GLP-1 medications have changed the weight-loss conversation.

For the right person, that can be a very good thing.

As I wrote recently, drugs like semaglutide and tirzepatide are proving to be much more than cosmetic weight-loss tools. Their potential benefits extend into the cardiovascular, kidney and metabolic health realms and they may ultimately prove to be some of the more consequential healthspan interventions of our generation.

But there’s a second-order question that I don’t think gets nearly enough attention:

What exactly are you losing when you lose the weight?

Because the goal shouldn’t simply be to make a person lighter.

It should be to reduce excess fat while preserving the muscle, strength and physical capacity that person will need for the decades ahead.

That distinction matters.

In a body-composition study of the SURMOUNT-1 trial, roughly 75% of the weight participants lost with tirzepatide came from fat mass and approximately 25% came from lean mass. Other GLP-1 studies have produced different ratios but the underlying point remains: when people lose substantial amounts of weight, some lean tissue often goes with it.

That doesn’t make GLP-1 medications bad, but it means that the prescription should come with another prescription: a muscle-preservation protocol.

A Lighter Body Isn’t Automatically a More Capable Body

This has become increasingly important to me as I’ve gotten deeper into longevity. I recently wrote about why getting strong after 40 has become one of my biggest health priorities.

I’m less interested in what my body looks like and more focused on what it can do.

Can I hoist my kids up in the air?

Can I quickly get out of the way if a car is coming toward me in a parking lot?

Can I get off the floor easily?

Can I lift something heavy?

Can I catch myself if I stumble?

That is physical capacity.

And as I wrote in that piece, I increasingly think of strength as physical reserve. The stronger and more capable you are today, the more margin you may have as aging inevitably begins taking some of it away.

That creates an interesting contradiction in the GLP-1 era.

We have become extraordinarily good at helping people lose weight.

The scale tells you how much weight you’ve lost. It doesn’t tell you whether that weight came from fat, muscle or both.

The Missing GLP-1 Prescription

In 2025, four major nutrition, lifestyle and obesity organizations jointly published a clinical advisory on supporting GLP-1 therapy.

Their conclusion wasn’t that GLP-1 medications should be avoided. It was that patients need a broader plan around them - one that includes adequate protein, strength training, nutritional assessment, sleep and attention to body composition.

That sounds obvious.

But I know many people who are effectively handed the medication and told to watch the scale.

Everyone gets the prescription.

Far fewer get the protocol.

If I were spending hundreds or potentially $1,000 or more a month on a GLP-1, these are the things I would want to build around it.

1. Treat Protein Like Part of the Medication

GLP-1 medications work in part because people become less hungry and eat less.

That’s obviously useful when the objective is weight loss.

But decreased appetite creates a new problem: when you eat less food, you have fewer opportunities to get enough protein.

That means protein can’t simply be something you hope happens somewhere in the diet.

It needs to become intentional.

A JAMA Internal Medicine guide for people taking GLP-1 medications suggests roughly 1.0 to 1.5 grams of protein per kilogram of body weight per day for moderately active adults, including approximately 20 to 30 grams at each meal.

The exact target matters less than the behavior: Eat the protein first.

If your appetite is low, build meals around eggs, Greek yogurt, fish, chicken, lean meat, tofu, beans or another quality protein source that works for you. If meeting the target with food becomes difficult, a protein shake can be a useful tool.

Weight loss gives your body a reason to get smaller.

Protein helps give it a reason to preserve muscle.

2. Strength Train - Then Actually Get Stronger

Protein alone isn’t enough.

If you want your body to keep muscle during substantial weight loss, give it a reason to believe it still needs that muscle.

That reason is resistance training.

But I would take the recommendation one step further:

Don’t simply exercise with weights.

Train progressively.

The 2026 American College of Sports Medicine position stand on resistance training concluded that progressive resistance training improves strength, muscle size, power and physical function. Strength benefits were enhanced by heavier loading and training at least twice weekly.

Progressive overload doesn’t have to be complicated.

More weight.

More repetitions.

Better range of motion.

Another set.

A harder variation.

You don’t need to become a powerlifter.

You need to give your body a progressively stronger signal to keep the tissue you want it to retain.

3. Stop Letting the Scale Be Your Only Measurement

Imagine two people, each lose 30 pounds.

One loses mostly fat while preserving most of their lean tissue.

The other loses considerably more lean tissue.

The bathroom scale gives them the exact same congratulations.

Their bodies didn’t undergo the same transformation.

This is why I like body-composition testing.

DEXA isn’t perfect and I don’t think everyone taking a GLP-1 needs to become obsessive about scanning themselves. But if someone is about to undergo substantial weight loss, a baseline can be useful.

The SURMOUNT-1 body-composition study used DEXA to distinguish changes in fat and lean mass - the exact distinction a bathroom scale can’t make.

If it were me, I’d want a baseline near the beginning of treatment and another meaningful comparison later, ideally using the same machine under similar conditions.

Then I would pair that information with something simpler:

Am I still strong?

Track your squat, your presses and rows, even your grip strength.

A scan tells you about tissue, performance tells you what your body can actually do.

4. Creatine Deserves a Conversation

If the objective is preserving strength and muscle, creatine is one of the first supplements I would discuss with a qualified clinician.

Not because it is fashionable.

Because it has a deep evidence base.

A meta-analysis examining creatine combined with resistance training found greater gains in lean tissue and strength among aging adults compared with resistance training alone.

A common maintenance approach is roughly 3 to 5 grams of creatine monohydrate per day.

This isn’t a GLP-1-specific therapy and I wouldn’t pretend we have robust trials showing that adding creatine to semaglutide or tirzepatide prevents muscle loss.

We don’t.

The logic is simpler: if you are deliberately trying to preserve strength while losing weight and you are resistance training, creatine is an inexpensive, well-studied tool worth discussing with your physician (and I’m personally a fan of Momentous’ Creatine Monohydrate)

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5. Sleep Is Part of the Muscle Protocol

If I wanted to design a bad environment for preserving muscle, I might combine:

A large calorie deficit.

Inadequate protein.

No resistance training.

And terrible sleep.

Yet sleep tends to get treated as the optional part of the plan.

It isn’t.

In a randomized crossover study of healthy young adults, a single night of total sleep deprivation reduced post-meal muscle protein synthesis by 18%. It was a small, acute study involving 13 participants, so I wouldn’t extrapolate that into a claim that every bad night costs you 18% of your gains. But it’s a useful reminder that sleep directly influences the physiological environment in which muscle is maintained.

Sleep also affects the thing that makes everything else possible:

Consistency.

It is harder to train progressively when you’re exhausted.

If someone is investing heavily in a medication designed to improve long-term health while routinely sleeping five hours a night, that feels like optimizing the wrong end of the stack.

6. Get the Labs and Have Someone Actually Interpret Them

There’s another trap created by successful weight loss:

The scale improves, so everyone assumes health must be improving with it.

Often it is.

But that should be measured, not assumed.

Which labs matter depends on why you’re taking the medication, your medical history, symptoms and other medications. Someone using a GLP-1 for diabetes will have different monitoring needs than someone without diabetes.

The point isn’t to order 75 biomarkers every month.

It’s to establish a baseline, define what success is supposed to look like and verify that the intervention is moving you in that direction.

Weight is one data point.

It shouldn’t be the entire dashboard.

If You’re Spending $1,000 a Month on the Drug, Don’t Ignore the Basics

There’s something strange about modern health optimization.

We will pay enormous amounts of money for a pharmaceutical intervention while ignoring behaviors that cost almost nothing.

Sleep doesn’t have a sales team.

Protein is boring.

Progressive overload is repetitive.

A DEXA scan will never generate the cultural fascination of Ozempic.

But those things may help determine whether the weight-loss story ends with you simply becoming smaller - or becoming leaner while retaining the physical capacity that lets you live well.

So if you are on a GLP-1, I would want five questions answered:

Am I getting enough protein?

Am I strength training and progressively getting stronger?

Do I know whether I’m losing fat versus lean tissue?

Is my sleep and recovery supporting the process?

Am I (alongside my physician) tracking the health markers that actually matter?

And I would add a sixth:

What is my plan for the body I want 20 or 30 years from now?

The Goal Isn’t Weight Loss. It’s Better Weight Loss.

I want to be clear about the argument here.

This is not an anti-GLP-1 piece.

I remain fascinated by these medications and optimistic about what they could mean for healthspan when used appropriately.

The argument is that a powerful medication deserves an equally serious protocol.

If semaglutide or tirzepatide helps someone lose substantial excess body fat and improve metabolic health, that can be transformative.

I just don’t want us to become so captivated by the falling number on the scale that we stop asking what we’re preserving underneath it.

Muscle.

Strength.

Bone.

Power.

The capacity to interact physically with the world.

Those things become more valuable with age, not less.

As I wrote recently, I’m increasingly trying to train for the body I want at 80 rather than simply the body I want next summer.

That same framework should apply to weight loss.

Don’t just ask:

How much weight did I lose?

Ask:

What did I lose and what did I manage to keep?

That may be the difference between a successful weight-loss intervention and a successful longevity intervention.

Yours in Health,

Ryan

Technology has made the world immeasurably better.

It allows us to speak face-to-face with someone on the other side of the planet. It gives a child access to an entire library from a kitchen table. It helps entrepreneurs build businesses, physicians care for patients remotely and families stay connected across continents. Digital connectivity has expanded access to education, health care, financial services and economic opportunity in ways that would have seemed impossible a generation ago.

I have built companies with technology.

I use it to research and write this newsletter, manage my health, connect with friends, research new ideas and communicate with people I otherwise may never have met.

The problem isn’t technology.

The problem is that a powerful tool has quietly become the environment we live inside.

Our phones wake us up. They deliver the news, our email, our work messages, our entertainment and our social lives. They fill the five minutes before a meeting, the walk to the car and the brief pause while someone else goes to the bathroom.

We no longer have to be bored.

And that may not be entirely good for us.

What Constant Connection Is Doing to Our Attention

Our brains didn’t suddenly become defective when smartphones arrived.

But they are highly adaptable.

When we repeatedly expose ourselves to rapid novelty, alerts and constantly changing information, we train ourselves to expect stimulation. We become more likely to reach for a device during the first hint of silence, difficulty or discomfort.

Even when we resist checking, the phone can continue competing for attention.

In one experiment, receiving a phone notification impaired performance on an attention-demanding task even when participants didn’t interact with the phone. Another series of experiments found that the mere presence of a person’s smartphone could reduce the cognitive capacity available for other tasks, with the largest effects among people who reported greater phone dependence.

The cost isn’t necessarily that technology makes us less intelligent.

It’s that part of our attention may remain occupied by what could be happening somewhere else.

Who emailed?

What happened in the news?

Did someone respond?

Is there something more interesting one swipe away?

That low-grade vigilance can make it harder to become fully absorbed in a conversation, a book, a creative problem or the moment directly in front of us.

Technology can also follow us into the hours when our nervous systems should be winding down. Controlled research on evening use of light-emitting devices has found delayed circadian timing, suppressed melatonin and reduced next-morning alertness.

This doesn’t mean every screen is harmful or that a weekend without Instagram will cure anxiety.

A 2024 meta-analysis found that digital-detox interventions produced a modest reduction in depressive symptoms but didn’t show consistent improvements in stress, life satisfaction or overall mental well-being. The evidence remains nuanced, and different people use different technologies in very different ways.

But newer experimental evidence is compelling.

In a month-long randomized trial, participants blocked mobile internet on their smartphones for two weeks while retaining calls, texts and internet access on computers. Sustained attention, mental health and subjective well-being improved. Participants also spent more time socializing in person, exercising and being in nature, and they slept more.

That last point may be the most important.

The benefit of unplugging may not come only from what we remove.

It may come from what returns in its place.

Nature Is the Ideal Place to Disconnect

There’s something fundamentally different about attention in nature.

A screen demands focus through alerts, headlines and motion.

Nature invites it.

Your eyes move across distance. Your pace slows. Your attention shifts toward trees, water, weather, sound and physical sensation. You’re stimulated, but not constantly interrupted.

In one well-known study, a 90-minute walk through a natural environment reduced self-reported rumination and activity in a brain region associated with repetitive negative thinking compared with a walk through an urban environment.

A large observational study also found that people reporting at least 120 minutes in nature each week were more likely to report good health and well-being. That doesn’t prove two hours is a magical threshold, but it offers a useful target.

For me, this begins early in the day.

I try to get outside for morning sunlight, both to move and to give my circadian system one of its strongest environmental signals: light. Research consistently shows that the timing and intensity of light exposure influence circadian rhythms, sleep and mood.

I also take work calls outdoors while walking whenever the conversation allows it. I may still be using technology, but I’m no longer sitting indoors staring at another screen. I’m moving, breathing fresh air and allowing part of my attention to widen.

Then there is Saturday morning.

I make a commitment to take my kids on a nature walk every Saturday. These walks aren’t always peaceful. There are snacks, random rocks they insist on carrying home and occasional negotiations about whether walking is still part of the activity.

But that is exactly why the ritual matters.

We’re outside.

We’re together.

And for at least part of the morning, we aren’t competing with a feed.

Doing a digital detox with other people may be especially powerful. Social connection isn’t merely pleasant, it’s one of the most important determinants of healthspan.

A phone-free walk with a friend therefore creates several benefits at once:

Movement.

Nature.

Uninterrupted conversation.

And the feeling that someone else has your full attention.

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Why My Best Ideas Rarely Arrive at My Desk

Some of my best business ideas have come while swimming in the pool or standing in the shower.

Obviously, I’m not checking Slack underwater.

I’m not toggling between email and a spreadsheet. I’m not reacting to an incoming request. My body is occupied by a simple, familiar activity, while my mind has permission to move more freely.

That experience is consistent with research on creative incubation. Studies suggest that undemanding activities that allow the mind to wander can improve performance on certain creative problems. Walking has also been shown to increase creative ideation during and shortly after the activity.

The shower isn’t magic.

The absence of interruption may be.

We often assume that solving a difficult problem requires staring at it harder. Sometimes the brain needs the opposite: distance, movement and enough silence for ideas that were forming below conscious awareness to connect.

A Digital-Detox Protocol That Survives Real Life

A digital detox doesn’t require disappearing into the woods for seven days.

Most people have jobs, children, aging parents, customers or patients who may genuinely need to reach them.

The goal isn’t total disconnection, it’s intentional access.

1. Protect the Bookends of the Day

Spend the first 20 minutes after waking away from email, news and social media.

Go outside. Walk. Drink coffee near a window. Let natural light and your own thoughts reach you before the rest of the world does.

During the final 30–60 minutes before bed, avoid unnecessary scrolling and emotionally stimulating content. Charge the phone outside the bedroom when practical.

2. Create Offline Work Islands

Choose one or two 45–90-minute blocks each day for focused work.

Turn off nonessential notifications and place the phone outside your immediate reach. Keep emergency contacts or genuinely essential work channels available when necessary.

The principle is simple: preserve access without preserving interruption.

3. Stack Disconnection With Something Healthy

Take one screen-free walk each day, even if it is only 10 or 20 minutes.

Eat one meal without a device.

Take an appropriate phone call outside while walking instead of sitting at a desk.

Schedule a weekly 90–120-minute nature block, ideally with family or friends. My Saturday walks with my kids are one version. Yours might be a hike, a park, a beach, gardening or simply walking through a tree-lined neighborhood.

4. Use a Deeper Monthly Reset

Once a month, take a half-day away from social media, email, news and recreational browsing.

Calls and texts can remain available for emergencies. You don’t need to become unreachable.

Use the time for movement, nature, reading, cooking, conversation, swimming or anything else that allows your attention to stay in one place.

The Goal Isn’t Less Technology, It’s More Agency.

Technology should help us live our lives, it shouldn’t become the place where our lives happen.

A digital detox isn’t a rejection of progress. It’s a way of restoring balance - to focus without interruption, rest without stimulation, spend time with people without dividing our attention and occasionally allow the mind to go somewhere we didn’t schedule.

You don’t have to throw away your smartphone.

Just create moments when it’s no longer the most interesting object in the room.

Start with 20 minutes.

Go outside.

Bring someone you care about.

Leave the phone in your pocket.

Then notice what returns when the notifications stop.

Yours in Health,

Ryan

I’ve been thinking a lot lately about what it actually means to be “fit” in your 40s.

For much of our lives, fitness is easy to frame aesthetically. How much do you weigh? How lean are you? Can you see your abs? Do your clothes fit the way you want them to?

There’s nothing inherently wrong with those goals. But the deeper I get into longevity, the less interested I am in what my body looks like and the more interested I am in what it can do.

Can I carry something heavy without thinking twice? Can I get up off the floor easily? Can I catch myself if I trip? Can I hike, run, climb stairs, lift my kids and keep doing all of those things decades from now?

That, to me, is increasingly what fitness after 40 is about.

Not aesthetics. Capacity.

And the science suggests that distinction matters.

Muscle Is Important. But Muscle Alone Isn’t the Goal.

We hear a lot about preserving muscle as we age, and for good reason. Skeletal muscle is metabolically active tissue, it helps us regulate glucose, it protects our joints and, most importantly, it allows us to interact physically with the world around us.

But there’s an important nuance: having muscle and being able to use it are not the same thing.

In a longitudinal study of older adults, declines in strength substantially outpaced changes in muscle mass. In other words, someone can preserve much of the quantity of their muscle while still losing a meaningful amount of their ability to generate force.

This is why I’ve started to think about muscle less as something cosmetic and more as physical reserve.

Physical reserve gives you options. It makes carrying a suitcase through an airport unremarkable. It makes a steep hike manageable. It allows you to pick up a child, move a piece of furniture or recover from a major medical experience.

Eventually, those same reserves may determine whether getting out of a chair, climbing a flight of stairs or carrying groceries remains easy or becomes a meaningful limitation.

The goal, then, isn’t simply to maintain muscle, it’s to maintain useful muscle.

Strength Matters. Power May Matter Even More.

There’s another component of fitness that gets far less attention: power.

Strength is your ability to produce force. Power is your ability to produce that force quickly, and that difference matters enormously in real life.

Standing rapidly from a chair requires power. So does catching yourself when you stumble, accelerating to cross a street, stepping onto a high ledge or reacting quickly when something unexpected happens.

