. The key drivers are:

1. Insulin Resistance

   • 88 million American adults have prediabetes. Each 1 mmol/L (18 mg/dL) increase in fasting glucose = 13% higher dementia risk

2. Dietary Drivers

   • Ultra-processed foods account for 57.9% of US calories and increase diabetes risk by 58%

3. Physical Inactivity Crisis

   • 81% of adolescents and 27% of adults fail to meet WHO activity guidelines

Much of what we’ll be discussing in the Young Centenarians newsletter will deal with the four above issues, which are preventable, diagnosable, treatable and overall well-understood. For now, I hope the above has helped as a starting point for our ongoing discussion.

Thank you for reading and, please stay tuned

Manos

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Sources:

1. Outlive, book by Dr Peter Attia

2. Cholesterol Treatment Trialists’ Collaboration

3. Lancet

4. NEJM

5. American Heart Association

6. Nature

It has been 10 days since my first post here, with 1 daily post, on each day that followed!

The focus has been on putting the work daily, writing daily, getting thoughts out daily, doing research daily and engaging with the platform daily.

‘Young Centenarians Newsletter’ was born with a mission to inform, educate, motivate people wishing to improve their health. It started with family and friends trusting me with their questions on simple aspects of health and nutrition, so I decided to write for them. Through Substack, I hope to continue to reach them, and hopefully an even bigger audience over time.

The name itself includes two contradicting concepts: of being ‘young’, vibrant, strong (in other words, of good healthspan), and of being a centenarian (100+ years of age), wise, experienced (in other words, of long lifespan).

And that’s exactly why it was chosen.

To reflect the boldness of the mission.

To show that it is possible to have both healthspan and lifespan.

To remind that good health is not a trivial pursuit.

What I hope this newsletter will be associated with:

• Cutting-edge longevity science

• Encompassing a holistic approach

• Actionable insights for everyone, for every day

• Useful for people of all ages

What I hope this newsletter will not be associated with:

• "Only for fit people"

• “Only for scientifically-minded people”

• “Unrealistic”

If you are interested in making small or big positive changes to your health, or the health of a loved one, a parent, children, a partner, then feel free to read, share, comment, subscribe.

To give you a flavor of the topics we’ll focus on, here’s a look at the past 10 days.

The first article focused on the impact obesity can have on the different aspects of health (Consequences of Obesity on Health & Wellbeing (23/04/25)). Obesity and strategies for weight management will be a recurring topic given how many people are impacted and given the benefits of reducing weight on heart (5 Lifestyle Factors For A Younger Heart (02/05/25)), brain and overall health. We delved into the biology of eating with the second post on The 3 Types of Hunger (24/04/25), to understand what compels people to eat above or below their physiological needs, and which ultimately results in over- or under-nourishment. Day 1 of ‘getting healthier’. Where do I even begin? Blood tests…(25/04/25), focused on the first step someone should take when starting their journey to improve their health, and since that is in my view, doing a basic panel of blood tests, I shared a list of key tests (Blood Tests: Take this Exact List with You Next Time (26/04/25)), followed by a guide on how to interpret the results (The simplest guide to understand your blood results (29/04/25)). I also shared a basic list of healthy habits for easier weight control (11 simple STEPS for weight control (27/04/25)) and for better tracking of one’s weight (The 6 most common mistakes when tracking your weight (28/04/25)). Diets Decoded: The Rules for Healthy Eating (and a Brief History & Biology of Nutrition) (01/05/25) looked at the biology of eating, the history of nutrition and the basics of constructing a healthy diet from scratch, whether that’s vegetarian, vegan, paleo, keto or any kind of diet. The latest post explored the view that nutrition or health coaches should be more widely relied upon by families with along term strategy to improve the overall health of the entire family and prevent or delay disease (Every Family Should Hire Their Own Health Coach. Here's why! (02/05/25))

Thank you for reading

Many families (granted, usually those with some extra resources…) tend to have access to a preferred family doctor.

Sometimes that person is a family member or friend, and other times just a trusted physician who has served the family for some time.

It makes perfect sense that families wish to have a single person who will be the first point of contact when a health concern arises.

Only a phone call away, family doctors bring much needed advice and reassurance to families by providing quick diagnosis.

Here’s why this is not enough.

A family doctor is contacted after a problem has arisen.

A family doctor is not concerned (and does not really have the time to deal…) with preventing those health problems.

We are beginning to understand that prevention is more impactful than treatment in the long run.

It is a mindset shift that is beginning to occur - in other words we are entering the era of ‘Medicine 3.0’

A little detour first, on Medicine 3.0

Top health voices in the space have started talking about the concept of Medicine or Health 3.0.

Peter Attia’s book ‘Outlive’, and podcast ‘The Drive’, which I’ve been listening to for years, have this concept at its core.

• Medicine 3.0 is the concept that the future vision for healthcare emphasizes proactive prevention, personalized approaches, and a shift from only treating diseases, to optimizing overall health and longevity. This model integrates preventative measures, lifestyle optimization, and data-driven insights to improve both lifespan and healthspan. The 3.0 refers to the next generation of Medicine to the current 2.0, which considers a level of personalization in the treatment, yet lacks an emphasis on proactive and preventive care, and which in turn follows the traditional 1.0 version of medicine, which is simply reactive, with no element of personalization or long term strategies

So, where I’m going with this, is that by putting family doctors aside, and adopting a Medicine 3.0 mindset at the family unit level, people could take proactive control of their long term health and address issues of old-age, early in life. But families would need some help in that…

Here’s where the concept of a ‘family health coach’ [insert any specialty here e.g. nutrition coach, wellness coach, fitness coach] would come in to help!

