Over the last several years I have tried to answer the question “What is a Healthy Lifestyle?”. The following is a brief summary of what I have learned (with some minor updates added in 2022). My conclusions seem to overlap a fair bit with what Dr Peter Attia advocates, and the insights from Blue Zones.
- Develop strong social connections
- Sleep: get at least 6 hours, or maybe 7.5 hours since that seems to be what experts say.
- Move! Be Active – Walk at least 7k steps. Don’t sit for hours in a row.
- Eat healthy / whole foods: Avoid big surpluses of energy and minimize sugar
- Be Mindful: Live in the moment, manage stress, cultivate a attitude of graditude
- Exercise: Low and high intensity which includes resistance training
- Get Outdoors: Be energized by sun, trees, nature
- Push beyond your comfort zones
By applying these principles I am in better condition in my 60s than I was for most of my adult life. I dropped 50 lbs in a couple of years while increasing my muscle mass. My body fat dropping from >32% (obese) to 15% (fit) measured using DEXA. I went from not being able to run 1 miles without pausing to completing the big sur marathon, did all five passes on the deathride, and completed backpacking trips covering more than 90 miles in 2 days with >25k ft elevation change. I was unable to do a pull up and now can do a number of pull ups with a 25lb backpack and can squat twice my bodyweight.
Have Strong Social Connections
The Harvard / MassGeneral Adult Development Study started in 1939 has studying the the lives of two cohorts and now their children found that the strongest predictors of a healthy (and happy) life was an individual’s quality of social relationships. Researcher Susan Pinker found that the secret to living longer may be your social life due to the correlation between social connections and people who are 100+ years old / live in the “Blue Zones”. Strong social connections have as much impact on all cause mortality as smoking!
For me social connections come from four sources: family, church community, work, and long term friends… many of whom I met in school. A key to keeping connections is taking initiative! Inviting people over for dinner or for a hike. Calling people up on the phone just to connect. Don’t wait for someone to contact you. Find ways to serve your community which involves person to person interactions.
Sleep >6 Hours
There is ever increasing evidence that sleep is absolutely critical to a mentally and physically healthy life. Sleep scientists believe healthy adults need between 7-9 hours of quality sleep each night and children require even more sleep. While we don’t yet fully understand all of the ways sleep impacts our health, there are a number of important processes that are primarily activate while you sleep, particularly during the deep, delta wave stage such as:
- Release of human growth hormone which is critical to fighting the effects of aging and repairing damage
- The glymphatic system clears toxins and “trash” from the brain which might contribute to Alzheimer’s and other neurological disorders.
- Interplay between the hippocampus and the prefrontal cortex which is critical to long term memory
I experienced the importance of sleep first hand when after a nine month period of sleeping <4 hours/night my body rebelled. For a week I was so exhausted I couldn’t get out of bed for more than an hour. After I partially recovered my boss recommended The Promise of Sleep written by a pioneer in sleep research who has since retired. I learned my lesson, but the damage was done. It took me more than 10 years to be back to “normal”. BTW: Matt Walker seems to have picked up the mantle of the leading sleep advocate.
I am now very careful to get enough sleep. When I cut my sleep short I am very aware of it the following day. The days following a night that I didn’t get enough sleep my resting heart rate rises by at least 10 bpm for several days and I have a tendency to gain weight. There are numerous things which help me sleep well:
- Go to bed at a consistent time
- Get up at a consistent time which provides enough rest. I am not shocked awake by an alarm, I naturally wake up.
- Use a chilipad (eight sleep is a more advanced product) keeps me at the right temperature for good sleep. People need to lower their body temperature 2-3 degrees F to fall asleep.
- Use a mask over eyes to keep the “room” dark while sleeping
- Take a calming walk in evening avoid things that will aggravate me
- Limit bright light (especially computer screen) 2 hours before bed.
- Associate bedroom with rest… e.g. don’t do work in the bedroom, no TV
- Avoid caffeine after lunch
- Avoid eating food, especially junk food, within a couple of hours of bed.