A 2025 prospective study published in Mayo Clinic Proceedings found that relative muscle power was an even stronger predictor of mortality than relative muscle strength among middle-aged and older adults.

That doesn’t mean everyone over 40 should suddenly start doing box jumps or Olympic lifts. It means there is value in maintaining the ability to move with some speed and explosiveness, using movements appropriate for your fitness level and injury history.

We shouldn’t train only to be strong enough to lift something heavy.

We should also preserve the ability to react when life moves faster than we expect.

The GLP-1 Era Makes This Even More Important

This conversation has become particularly relevant because of the enormous rise of GLP-1-based medications.

Drugs like semaglutide and tirzepatide are changing far more than waistlines. For people with appropriate medical indications, they can be extraordinarily powerful tools, with benefits that increasingly extend beyond weight loss into cardiovascular, kidney and metabolic health.

But major weight loss comes with a tradeoff that deserves more attention: not all of the weight that disappears is fat.

In a body-composition substudy of the SURMOUNT-1 trial, people taking tirzepatide lost substantially more fat than lean tissue, which is good news. Still, roughly 25% of the weight lost came from lean mass. Semaglutide studies have similarly documented decreases in lean mass alongside the much larger reductions in fat mass.

If we’re using increasingly effective tools to make people lighter, we should be equally serious about helping them remain strong. Resistance training, sufficient nutrition and adequate protein become important companions to weight-loss strategies because the goal shouldn’t simply be to minimize the number on the scale. It should be to lose excess fat while preserving as much functional tissue and physical capacity as possible.

This is one reason I think our cultural obsession with getting lean can occasionally miss the point.

A lighter body isn’t automatically a more capable body. And when thinking about longevity, capability is what I care about most.

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Grip Strength Is a Surprisingly Powerful Signal

One of the simplest longevity measurements also happens to be one of the most interesting: grip strength.

A large meta-analysis covering 48 studies and more than three million participants found a clear inverse relationship between grip strength and mortality risk. Higher grip strength was associated with lower mortality risk across a broad range of adults.

That doesn’t mean squeezing a hand gripper is some secret life-extension hack. Grip strength is valuable because it appears to be a signal of something much broader - the integrated ability of your muscles and nervous system to generate force.

I like metrics like this because longevity can become incredibly complicated. We can measure hundreds of biomarkers, run sophisticated imaging and debate marginal differences in lab values.

But sometimes a remarkably basic question tells us something important:

Are you still strong?

Balance Is Easy to Ignore Until You Lose It

Balance is another physical capacity most of us take completely for granted when we’re younger.

But balance isn’t a niche skill for old age. It’s something worth preserving long before falls become an obvious concern. It depends on strength, coordination, vision, proprioception, the vestibular system and the nervous system working together.

A British birth-cohort study that began assessing people in midlife found that poorer one-legged balance was associated with recurrent falls years later. Participants who consistently recorded balance times under 15 seconds had more than three times the risk of recurrent falls at age 68 compared with those who could maintain the position for 30 seconds.

The finding is a useful reminder that the abilities we lose later in life often begin deteriorating well before we notice them.

So train balance while balance still feels easy.

And Then There’s Bone

Muscle gets most of the attention in longevity circles. Bone deserves more.

You can have excellent cardiovascular fitness and plenty of muscle, but if your skeleton becomes fragile, your physical world can shrink very quickly. A fracture later in life can be far more than an orthopedic inconvenience; it can become the event that interrupts mobility and independence.

Resistance training is particularly attractive because it can work both sides of the equation. A systematic review and meta-analysis found that progressive resistance training increased lower-body strength while also improving bone mineral density at the hip and femur in older adults.

I think of the relationship simply: strong muscles help prevent a fall; strong bones help withstand one.

Longevity requires both.

What I’m Optimizing for After 40

The more I learn, the more my own training philosophy simplifies.

I’m not trying to build the perfect physique. I’m trying to build physical margin -enough excess capacity that normal life remains easy even as some decline inevitably occurs with age.

For me, that means prioritizing strength through regular resistance training and progressive overload. It means maintaining some power and speed rather than performing every movement slowly. It means pulling, carrying and gripping heavy things. It means including single-leg movements and exercises that challenge stability. And it means giving my bones a reason to remain strong through meaningful resistance and weight-bearing loading.

None of this requires living in a gym. In fact, a 2022 meta-analysis found that resistance training was associated with lower all-cause mortality, with meaningful benefits appearing at relatively modest weekly volumes.

The point isn’t that there is one perfect training program. The point is to keep giving your body a reason to retain capabilities that it will otherwise gradually surrender.

Train for the Body You Want at 80

One of my favorite mental models in longevity is to work backward.

Instead of asking only what I want my body to look like next summer, I increasingly ask what I want my body to be able to do at 80.

I want to carry my own luggage. I want to get down on the floor and stand back up without giving it any thought. I want to walk through a new city all day, hike on vacation, climb stairs, carry groceries and live in my own home without arranging my environment around physical limitations.

None of those things sound particularly impressive. That’s precisely why they matter.

The great irony is that the physical abilities we barely notice in midlife may become some of our most valuable possessions later on. Independence is built out of ordinary movements: getting up, carrying, reaching, walking, reacting and maintaining your balance.

And that changes how I think about training today. I’m not only exercising for the body I have now. In some small way, I’m making deposits into the body I hope to have several decades from now.

There are no guarantees. Aging will happen, injuries happen and biology always gets a vote. But there is a major difference between arriving at older age with a large reservoir of strength, power, balance and bone - and arriving there having spent decades allowing that reservoir to slowly drain.

So yes, build muscle. But don’t stop there.

Build strength you can use, power you can access quickly, bones that can tolerate load and enough balance and coordination to navigate an unpredictable world.

The goal isn’t simply to look younger for longer.

It’s to remain capable for longer.

And after 40, I’m increasingly convinced that may be the better definition of fitness.

Yours in Health,

Ryan

GLP-1 medications are usually discussed in one context.

Weight loss.

Ozempic, Wegovy, Mounjaro and Zepbound have become cultural shorthand for shrinking waistlines, quieting “food noise” and changing how we treat obesity.

But that framing is becoming incomplete.

Researchers are increasingly finding that these medications may positively affect the heart, kidneys, liver, brain and other systems throughout the body. Some of these benefits are now supported by large randomized trials. Others remain intriguing but preliminary.

I should make something clear upfront: Unlike some of my other posts, I’m not coming at this from personal experience. I’m too far on the other side of the spectrum - needing to gain weight and preserve and grow muscle mass at this stage in my life. I’m interested because it’s difficult to study longevity without paying attention to a class of medications that is beginning to influence so many of the diseases that shorten healthspan.

What GLP-1 Medications Actually Do

GLP-1, or glucagon-like peptide-1, is a hormone your body naturally releases after eating.

It helps your pancreas release insulin when blood sugar rises, reduces glucagon secretion, slows the movement of food through the stomach and signals fullness to the brain.

Medications such as semaglutide mimic this hormone but remain active much longer than naturally produced GLP-1. Tirzepatide works slightly differently, activating both GLP-1 and GIP receptors (another gut hormone that is released after eating to help regulate insulin secretion and metabolism).

These medications don’t simply suppress appetite. They intervene in a hormonal network connecting the gut, pancreas, brain and metabolism.

Once you understand that, their wider effects become less surprising.

The Heart Benefits Are No Longer Speculative

The clearest evidence outside of weight loss involves cardiovascular disease.

The SELECT trial followed more than 17,000 overweight adults with established cardiovascular disease. Participants receiving semaglutide experienced a 20% lower risk of cardiovascular death, nonfatal heart attack or nonfatal stroke than those receiving a placebo.

That result was significant enough for the FDA to approve Wegovy for reducing serious cardiovascular events in this population.

Tirzepatide has also shown promising results in people with obesity and heart failure with preserved ejection fraction, a condition that has historically been difficult to treat. In the SUMMIT trial, it reduced the risk of worsening heart failure or cardiovascular death while also improving symptoms and physical function.

These results alone wouldn’t be terribly surprising if it was strictly a function of weight loss resulting in better cardiovascular health. Think about it - the less unhealthy body mass, the lower the strain on the heart. However, the authors of the study ran an analysis accounting for how much weight participants had lost and they still found that 35% - 55% of the cardiovascular benefit remained.

The point is this: these are no longer merely cosmetic weight-loss drugs. They are medications with demonstrated cardiovascular outcomes and I’m personally excited to follow the ongoing research into the purported cardiovascular benefits of GLP-1s.

The Kidneys and Liver May Benefit Too

In the FLOW trial, semaglutide reduced major kidney outcomes by 24% in people with type 2 diabetes and chronic kidney disease. Those outcomes included worsening kidney function, kidney failure and death from kidney or cardiovascular causes.

The liver evidence has also moved quickly.

In the phase 3 ESSENCE trial, nearly 63% of participants receiving semaglutide saw their metabolic dysfunction-associated steatohepatitis, or MASH, resolve without any worsening of liver fibrosis, compared with roughly 34% of those receiving a placebo. Semaglutide also led to greater improvements in liver scarring.

In August 2025, the FDA granted accelerated approval to Wegovy for adults with MASH and moderate-to-advanced fibrosis. Continued approval remains contingent on confirmation of longer-term clinical benefit.

This is an important distinction.

The drug didn’t simply improve a blood test. It produced measurable changes in liver tissue.

Special Thanks to Our Partner

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I respect Resbiotic as the company is lead by a truly high-caliber team of professionals - something that’s critical in an industry where so many products and services aren’t grounded in real science and where the marketed benefits grossly overstate the underlying products.

To learn more about Resbiotic visit Resbiotic.com or learn more at Workup.

Could GLP-1s Quiet More Than Hunger?

One of the most interesting emerging areas involves reward and compulsive behavior.

A large observational study of more than two million veterans with diabetes found that GLP-1 receptor agonist use was associated with lower risks of several substance-use disorders, seizures and some neurocognitive conditions. It also identified increased risks in areas including gastrointestinal problems, low blood pressure and certain kidney complications.

Observational studies can reveal patterns but they can’t prove that the medication caused them.

But a small randomized trial has added support to the addiction hypothesis. Among 48 adults with alcohol use disorder, low-dose semaglutide reduced alcohol consumption in a laboratory setting and reduced some measures of drinking and alcohol craving over nine weeks. It didn’t improve every outcome and naturally the study was far too small to change clinical practice.

Still, the idea is biologically plausible.

If these drugs influence brain circuits involved in appetite, reward and reinforcement, their effects may extend beyond food.

Where the Evidence Hasn’t Lived Up to the Hype

GLP-1 enthusiasm has occasionally drifted toward the idea that these medications might protect against nearly every chronic disease.

The Alzheimer’s research is a useful reality check.

Early observational evidence suggested that GLP-1 users had lower rates of dementia. But in two large phase 3 trials involving approximately 3,800 people with early Alzheimer’s disease, oral semaglutide didn’t meaningfully slow cognitive or functional decline.

The medication improved certain biological markers, but those changes didn’t translate into a clinical benefit.

Cancer research is similarly unsettled.

A 2026 observational study of more than 110,000 women found that GLP-1 use was associated with roughly 30% lower breast cancer incidence after researchers adjusted for several major risk factors.

That’s a compelling signal.

But randomized-trial reviews have generally found little or no clear effect on overall obesity-related cancer risk, in part because most trials were not long enough or designed to detect cancer outcomes.

At this point, nobody should take a GLP-1 medication solely to prevent dementia or cancer.

The research belongs in the “worth investigating” category, not the “clinically proven” category.

The Tradeoffs Still Matter

Powerful medications come with powerful tradeoffs.

Nausea, vomiting, diarrhea, constipation and abdominal discomfort are common.

Then there is muscle.

In a body-composition study of tirzepatide, approximately 75% of the weight lost came from fat mass and 25% from lean mass. That ratio isn’t necessarily unusual during major weight loss, but losing lean tissue still matters - especially for older adults, people starting with limited muscle or anyone who loses weight rapidly without resistance training and adequate nutrition.

This concern is particularly relevant to me.

My goal isn’t to become lighter. It’s to become stronger and add metabolically useful tissue. A medication that is transformative for someone living with obesity may be entirely wrong for someone with different needs.

There’s also the maintenance question.

In the STEP 1 extension, participants regained approximately two-thirds of the weight they had lost within one year of stopping semaglutide. Many of their cardiometabolic improvements also moved back towards baseline.

That isn’t evidence of weak willpower. Instead, it’s evidence that obesity is a chronic biological condition and that these drugs often function more like long-term blood-pressure medication than a temporary treatment with a clear finish line.

The Right Reframe

The real story isn’t that GLP-1 medications cure everything.

They don’t.

The real story is that obesity, insulin resistance and metabolic dysfunction affect almost every organ system. Treating those conditions effectively can therefore produce benefits throughout the body.

Some effects may be driven by weight loss.

Some may come from improved blood sugar, lower inflammation or reduced organ fat.

Some may eventually prove to be direct effects of GLP-1 signaling.

And some of today’s most exciting hypotheses will fail when tested in rigorous trials.

That’s how science is supposed to work.

For people with the right medical indications, GLP-1-based therapies may be among the most important healthspan tools developed in decades.

And I for one, am personally excited to be living in an era where we’re increasingly finding ways to move the needle on healthspan.

Yours in Health,

Ryan

“Inflammaging” sounds like a word invented by the wellness industry to sell you something.

It wasn’t.

The term was introduced by researchers in 2000 to describe a pattern they were seeing in older adults: chronic, low-grade inflammation that persists even when there is no obvious infection or injury.

Unlike the inflammation that makes your ankle swell after a sprain, inflammaging is usually quiet.

You may not feel it.

There is no flashing warning light.

But over years or decades, this persistent immune activation may contribute to many of the conditions we associate with aging, including cardiovascular disease, type 2 diabetes, frailty, cognitive decline and some cancers.

That sounds alarming.

The more useful question is whether it’s inevitable.

And increasingly, the answer appears to be no.

Inflammation Is Not the Enemy

Before we try to eliminate inflammation, we need to understand why it exists.

Inflammation is one of the body’s most important survival systems. When you encounter an infection, cut your skin or damage muscle during a workout, your immune system sends inflammatory signals to contain the threat and begin repair.

That is acute inflammation.

It turns on for a reason and, ideally, turns off when the job is done.

Inflammaging is different.

Think of acute inflammation as a fire department responding to an emergency.

Inflammaging is more like a crew that never fully leaves. The trucks remain outside. The alarms keep chirping. Resources continue being diverted, even though there is no fire to put out.

The problem isn’t that the immune system is working, it’s that it may have trouble returning to baseline.

Where Does Inflammaging Come From?

There is no single cause.

As we age, damaged cells and cellular debris accumulate. Some older cells enter a state known as senescence. They stop dividing but remain biologically active, releasing inflammatory molecules that can affect nearby tissue.

Visceral fat can also produce inflammatory signals. So can poor metabolic health, disrupted sleep, smoking, chronic infections, inactivity and changes in the gut microbiome.

At the same time, the aging immune system may become less precise. It can be slower to respond to a real threat while remaining more activated in the background.

This creates a frustrating combination: less effective immunity when you need it, more inflammation when you don’t.

But there’s an important nuance.

Researchers still don’t have one universally accepted way to measure inflammaging. Markers such as high-sensitivity C-reactive protein, or hs-CRP, interleukin-6 and tumor necrosis factor-alpha can provide information, but none offers a complete “inflammaging score.” A single elevated marker is a signal requiring context, not proof that your body is aging badly.

Special Thanks to Our Partners

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I am careful about how supplements fit into longevity. They’re supporting actors, not the plot.

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The Most Hopeful Inflammaging Study I’ve Seen

For years, inflammaging was often presented as a near-universal consequence of getting older.

Then researchers looked beyond industrialized populations.

A 2025 study published in Nature Aging compared inflammatory patterns across older adults in Italy and Singapore with two non-industrialized Indigenous populations: the Tsimane in Bolivia and the Orang Asli in Malaysia.

The classic inflammaging pattern appeared in the industrialized populations.

It did not consistently appear in the nonindustrialized groups.

The researchers concluded that inflammaging, at least as measured through the cytokines in their study, may be heavily influenced by industrialized environments and lifestyles rather than aging alone.

This doesn’t prove that aging has nothing to do with inflammation, but it does suggest that the environment in which we age matters.

Our food, movement, sleep, metabolic health, infections, stress and daily exposures may shape the inflammatory burden we accumulate over time.

Age may load the gun.

Lifestyle and environment may influence how often the trigger gets pulled.

So, Can You Actually Change It?

Probably, but not through one intervention.

The strongest evidence points toward reducing the major inputs that keep the immune system activated.

Build and Use Muscle

Exercise is one of the most reliable tools we have.

A systematic review and meta-analysis of randomized trials in older adults found that exercise training reduced several inflammatory markers, although the effects varied according to the type of exercise and the health of the participants.

Resistance training appears especially valuable because it addresses several problems at once.

It helps preserve muscle.

It improves glucose disposal.

It can reduce visceral fat.

And over time, it may lower resting inflammatory markers. A separate meta-analysis found that resistance training reduced CRP in older adults, with more consistent benefits in longer and more frequent programs.

The lesson isn’t that one hard workout “detoxes” inflammation, it’s that a body that moves regularly tends to manage inflammatory signals better than one that doesn’t.

Improve Metabolic Health

Fat tissue isn’t simply stored energy, it’s metabolically active tissue.

Visceral fat - the fat stored around internal organs - can release inflammatory molecules and contribute to insulin resistance.

In a randomized trial of women with obesity, a two-year lifestyle intervention combining a Mediterranean-style eating pattern, increased physical activity and weight loss lowered CRP, IL-6 and other inflammatory markers.

This isn’t a message about pursuing thinness, it’s a message about improving metabolic function.

Waist circumference, blood pressure, glucose regulation, triglycerides, fitness and muscle mass often tell us more than body weight alone.

Eat a Pattern, Not an “Anti-Inflammatory” Superfood

There is no berry, spice or green powder that switches off inflammaging.

Dietary patterns matter more than individual ingredients.

In a randomized trial involving 180 people with metabolic syndrome, a Mediterranean-style diet improved endothelial function and reduced markers of vascular inflammation compared with conventional dietary advice.

In practical terms, that pattern looks familiar:

Vegetables and fruit.

Beans and lentils.

