3 Bullet Point Summary This is the most impactful class of medication released since I finished training. I say that as someone who was skeptical of it for a decade, for reasons that turned out to be wrong. The drug is not the plan. Roughly 85% of people started on one for weight loss are off it within two years, and the trial data say most of the weight comes back when they stop. The people who keep the result are the ones who built something underneath it. The right questi

Part III of the Risks series. Part I covered cardiovascular disease. Part II covered cancer. The short version Lifetime risk is higher than most people think, and later than they fear. Roughly 42% of Americans who reach 55 will develop dementia by 95. But the risk is about 4% by 75 and 20% by 85. Most of it lands after 85. Midlife is where the risk gets set. About 45% of dementia traces to 14 modifiable factors, and most of the leverage sits before 65. The two largest single

Part II of the Risks series. Part I covered cardiovascular disease. Cancer is the second leading cause of death in this country, behind heart disease. For the age group I take care of — call it 38 to 58 — it is the one people are actually afraid of. Nobody lies awake worried about their LDL. Plenty of people lie awake after a friend their age gets a diagnosis. That fear is not irrational. Roughly one in two men and one in three women will get a cancer diagnosis at some point.

The Health Score Card: Five Measurements That Are Good Enough One of the questions I keep coming back to is how we get a more accurate depiction of someone's overall state of health. Not a lab value. Not a symptom. The whole picture. In 2027 we'll be rolling out the health score card. The idea is simple: the same way a business has a scorecard, a person should have an objective evaluation of where their health actually stands — and a way to tell, year over year, whether it's

The Tools Got Fancier. The Fundamentals Didn't. Cardiovascular disease is still the number one killer of men and women, in this country and globally. The major levers haven't changed in decades: hypertension, hyperglycemia, and hyperlipidemia. Add two things we don't have a clean number for — stress, which feeds all three, and the body's tendency to clot — and you've more or less described what's going to land most people in a cardiology office. In 2026 the guidelines for two

Right now everyone wants to know their biological age. The wearables sell it, the clinics sell it, the supplement companies sell it. People walk in genuinely rattled that an app told them their "true age" is seven years north of their driver's license. I understand the appeal. It's a more interesting question than how many times you've circled the sun. But you don't have one age. You have at least four — chronological, biological, functional, and emotional — and the inconveni

When it comes to your long-term health — how long you live, and how long you stay functional while you do — I'm not sure anything matters more than your metabolic health. That's a big claim. Here's why I make it. Metabolic health is how efficiently your body manages fuel. It's the ability to take in energy and process it without the system backing up. Almost every other topic in this series eventually drains into this one. Sleep, exercise, nutrition, cellular function — they

Two terms have been making the rounds lately: cellular health and mitochondrial health. The pitch is roughly the same in both cases. If the cell is functioning efficiently, the whole organism is healthy. Optimize the mitochondria and the rest of the body falls in line. This gets positioned as a more sophisticated alternative to traditional medicine, which is framed as a reductionist, organ-system-by-organ-system approach that misses the deeper picture. I don't have a problem

Longevity VII: The Mind Is Not a Wellness Topic If we're being honest about the longevity stack, mental health belongs in the top tier — alongside sleep, exercise, diet, and not smoking. Not in a separate "wellness" bucket where it gets lip service and a meditation app recommendation. The data is too strong for that. Depression carries an all-cause mortality hazard ratio in the 1.5–2.0 range. That's the same neighborhood as smoking and sedentary behavior. Loneliness and chron

The People in Your Life Are Keeping You Alive Human beings are wired for connection. Underneath most of our frustrations, our political tribalism, our late-night arguments with people we barely know on the internet — there's a more basic craving. We want to feel heard. We want someone to understand our perspective. The trouble is that's an unreasonable expectation. No one will ever fully understand your personal narrative because they haven't lived it. I write more than most

Nutrition is the longevity topic everyone wants a clean answer to and almost nobody acts on. Most patients want to know which diet correlates with the longest lifespan. Then under 1% of them will make a sustainable change over the following year. The information isn't the bottleneck. It hasn't been for a long time. So this piece is going to do two things. First, lay out what actually moves the needle. Second, name the reasons people don't follow through, because that's the mo

Exercise is the closest thing we have to a wonder drug, and yet most people get it wrong in predictable ways. I covered the mechanics in an earlier four-part series on exercise, and a year later, my thinking hasn’t really shifted. The way I find it most useful to think about training is through four lenses — strength, cardiovascular, psychological, and social. Each one matters. Most people are heavily underweighted in at least two of them. The one principle that governs stren

Pills, Potions, and Sorcery - Longevity Drugs, Supplements and Interventions The single most common question I get in the longevity space is some version of: is there a chemical that will actually make me live longer? People want the holy grail — a pill, a peptide, a protocol — that requires minimal effort and delivers more years on the clock. I understand the appeal. I also have to tell you the truth. The Core Problem: We Don't Have the Data Before we can talk about specific

Sleep is where most people want to skip to the end. Before asking me about peptides, hormone protocols, or whatever biohacking supplement is trending this month, ask yourself how your sleep is. Because if that's broken, nothing else is going to work very well. Sleep has a nonlinear relationship with mortality — a Goldilocks problem. Too little and you're in trouble. Too much and the data suggests the same. The goal isn't more sleep or less sleep. It's the right amount for you

Longevity Starts With Genetics — But It Doesn't End There Longevity medicine is having a moment. Podcasts, clinics, supplement companies — everyone wants a piece of it. The irony is that all medicine should be longevity medicine. But before we can have a serious conversation about it, we need to agree on what we're actually talking about. Two Different Goals Longevity and healthspan sound interchangeable. They aren't. Longevity is chronological — how many years you accumulate