- Some folks with chronic pain report that PEMF mats help them sleep and recover.
Avoid frequently changing time zone or having a life which doesn’t align so you are most active when the sun is out. There are numerous studies which have found being out of sync with the sun throws off your circadian rhythms which has a negative impact to physical and mental health. For NASA lovers, check out a summary of their research applied to designing sleep spaces.
Stay Active… Move!
Our bodies are made to move and our brains are made to direct that movement. Through most of history this was a given. Life was filled with physical activity. This is only true today for “blue collar” and agriculture jobs. I find it fascinating that the jobs that are often considered least desirable might be the best for our health and wellness.
For those of us with “office jobs”, e.g. we sit on our butts most of the day, one of the most natural and health promoting activities is walking. Walk at least 30 minutes each day, getting a total of >=7,500 steps. There is a huge advantage of getting to just 5-7K rather than they typical sedentary 3K. It is also highly recommended to walk right after you eat because it can help with glycemic control. There is evidence that significant benefits drop off at around 12k steps and don’t have any impact to mortality after 17k. My personal experience is when I am walking 15K steps / day everything seems to be a bit better. Besides the physical benefits, walking engages our brain, strengthen our creativity, improves cognitive function, and ability to focus. It’s best if you walk outdoors to get the benefits of movement and the exposure to nature.
Minimum effective dose from mortality data suggests 150 minutes / week (vigorous exercise counts double). Maximum returns seems to be around 600 minutes / week (study).
Eat Healthy Foods
Michael Pollan, who wrote a number of excellent books on food distilled his nutritional insights into three simple rules: “Eat food. Not too much. Mostly plants.” By “food” Pollan means real food—vegetables, fruits, nuts, whole grains, and meat and fish—rather than what he calls “edible food-like substances” found in the processed-food aisles of the grocery store. Lifehacker’s the only three things everybody agrees on aligns with Pollan, highlight two specifics to avoid and doubles down on more vegtables. What’s the optimal mix of meta-nutrients? Whatever works for you. A combined Stanford and NIH study found that when it come to weight lose, that neither low fat or low carb was superior. My read of all Cochrane’s findings about of diets and time restricted feeding (intermittent fasting) is that none are significantly better than another in terms of health outcomes. What’s important is not to eat too much. The biggest issue for most people is compliance. My read of this, use whatever approach works for you and realize it likely won’t work for others. My rules:
- Eat as many non-starchy vegetables as you can, especially those that have deep colors. The caloric density of these vegetables is small enough that you will not eat too much. The vegetables are packed with health promoting micro nutrients and nutritional building blocks. This will also get your fiber consumption up to an healthy level. Fiber is critical to your micro-biome health. These days I strive for 50% (by weight) of my food to be these sort of vegetables.
- Avoid highly processed food including white flour based bread & pasta, food filled with ingredients you can’t pronounce. Eliminate all “foods” which are high in trans-fats. There is significant evidence that trans-fats have a negative impacts to health.
- Minimize the sugar in your diet, and eliminate any products that have added sugar. There has been significant evidence since the 1960s that sugar is directly linked to a number of health issues including heart disease. There is a very strong connection between fructose and metabolic disease. Fruit with the skin is ok in moderation because it has many good micro nutrients. I believe berries and pomegranates are some of the healthiest fruits. Try to avoid fruit juices.
- Minimize the calories you drink. In particular alcohol, sodas, and fruit juices which pack a lot of calories and spike blood glucose levels.
- Eat enough protein to maintain your muscles. A good rule of thumb for adults is .7 grams/1lb of your lean body weight will allow you to maintain your muscles as you age. For more info, see my Protein post.
- If you eat meat, focus on cold water fish and free-range / grass fed animals
- If the vegetables and protein don’t give you enough calories: focus on whole foods which contain resistant starch, beans, lentils, and/or nuts. Be aware that nuts are very calorie dense. Learn what food will make you feel more satiatied.