Nuts and seeds.

Olive oil.

Fish.

Adequate protein.

High-fiber carbohydrates.

Fewer ultra-processed foods.

The value isn’t in eating perfectly, it’s in creating a food environment that your metabolism and immune system can handle repeatedly for decades.

Treat Sleep as Immune Maintenance

As I’ve written about in the past, sleep is not simply downtime for the brain.

It’s part of immune regulation.

A systematic review and meta-analysis found that sleep disturbance was associated with higher levels of CRP and IL-6, two commonly studied markers of systemic inflammation.

One bad night isn’t going to age you overnight.

But years of fragmented, inconsistent or insufficient sleep may become another signal telling the body that something is wrong.

This is also why persistent snoring, suspected sleep apnea or chronic insomnia shouldn’t be dismissed as inconveniences. They deserve attention.

Don’t Try to Drive Inflammation to Zero

The goal isn’t to suppress your immune system.

You need inflammation to heal, adapt to exercise and fight infection.

The goal is flexibility.

A healthy immune system should be capable of responding aggressively when necessary and settling down afterward.

That’s the difference between resilience and chronic activation.

It’s also why I would be cautious about anyone selling an “anti-inflammaging protocol” based on one blood test or one supplement stack.

Inflammaging isn’t a disease that can be diagnosed with a single consumer score.

Instead, it’s a biological pattern shaped by many systems.

What I Would Do

I wouldn’t begin with an exotic test.

I would begin with the areas most likely to lower unnecessary inflammatory load while improving nearly every other dimension of health:

• Strength train two or three times each week.

• Walk most days and build cardiovascular fitness.

• Eat mostly minimally processed foods with adequate protein and fiber.

• Protect a consistent sleep schedule.

• Improve blood pressure, glucose regulation and visceral fat when necessary.

• Stop smoking.

• Address chronic dental problems, untreated sleep disorders and other ongoing sources of inflammation with the appropriate clinician.

Then, where clinically appropriate, use markers such as hs-CRP as context rather than as a verdict.

The objective isn’t to micromanage every cytokine. It’s to build a body that has fewer reasons to remain on high alert.

The Bigger Longevity Lesson

Inflammaging matters because it connects many of the things we already care about:

Muscle. Metabolism. Cardiovascular health. Brain health. Recovery. Immune function.

But it also teaches us something more encouraging: aging isn’t simply a collection of biological processes happening to us - it’s an ongoing interaction between our biology and our environment.

You can’t control every part of that interaction, but you can influence more of it than you may think.

Inflammaging isn’t something you defeat with a hack, it’s something you gradually turn down through the same unglamorous behaviors that repeatedly show up in credible longevity research.

Movement. Strength. Sleep. Metabolic health. Real food. Consistency.

Not a perfect life, just a body with fewer fires to fight.

Yours in Health,

Ryan Frankel

Looking back, there have been times when my children wanted me to play, but I chose a workout instead.

The session was on my schedule. I had a goal. Missing it felt like falling behind.

There have also been evenings in my past when I’ve departed social functions on the earlier side because I wanted to be rested for an early workout the next morning. Friends probably stayed out late, talking and laughing while I was back at home, protecting my sleep score.

Each decision was defensible in isolation.

Exercise matters. Sleep matters. Consistency matters.

But over time, I began to see the flaw in the system I had built.

My health protocol was occasionally pulling me away from the very people I was supposedly trying to stay healthy for.

When Healthy Choices Become an Unhealthy Life

Longevity culture is built around inputs.

We track protein, steps, resting heart rate, glucose, sleep stages, supplements, training volume and recovery. The underlying promise is appealing: measure enough variables, make enough good decisions and perhaps we can meaningfully influence how well we age.

I believe in much of this. I have built a significant part of my life and work around helping people make more informed health decisions.

But there is a danger in treating life like an engineering problem.

The more variables we monitor, the easier it becomes to assume that everything valuable must be measurable. The activities that don’t produce a clean data point - playing, laughing, lingering over dinner or doing something for no productive reason - begin to look optional.

Joy becomes what we allow ourselves after the important work is complete.

The problem is that the important work is never complete.

There will always be another workout, another early alarm, another health target and another reason to postpone the experience directly in front of us.

Joy Is Not a Luxury Metric

Joy doesn’t mean being happy all the time.

It can be a shared joke, a game with your children, a long dinner, live music, a hobby, a spontaneous trip or an afternoon during which you briefly forget to be productive.

These moments may look biologically insignificant but the science suggests otherwise.

Meta-analyses have found that positive psychological well-being and positive affect are associated with lower mortality risk. In one longitudinal study of adults over 50, people who repeatedly reported greater enjoyment of life had lower mortality during follow-up than those who consistently reported little enjoyment.

To be clear, that doesn’t necessarily guarantee that adding a weekly game night will extend your life.

Much of this research is observational. Healthier people may have more opportunities to experience joy. And factors such as income, mobility, relationships and underlying health influence both well-being and longevity.

But the association persists across enough studies that joy should not be dismissed as irrelevant simply because it’s difficult to place on a dashboard.

There is also evidence linking positive psychological traits such as optimism and emotional vitality with lower rates of cardiovascular events and coronary heart disease. Again, these findings don’t turn happiness into medicine, but they do suggest that our internal experience of life interacts with our physical health rather than existing outside it.

Connection May Be Joy’s Most Powerful Pathway

Many of our most joyful experiences involve other people.

A large meta-analysis covering 148 studies and more than 300,000 participants found that people with stronger social relationships had a 50% greater likelihood of survival during the study periods than those with weaker relationships. The strongest associations appeared in measures that captured meaningful social integration, not simply whether someone lived alone.

This matters because optimization can quietly create isolation.

We decline the late night dinner because the timing of the meal will impact our preferred sleep window. We skip the trip because it will interrupt training. We leave the gathering early because our wearable has told us precisely when to begin winding down.

None of these choices is automatically wrong.

The issue is the pattern.

One early bedtime may support health. Repeatedly leaving your partner to socialize alone may erode connection.

One solo workout may strengthen your body. Consistently choosing it over playing with your children may weaken something equally important.

The question is not whether sleep or exercise matters more than joy.

The question is whether your longevity habits are creating more capacity for relationships or continually competing with them.

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Play Trains Capacities We Rarely Measure

Children don’t need to be persuaded to play.

Adults often do.

At some point, activities without a visible outcome start to feel wasteful. We turn hobbies into side businesses, walks into step goals and recreational sports into performance programs.

Even leisure becomes another assignment.

The scientific literature on adult play is less mature than the literature on exercise, sleep or nutrition, so we should resist exaggerated claims. But research on leisure activities is encouraging. Systematic reviews have associated cognitive, physical and social leisure with lower dementia risk, while activities such as reading, games, music and dancing may help support cognitive reserve and social engagement.

More importantly, play gives us something no biomarker can fully capture: practice being flexible.

Play requires responsiveness. It asks us to improvise, tolerate unpredictability and participate without controlling every outcome.

Those are useful abilities in a life that will never follow a perfect plan.

Spontaneity is not the enemy of consistency. It may be what keeps consistency from hardening into rigidity.

Discipline and Delight Belong Together

This is not an argument for abandoning structure.

Chronic sleep deprivation isn’t joy. Neglecting movement isn’t freedom. Using pleasure to avoid every difficult but worthwhile behavior isn’t balance.

The foundations still matter:

• Move your body

• Build and preserve muscle

• Protect sleep

• Eat nourishing food

• Manage cardiovascular risk

• Maintain meaningful relationships

But foundations are supposed to support life, not replace it.

A strong longevity plan needs enough structure to keep us healthy and enough flexibility to let us be human.

Sometimes the healthier choice will be completing the workout.

Sometimes it will be getting into the basement bounce house with your kids (side note, exercise and mobility does help with this activity - I learned the hard way after nearly pulling a muscle bouncing around like a goofball).

Sometimes it will be going to bed on time.

Sometimes it will be staying downstairs for another hour because the conversation is too good to leave.

The wisdom lies in knowing that no single decision defines your health. Patterns do.

The Joy Audit

Most health audits begin by asking what we should add.

More protein. More steps. More sleep. More training.

A joy audit asks a different set of questions.

1. What gave me genuine pleasure this week?

Not achievement. Not relief after completing a task.

What made you feel lighter, more connected or more alive?

2. What meaningful experience did I sacrifice to protect my routine?

Was the sacrifice necessary or did following the plan simply feel safer than breaking it?

3. Who do I feel better after spending time with?

When did you last see that person? Is the relationship receiving actual time or only good intentions?

4. When did I last do something with no productive outcome?

Play a game. Listen to music. Make something badly. Wander. Read something that won’t improve your career.

5. Has my health protocol expanded my life or narrowed it?

Are you stronger and more available?

Or more anxious, rigid and difficult to make plans with?

6. What am I postponing until life calms down?

The trip. The hobby. The dinner. The afternoon with your children.

Life may not calm down on its own.

7. Where could I leave more room for spontaneity?

A calendar filled to maximum efficiency has no room for surprise.

Protecting joy may require protecting some unassigned time.

After completing the audit, choose one small repair.

Replace one solitary workout with active play. Stay at dinner a little longer. Leave one weekend block unscheduled. Call the friend you keep meaning to call. Eat one meal without turning it into a performance optimizing nutritional calculation.

Don’t track the result.

Just notice how it feels.

Don’t Turn Joy Into Another Protocol

There is an obvious irony here.

The longevity world could take an idea like joy and immediately optimize it.

We could create joy scores, prescribe a minimum number of weekly leisure minutes and feel guilty when we fail to reach our play target.

That would miss the point.

Joy is valuable partly because it interrupts the belief that every minute must be productive.

It reminds us that the body we are training, fueling, monitoring and trying so hard to preserve is not the final objective.

The objective is the life that body allows us to experience.

I still believe in exercise. I still protect my sleep. I still care about health data and long-term risk.

But I am trying to become better at recognizing when the protocol is serving my life and when my life has begun serving the protocol.

Longevity should help us remain present for more dinners, more friendships, more adventures and more time on the floor playing with our children.

It should not require us to miss all of those things in preparation for a future we are fortunate enough to reach.

The goal is not merely a longer lifespan.

It’s a longer joyspan - the number of years we remain capable of feeling connected, playful, curious, spontaneous and fully alive.

Because longevity is not only about how long we live.

It’s about how long life still feels worth living.

Yours in Health,

Ryan Frankel

I have a complicated relationship with the modern wellness world.

On one hand, I love that more people are talking about sleep, stress, movement, recovery, sunlight, time in nature and preventative health. These are not soft topics. They are central to how we age, how we perform and how we show up for the people we love.

On the other hand, something feels off.

We’ve built an entire culture around recovery while continuing to reward the behaviors that make recovery necessary in the first place.

Work harder. Push more. Optimize everything. Answer the late email. Take the early call. Track the metric. Hit the goal. Then, when your nervous system is fried, buy the recovery tool.

The wellness world sells the antidote to a lifestyle it often quietly celebrates.

That is the contradiction I keep coming back to.

The Problem Isn’t Self-care. It’s Self-care Theater.

I’m not against recovery rituals.

I use the sauna. I take long walks. I love long bike rides. I try to spend time away from technology. Some of my best thinking happens outside, often on a walk with my dog, away from screens, inputs and the low hum of constant productivity.

But recovery becomes theater when it’s performed more than it’s protected.

A cold plunge after four hours of sleep is not recovery.

A meditation app between back-to-back Zoom calls is not recovery.

A sauna session squeezed between emails, Slack messages and a calendar that leaves no white space is not recovery.

It might help. It might feel good. It might create a momentary shift.

But if the structure of your life is still built around chronic overextension, recovery becomes another layer of performance.

Another thing to schedule.

Another thing to optimize.

Another thing to feel behind on.

The point of recovery isn’t to make overwork more tolerable. The point of recovery is to restore capacity, create margin and remind the body that it’s not supposed to live in a permanent state of threat.

Overwork Isn’t Just a Mindset Problem

The critique of hustle culture can sound philosophical, but the biology is very real.

Long working hours have been linked to serious health consequences. A joint World Health Organization and International Labour Organization analysis estimated that long working hours contributed to 745,000 deaths from stroke and ischemic heart disease in 2016, a 29 percent increase since 2000.

That should give us pause.

Not because work is bad. Work can be meaningful (I absolutely love jumping out of bed each morning, ready to tackle the workday). Ambition can be healthy. Building something can be deeply energizing.

The problem is when output becomes identity.

When rest has to be earned.

When exhaustion becomes proof that we care.

The body doesn’t distinguish perfectly between “good stress” and “bad stress” when there is no recovery on the other side. Chronic stress can contribute to allostatic load, the cumulative wear and tear that builds when our physiological stress systems are repeatedly activated without sufficient restoration.

That phrase, “wear and tear,” matters.

Because burnout isn’t just feeling tired.

It’s what happens when your system stops believing relief is coming.

Real Recovery Requires Detachment

One of the most useful concepts in recovery research is psychological detachment.

Not vacation.

Not distraction.

Detachment.

In the recovery literature, detachment refers to mentally disengaging from work during non-work time. It’s one of those key recovery experiences that help people unwind and recuperate from work stress.

That sounds simple until you try to do it.

Because many of us are physically away from work while mentally still inside it.

We’re at dinner but thinking about the unanswered message.

We’re with our kids but replaying the meeting.

We’re in bed but solving tomorrow’s problem.

We’re on a walk but checking the phone.

This is where hustle culture has become especially sneaky. It no longer requires us to be at a desk to keep working. It just requires us to stay mentally available.

Always reachable. Always processing. Always half-present.

Recovery begins when we stop confusing proximity to rest with actual rest.

Special Thanks to our Partners

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The Recovery That Actually Works is Usually Not Glamorous

The recovery habits that seem to help me most are not particularly impressive.

A long walk outside.

Time with family where my phone is not the center of gravity.

A sauna session that isn’t paired with multitasking.

A long bike ride that lets my mind settle.

A walk with my dog where the goal isn’t steps, pace or productivity, but simply being outside long enough for my nervous system to downshift.

There is real science behind some of this.

In a large study of nearly 20,000 people in England, spending at least 120 minutes per week in nature was associated with higher self-reported health and well-being.

Sauna bathing has also been associated with cardiovascular and mortality benefits in observational research. In a long-term Finnish study, more frequent sauna bathing was associated with lower risk of fatal cardiovascular events and all-cause mortality.

And sleep, the least sexy recovery tool of all, remains one of the most powerful. Meta-analyses have found that both unusually short and unusually long sleep duration are associated with higher mortality risk, a reminder that sleep is not a wellness luxury. It is a biological requirement.

But the larger point is this:

The best recovery practices are not the ones that make you look optimized.

They are the ones that restore you enough to be more present, patient, clear and resilient.

RecoveryShouldn’t Become Another Form of Achievement

This is where I think the wellness world often loses the plot.

We take practices meant to reconnect us with our bodies and turn them into status symbols.

Who slept the best?

Who had the highest HRV?

Who trained the hardest?

Who recovered the most efficiently?

Who has the cleanest routine?

It’s the same achievement loop in better clothing.

But real recovery isn’t a competition. It’s not an aesthetic. It’s not a morning routine designed for social media.

It’s often quiet.

It might look like saying no.

It might look like leaving the phone inside.

It might look like going to bed instead of squeezing in one more thing.

It might look like taking the walk even when there is no workout credit attached to it.

It might look like being fully present with your family instead of physically present and mentally elsewhere.

For me, this has become one of the harder parts of longevity. Not learning more. Not finding more tools. But protecting the simple things from being crowded out by the urgent things.

The Goal Isn’t Less Ambition. It’s More Honest Ambition.

I don’t think the answer is to stop striving.

I like ambitious people. I like building. I like working hard toward things that matter.

But I’m increasingly skeptical of ambition that requires us to abandon ourselves to prove we are serious.

The future version of you doesn’t just need your output.

It needs your health.

It needs your relationships.

It needs your nervous system to still know how to come down.

It needs your body to have enough margin to absorb stress without breaking.

That is the deeper promise of recovery. Not escape from responsibility, but the capacity to keep meeting responsibility without losing yourself in the process.

Longevity isn’t built by performing wellness on top of burnout.

It’s built by designing a life where recovery is not an emergency intervention.

It’s part of the operating system.

Yours in Health,

Ryan

We tend to think about oral health in cosmetic terms.

White teeth. Straight teeth. Fresh breath. A better smile.

But that framing misses the bigger picture.

Your mouth is not separate from the rest of your body. It’s one of the most biologically active gateways into it. It’s home to bacteria, blood vessels, immune cells, inflammatory signals and daily exposures that can either support your health or quietly work against it.

In longevity, we talk a lot about sleep, strength training, glucose control, blood pressure, VO2 max and inflammation.

We should probably be talking more about flossing.

Not because flossing is magical. But because oral health is a window into something much larger: how well your body is managing inflammation, infection, metabolic health and repair over time.

The World Health Organization defines oral health as integral to general health and well-being, not simply the absence of dental disease. That distinction matters. A healthy mouth helps us eat, breathe, speak, socialize and live without pain or chronic infection. It’s foundational, not superficial.

And increasingly, the science suggests that the health of your gums may tell you more about your long-term health than most people realize.

The Mouth-Body Connection

Gum disease isn’t just a local dental problem.

It’s a chronic inflammatory condition driven by bacterial biofilm around the teeth and gums. Over time, that inflammation can damage the tissues and bone that support the teeth. But the concern doesn’t stop there.

When the gums are inflamed, the barrier between the mouth and bloodstream can become more permeable. Bacteria and inflammatory molecules can enter circulation. Your immune system responds. And if that response becomes chronic, it may contribute to the broader inflammatory burden associated with aging.

This is where oral health starts to look less like a dental issue and more like a longevity issue.

A 2024 review found that gum disease is associated with cardiovascular disease. And another 2024 systematic review looked at oral hygiene practices and cardiometabolic outcomes, highlighting gum disease as a chronic inflammatory risk factor that is still under-discussed in mainstream health conversations.

That caveat is important. Gum disease doesn’t automatically mean you will develop heart disease. Association is not destiny.

But in longevity, we should pay attention to signals that repeatedly show up across large bodies of research.

And oral health keeps showing up.

Inflammation Is the Common Thread

Many of the biggest diseases of aging share a common feature: chronic, low-grade inflammation.

