Outlive: The Science and Art of Longevity

Once you understand that apoB particles—LDL, VLDL, Lp(a)—are causally linked to ASCVD, the game completely changes. The only way to stop the disease is to remove the cause, and the best time to do that is now.

Medicine 2.0 relies on two types of tactics, broadly speaking: procedures (e.g., surgery) and medications. Our tactics in Medicine 3.0 fall into five broad domains: exercise, nutrition, sleep, emotional health, and exogenous molecules, meaning drugs, hormones, or supplements.

The key difference between Medicine 2.0 and Medicine 3.0 has to do with how and when we apply our tactics. Typically, Medicine 2.0 steps in only when something is acutely wrong, like an infection or a broken bone, with short-term fixes for the immediate problem. In Medicine 3.0, our tactics must become interwoven into our daily lives. We eat, breat

In technical terms, San Millán describes zone 2 as the maximum level of effort that we can maintain without accumulating lactate. We still produce it, but we’re able to match production with clearance. The more efficient our mitochondrial “engine,” the more rapidly we can clear lactate, and the greater effort we can sustain while remaining in zone

This is why our approach to exercise must increase not only our conventional measures of fitness, such as our VO2 max and our muscular strength, but above all our resistance to injury.

TR or time restriction—also known as intermittent fasting—is the latest trend in ways to cut calories. In some ways I think it’s the easiest. When I was a cyclist, and I was trying to drop that six final pounds from my already very light (for me) frame, this became my jam. I would allow myself only one meal per day, despite doing about three hours

From the standpoint of pure efficacy, CR or caloric restriction is the winner, hands down. This is how bodybuilders shed weight while holding on to muscle mass, and it also allows the most flexibility with food choices. The catch is that you have to do it perfectly—tracking every single thing you eat, and not succumbing to the urge to cheat or snac

Some researchers are beginning to develop ways to use blood tests to screen for cancer generally, in otherwise healthy people. This is an order of magnitude more difficult, like looking for a needle in ten haystacks; worse, in this case we don’t even know what the needle should look like. We don’t know anything about the patient’s tumor mutation pa

It’s not “preventive” medicine; it’s proactive medicine, and I believe it has the potential not only to change the lives of individuals but also to relieve vast amounts of suffering in our society as a whole.

One test that I like to give patients is the oral glucose tolerance test, or OGTT, where the patient swallows ten ounces of a sickly-sweet, almost undrinkable beverage called Glucola that contains seventy-five grams of pure glucose, or about twice as much sugar as in a regular Coca-Cola.[*6] We then measure the patient’s glucose and their insulin,