- Make sure you get at least 3g of omega-3, 6g of omega-6, and 10g of essential fatty acids each day. It’s good to keep omega-3 to omega-6 to be 1:2 ratio.
A great resource for thinking about healthy eating is Reframe Health Lab’s Healthy Eating page which contains links to a short screencast and several resources available on the Internet. It’s worth noting shifting to a mostly plant based diet (eat your vegetables!) is not only good for your health, but for the planet as well because of the inefficiencies of animals converting feed into tissue we eat. For example, cows require at least 8x the amount of feed as we get by consuming them.
I have tried a variety of diets: south beach, the zone, ketogenic, basic 30, vegan, with and without intermittent fasting. Most diets I was on for at least 6 months. I didn’t find any diet significantly better regarding weight management or optimizing bio-markers over the long term. I did find a ketogenic diet was slightly more effective at reducing visceral fat. My “diet” today is never to run a deficit which is more than 21-31cal/1lb of body fat what typical metabolism can extract in a normal day according to one analysis, maybe as high is 31cals. I strive to get enough protein for building muscles which is around 113 grams / day and at least half my food by weight are vegetables. Normally this means calories are fairly evenly split between carbs, fats, and protein.
While I believe nutrition and food quality is important, I am skeptical of the value of supplements. Repeatedly I have seen attempts to “distill” important elements from food fail to deliver on their promises. A recent study found Vitamin, Mineral, and Multivitamin Supplementation failed to show significant impact Preventing Cardiovascular Disease and Cancer.
Practice Mindfulness and Attend to Mindset
Thanks to Paul Roy to mentioning that something should be added…
Mindfulness has been a practice in every major culture and religion for millennia. I am drawn to the Christian mindfulness practices which is closely related to the practice of Christian meditation. In more recent times there has been a growing enthusiasm in secular society for mindfulness fueled by a body of scientific evidence that intentional mindfulness re-wires our brains for the good, producing improved physical and mental health. Mindfulness is incorporated in a number of therapeutic programs. There is stunning imagery from fMRI scans while people practice these disciplines showing changes in the areas of the brain that are activated. Mindfulness can improve empathy and gratitude which in turn leads to more joy in everyday life which has a significant protective effect on health. Gratitude and joy, unlike happiness, are not dependent on external circumstances, but rather are an internal response which we can choose.
Though I am not Catholic, I found the Spiritual Exercises of Saint Ignatius to be very helpful. A while ago I wrote about how start with the mind and spirit might be the best way to improve the human condition.
It’s also important to point out that our mindset can directly impact our physical health via the placebo effect discussion in an episode of the hidden brain.
I strive to engage in exercise that encourages high V02Max, high metabolic function, and preserving my strength. Numerous professional trainers and researchers (for example 80/20 endurance training) recommend that exercise is best performed at two level. The majority of your exercise should be performed in zone 2 (description of zone 2) where you can fully rely on energy from your mitochondrial and you are using type I (slow twitch) muscles. Exercising at this level improves your ability to burn fat, clear lactate, and improves mitochondrial function. This has been used in some cases to address type II diabetes. The recommendation is 3-4 times a week, for between 60-90 minutes for each session. It’s worth noting that people whose day to day life involves significant movement: manual work in the yard, cleaning houses, doing construction, etc likely get plenty of zone 2 activity. There is an excellent article by Iñigo San Millán about training in zone 2 as well as a a very informative podcast (best in video form to see graphs)
On top of the “base” zone 2 work, It is recommended that people engage in 2 sessions / week of between 30-60 minutes in zone 5, e.g heavy work. This is often done via high intensity internal training. Vigorous exercise has many positive impacts. It helps control stress hormones, strengthens the circulatory systems and metabolic systems. Experts have a a wide variety of protocols / specifics for this sort of exercise, but what’s most important is consistency. Pick activities that you will stick with.
Your strength will degrade as your age so you should make sure you are working on building / maintaining your strength. Peter Attia encourages people to think about Healthspan rather than lifespan and training for the centenarian olympics which is not a sporting event, but being able to engage in activities such as catch a great-grand child that wants to leaping into your arms and places a suitcase in the overhead storage area on a plane. For a bit of inspiration watch this heart warming video.