Cardiovascular disease. Type 2 diabetes. Cognitive decline. Kidney disease. Frailty. Even some cancers.

Inflammation is not always bad. In the short term, it’s how we heal. But when the immune system is persistently activated, it can become damaging.

Gum disease appears to be one potential contributor to this inflammatory load.

The relationship with diabetes is especially striking. Diabetes can worsen gum inflammation and tissue breakdown, while gum disease may worsen glycemic control and insulin resistance. In other words, the relationship appears to run in both directions.

That should change how we think about a bleeding gumline.

It is not just something to mention casually at your next cleaning. It may be a metabolic clue.

The same is true for brain health. A 2024 systematic review and meta-analysis in GeroScience examined gum disease in relation to dementia, cognitive disorders and depression, reflecting a growing research interest in how oral inflammation may connect to the aging brain. Earlier research has also found that poor periodontal health and tooth loss appear to be associated with increased risk of cognitive decline and dementia.

Again, this doesn’t mean gum disease causes Alzheimer’s disease.

It means the mouth may be part of a larger biological network that includes inflammation, vascular health, metabolism and the microbiome.

And if you care about living longer and better, that network matters.

Special Thanks to Our Partners

Ezra

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The Longevity Lesson: Don’t Ignore Quiet Signals

One of the biggest mistakes we make in health is waiting for pain.

We wait until our back hurts to think about mobility. We wait until our blood pressure is high to think about stress, sleep and sodium. We wait until a diagnosis to think seriously about prevention.

Oral health often follows the same pattern.

A little bleeding while brushing. Some gum sensitivity. A skipped cleaning. A cavity we put off dealing with. A sense that dental care is optional if nothing hurts.

But gum disease can progress quietly. Cardiometabolic risk can progress quietly. Cognitive decline can begin quietly. Many of the things that shorten healthspan do not announce themselves loudly at first.

That is why the mouth is such a useful metaphor for longevity.

It reminds us that small, daily habits accumulate. It reminds us that the body is interconnected. It reminds us that prevention is rarely dramatic in the moment, but can be enormously meaningful over decades.

What To Actually Do

The practical takeaway is not complicated.

Brush thoroughly twice a day. Floss or use interdental brushes daily. Get regular dental cleanings. Don’t ignore bleeding gums. Ask your dentist about periodontal pockets and gum health, not just cavities. If you have diabetes or prediabetes, treat oral health as part of metabolic care. If you have cardiovascular risk factors, don’t let oral inflammation linger in the background.

And perhaps most importantly, stop treating dental visits as separate from healthcare.

Your dentist may be one of the few clinicians regularly looking at signs of chronic inflammation, tissue breakdown, infection, bone loss and behavior change over time.

That is valuable information.

In a world obsessed with advanced wearables, personalized supplements and complex protocols, oral health is almost comically basic.

But basic doesn’t mean unimportant.

Sometimes the most powerful longevity interventions are the ones hiding in plain sight.

A toothbrush. A floss pick. A cleaning. A question about your gums.

The mouth is not just about your smile.

It may be one of the earliest places your body whispers that something deeper is going on.

And longevity, at its best, is learning to listen before the whisper becomes a warning.

Yours in Health,

Ryan

One of the hardest things about dementia is that it doesn’t just happen to one person. It happens to a family.

I saw that up close when helping my Mom care for a parent with dementia. The disease slowly takes things that feel almost sacred: memory, independence, personality, rhythm, confidence and connection. And for the people who love that person, it creates a kind of grief that starts long before goodbye.

That experience changed how I think about longevity. Living longer only matters if we’re also preserving the parts of ourselves that make life feel like life.

That’s why cognitive health can’t be something we start caring about once we forget names, lose our train of thought or feel like our brain is slipping. By the time symptoms show up, many of the underlying biological changes may have been building for years.

So the question is simple: What are we doing now to protect the brain we want later?

Dementia Risk Is More Modifiable Than We Think

Dementia isn’t completely preventable. Genetics matter. Age matters. Luck matters.

But lifestyle and medical risk factors matter too.

The 2024 Lancet Commission on dementia prevention estimated that addressing 14 modifiable risk factors across life could prevent or delay about 45% of dementia cases. Those factors include hearing loss, high blood pressure, physical inactivity, diabetes, smoking, obesity, depression, excessive alcohol, traumatic brain injury, social isolation, air pollution, lower education, high LDL cholesterol and untreated vision loss.

That number should stop us in our tracks. Not because it means dementia is anyone’s fault. It isn’t. But because it means prevention isn’t some vague wellness concept. It’s a practical, measurable set of actions we can begin earlier than most people think.

Your Brain Is Not Fixed

One of the most hopeful ideas in brain health is neuroplasticity: the brain’s ability to adapt, remodel and strengthen over time.

A big part of that story involves BDNF, or brain-derived neurotrophic factor. Think of BDNF as one of the brain’s growth and maintenance signals. It supports neurons, helps with learning and memory and is one reason exercise appears to be so powerful for cognitive health.

Dr. Rhonda Patrick has done a great job popularizing this concept through her work at FoundMyFitness, especially around the role of vigorous exercise, lactate and BDNF. One of the key ideas she’s highlighted is that lactate isn’t just a waste product from hard exercise. It may also act as a signaling molecule that helps connect intense physical effort to brain adaptation.

Dr. Patrick has illuminated how higher lactate after vigorous exercise is linked to improved executive function and that high-intensity interval training may produce larger BDNF responses than moderate continuous exercise.

This doesn’t mean you need to destroy yourself in every workout. It means intensity has a role. Zone 2 builds the base, strength training protects the system and small doses of vigorous effort may provide a unique brain-health signal.

Curious about BDNF? I wrote a deeper dive on why everyone is talking about it, what it does and how to think about it practically here: Why Everyone Is Talking About BDNF⁠.

Special Thanks to our Partner

This post is sponsored by Cenegenics, a leader in personalized longevity medicine.

What I appreciate about the personalized medicine model is that it starts with a simple idea: don’t wait for decline to become obvious before paying attention.

Cognitive health is deeply connected to vascular health, metabolic health, hormone health, inflammation, sleep, fitness, nutrition and stress. A more proactive model of care looks at the whole system earlier, when there’s still time to make meaningful changes.

And that’s the broader message of this post: whether it’s through your physician, your own tracking, better habits or a more comprehensive longevity approach, the goal is to take action before symptoms force action.

Visit Cenegenics.com to learn more and for a deeper dive, check out my review of Cenegenics: Why More People Are Turning to Physician-Led Longevity Programs.

The Cognitive Longevity Checklist

Here’s where I’d start.

1. Train for your brain, not just your body

Exercise may be the closest thing we have to a brain-health keystone habit.

The practical target isn’t complicated: aim for 150+ minutes per week of zone 2-style cardio, like brisk walking, cycling, swimming, hiking or anything that gets your heart rate up while still allowing conversation.

Layer in 2–3 days per week of strength training. Muscle is metabolic armor. Better metabolic health means better vascular health. Better vascular health means better brain health.

Then add a few short bursts of higher intensity when appropriate. That could mean hill sprints, intervals or faster efforts on a bike, rower or treadmill. The goal isn’t to suffer. The goal is to remind the brain and body that they still need to adapt.

2. Protect sleep like it’s a nightly brain treatment

Sleep is when the brain consolidates memories, regulates emotion and clears waste products. Poor sleep isn’t just an annoyance. It’s a cognitive risk signal.

The basics still matter: keep a consistent sleep and wake time, get morning light, limit alcohol near bedtime and treat snoring, gasping or suspected sleep apnea seriously.

Also, stop pretending 5.5 hours is “fine” because you can still function. There’s a difference between surviving the day and protecting your brain for the next 30 years.

3. Treat blood pressure as a brain metric

We tend to think of blood pressure as a heart issue. It’s also a brain issue.

In the SPRINT MIND randomized clinical trial, intensive systolic blood pressure treatment significantly reduced the risk of mild cognitive impairment compared with standard treatment, though the reduction in probable dementia didn’t reach statistical significance in the primary analysis.

That nuance matters. This isn’t a license to chase lower numbers blindly. Blood pressure targets should be individualized with a clinician.

But it is a reminder that the small vessels feeding the brain matter. Decades of elevated pressure can damage the very infrastructure your cognition depends on.

Know your numbers. Track them. Act early.

4. Get your hearing checked before it becomes obvious

This one surprises people.

Hearing loss is one of the most important modifiable dementia risk factors, in part because it may increase cognitive load, reduce social engagement and make the brain work harder just to interpret the world.

Even beyond dementia risk, treating hearing loss helps people stay connected. And connection is brain health.

If you’re asking people to repeat themselves, avoiding noisy restaurants or pretending you heard something when you didn’t, don’t tough it out. Get tested.

5. Build social ties like they’re medicine

Loneliness isn’t just a feeling. It’s a risk factor.

This is one of the reasons dementia can be so cruel. The disease disconnects people from the world, but disconnection itself may also increase risk.

So the prescription here is both simple and hard: schedule recurring time with friends, join groups where people expect you to show up, call family, walk with someone, volunteer and say yes more often than feels convenient.

A sharper brain later may depend, in part, on deeper relationships now.

6. Don’t ignore the “boring” risk factors

The brain is an energy-hungry organ. It depends on blood flow, insulin sensitivity, oxygen, nutrients and healthy vessels.

So the boring stuff isn’t boring. It’s foundational.

Manage LDL cholesterol. Address insulin resistance. Don’t smoke. Limit alcohol. Protect your head. Treat depression. Correct vision loss. Eat mostly whole foods. Move after meals.

These don’t sound like “brain hacks,” but they’re exactly the kinds of levers that show up again and again in dementia prevention research.

The unsexy truth is that the brain often reflects the health of the system it lives in.

The Point Isn’t Perfection

The point is direction.

You don’t need to become a monk, wear 12 devices or optimize every minute of your life. But you do need to stop thinking of cognitive decline as something that only belongs to “old age.”

The prevention window opens much earlier.

It opens in your 30s when you decide whether exercise is optional. It opens in your 40s when blood pressure, LDL and sleep debt start compounding. It opens in your 50s when hearing, social connection and metabolic health become impossible to ignore.

And it stays open later than we think, because the brain remains responsive to better inputs.

For me, this is personal. Watching dementia up close made one thing very clear: protecting cognitive health isn’t just about protecting memory.

It’s about protecting dignity. It’s about protecting family. It’s about giving the people we love more years with the version of us they recognize.

So start before symptoms.

That’s the window.

Yours in Health,

Ryan Frankel

I started this newsletter nearly 3 years ago to help consumers filter real and valuable science-backed solutions amidst a market filled with bold claims, misinformation and expensive snake oil.

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Yours in Health,

Ryan

There is a version of the longevity movement that I love.

It is curious. It is humble. It is rooted in science, prevention, better habits, earlier detection and the simple but profound idea that we should not wait until we are sick to care about our health.

Then there’s the other version.

The version that promises “age reversal” after a blood test.
The version that sells a $1,000 IV drip as a shortcut to vitality.
The version that turns a preliminary mouse study into a human miracle cure.
The version that implies, subtly or explicitly, that aging has already been solved and that all you need is the right clinic, supplement stack, peptide, plasma infusion, biological age test or “optimization protocol.”

That version has a trust problem.

And if the longevity industry doesn’t fix it, the people who suffer most will be the consumers who came to this movement for the right reasons: to live longer, healthier, more capable lives.

This is also one of the reasons I co-founded Workup⁠. The consumer health market is exploding with new clinics, diagnostics, products, protocols and wellness solutions. Some are thoughtful and evidence-informed. Some are speculative. Some are noise. And some, frankly, veer into snake oil.

Workup was created to help consumers filter signal from noise - to find trusted health and wellness solutions without having to become a full-time researcher, biohacker or skeptic just to make basic decisions about their own body.

Because in longevity, trust is not a nice-to-have.

It’s the whole game.

The Science Is Real. The Claims Often Aren’t.

Aging biology is one of the most exciting fields in science.

Researchers have identified major biological processes associated with aging, including genomic instability, mitochondrial dysfunction, cellular senescence, altered nutrient sensing and chronic inflammation.

But here is where things get slippery: identifying mechanisms of aging is not the same as proving that a consumer product, clinic protocol or supplement meaningfully extends human healthspan.

There is a big difference between:

“This pathway appears to be involved in aging.”

and

“This expensive intervention will make you biologically younger.”

The first statement is science.
The second is often marketing wearing a lab coat.

This is where the longevity industry loses me. Not because I’m skeptical of longevity science. Quite the opposite. I care about this field too much to watch it get diluted by exaggerated claims.

Clinics Are Selling Certainty Where There Is Still Uncertainty

Walk into the modern “optimization” ecosystem and you can find almost anything: NAD+ IVs, stem cell injections, peptide cocktails, hyperbaric oxygen, biological age testing, hormone protocols and full-body scans bundled into executive longevity packages.

Some of these tools have legitimate medical uses in specific contexts. Some may eventually prove useful. Some are simply unproven. Others may be risky when marketed outside appropriate clinical oversight.

A glossy clinic website can make something feel established. A physician founder can make it feel legitimate. A celebrity testimonial can make it feel safe.

But credibility shouldn’t come from branding. It should come from evidence.

The question shouldn’t be, “Does this sound cutting-edge?”

The question should be, “Has this been shown in well-designed human studies to improve outcomes that matter?”

Energy. Strength. Cognition. Metabolic health. Disease risk. Function. Mortality. Quality of life.

Not just a biomarker.
Not just a before-and-after dashboard.
Not just a “biological age” number that drops after a protocol.

The Biological Age Trap

I understand the appeal of biological age testing.

Who wouldn’t want a single number that tells them whether their body is aging faster or slower than the calendar?

But we should be careful. Biomarkers of aging are a promising research area and they may eventually become useful clinical tools. Researchers are actively studying clocks based on DNA methylation, blood markers, proteins, organ-specific aging patterns and other measures.

The problem is not the research.

The problem is when a complex, evolving scientific tool gets turned into a consumer scoreboard.

Your biological age score may be interesting. It may be directionally useful. It may help motivate behavior change. But it is not yet a perfect receipt for how long you will live, nor is it proof that a product has reversed aging.

There is a dangerous psychological trick here: when something is measurable, we assume it is meaningful.

But not everything that moves a metric changes a life.

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Supplements: Helpful Sometimes, Overhyped Often

Supplements are another place where the trust problem shows up.

To be clear, I am not anti-supplement. I take supplements. Many people benefit from targeted supplementation, especially when there is a deficiency, a specific health goal or a clinician-guided reason.

But the supplement industry has a structural problem: in the U.S., dietary supplements are generally not approved by the FDA for safety and effectiveness before they are marketed. Companies are responsible for ensuring their products are safe and properly labeled.

That creates room for responsible brands.

It also creates room for inflated promises.

The words are usually carefully chosen:

“Supports healthy aging.”
“Promotes cellular vitality.”
“Activates longevity pathways.”
“Boosts mitochondrial function.”
“Reverses biological age.”

Some of those statements may be technically legal. Some may be based on early evidence. Some may be directionally plausible.

But consumers often hear something much stronger: “This will help me live longer.”

That is a much higher bar.

And in longevity, the bar should be high.

This is why I so deeply appreciate the work that SuppCo⁠ is doing. The supplement category is one of the hardest places for consumers to know whom to trust. Labels can be confusing. Quality varies. Claims can be vague. And even well-intentioned consumers can end up buying products without knowing whether what is on the label is actually what is in the bottle.

SuppCo brings more transparency and structure to that process through tools like supplement tracking, product search, quality ratings, expert protocols and independent testing initiatives. Its TrustScore system evaluates supplements across quality attributes and they verify products through third-party lab testing and publishes product-level results.

That is the kind of infrastructure this industry needs more of.

Not more hype.
More clarity.

Not more miracle language.
More accountability.

NAD Is a Perfect Example

NAD+ is fascinating biology. It plays a real role in cellular metabolism, energy production and repair processes. NAD levels appear to decline with age, which has made NAD-boosting strategies a major focus of longevity research.

But fascinating biology does not automatically justify every NAD+ IV clinic promising better aging.

Some NAD precursors can raise NAD levels in humans. That doesn’t necessarily mean they extend lifespan, prevent disease or meaningfully improve long-term health outcomes.

This is the pattern across the industry.

The molecule is real.
The mechanism is real.
The marketing leap is the problem.

What Trustworthy Longevity Should Look Like

The longevity industry doesn’t need to become boring.

It needs to become more honest.

Here is what I want to see more of:

Clear distinction between proven, promising and speculative.

Exercise is proven. Sleep matters. Blood pressure control matters. Nutrition matters. Smoking cessation matters. Strength training matters. Social connection matters. Managing ApoB, glucose, visceral fat and cardiorespiratory fitness matters.

Certain drugs, supplements, diagnostics and therapies may be promising.

Others are speculative.

Those categories should not be blurred.

More humility around biomarkers.

A lower biological age score is interesting. A better VO2 max, lower blood pressure, improved insulin sensitivity, lower ApoB, stronger grip strength and better sleep may be more actionable.

More outcome-based evidence.

Show me human data. Show me meaningful endpoints. Show me safety. Show me durability. Show me whether the benefit persists after the intervention stops.

Less miracle language.

No more “reverse aging” unless we are very clear about what is being reversed, in whom, for how long and according to what measure.

More respect for the consumer.

People aren’t stupid. They can handle nuance. In fact, many people are hungry for it.

That is the opportunity I see for this next era of consumer health: not just more access, but better filters. Not just more products, but better standards. Not just more data, but more wisdom about what to do with it.

The Real Longevity Revolution Isn’t a Shortcut

The irony is that the most evidence-based longevity interventions are not very sexy.

Go for a walk after meals.
Lift weights.
Eat mostly whole foods.
Get enough protein and fiber.
Sleep enough.
Build strong relationships.
Avoid smoking.
Drink less alcohol.
Know your blood pressure.
Track the biomarkers that actually matter.
Find a doctor who takes prevention seriously.

These habits don’t trend the way a $1,000 infusion trends.

But they work.

And they compound.

That has become the lens through which I try to view longevity: not as a desperate search for the newest hack, but as a long-term practice of stacking small advantages while staying honest about what we know and what we don’t.

I want the longevity industry to win.