WHAT IF the family unit had a person (or group) they could rely on for preventing health issues.

WHAT IF the family unit could get instant and continued advice for the younger, and older members on:

• nutrition

• sleep

• exercise

• weight management

  

The benefits would be huge…

• Addressing kids’ nutrient deficiencies would become more straightforward

• Working parents would be able to nourish themselves adequately when travelling for work

• Teenagers who are studying for exams would have a tailored eating plan to optimize their brain health and performance

• The highly active athletes of the family would be able to get personalized advice on how to optimize recovery

• Parents could learn to exercise with their children

• Grandparents would have their own training plan to ensure their musculoskeletal system is strong into their old age, with the support and oversight of the younger family members

• Kids would gain a great foundation on nutrition early in life and learn to appreciate healthy foods, relying less on ultra-processed foods (another essential life skill; N.B. i’ve discussed some other life skills in previous posts including the ability to understand blood tests [Blood Tests: Take this Exact List with You Next Time (26/04/25); Day 1 of ‘getting healthier’. Where do I even begin? Blood tests…(25/04/25)])

• Healthcare costs to the family (and probably the society) would be reduced assuming disease would be delayed or prevented

But how would this work exactly?

A basic blueprint would look like this…

1. Family hires a nutrition coach who would work together with the family doctor’s advice

2. Family meets with the coach as a group and individually to formulate goals, strategies and the tactics to meet those goals (e.g. weight loss, managing a healthy diet within a demanding work life, improved athletic performance etc. etc.)

3. Family members would now be working as a team to help each member achieve their goals, ensuring healthy habits are seamlessly incorporated into the family’s day-to-day

4. Goals would be both short term and long term [we’ll be talking about the different approaches to goal setting and strategy selection, in the future]

5. Quarterly check-ins would take place where the coach would take a record of the progress made by each member, any challenges, any updates to the protocols involved

6. A family record of the ongoing health status and overall progress would be taken for each member to save for future reference [we’ll be talking about the importance of keeping medical and health records, in the future]

7. Any updates from a medical point of view would be shared with the coach for their consideration, it would be important for the coach to remember to stay ‘in their lane’ and not interfere with medical issues, as this would be out of scope

8. Reminders on group chats could be sent to ensure the continued motivation and goal alignment of the family members

9. Annual or bi-annual check ups and comprehensive blood tests, weight/BMI, overall health check-ups would be ordered and the family would review first with their doctor and subsequently with their coach to arrive at an updated plan

Bringing it back to the real world…

I know readers will say: “Manos, which world do you live in?”

Hear me out…the above does sound utopian

Like a world where all other problems of this fictional family have been solved and now the only matter remaining is how to optimize their health.

I understand there would be many barriers to the above, including:

• financial: apprehension to pay for a coach

• cultural/religious: difficulties in letting go of food preferences

• time limits: different and busy schedules of each member

• execution: these plans may sound great in theory, but in reality may suffer from poor execution, poor results, diminishing motivation and lack of consistency

• injuries or health limitations: members with certain disabilities, injuries or other physical or mental limitations may already require significant resources and attention from the entire family or may prove challenging overall

• lack of awareness/education: resistance by family members due to lack of education around the positive impact that lifestyle changes can have on overall health

• willingness and readiness gaps: a key concept in effecting change is how willing and how ready one is to introduce a number of lifestyle change. It would be expected that different members of a family would have different levels of willingness and readiness to stick to a diet and exercise plan

• generational gap: different generations within a family have different levels of understanding of nutrition and exercise and the role it plays in overall, long term health and ageing.

How could this become the future?

At the societal level, it would definitely take time.

At the individual/family level, here’s what could be done. Parents reading this could consider one or more of these to get one step closer to living a life of healthy habits as a family.

• Financial barriers:

  • Try a 3-month trial: Hire a nutrition/fitness coach for one specific goal (e.g., better meal planning or daily steps).

  • Use free/low-cost apps:

    • MyFitnessPal (track meals), Cronometer (nutrient gaps), Strava (family fitness challenges)

  • Split fees with another family (~$100/month each) or use employer wellness programs.

• Cultural/religious barriers: Find a coach who customizes plans (e.g., halal, vegetarian, or budget-friendly meals).

• Time barriers: Replace 1 takeout night/week with a coached "family cook-along" (15 mins prep).

• Conflicting schedules: Record short coach videos (e.g., "5-min morning stretches") for flexible access.

• Motivational/willingness/readiness barriers:

  • Turn goals into games (e.g., "Kids vs. Parents" step competition with fun rewards). [There is research that is emerging on the effectiveness of gamification to achieve health goals - we’ll be talking about this as well, in the future]

  • Integrate simple challenges into the routine:

    • "Meatless Monday": Coach helps pick one plant-based recipe.

    • 10-min family walks: After dinner, no devices allowed.

    • Hydration challenge: Track water intake with fun stickers for kids.

  • Team up with neighbours: your coach teaches nutrition; theirs teaches weekend yoga lessons.

  • Kids as coaches: Let teens research/share one health tip weekly (e.g., "Why protein matters").

• Generational gaps and different preferences: These gaps between generations would require a very skilled coach who could communicate with the different types of audience and bring together a plan that works for the entire family as a team. Technology can be a useful tool in this process:

  • AI chatbots (e.g., ChatGPT for quick Q&A on healthy snacks).

  • Shared Google Sheets to log family progress.

• Lack of awareness/education: use low cost resources to bring different members up to speed with the objectives and strategies pursued to improve health.

  • YouTube: Follow certified coaches online

We can all do better for our health and it can start from home, with family

Thank you for reading -