Some people are really into stretching. I haven’t found a lot of value in stretching as a specific activity. What I have found is that it’s important that the body is warmed up before do something really strenuous. This could be stretching, mobility focused exercise, or just taking it easy for the first 10 minutes.
The last thing to keep in mind is that we often componsate for weakness or pain by changing the way we move. If you are having issues with chromic injury, work with someone who can help you analyze the way you move / perform tasks.
My personal routine is running and/or biking everyday. 6-7 days a we I do “zone 2” for 60-90 minutes (running or biking). 2 days / week I do HIIT sessions of ~60 minutes biking or using a rowing machine (warm-up, 4 4×4 (4 minutes zone 5, 4 minutes active recovery), 10 minutes threshold pace, cool down. I found this produced significantly better adaption for me than similar duration static workout at threshold pace or a more compressed time doing tabata intervals. Five days a week I do the The Simple Six for basic strength. I generally get in 12k steps each day not counting my runs. Whenever possible I turn meetings into walking meetings, and time with friends and family are often walking in our neighborhood or on hikes. Whenever possible I walk or biking rather than using a car (grocery shopping, commuting to work, etc).
Spend time in Nature
One of the best things you can do for your health and wellness is spend some time outdoors among trees and other sources of natural beauty. USDA&USFS jointly published Health and Wellness Benefits of Spending Time in Nature cites a number of studies which have shown time spent in nature, especially when combined with walking has a significant, positive impact to people’s physical and mental health. The APA published a list of research papers about how nature contributed to our mental health. The podcast Hidden Brain episode Our Better Nature: How The Great Outdoors Can Improve Your Life covers similar material in greater depth. They found that a three day retreat in a forest made significant improves in a number of bio-markers, and that these improves persistent for several weeks. People who got a three day vacation in a city saw no improvements in their bio-markers. The WSJ journal had an article about the benefits of spending time outdoors. A study in Scientific Reports found the minimum effective dose of nature was around 120-190 minutes in a week, with not additional benefit over 300 minutes. Other studies found the practice of forest bathing helped general health and lowered hypertension; time in forests saw increases in anti-cancer proteins, lowered parents stress, and increase resilience in children.
Jackie and I take a several hour hike in a forest at least once a week, typically Saturday morning. Several times a week we try to take a walk around sunset to enjoy the changing sky. We regularly will take longer duration trips to destinations known for their natural beauty.
Push Beyond Comfort Zone
Chronic stress is unhealthy, but an appropriate amount of acute stress encourages adaption. Humans are the most adaptable species on the planet. Our adaptability comes from our bodies natural ability to physiologically adapt to highly varied conditions as well as our ability to transform the environment we live in. Civilization has favored adapting our environment to provide a “comfortable” experience rather than encouraging people to exercise their physiological adaption “muscles”. I believe we need to periodically move outside our comfort zones so our body doesn’t “get lazy” and adapts to changes. Example of the adaptability we should cultivate:
- High Intensity Interval Training (HIIT) produces better performance improvements than more static training in short periods of time.
- Short duration exposure to heat (sauna) and cold (ice baths)
- Periodic fasting reset several human systems and can be an effective treatment for several conditions.
Other People’s Summary on Health & Fitness
- White Coat Investor’s Functional Longevity
- Peter Attia
- Hummerman Lab
- dr casey means – cmo of levels
- FoundMyFitness – Episodes #76, #78 particularly good on exercise and diet composition
- Pearl’s Fitness Cheat Sheet
One final encouragement. This list provides a foundation to live a healthy life, but it’s not what life should be focus on. These items (other that social connection) merely enable to you engage in a meaningful life, they will not provide meaning.
Or do you not know that your body is a temple of the Holy Spirit within you, whom you have from God? You are not your own, for you were bought with a price. So glorify God in your body.
I Corinthians 6:19-20