But it will not win by overpromising. It will win by earning trust.

The future of longevity should be ambitious, scientific, accessible and honest.

Because the goal is not to sell people the feeling of control.

The goal is to help people live better, longer - for real.

Yours in Health,

Ryan

For most of my life, I thought of bone health as something that mattered later.

Much later.

It sounded like a concern for people in their 70s or 80s. Something that entered the conversation after a fall, after a hip fracture, after a doctor used the word “osteoporosis.”

Then I got a DEXA scan.

As part of my work with Cenegenics, I received a much more comprehensive look under the hood. Not just the usual annual physical markers. Not just cholesterol, glucose and blood pressure. But body composition, visceral fat, lean mass and bone density.

That is when I was told I had early signs of osteoporosis.

That sentence got my attention.

Not because anything hurt. Not because I had broken a bone. Not because I had any obvious symptoms.

That is exactly the point.

Bone loss is usually silent until it isn’t.

And by the time it announces itself, the announcement can be life-changing.

Bone Isn’t Static

We tend to think of our skeleton as architecture: beams, columns, structure.

But bone is living tissue. It’s constantly being broken down and rebuilt. In youth, we build more than we lose. By our late 20s and early 30s, most of us have reached peak bone mass. After that, the job shifts from “build” to “preserve.”

The problem is that modern life is almost perfectly designed to weaken bones over time.

We sit more. We lift less. We outsource physical labor. We spend less time in the sun. Many people under-eat protein. Some aggressively lose weight without thinking about muscle and bone. And by the time a standard medical system starts paying close attention, a lot of preventable loss may have already happened.

A DEXA scan measures bone mineral density and compares it to reference populations. A T-score between -1 and -2.5 is typically considered osteopenia, or low bone density; -2.5 or lower is considered osteoporosis.

The key word there is typically. A scan is not destiny. It is information.

But it is information most people do not get early enough.

The Real Risk Is Not “Weak Bones.” It’s Fragility.

Bone density matters because fractures matter.

A fracture isn’t just an inconvenience. It can be a turning point. Hip fractures in particular are associated with loss of independence, hospitalization, long recovery periods and increased mortality risk.

Falls are the most common mechanism behind those injuries. According to the CDC, about 300,000 older adults are hospitalized for hip fractures each year in the United States and in 2019, 83% of hip fracture deaths and 88% of emergency department visits and hospitalizations for hip fractures were caused by falls.

That statistic should change how we think about longevity.

Longevity isn’t just about living longer. It’s about preserving the physical capacity to keep living fully.

And that means bone density is only one part of the equation. The bigger goal is skeletal resilience: strong bones, strong muscles, good balance, fast reaction time, stable gait and enough power to catch yourself when life gets unpredictable.

The fracture often happens in a split second.

The prevention happens years earlier.

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How to Measure Bone Health

The gold standard is a DEXA scan. It’s a low-radiation scan that can measure bone mineral density at clinically important sites like the hip and spine. Many DEXA scans also provide useful body composition data, including lean mass and fat mass.

A few things to understand:

T-score compares your bone density to a healthy young adult reference population.

Z-score compares your bone density to what is expected for someone your age and sex.

Site matters. Hip, femoral neck and lumbar spine numbers can differ. A person may look fine in one region and concerning in another.

Trends matter. One scan is a snapshot. Repeating the scan over time, ideally on the same machine or same type of machine, can show whether your plan is working.

Current preventive guidelines commonly recommend routine osteoporosis screening for women beginning at age 65, and earlier screening for some younger women at increased risk. But from a longevity perspective, I think there is a broader conversation worth having, especially if you have risk factors: family history, prior fracture, low body weight, long-term steroid use, low testosterone or estrogen, heavy alcohol intake, smoking history, eating disorders, low vitamin D or major weight loss.

For men, routine screening is less standardized, which is one reason I think proactive testing can be especially valuable when risk factors are present.

You can ask your physician about ordering a DEXA scan. In many cities, you can also go directly to imaging or body-composition providers that offer DEXA scans out of pocket.

The question is not, “Am I old enough to care?”

The question is, “Would this data change what I do?”

For me, it did.

The Best Bone Strategy Is Load

Bones respond to stress.

That doesn’t mean reckless stress. It means appropriate, progressive loading. Your skeleton needs a reason to stay strong.

The most important tools are:

1. Heavy Resistance Training

Lifting weights isn’t just for muscle. It’s one of the core interventions for bone health.

Resistance training places force through the skeleton. Over time, that signal can help maintain or improve bone mineral density, especially when the training is progressive and sufficiently challenging.

The word “heavy” is relative. For one person, it may be a barbell deadlift. For another, it may be goblet squats, step-ups, loaded carries, leg presses or resistance machines.

The principle is the same: your body adapts to the demands placed on it.

A bone-focused training program should usually include some version of:

• Squats or leg presses

• Hip hinges such as deadlifts or Romanian deadlifts

• Lunges or step-ups

• Rows and presses

• Loaded carries

• Core work that improves trunk control

The goal isn’t to become a powerlifter. The goal is to become harder to break.

2. Impact, When Appropriate

Walking is good. But walking alone may not be enough.

Bone tends to respond especially well to higher-force, higher-rate loading: jumping, hopping, bounding, stair climbing and other impact-based movements. Of course, this has to be individualized. If someone already has osteoporosis, joint issues, poor balance or a prior fracture history, impact work should be introduced carefully, ideally with guidance.

For some people, the right starting point is not jumping. It’s learning to land well. Then step-downs. Then small hops. Then more dynamic work.

The dose matters.

So does the progression.

3. Weighted Vests and Rucking

Weighted vests have become popular for a reason: they’re simple.

I’ve been using a weighted vest because it turns an ordinary walk into a more loaded activity. That added load may increase the mechanical stimulus on the bones and muscles, especially when combined with hills, stairs, squats or other movements.

But the research is nuanced.

One long-term study found that a five-year program using weighted vests plus jumping exercise helped maintain hip bone mineral density in older postmenopausal women. Another study found that weighted vest use during weight loss may help attenuate hip bone loss in older adults with obesity, though the authors noted that more research was needed.

The important distinction: a weighted vest isn’t magic. It’s a tool.

A vest worn casually during easy walks may be helpful for general fitness, posture and energy expenditure, but the strongest bone signal likely comes when added load is paired with meaningful mechanical stimulus: resistance training, hills, stairs or carefully programmed impact.

Start light. Think 5% of body weight or less if you are new to it. Make sure the vest fits snugly. Don’t use it to compensate for poor movement mechanics. And if you already have low bone density, back pain, joint issues or cardiovascular concerns, get professional guidance first.

4. Protein, Calcium, Vitamin D and the “Raw Materials” Problem

Training provides the signal.

Nutrition provides the raw materials.

Calcium is a major structural component of bone. Vitamin D helps the body absorb calcium. Protein supports muscle and bone remodeling.

Protein deserves special attention. For years, some people worried that higher protein intake might harm bones. The better reading of the evidence is more nuanced: adequate protein, especially with adequate calcium intake, appears supportive of bone and muscle health. Reviews have found associations between higher protein intake and modestly reduced hip fracture risk, though results vary across studies.

For longevity, I think about nutrition less as “bone food” and more as “tissue support.”

You want enough protein to maintain muscle. Enough calcium and vitamin D to support mineral metabolism. Enough total calories to avoid chronic under-fueling. Enough micronutrients from real food to support the entire remodeling process.

Bones don’t exist in isolation.

They’re part of a system.

Do Not Ignore Balance

The biggest mistake in bone health is focusing only on the scan.

A higher bone density is good. But a person with decent bone density who falls often is still at risk. A person with lower bone density who has excellent strength, balance, coordination and reaction time may be far more resilient than the scan alone suggests.

Fall prevention should begin long before you consider yourself “at risk.”

Balance training can include:

• Single-leg stands

• Farmer’s carries

• Lateral lunges

• Step-downs

• Agility drills

• Training on uneven but safe surfaces

• Getting up and down from the floor

The CDC notes that more than one in four older adults falls each year, and falling once doubles the chances of falling again.

That means fall prevention is not a geriatric concern.

It’s a human performance concern.

Can you stand on one leg? Can you recover from a trip? Can you descend stairs without holding the rail? Can you carry groceries while turning your head? Can you get off the floor without using your hands?

These are longevity tests hiding in plain sight.

The Earlier You Know, the More Options You Have

What struck me about my own DEXA experience wasn’t fear.

It was the realization that I could have gone years without knowing.

That is the quiet danger of bone loss. You can feel healthy. You can look fit. You can be active. And still, beneath the surface, your skeletal reserve may be lower than you think.

But the opposite is also true.

Once you know, you can act.

You can lift. You can load. You can improve balance. You can eat enough protein. You can check vitamin D. You can use tools like a weighted vest intelligently. You can work with a physician or longevity-focused provider to understand the broader picture.

The goal is not simply to avoid osteoporosis.

The goal is to be the kind of person who can fall and not fracture. Who can travel, hike, carry, climb, lift and play decades from now. Who has enough muscle and bone to support the life they want to live.

Bone density should matter long before a fracture because the fracture is not the beginning of the story.

It is often the consequence of a story that started silently years earlier.

And the best time to change that story is before anything breaks.

Yours in Health,

Ryan Frankel

I’ve always been drawn to prevention because it’s far easier to address a problem early than to treat illness once it has taken hold.

Ben Franklin said it best when he stated that “an ounce of prevention is worth a pound of cure.”

For many of us, the annual physical has become the ritual of reassurance. We get our standard labs. We glance at cholesterol, glucose, maybe A1c. We see a few numbers in the “normal” range. Our doctor says, “Everything looks good.” We leave feeling like we checked the box.

And sometimes that’s true.

But sometimes the dashboard is incomplete.

Heart disease often develops quietly over decades. And while LDL cholesterol, blood pressure and blood sugar are all important, they aren’t the full picture. Some of the most useful cardiovascular risk markers are still rarely ordered, inconsistently covered or misunderstood.

The uncomfortable truth is this:

You can look healthy, feel healthy, exercise regularly and still be carrying hidden cardiovascular risk.

That doesn’t mean we should panic.

It means we should measure better.

ApoB: The Particle Count That Deserves More Attention

Most people know LDL-C as “the bad cholesterol.”

But LDL-C is not actually a count of LDL particles. It’s a measure of how much cholesterol is being carried inside those particles.

ApoB is different.

ApoB is a protein found on the surface of the main plaque-forming particles in the blood, including LDL, VLDL, IDL and Lp(a) (more on this in a moment). In simple terms, ApoB gives us a better estimate of how many atherogenic particles are circulating.

One analogy I like: LDL-C tells you how much cargo is in the cars. ApoB tells you how many cars are on the road.

That distinction matters because atherosclerosis is driven by particles entering the artery wall. More particles generally means more opportunities for those particles to get trapped, oxidized and contribute to plaque formation.

This is especially important when LDL-C and ApoB are “discordant,” meaning LDL-C looks acceptable but ApoB is elevated. In those cases, cardiovascular risk often tracks more closely with ApoB than LDL-C. A 2024 review in The Journal of Clinical Lipidology noted that when ApoB, non-HDL-C and LDL-C disagree, ApoB is generally the strongest predictor of ASCVD risk.

This is one of the reasons I think ApoB belongs in more prevention conversations.

Not because LDL-C is useless. It isn’t.

But because LDL-C can miss the person with a high number of cholesterol-carrying particles, particularly in the setting of insulin resistance, elevated triglycerides, metabolic syndrome or family history.

For a longevity-minded person, ApoB is one of those markers that can move the conversation from “your cholesterol is fine” to “what is your actual lifetime exposure to atherogenic particles?”

And that is a much better question.

Lp(a): The Genetic Risk Marker That Changed How I Think About Prevention

Lp(a), pronounced “L-P-little-a,” is one of the most under-discussed cardiovascular risk markers.

It is also one of the most personal for me.

About four years ago, Lp(a) got on my radar because of a family history of elevated Lp(a). I started reading more about it and realized two things very quickly.

First, Lp(a) is largely genetic. Unlike many other biomarkers, it isn’t something you can meaningfully fix with cleaner eating, more Zone 2 cardio or better sleep. Those things still matter enormously for overall cardiovascular health, but they don’t typically move Lp(a) in a major way.

Second, many people have never had it tested.

When I asked to get my own Lp(a) checked, I expected it to be straightforward. Unfortunately, it wasn’t.

I was met with pushback from my practitioner at the time. Then, after finally getting the test, I received a surprise medical bill from my insurance company.

That experience stayed with me.

Not because one lab test was hard to get.

But because the entire process felt backwards.

Here I was, trying to be proactive because of a known family risk. I wasn’t asking for something exotic. I was asking for a validated cardiovascular risk marker that could help me better understand my long-term risk. And yet the system made it feel difficult, opaque and oddly adversarial.

That experience ultimately became one of the sparks behind launching Workup: the belief that proactive and preventive health should be easier to access, easier to understand and more transparent in price. Workup was built around the idea that people should be able to discover trusted health information, products and services without feeling like they are navigating a black box.

Lp(a) is a perfect example of why that matters.

The American Heart Association describes Lp(a) as a genetically inherited, independent risk factor for heart disease, stroke and peripheral artery disease. It also notes that Lp(a) levels of 125 nmol/L, or 50 mg/dL and above may increase risk, while higher levels may substantially increase risk further.

If your Lp(a) is elevated, the goal is not to obsess over a number you may not be able to change directly. The goal is to manage the risks you can change more aggressively: ApoB, LDL-C, blood pressure, insulin resistance, inflammation, smoking status, sleep, exercise and overall metabolic health.

In other words, Lp(a) tells you how seriously to take the rest of the dashboard.

The Other Heart-Risk Numbers Worth Knowing

ApoB and Lp(a) are the two I would put at the center of this conversation, but they aren’t the only numbers I care about.

Non-HDL-C

Non-HDL-C is simply total cholesterol minus HDL-C.

It captures the cholesterol carried by all potentially atherogenic particles, not just LDL. It is not as precise as ApoB, but it’s useful, easy to calculate and often already available on a standard lipid panel.

Triglycerides and HDL-C

High triglycerides and low HDL-C can be clues that something metabolic is going on under the surface.

This pattern often overlaps with insulin resistance. It does not diagnose it by itself, but it can tell you where to look next.

Fasting insulin, glucose and A1c

A1c and fasting glucose are common. Fasting insulin is less commonly ordered.

But insulin can rise years before glucose looks abnormal. For people interested in prevention, that matters. You want to know whether your body is working harder than it should to keep blood sugar in range.

hs-CRP

High-sensitivity C-reactive protein or hs-CRP, is a general marker of inflammation.

It doesn’t tell you exactly where inflammation is coming from, but it can add context to cardiovascular risk. The JUPITER trial famously studied people with elevated hs-CRP but without high LDL-C and found that statin therapy reduced LDL-C, hs-CRP, and cardiovascular events.

Inflammation is not the whole story, but it is part of the story.

Blood pressure

Blood pressure is not fancy, nor is it new. And it doesn’t sound like a longevity hack.

But it remains one of the most important cardiovascular risk factors we can track and improve.

The mistake is thinking advanced biomarkers replace the basics.

They don’t.

The better model is: get the basics right, then use better biomarkers to personalize the strategy.

Special Thanks to Function Health

This post is sponsored by Function Health, a company helping people access a much more comprehensive view of their health through broad lab testing, transparent pricing, and longitudinal tracking.

Function’s membership includes access to 160+ lab tests, including markers tied to cardiovascular, metabolic, hormonal, liver, kidney, thyroid, nutrient, and inflammatory health. Their model is designed to help people see more than the standard annual physical, track changes over time, and bring better information into conversations with their clinicians.

That mission fits directly with the theme of this article.

The point is not to collect biomarkers for the sake of collecting biomarkers. The point is to understand what is happening early enough to make better decisions.

Function Health is also making this even easier: beginning next month, members will have access to concierge blood draws at home or at the office, available nationwide based on geographic availability.

Biomarkers Are Not Destiny

One reason people avoid testing is that they worry about what they might find.

I understand that.

But I see it differently.

A biomarker isn’t a verdict, it’s a signal.

ApoB doesn’t tell you that you are doomed. It tells you how much atherogenic particle exposure you may be accumulating.

Lp(a) doesn’t tell you that your future is fixed. It tells you whether you may need to take the modifiable parts of cardiovascular risk more seriously.

hs-CRP doesn’t tell you exactly what’s wrong. It tells you inflammation may deserve attention.

Fasting insulin doesn’t mean you have diabetes. It may tell you that your metabolism is compensating before glucose rises.

The goal isn’t to become anxious, it’s to become informed.

Because the tragedy of cardiovascular disease is that for many people, the first symptom is the event.

A heart attack.

A stroke.

A stent.

A diagnosis that changes the rest of their life.

Prevention asks a different question:

What could we know before then?

What I’d Ask My Doctor

At your next physical, consider asking your clinician whether these markers make sense for you based on your age, family history, current labs and overall risk profile:

ApoB
Lp(a), at least once in adulthood
Non-HDL-C
Fasting insulin, fasting glucose and A1c
Triglycerides and HDL-C
hs-CRP
Blood pressure, ideally measured consistently outside the office too

And if you have a family history of premature heart disease, elevated cholesterol, elevated Lp(a), stroke or aortic valve disease, say that clearly.

Family history changes the conversation.

So does asking better questions.

The old model was waiting until something looked obviously wrong.

The better model is building a fuller picture while there is still time to act.

That isn’t over-testing.

That is ownership.

Yours in Health,

Ryan Frankel

There’s a particular kind of person in the longevity world who can tell you their fasting glucose, VO2 max, HRV trend, sleep score, biological age estimate, supplement protocol and what peptide they’re “experimenting with.”

But ask them whether they’ve lifted weights twice this week.

Ask whether they’ve had seven hours of sleep for more than three nights in a row.

Ask whether they’ve had the conversation with themselves about alcohol, stress, food, resentment, boundaries or why they keep breaking promises to themselves.

That’s when things get quiet.

And I say this with a very uncomfortable amount of self-recognition.

I love the frontier. I love the research (it’s why I started Longevity Today years ago). I love the tools. I’ve gone down the rabbit holes on advanced blood testing, peptides, wearables, supplements, cold exposure, fasting windows and all the shiny objects that make this space so intoxicating. But the more I study longevity, the more I come back to an annoying truth:

Most of us don’t need a more advanced health stack. We need a more honest life.

Not always. Not everyone. There are people dealing with real medical complexity who need deeper testing, better physicians, precision diagnostics and a more sophisticated plan. But for a lot of otherwise healthy, high-functioning people, “optimization” has become a hiding place. A socially acceptable way to avoid the boring stuff. The hard stuff. The stuff that requires no affiliate code.

The Stack Is Not the Problem. The Escape Is.

I’m not anti-supplement. I’m not anti-wearable. I’m not anti-testing. I’ve written before about why we should stop majoring in the minors and think more clearly about supplements. I believe in high-quality inputs and knowing your numbers. And I firmly believe that better data can lead to better decisions.

But data doesn’t make decisions for you.

Your wearable can tell you that your sleep was terrible. It can’t make you stop scrolling at 10:45 p.m. Your blood test can show you that your metabolic health is drifting in the wrong direction. It can’t make you stop eating like your future self is someone else’s problem. Your supplement stack can support your health. It can’t compensate for never training, never recovering and never addressing the relationships that keep you dysregulated.

Your cold plunge can build resilience. It can also become a performative ritual that distracts from the fact that you haven’t had a difficult conversation with your spouse, your business partner, your doctor or yourself.

The question isn’t whether these tools are useful. The question is whether you’re using them to build a better life or to avoid looking at the one you’re actually living.

The Basics Are Not Basic. They’re Brutal.

The wellness industry loves to call sleep, exercise, nutrition and relationships “the basics.” That makes them sound easy.

They’re not.

The basics are brutally hard because they require consistency. They require identity change, tradeoffs and saying no to things you like, people you love and versions of yourself you’ve outgrown.

The science is not subtle here. People who meet recommended physical activity levels have meaningfully lower mortality risk.

Strength training is its own longevity lever. A 2022 meta-analysis found that muscle-strengthening activity was associated with a 10% to 17% lower risk of all-cause mortality, cardiovascular disease, total cancer, diabetes and lung cancer. I’ve made this case more fully in Muscle as Medicine, but the simplest version is this: muscle is not vanity. It’s metabolic infrastructure.

Sleep is equally unforgiving. A 2022 study found a U-shaped association between sleep duration and all-cause and cardiovascular mortality, with roughly seven hours associated with the lowest risk.

And relationships? They may be one of the most underappreciated health interventions we have. A landmark meta-analysis found that people with stronger social relationships had a 50% greater likelihood of survival than those with weaker social relationships.

This is the part nobody wants to hear: your longevity protocol might be less important than whether you go to bed on time, train consistently and stop living in quiet conflict with the people closest to you.

That doesn’t sell as well. But it’s probably more true.

The Hardest Conversation Is Usually With Yourself

I’ve noticed something in myself. When I’m tempted by the newest biohacking tool, it often shows up at the exact moment I’m bored with consistency.

Not always. Sometimes curiosity is just curiosity. But sometimes the impulse sounds like this: maybe this new test will reveal the hidden thing. Maybe this peptide will unlock the next level. Maybe this device will give me the edge. Maybe this protocol will make the boring work unnecessary.

It rarely does.

At some point, the harder question is not “What else can I add?” It’s: What am I still refusing to do consistently?

That question is uncomfortable because it removes the mystery. It turns the problem from technical to personal.

It’s much easier to believe your health is being held back by a missing biomarker than by the fact that you keep staying up too late. It’s much easier to blame your stack than to admit you haven’t trained with intensity in months. It’s much easier to research inflammation than to admit your life is organized around chronic stress that you’ve normalized because everyone around you is doing the same thing.

This is where longevity stops being a hobby and starts becoming a standard. A standard for how you live. A standard for what you tolerate. A standard for how often you keep promises to yourself.

Special Thanks to Our Sponsor: POM Health

This post is brought to you by POM Health.

I’ve had a great personal experience with POM and their team. They’re friendly, thoughtful and deeply focused on helping people be more proactive about their health, especially in areas where the traditional system can feel reactive or fragmented.

POM Health focuses on comprehensive cancer screening, including lab testing, biomarker panels, multi-cancer early detection testing and access to oncologists to help interpret results and guide next steps. Their model is built around early detection, proactive monitoring and giving people more clarity rather than leaving them to navigate complex testing on their own.

As always, no test replaces the foundations. But the right testing, interpreted by the right experts, can be a powerful part of a thoughtful health plan.

You can learn more about POM Health here.

A Better Definition of Discipline

Discipline gets a bad reputation. People hear the word and think punishment, rigidity or joyless self-denial.

I think that’s wrong.

Discipline is not about hating yourself into a better body. Discipline is remembering what you said mattered when convenience tries to negotiate.

It’s putting your phone away because sleep matters. It’s lifting when you don’t feel inspired because future-you deserves muscle. It’s eating the meal that supports your goals because your energy affects everyone around you. It’s being honest about the glass of wine that became three, the “busy season” that became a lifestyle, the stress you keep calling ambition and the health goals you keep outsourcing to products.

Discipline isn’t glamorous. It’s usually invisible. Nobody claps when you go to bed. Nobody applauds when you do the workout you didn’t post. Nobody gives you status points for having the same breakfast that works, taking a walk after dinner or saying no to the thing that makes tomorrow worse.

But this is where health is built. Not in the dramatic overhaul, but in the repeated vote. Again. Again. Again.

Your Health Stack Should Serve Your Life, Not Replace Your Character

The longevity world has created an illusion that the most informed person is the healthiest person.

I don’t buy it.

The healthiest person is often not the one with the most elaborate stack. It’s the one who can execute. The one who walks daily. The one who trains weekly. The one who protects sleep. The one who eats mostly real food. The one who has close relationships and tends to them. The one who can hear hard feedback without collapsing. The one who doesn’t confuse tracking with changing. The one who has built a life where healthy choices are not heroic. They’re normal.

That’s the real longevity operating system. Not a spreadsheet full of interventions, but a life designed to make the right actions repeatable. I explored this idea more directly in The Longevity Operating System, but the core idea is simple:

Your system matters more than your intention.

And your standards matter more than your stack.

The Question I Keep Coming Back To

So here’s the harder conversation. Not “What supplement should I take?” Not “What wearable should I buy?” Not “What’s the newest peptide?” Not “What’s the perfect protocol?”

Those can be useful questions. But they are second-order questions.

The first-order question is: What am I pretending not to know?

You probably know whether your sleep is off.

You probably know whether your training is inconsistent.

You probably know whether alcohol is helping or hurting.

You probably know whether your stress is seasonal or structural.

You probably know whether your closest relationships give you energy or quietly drain it.

And you probably know whether your health plan is actually a plan, or just a rotating cast of purchases that make you feel like you’re doing something.

That knowing is inconvenient. But it’s also liberating.

Because once you stop hiding behind optimization, the path gets simpler. Not easier. Simpler.

Go to bed. Lift the weights. Eat the protein. Take the walk. Have the conversation. Book the screening. Repair the relationship. Set the boundary. Keep the promise.

Then repeat it long enough for your identity to catch up.

That’s not as sexy as the next frontier intervention.

But for most of us, it’s what matters most.

Yours in Health,

Ryan

There’s a quote I’ve been sitting with recently: “The words you speak become the house you live in.”

At first, it sounds poetic. Maybe even a little too neat. But the more I think about it, the more I believe it may be one of the most practical health ideas we can carry.

At Longevity Today, we spend a lot of time exploring the tools, habits and science that can help us live longer and live better. We talk about nutrition, movement, recovery, sleep, heat therapy, biomarkers and the emerging world of longevity innovation. But sometimes the most powerful lever isn’t the newest device, the trendiest biohack or the most expensive protocol. Sometimes it’s the operating system underneath all of it: our mindset.

Because the words we repeat don’t just describe our lives. Over time, they shape the way we experience them. They become the mental architecture around us: the walls, the windows, the ceiling the floor.

“I’m too old for this.”
“I’ll probably fail.”
“I’m not smart enough.”
”My actions don’t matter.”
“I don’t matter.”

These sentences feel harmless in the moment. Almost automatic. But repeated often enough, they become a kind of internal operating system. And once a belief becomes familiar, we often stop questioning whether it’s actually true.

The reverse is also true. The right words, repeated at the right moments, can become scaffolding. They can hold us up when the body is tired, when fear is loud, when a setback arrives or when the path ahead feels daunting.

The 140.6-Mile Conversation

When friends ask me about completing an Ironman triathlon, the numbers are usually the first thing that come up. A 2.4-mile swim followed by a 112-mile bike and then a 26.2-mile marathon. A 140.6-mile day.

And yes, the physical challenge is real. Your body has to be trained. Your nutrition has to be dialed in. Your pacing matters. Your preparation matters.

But what I remember most is not just the distance, but the conversation I had with myself across the distance - and not just on race day, but in the thousands of hours of training leading up to the event.

At some point in a journey that long, your body makes a very compelling argument for stopping. It doesn’t whisper. Rather, it presents evidence. It reminds you of every ache, every doubt, every reason this whole thing may have been a bad idea.

And in that moment, the race becomes less about fitness and more about language.

Not fake positivity. Not pretending it doesn’t hurt. But the ability to say: keep moving. Get to the next mile. You’ve done hard things before. This is what you trained for.

The body follows the story the mind keeps telling.

That doesn’t mean words magically erase suffering. They don’t. But they can change our relationship to suffering and that can change what we do next.

Shawn Achor and the Science of Belief

This is one reason I’ve always appreciated Shawn Achor’s work. Achor, best known for The Happiness Advantage and Big Potential, has spent much of his career studying the relationship between mindset, happiness, performance and human flourishing.

His new book, The Power of Beliefs, takes this theme even further. The book focuses on seven “core beliefs” that Achor argues can influence our future health, success, wealth and education, especially in a world increasingly shaped by burnout, anxiety, loneliness and depression.

That idea feels deeply connected to the quote above. The beliefs we carry become the rooms we inhabit. They influence what we attempt, how we recover, how we interpret pain and whether we see setbacks as evidence that we are failing or evidence that we are still in the arena.

One of the most powerful ideas here is not just the value of creating positive mantras. It’s the importance of noticing and interrupting the negative ones.

Most of us think of a mantra as something intentional. A phrase we choose during meditation, before a workout or in a stressful moment. But we also carry unintentional mantras and those may be even more powerful because they often go unexamined.

“I’m too busy.”
“I can’t handle this.”
“People like me don’t do things like that.”
“I’m getting too old.”
“This always happens to me.”

The danger isn’t that these thoughts appear. After all, we are human and it’s natural for doubt, fear and insecurity to appear. The danger is when we start treating those thoughts as facts.

Optimism Is Not Delusion

Whenever we talk about positive self-talk, we need to draw a clear line. This isn’t about pretending everything is fine. It’s not about ignoring illness, grief, aging, disappointment or real obstacles.

Optimism, at its best, isn’t delusion. It’s disciplined attention.

It’s the decision to keep asking: “What is still possible here?” It’s choosing to focus not only on the problem, but also on the next constructive action available to us.

The science suggests this matters. A 2019 study published in Proceedings of the National Academy of Sciences found that higher optimism was associated with an 11–15% longer lifespan, on average and greater odds of reaching exceptional longevity, defined as living to age 85 or older.

This doesn’t prove that saying a positive phrase in the mirror will add years to your life. Human longevity is far too complex for that. But it does suggest that the way we interpret the future may influence how we live in the present.

Optimistic people may be more likely to exercise, recover from setbacks, maintain social ties, follow through on health behaviors and believe that effort is worth it. That last part may be the key.

When you believe your actions matter, you act differently.

The Biology of Self-Talk

The benefits of constructive self-talk also show up in stress research. In one study, participants who reflected on their personal values before a stressful task had lower cortisol responses compared with a control group.

In another study, self-affirmation improved problem-solving performance among people experiencing chronic stress. That finding is important because stress doesn’t just make us feel bad; it narrows us, reducing creativity, impairing decision-making and making every challenge feel more threatening.

A useful mantra can widen the frame. It can remind us: I am more than this moment. I am more than this fear. I am more than this one outcome.

This is why positive self-talk shouldn’t be dismissed as soft or superficial. At its best, it’s a form of nervous system training. It helps us create a little more space between stimulus and response.

When the Negative Voice Gets Loud

I’ve felt the negative voice in many forms.

During health setbacks, it can sound like: “What if this doesn’t get better?” Before big presentations, it can sound like: “What if I’m not ready?” In moments of uncertainty, it can sound like: “Who am I to be here?”

I remember speaking in front of an audience of more than 10,000 people after being introduced by a friend and mentor, John Sculley, former CEO of Apple. And giving a talk that would live up to John’s standards and that did right by his incredible introduction was undoubtedly more nerve-wracking than the size of the audience.

That kind of moment is humbling and energizing. It’s also a perfect breeding ground for self-doubt.

The old voice says: who are you to be here?

The better voice says: you prepared, you care, now serve the room.

That shift is everything. One voice makes the moment about fear. The other makes it about contribution.

The same principle applies in health. Negative self-talk often makes the body feel like an enemy and the future feel fixed. Constructive self-talk helps us re-enter the role of participant, not victim. It reminds us that while we do not control everything, our actions still matter.

Special Thanks to Our Partners

This post is brought to you by Heavenly Heat Saunas, a brand that I personally love.

One of the reasons I’ve been so drawn to Heavenly Heat is that sauna has become more than a recovery tool for me. It has become a transition point. A place to sweat, breathe, slow down and let the day quiet a bit.

And in the spirit of this post, it has also become a place to notice the internal dialogue I’ve been carrying.

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How to Build a Better Inner House

The goal isn’t to become someone who never has a negative thought. Trust me, that person doesn’t exist.

The goal is to become someone who notices the thought, questions it and chooses a better sentence. Not necessarily a grand sentence. Not necessarily something that would look good on a poster. Just something more true, more useful and more life-giving than the automatic script.

A simple place to start is by replacing identity-based negativity with process-based language. Instead of “I’m not disciplined,” try “I’m practicing consistency.” Instead of “I always fail,” try “I’m learning how to recover faster.” Instead of “I’m too old,” try “I can still adapt.”

The best mantras are often believable rather than dramatic. “This is hard and I can keep going.” “One next step.” “My actions matter.” “I have done hard things before.” These aren’t magic spells. They’re reminders of agency.

And they’re worth practicing when the stakes are low. Don’t wait for the Ironman, the health scare, the big speech or the crisis. Practice your language on an ordinary Tuesday. Practice it before a workout. Practice it when you’re tired. Practice it when you’re tempted to spiral.

The words become easier to access when you have already rehearsed them.

The Longevity of Language

We spend so much time talking about the visible pillars of longevity: nutrition, movement, sleep, heat, cold, supplements, biomarkers and recovery. All of that matters.

But underneath those habits is a quieter question: Do I believe my actions matter?

Because if I do, I am more likely to take the walk. I am more likely to make the better meal. I am more likely to prioritize sleep, call the friend, recover after a setback and keep going when the road gets long.

The words we speak become the house we live in.

So the invitation is simple: build carefully.

Speak to yourself like someone you are responsible for helping.

Because you are.

Yours in Health,

Ryan

A treadmill becomes a clothing rack. A recovery gadget ends up in a drawer. A meditation cushion slowly migrates to the corner of the room.

A sauna, at least in my experience, is different.

When the right sauna is sitting inside your home, already warm, already waiting and easy enough to use without friction, it becomes less of a “wellness product” and more of a ritual. That has been my experience with the Heavenly Heat 2 Person Red Light Infrared Sauna, which I’ve had the pleasure of testing.

And after using it regularly in my home gym, often for 20–25 minutes at 140+ degrees, I can say this plainly: it has become one of the most enjoyable and consistent additions to my health routine.

Not because I believe any one product is magic.

But because the right tool, built well, placed in the right environment, can make the healthy choice the easy choice.

Why Saunas Are Having a Moment

The wellness industry has a habit of turning ancient practices into modern trends. Sauna bathing is a perfect example.

For centuries, cultures around the world have used heat as a way to recover, cleanse, connect and reset. Today, sauna use is being re-examined through the lens of cardiovascular health, stress resilience, sleep, inflammation and longevity.

Some of the most-cited research comes from Finnish cohort studies which revealed that more frequent sauna bathing was associated with lower risk of sudden cardiac death, fatal coronary heart disease, fatal cardiovascular disease and all-cause mortality. Importantly, this does not prove that sauna use alone caused those outcomes, but the association is strong enough to make heat exposure one of the more interesting lifestyle tools in the longevity conversation.

Broader reviews have also found that sauna bathing has been linked to improvements in vascular health, blood pressure, cardiovascular disease, neurocognitive disease, respiratory conditions, pain and quality of life.

Still, sauna is not a replacement for exercise, sleep, nutrition, medical care or strength training. It’s not a shortcut. But as part of a broader health and wellness routine, it may be a powerful complement.

For me, that is exactly where it fits.

My core routine still revolves around movement, nutrition, sleep, recovery and consistency. The sauna has become another layer: a way to wind down, sweat, decompress and create a small daily separation between the intensity of the day and the restfulness of the evening.

Not All Saunas Are Created Equal

One thing I’ve learned from spending more time around this category is that “infrared sauna” is a very broad term.

Two saunas can look similar online and deliver very different experiences in person.

The differences can show up in the quality of the wood, the stability of the structure, the type and placement of the heaters, the red light components, the electrical requirements, the EMF/ELF and VOC considerations, the ease of installation, the controls, the warranty, the responsiveness of the team and even whether the brand actually helps you through the logistics of getting a large wellness product delivered and assembled inside your home.

That last point is not a small thing.

A premium sauna is not a supplement bottle arriving in a padded envelope. It’s a substantial piece of wellness infrastructure. The product matters, but so does the experience around the product.

This is where Heavenly Heat stood out from the beginning.

Their 2 Person Red Light Infrared Sauna is a full-spectrum model combining far infrared, near infrared, red light and grounding technologies. Importantly for me, the sauna uses a standard 120V outlet so I didn’t have to bring in an electrician to install a more powerful 240V setup. In addition, I love how Heavenly Heat stands by their products by offering free U.S. shipping, a 30-day home trial, premium warranty and dedicated support.

The Science: Infrared, Red Light and Why Wavelengths Matter

There are really two overlapping conversations here: heat therapy and light therapy.

A traditional sauna primarily heats the air around you. Infrared saunas use infrared wavelengths to warm the body more directly, usually at lower ambient temperatures than many traditional saunas. Heavenly Heat saunas can reach up to 165°F whereas many infrared saunas top out closer to 150°F.

The red light side is related but distinct.

Red light therapy, also known as photobiomodulation, typically refers to the use of red and near-infrared light to influence biological processes.

Red light is generally discussed in relation to skin, superficial tissue and cellular signaling.

Near infrared tends to penetrate more deeply than visible red light and is often discussed in relation to recovery, tissue effects and mitochondrial signaling.

Far infrared is the wavelength category most associated with infrared sauna heating, sweating, relaxation and whole-body heat exposure.

My take is that while the research is still evolving, there is evidence of potential health benefits and at the very least, saunas offer a truly relaxing experience.

That’s a balanced way to think about it.

Promising? Yes.

Worth incorporating if you enjoy it, tolerate heat well, hydrate and use common sense? In my opinion, absolutely.

A cure-all? No.

My Protocol

My personal sweet spot has been 20–25 minutes at 140+ degrees.

That’s long enough to sweat, breathe and feel a meaningful shift in my physiology, but not so long that it becomes a production. I typically think of it as a recovery and nervous system session, not a test of toughness.

The goal is to create a repeatable practice that leaves me feeling better afterward.

For readers who are new to sauna, I would start lower and shorter, especially if you’re not heat-adapted. Hydrate. Pay attention to dizziness or discomfort. And as always, anyone with cardiovascular disease, blood pressure concerns, pregnancy, heat intolerance or a medical condition should consult a clinician before starting heat therapy.

For me, the benefits I have noticed most are better mood, better sleep, stress reduction and perhaps most importantly, a ritual that my wife and I can both use to improve our health but also carve out additional special time together.

From Order to Delivery: Where Heavenly Heat Earned Trust

My experience with Heavenly Heat started well before I ever turned the sauna on.

From the beginning, communication was excellent. Abby from their team was particularly helpful, friendly and proactive.

I ordered in January and was initially told to expect a June or July delivery window. That was not surprising for a premium product with meaningful demand and I had mentally prepared for the wait.

Then I received an update that the sauna would be available much sooner, potentially as early as mid-to-late April.

That kind of communication matters.

When you are making an investment in the $8,000–$10,000 range, depending on incentives and promotions, you want to know what is happening. You want updates. You want a human being on the other side. You want to feel like the company is managing the process rather than simply taking the order and disappearing.

Heavenly Heat did that well.

Once the sauna left the warehouse, the communication continued. I knew when it was loaded onto the truck and when to expect delivery. Within a week, a large pallet arrived right at our doorstep.

There was also one unexpected bonus item . . . a frying pan.

I still don’t know exactly how or why the pallet arrived with a frying pan, but it did. And given how well the sauna heats, I joked that maybe I could crack an egg into the pan, bring it inside and have the perfect post-workout, post-sauna meal waiting for me!

Note, I haven’t yet tested this protocol :).

For science, perhaps I should.

Pallet + frying pan in garage . . . Awaiting assembly

Assembly Was Shockingly Easy

This was one of the most pleasant surprises.

Immediately after delivery, I received an email from the local assembly team Heavenly Heat partners with. We scheduled the assembly for just three business days later.

The team arrived, was incredibly friendly and had the sauna set up in less than 90 minutes.

That’s worth pausing on. A home sauna can sound intimidating. Will it be complicated? Will it take all day? Will it require special electrical work? Will I be stuck reading a manual while surrounded by wood panels and hardware?

In my case, no.

The process was efficient, clean, professional and easy. The sauna went into my gym, and very quickly it looked like it had always belonged there.

It also came with protective goggles for the red light therapy component, which is a small but important detail. When you are using red light, especially in an enclosed space with bright panels, eye protection matters.

The First Use

The first thing I noticed was how easy it was to operate.

The control panel is intuitive. The sauna heats fairly quickly (we turn it on 30 - 60 minutes beforehand which isn’t a problem, especially if we’re working out just prior). The temperature climbs efficiently. The red light component is easy to use. The whole experience feels polished rather than fussy.

The other unexpected standout: the Bluetooth sound quality.

I assumed the built-in audio would be a nice extra. It’s better than that. The sound is genuinely strong, clear and enjoyable and I’ve used it for music, podcasts and quieter wind-down sessions.

The Experience of Regular Use

After using the sauna consistently, what I appreciate most is not any single feature. It’s the way the whole system comes together.

The heat feels even and enveloping, the cabin is solid and well-built and the red light adds a sense that the session is doing more than simply making me sweat.

Lastly, I’m genuinely excited to share it with friends and family when they visit. That may sound like a small thing, but part of building a healthier life is creating an environment that invites other people into it.

A sauna isn’t just a product, it can become a gathering point.

Is It Worth the Investment?

This isn’t an inexpensive product. Depending on current incentives, promotions and configuration, the 2 Person Red Light Infrared Sauna is generally in the $8,000–$10,000 range.

But this is also one of those categories where I believe you get what you pay for.

When you are putting a heated structure in your home, sitting inside it regularly, exposing yourself to its materials, relying on its electrical components and building a health ritual around it, I would rather work with a brand that is obsessed with quality than save money on something that feels uncertain.

Bonus: For Longevity Today readers, Heavenly Heat is offering a special discount of 6% off.

You can learn more here or use code LTWORKUP for 6% off.

Final Thoughts

The more I think about longevity, the more I come back to one principle: the best health tools are the ones that help you live better consistently.

A great sauna supports that because it creates a repeatable ritual around recovery, relaxation, sweat, sleep and stress reduction. But quality matters enormously. A sauna isn’t just a box that gets hot. It’s an ecosystem of materials, engineering, light, heat, safety considerations, support, logistics, installation and trust.

My experience with Heavenly Heat has been excellent from start to finish.

From Abby’s communication, to the earlier-than-expected shipping update, to the doorstep delivery, to the unexpectedly hilarious frying pan cameo, to the fast professional assembly, to the daily experience of actually using the sauna, this has felt like a premium product delivered by a premium company.

And that matters, because in this industry, the outcome isn’t only about whether a sauna can make you sweat. It’s about whether the entire experience makes you want to keep coming back.

Heavenly Heat has done that for me.

For readers considering a serious home sauna, especially one that combines infrared and red light therapy in a beautifully built two-person unit, I would absolutely recommend taking a close look at Heavenly Heat.

And if you are considering one and want to hear more about my experience directly, reach out. I am happy to share more.

Yours in Health,

Ryan

I’ve been thinking a lot lately about the disproportionate returns of kindness.

Not grand gestures. Not life-changing interventions. Not the kind of help that requires a long plan, a large check or a dramatic sacrifice.

I’m talking about the small stuff. A text sent out of nowhere. A coffee paid for anonymously. A handwritten note. A call to someone you haven’t spoken to in years. A sentence that says, simply, I was thinking about you.

These actions cost us almost nothing. A few seconds. A few dollars. A few moments of attention.

And yet, on the other side of that action, the impact can be enormous.

That is the magic of random acts of kindness: the cost to the giver is often tiny, but the value to the recipient can be immeasurable.

Recently, through personal experiences that I may or may not share more about one day, I’ve been reminded of this in a very real way. Small actions from others - brief, simple, seemingly ordinary gestures - have stayed with me. They have landed more deeply than the people offering them probably realized. They have left an imprint.

And it has made me wonder:

• How many opportunities do we miss because we assume the small thing won’t matter?

• How often do we think about reaching out to someone, then talk ourselves out of it?

• How often do we have the impulse to do something kind, but dismiss it because it feels too minor?

The research suggests we are wrong more often than we think.

We Underestimate How Much Kindness Matters

A 2022 study published in the Journal of Personality and Social Psychology found that people consistently underestimate how much others appreciate being reached out to unexpectedly. In one series of experiments involving nearly 6,000 participants, people who sent a note, text, email or small message tended to undervalue how meaningful it would be to the person receiving it. The more surprising the outreach, the more the recipient appreciated it.

That feels important, because the barrier is rarely the act itself. The barrier is the story we tell ourselves before the act.

• “It might be awkward.”

• “It’s been too long.”

• “This is such a small thing.”

• “They won’t care.”

But what if they do?

What if your two-sentence text arrives on a hard day? What if the person in line behind you at the coffee shop is quietly carrying something heavy? What if the friend from your past has been wondering whether anyone still remembers that version of them?

What if the small thing isn’t small to the person receiving it?

Kindness as a Longevity Practice

We talk a lot in longevity circles about sleep, exercise, nutrition, metabolic health, VO2 max, zone 2 training, supplements, fasting, bloodwork and biomarkers.

All of that matters.

But we also know that social connection is one of the pillars of longevity. As such, relationships are biomarkers too.

Maybe not the kind we can measure with a wearable or a blood draw, but the kind our bodies feel.

Do I belong? Am I seen? Would someone notice if I disappeared for a while? Do I have people I can call? Do people feel they can call me?

Longevity isn’t just about adding years to life. It’s about creating a life that feels worth extending. And few things make life feel more worth living than connection.

Random acts of kindness are one of the simplest ways to strengthen that connection.

They are small deposits into the invisible accounts that hold our relationships together.

The Side Benefit: We Feel Better Too

The beautiful thing about kindness is that it doesn’t only affect the recipient.

It changes the giver too.

A 2020 meta-analysis in Psychological Bulletin found that prosocial behavior - actions intended to benefit others - is associated with greater well-being, especially psychological functioning. In plain English: doing good for others tends to make us feel better too.

This doesn’t mean kindness should become transactional.

That isn’t the point.

We aren’t kind because we expect something in return. We aren’t giving in order to get. We are not keeping score.

The point is simpler and more profound: When we act kindly, we are reminded that we are connected. We step out of our own inner loop. We interrupt the self-focus that modern life so often reinforces. We remember that we have the power to change the emotional temperature of someone else’s day.

And in doing so, our own day changes too.

Pay It Forward, Without Keeping Score

I love the idea of paying it forward, but I think it’s often misunderstood.

The point is not: I do something for you and someday someone does something for me.

That is still a form of accounting.

The deeper version is this: I do something for you. It makes you feel seen.

Maybe you carry that feeling into your next interaction. Maybe you are a little more patient with your child. Maybe you text someone else. Maybe you hold the door. Maybe you forgive someone faster. Maybe you buy the next coffee.

The gift moves.

Not because anyone demanded repayment, but because kindness has momentum.

It creates a domino effect.

One small act becomes two. Two become four. A moment becomes a mood. A mood becomes an atmosphere. An atmosphere becomes a culture.

And it can start with almost nothing.

A Few Small Acts That Are Bigger Than They Look

Here are a few simple ways to practice this today:

• Send a text to someone from your past that says, “I was just thinking about you and wanted to say hello.”

• Pay for the person behind you at your local coffee shop

• Send a voice memo instead of a text so someone can hear your voice

• Write a short note to a teacher, coach, mentor or former colleague who shaped your life

• Tell a friend one specific thing you admire about them

• Leave a generous tip with a kind note

• Bring coffee to a coworker without asking if they want one

• Let someone merge in traffic without making it a moral negotiation

• Compliment a stranger in a way that is genuine and not performative

• Send a photo to someone that reminds you of a shared memory

• Check in on someone who seemed a little off the last time you saw them

• Introduce two people who might enrich each other’s lives

• Ask the cashier, “How is your day going?” and actually listen

• Tell your spouse, partner, child or friend something you usually assume they already know

None of these will make headlines. Most will not be remembered by the world. But they may be remembered by the person. And sometimes that is more than enough.

The Nudge

So here’s my invitation:

Don’t wait until you have the perfect words. Don’t wait until you have more time. Don’t wait until the gesture feels big enough.

The next time someone crosses your mind, treat that as the signal.

Send the text. Make the call. Buy the coffee. Write the note. Say the kind thing out loud.

Because one of the great truths of life is that we rarely know the full weight of what others are carrying. And we rarely know the full power of the kindness we are capable of offering.

A random act of kindness may take you ten seconds.

But for someone else, it may last years.

Yours in Health,

Ryan Frankel

We tend to talk about energy as if it were something we either have or don’t have.

You wake up energized or you wake up depleted. You hit 3 p.m. and crash or you carry momentum through the day. You feel sharp, clear and motivated or foggy, distracted and strangely flat.

But in my experience, energy is rarely random.

It’s usually the product of what we’re doing consistently, what we’re neglecting repeatedly and what our days are quietly asking from us.

Yes, energy is built on the fundamentals: sleep, nutrition, movement, recovery, time outdoors and addressing true medical needs with qualified professionals. The science behind those pillars is strong. Sleep extension has been shown to improve fatigue and daytime functioning, while poor or extreme sleep duration is associated with worse cognitive outcomes. Regular physical activity is consistently linked with better feelings of energy and lower fatigue. Nature exposure is associated with lower stress and better mental well-being. And highly processed diets can drive excess calorie intake and worsen the quality of what we’re giving our bodies.

Those matter a lot. But one of the most overlooked levers for getting your energy back is much simpler:

You need to know what your life is doing to your energy.

That is what I call an Energy Audit.

The Basics Still Matter

Before I get to the audit itself, it’s worth saying clearly: if your energy is chronically low, the first place to look is still the foundation.

Are you sleeping enough, and sleeping consistently?

Are you eating in a way that supports stable energy rather than spikes and crashes?

Are you moving your body enough, including both cardio and strength work?

Are you building in actual recovery, not just collapsing at the end of an overstuffed day?

Are you getting outside, seeing sunlight and spending any meaningful time away from screens?

And if something feels truly off, are you working with a qualified practitioner to evaluate whether there is a medical, hormonal, nutritional or medication-related reason for it?

None of that is optional. But even when those are in decent shape, many people still feel tired. Not because they are broken, but because their calendar is quietly draining them.

The Energy Audit

Here’s the simplest version.

Go back and look at your calendar from the last week or month. Not your ideal week, but your actual one.

Then color-code what was on it:

Green: activities that gave you energy, excitement, clarity, momentum or joy

Yellow: activities that felt neutral, mixed or uncertain

Red: activities that left you drained, tense, frustrated, anxious or depleted

Do this honestly.

Not based on what should energize you, based on what actually did.

Then step back and ask:

• What categories do my greens fall into?

• What categories do my reds fall into?

• Which yellows can be improved?

• Which yellows are really reds that I have been rationalizing?

Once you see the pattern, the work becomes practical:

• Remove the reds where possible

• Reduce the frequency or intensity of the reds that can’t be eliminated.

• Protect and prioritize the greens

• Refine the yellows until they either become green or get cut

So simple and yet so powerful.

A Personal Truth I’ve Learned the Hard Way

As much as I thrive as a founder and CEO, my natural personality is much closer to an introvert.

That distinction matters more than people realize.

From the outside, it may look like networking events, business travel, presentations, client meetings, packed days of calls and high-volume social interaction should energize me. After all, those things are often part of building a company and leading from the front.

But the truth is, too much of that leaves me more drained than inspired.

I can do it and I often do but that doesn’t mean it restores me.

A quiet dinner at home with family, a loved one or a close friend, a good book or even a movie and a slower evening can do more for my energy than another “productive” night out ever could.

That’s the point of an Energy Audit: not to build someone else’s ideal life, but to understand your own.

Research on personality has long found that extraversion is associated with greater positive affect and people higher in extraversion often experience pleasant social situations differently than introverts do.

So yes, an extrovert may walk out of a big networking event feeling alive, stimulated and more like themselves and an introvert may walk out of that exact same room feeling flattened.

Neither is wrong. But both need to know it.

Special Thanks to Our Partners

This post is supported by Momentous, a company focused on high-quality human performance supplements.

Momentous offers foundational products like protein, creatine and omega-3, which they package as “The Momentous Three.” That foundation-first philosophy is one I generally agree with: supplements should support the basics, not distract from them.

Sleep, nutrition, exercise, recovery, appropriate medical care and your energy audit should still do most of the heavy lifting, but the right supplements from a high-quality brand like Momentous can augment a strong foundation.

Other Ways This Shows Up

The introvert-extrovert example is one of the clearest, but it’s far from the only one.

Some people think travel energizes them and sometimes it does. But it could also be just stimulation layered on top of poor sleep, disrupted eating and low-grade stress.

Some people assume every workout should leave them feeling crushed. But for one person, hard intervals may feel invigorating, while for another, a long walk and strength session is what creates sustainable energy.

Some people say yes to every dinner, every coffee, every obligation because they don’t want to disappoint anyone. Then they wonder why they are tired all the time.

Some people confuse digital consumption with recovery. But scrolling isn’t always rest. Sometimes it’s just more input. Nature exposure and time away from technology are associated with lower stress and better mental well-being, which helps explain why even a short walk outside can feel more renewing than another 30 minutes on a screen.

And in work settings, not all meetings are created equal. Research on meeting fatigue suggests that meetings can create a real need for recovery, especially when quality is poor or transition time is lacking.

That should sound familiar to almost anyone with a modern calendar.

How to Do Your Own Energy Audit This Week

Here’s a simple place to start:

1. Review the last 2 to 4 weeks of your calendar.

Look at work meetings, social plans, workouts, travel, family commitments, downtime, everything.

2. Color-code each item.

Green, yellow or red.

3. Look for patterns.

Maybe your greens are morning workouts, deep work, dinners at home, one-on-one conversations, reading or walks outside.

Maybe your reds are stacked Zoom calls, oversized social events, late-night travel, overcommitted weekends or workouts that leave you more exhausted than stronger.

4. Edit the next two weeks in advance.

Remove one red. Reduce one red. Add one green. Improve one yellow.

5. Repeat monthly.

Your energy is dynamic. Your audit should be too.

This is not about building a perfectly optimized life, it’s about building a more honest one.

The Goal Isn’t Just More Energy. It’s Better Energy.

That’s the distinction that matters. You can chase stimulation and call it energy, you can run on stress and call it ambition and you can stay busy and call it momentum.

But real energy feels different. It feels steady, clear, grounded and renewable. .

The basics are still the basics for a reason: sleep, nutrition, exercise, recovery, outdoor time and medical support when appropriate all matter enormously. Exercise training is linked with better energy and less fatigue and sleep extension can meaningfully improve fatigue and daytime functioning. Whole, less processed foods also appear to support better regulation of intake and metabolic health than ultra-processed patterns.

But if you’re doing many of those things and still feel off, look at your calendar.

Your energy is not only shaped by how you live, it’s shaped by what your life keeps asking you to be.

And sometimes the most powerful step is not adding another habit.

It’s removing what has been draining you all along.

Yours in Health,

Ryan

If you’ve followed me for a while, you know my views on the importance of adequate protein intake.

Not in a fad-diet, macros-obsessed, “every meal needs to be a shake” kind of way. I care about it because protein is one of the most practical, evidence-backed levers we have for supporting muscle, strength, recovery, satiety and healthy aging. Higher protein intake, especially when paired with resistance training, is consistently associated with better maintenance of lean mass as we get older and many experts argue that older adults often benefit from intakes above the bare-minimum RDA. A practical range often discussed is roughly 1.0–1.6 g/kg/day depending on age, activity level and goals, rather than one rigid target for everyone.

I’ve written before about why muscle matters so much in the longevity conversation and why building and preserving it is one of the best investments we can make in our future selves. In that sense, this post is a companion to two earlier pieces: The Key to a Healthy Aging Journey and How to Build Muscle at Any Age.

My bias is still the same: real food first.

That means eggs, Greek yogurt, cottage cheese, high-quality meat, fish, poultry and other whole-food staples do most of the heavy lifting in my diet. But snacks, bars, jerky and protein powders absolutely have their place. They’re useful when you’re running between meetings, traveling, need something post-workout or simply want an easy way to close the gap on a protein goal without overcomplicating your day.

And because I’ve spent years paying attention to quality, ingredients, sourcing and how products actually make me feel, I wanted to do a simple roundup of the best and highest quality protein products I genuinely use and like.

Why protein matters more than most people realize

One of the biggest misses I see is that people think of protein only through the lens of bodybuilding. But protein is not just about aesthetics. It helps support muscle protein synthesis, recovery from training, physical function and satiety and those benefits matter whether you’re 28 or 68. The aging piece is especially important because we naturally become less responsive to dietary protein over time, which is one reason preserving muscle gets harder with age.

That does not mean everyone needs to eat the same amount. Protein needs vary. They depend on body size, training status, age, appetite and goals. But the bigger point stands: many people would likely do better by being more intentional about protein, especially earlier in the day and more consistently across meals.

That’s where smart convenience comes in.

I still prefer to consume most of my protein from real meals. But I also live in the real world. I travel. I’m on the move. Some days don’t go according to plan. On those days, having high-quality protein options in a bag, car, carry-on or pantry makes it much easier to stay on track.

The products I keep coming back to

1) Lineage Provisions

There’s a reason Lineage makes the list first. Their overall philosophy aligns closely with how I think about nutrition: prioritize real food, keep ingredient decks clean and care deeply about sourcing and testing. Lineage’s products are built around real-food nutrition, 100% grass-fed and finished beef, regenerative sourcing and rigorous third-party testing for hundreds of contaminants. That quality-first approach is a big part of why the brand resonates with me.

The Lineage Protein Bar

I absolutely love their Chocolate and Mixed Berry protein bars. Both bars are built around 20g of grass-fed protein, come in under 200 calories and avoid a lot of the usual stuff that can make bars feel more like candy with a wellness halo. Lineage emphasizes real-food ingredients, raw honey and coconut nectar for sweetness and no sugar alcohols, gums or fiber syrups. That matters, because plenty of bars look good on paper and then leave you feeling bloated or underwhelmed. These don’t.

Grass-Fed Beef Sticks

These are exactly the kind of snack I want around when I’m traveling or just need something savory and easy. Lineage’s beef sticks are made from 100% grass-fed beef and deliver a high-protein, real-food option. Again, the sourcing story matters here. It’s not just protein for protein’s sake; it’s protein from a brand whose quality standards and ingredient philosophy fit the broader way I try to eat.

Animal-Based Complete Protein (Chocolate)

I’m generally selective with powders, but this one is genuinely interesting. Lineage’s grass-fed beef protein packs over 20g per serving, simple ingredients and no gums, lecithins or artificial sweeteners. For someone who wants a different protein option than whey or simply values the brand’s nose-to-tail, real-food philosophy, this is a compelling one.

What I like most about Lineage is that the mission doesn’t feel bolted on. It feels central. Real-food nutrition, grass-fed sourcing, testing and a clear point of view on ingredient quality are all highly aligned with the way I think about long-term health.

Note: Lineage Provisions has offered up 15% off all of their products to Longevity Today subscribers. Use this link or the code, “LONGEVITYTODAY”.

Special Thanks to Our Partner

This edition is sponsored by Cenegenics.

Cenegenics offers a performance health management program built around deep assessment and personalization, including a full-day evaluation that may include DEXA, VO2 max, cognitive and metabolic testing, fitness and nutrition assessments, and physician consultation, with programming shaped by extensive biomarker review. That kind of data-driven, individualized approach is very much in line with a broader longevity mindset: measure thoughtfully, personalize intelligently, and focus on healthspan, not just lifespan.

Learn more about Cenegenics

2) Momentous Grass-Fed Whey Protein

Momentous is one of the supplement brands I trust most in the space and trust is not a word I use lightly here. Their whey isolate delivers 20g of protein per serving, is sourced from European grass-fed dairy and is NSF Certified for Sport. Momentous also emphasizes no artificial ingredients, sweeteners or fillers, plus third-party testing and batch-level transparency. In a supplement category full of noise, that matters.

I also have an extra layer of conviction here because I’ve had the pleasure of interviewing Momentous CEO Jeff Byers. My takeaway from that conversation was simple: this is a brand deeply focused on science, standards and staying grounded in the fundamentals instead of chasing every trend. That’s a philosophy I respect.

3) Maui Nui Venison

Maui Nui is one of the most unique brands in this roundup because its story goes well beyond macros. The company’s mission is centered on helping balance Axis deer populations in Hawaii for the good of the environment, communities and food systems. That combination of nutrient-dense food and a meaningful sourcing story is a big part of why I appreciate it.

Peppered Venison Jerky Sticks

These are a great on-the-go option, made from 100% wild-harvested Axis deer, naturally hardwood smoked, with no added sugar and packing 10g of protein for just 55 calories per stick. That’s a strong protein-to-calorie ratio in a very travel-friendly form factor.

Venison steak cuts

This is where I’d remind everyone that while this is a “snack edition,” real food still comes first for me. Maui Nui’s naturally sourced venison cuts are part of that equation. Their tenderloin, for example, is lean, nutrient-dense and provides 21g of protein. When I talk about prioritizing protein from actual food, this is exactly the kind of product I mean.

4) Kodiak Cakes Blueberry Flapjacks

This is probably the most Ryan in real life item in the roundup.

I make these ahead of time and they’re one of my favorite quick, transportable grab-and-go options. Kodiak’s Blueberry Power Cakes are made with 100% whole grains and provide 14g of protein per serving. Are they the most protein-dense item on this list? No. But they are practical, tasty, easy to prep in batches and much better than ending up with a low-protein breakfast or random airport pastry.

Sometimes the “best” protein option is not the most extreme one. It’s the one you’ll actually make, actually eat and actually bring with you.

5) Outwork Nutrition Build Whey Protein — Peanut Butter Cup

Outwork is another brand that earns trust by leading with evidence instead of hype. The brand was founded by Dr. Layne Norton and focuses on science-based formulas, third-party testing, clinical dosing and no proprietary blends. That’s the kind of supplement philosophy I want to see more of.

The specific flavor I’d call out here is Peanut Butter Cup. Their Build Whey uses 100% whey isolate, provides 25g of protein per serving, contains about 3g leucine per serving and is low in lactose. And yes, I absolutely trust Dr. Layne Norton’s brand when it comes to taking a science-first approach in a category that too often rewards marketing over substance.

Final thoughts

The biggest point I’d leave you with is this: protein doesn’t need to be complicated.

Start with real food. Build meals around quality protein sources. Lift weights. Be consistent. And then use bars, jerky, flapjacks and powders strategically, not mindlessly. They should support your foundation, not replace it.

That’s how I think about all five of these brands. They’re not magic. They’re tools. But they’re tools I genuinely like, use and feel good recommending because they make it easier to stay consistent with a protein-forward lifestyle in the real world.

And I’d genuinely love to hear from you: what protein products or brands do you love? Feel free to reply directly or comment on the post with the ones that have earned a permanent place in your routine.

Yours in Health,

Ryan

Disclosure: Some of the brands mentioned are sponsors or companies with whom I have a direct relationship, however as always, I only surface the best companies, products and services.

Have you ever wondered what it actually feels like to put your health in the hands of a truly high-touch, deeply personalized longevity and performance medicine team?

Not the marketing version. Not the polished sales pitch. The real experience: what happens before you walk through the door, what the testing actually looks like, how the doctors and coaches think, what follow-up feels like and whether the care truly lives up to the promise.

As interest in preventive health, longevity medicine and concierge-style care continues to grow, more people are asking an important question: what is the patient journey actually like inside one of these platforms? What do you really get, who is it for and how does it compare to the kind of healthcare most of us are used to navigating?

That’s what this post is about.

Over the last three months, I’ve had the opportunity to experience Cenegenics firsthand, both in person and virtually. What follows is an inside glimpse at that journey: why I was interested in the company to begin with, what Cenegenics actually does, how its model differs from traditional healthcare and what it looks like to be cared for by their team across testing, physician guidance, health coaching, follow-up and ongoing refinement.

Before getting into my own experience, it’s worth stepping back to understand why a platform like this exists in the first place and why it’s resonating with a growing number of people who want a more proactive, data-driven and comprehensive approach to their health.

Let’s Dive In

Traditional healthcare is still largely reactive. You get your annual physical, maybe a standard lab panel and if something is clearly wrong, you address it. That model has real value, but it isn’t built for people who want a deeper understanding of how they are aging, where risk may be building and what they can do now to improve how they feel and function over the next 10, 20 or 30 years.

Cenegenics is built around that gap.

The company describes itself as a physician-led, data-driven performance health and age-management practice focused on cognitive, physical and metabolic health. Its model starts with a deep baseline assessment and then pairs members with an ongoing care team that uses labs, diagnostics, coaching and regular follow-ups to build a personalized plan. Cenegenics delivers advanced testing solutions including DEXA, VO₂ max, carotid ultrasound, neurocognitive screening and broad biomarker analysis, along with ongoing physician and health coach access.

That last point matters.

A lot of longevity platforms can feel fragmented. Testing over here. Coaching over there. Supplements from someone else. Labs somewhere else. What makes Cenegenics interesting is the comprehensiveness of the offering: diagnostics, physician interpretation, performance coaching, follow-up lab work and ongoing iteration sit under one roof. Members are supported year-round through follow-up testing and a personalized program rather than a one-time snapshot, which represents a stark contrast from what conventionally has been offered in traditional care models.

In a traditional primary care setting, time is limited, baseline testing is narrower and the system is often structured around treating disease once it is visible. Cenegenics is positioned much more as proactive, longitudinal and optimization-oriented. Even the company’s own framing is explicit: find weak links early, prioritize what matters and intervene before those issues become larger problems.

Why This Category Matters

Zooming out, there’s a bigger reason platforms like this are getting attention.

We know that cardiorespiratory fitness is strongly associated with long-term survival, with higher fitness levels linked to lower all-cause mortality. We also know that muscular strength and resistance training are associated with lower risk of mortality and cardiometabolic disease. Meanwhile, deeper body-composition analysis and cardiovascular screening can uncover risks that don’t always show up in a basic office visit.

That’s the real promise of this space: not magic, not shortcuts, but earlier visibility and tighter feedback loops.

The Cenegenics Program

The patient journey starts with an easy but comprehensive online intake form and from there, the real experience begins a few weeks later with a full-day in-person Performance Health Assessment that includes physician review and a wide range of diagnostic and performance testing.

From a cost perspective, it’s certainly a premium service. Prices vary from $500 - $750 per month, depending on your desired plan and this fee doesn’t include the cost of medications, supplements or specialty testing. Since protocols vary considerably by patient, I would treat those figures as directional rather than universal.

My Experience: The First Three Months

What impressed me most about Cenegenics is that the experience felt comprehensive without feeling clinical in a cold or impersonal way.

I started in February with a kickoff appointment that lasted essentially the full day, from 8:30 a.m. to 4:30 p.m. Before I ever arrived, the process was already remarkably smooth. I completed a detailed but easy-to-navigate intake form and I received a DNA genetics kit powered by 3X4 Genetics with clear instructions for collection and FedEx drop-off.

That set the tone: thoughtful, organized and easy.

The in-person assessment itself was extensive and incredible. My day began with a DEXA scan, followed by a carotid artery ultrasound and then a physical performance evaluation that included max pushups, max crunches and a plank hold that topped out at three minutes.

Image courtesy of Cenegenics

From there, things got even more interesting.

I went through a cognitive assessment that measured brain waves, reaction time, memory recall, focus and other neurological markers. I also had conversations around nutrition and strength training, completed a VO₂ max test and finished the day with both a health coach consultation and a nearly two-hour discussion with my physician.

Image courtesy of Cenegenics

It was a lot of information, but it never felt chaotic.

It felt orchestrated.

That’s where the human side of the experience really stood out.

My health coach, Pete, was phenomenal from day one: friendly, sharp, practical and deeply informed. He consistently translated data into action, especially around nutrition and physical fitness and he brought the kind of accountability that’s easy to say you want and much harder to build into your life on your own.

Brianna, the team’s Member Experience Lead, made everything around the logistics feel seamless. The weeks leading up to the assessment, the day itself and the months that followed all ran with a level of polish that is very rare in healthcare.

And then there was Dr. Renata Burigatto, who I worked with most closely throughout the initial experience and beyond. She was incredibly knowledgeable, thorough, warm, responsive and refreshingly ego-free. That last point is worth emphasizing. Concierge medicine can sometimes feel stuffy, overproduced or almost performative. That was not my experience here. Dr. Burigatto was thoughtful, direct, supportive and fully open to collaborating with my other physicians. She proactively expressed interest in comparing notes and incorporating multiple perspectives, which I found confidence-inspiring.

That’s what high-level care should look like.

Not territorial. Not theatrical. Collaborative.

Within 24 hours of my Performance Assessment, Dr. Burigatto had written a comprehensive summary and plan. Medications and supplements were set in motion almost immediately and some arrived at my door overnight. Cenegenics also worked across both local pharmacy options and its own pharmacy solutions, with refills designed to be frictionless. Just as importantly, I was told I could text, email or call whenever I needed anything, including evenings and weekends.

And they meant it.

From there, the relationship moved into its next phase: virtual appointments, follow-up calls, additional lab testing and ongoing refinements. This is where a service like this either proves itself or doesn’t. Plenty of companies are good at the initial “wow” factor. Fewer are good in the ongoing care model.

Cenegenics was.

One of the most interesting parts of the process was a one-hour call with Jason to review my genetic results. That conversation focused on my “Top 3 Pathways” for improving my health and gave me a much more tangible understanding of how my genetics may shape nutrition, inflammation, metabolism and broader optimization decisions. It was fascinating, but more importantly, it was actionable.

That’s a theme I kept coming back to over these first three months: actionability.

Not just information. Not just interesting data. A real plan.

And for me personally, that mattered because I had felt some decline in physical fitness and energy. Nothing dramatic, but enough to notice. Enough to know I needed to take a more aggressive and structured approach to training, nutrition and recovery than I probably would have on my own.

Cenegenics helped create that structure.

It gave me more confidence in my health plan. It gave me the comfort of knowing I had strong people looking after me from both the medicine side and the nutrition and fitness side. And it created a level of accountability that’s hard to replicate when you’re operating solo, even if you are highly motivated.

Special Thanks to the Team Behind the Experience

What stood out to me most was not just the testing, but the consistency of the people. Dr. Burigatto, Pete, Brianna and Jason each played a different role, but together they made the experience feel joined-up in a way that most healthcare simply doesn’t.

This wasn’t a one-day battery of tests followed by silence, it was an ongoing relationship.

Who Cenegenics is For

Cenegenics makes the most sense for someone who wants a more proactive approach than standard healthcare typically offers. Someone who values data, but doesn’t want to interpret everything alone. Someone who wants both medical oversight and day-to-day coaching. Someone who knows that energy, body composition, fitness, cognition and recovery don’t improve by accident.

It’s also best suited for people who are ready to engage.

This isn’t passive care. It’s not a magic pill. It’s a structured, physician-guided partnership that still requires effort, consistency and follow-through.

Final Thoughts

After three months, what I can say with confidence is that Cenegenics delivers an experience that feels truly high-quality and best-in-class.

Not because it was luxurious for the sake of being luxurious, but because it combined depth, responsiveness, professionalism and human support in a way that’s still far too rare in healthcare.

There is something game-changing about having dedicated professionals who know your case, move quickly, communicate clearly and are available to help you make smart adjustments in real time. When that support spans medicine, fitness, nutrition, follow-up testing and everyday accountability, it can change not only the quality of your plan, but your willingness to actually stick to it.

And that may be the biggest differentiator of all.

Health isn’t transformed by information alone. It’s transformed by timely action, consistent guidance and the feeling that someone capable is in your corner. My first 90 days with Cenegenics has certainly made that feel very real so far.

At the same time, 90 days is still early. It’s enough time to understand the caliber of a team, the depth of a process and the seriousness of an approach. But when it comes to body composition, metabolic health, cardiovascular fitness, cognitive performance and the kinds of changes most people actually care about, the most meaningful results often take many months and sometimes a year or more to fully unfold.

That is part of what makes this kind of work so compelling. Done properly, it’s not a quick fix or a short sprint. It’s an ongoing process of testing, learning, refining and staying accountable over time. I feel like I’ve had a strong introduction to what Cenegenics is capable of. What interests me just as much now is what this kind of physician-led, coach-supported partnership can look like over a longer arc.

If you’ve ever considered a service like this, my advice is simple: think beyond the initial testing and the first few weeks of momentum. The real value is in the consistency, the iteration and the compounding effect of having the right people in your corner over time.

And if there’s interest, I would be glad to continue documenting that journey and share what a deeper, longer-duration engagement can reveal over time with a platform like Cenegenics.

Yours in Health,

Ryan Frankel