#04 - AMA #1: alcohol, best lab tests, wearables, finding the right doc, racing, and more

1. Embrace the Half-Life of Facts

Approach knowledge with the understanding that ‘most facts have a half-life,’ maintaining humility and readiness for current beliefs to be proven untrue or nuanced by new information, as science only increases the probability of belief, rather than providing definitive proofs.

2. Make Decisions Despite Uncertainty

Recognize that in life and medicine, you often cannot wait for 100% certainty; make decisions by assessing the risk of inaction against the risk-adjusted outcome of taking action, even if the latter isn’t guaranteed perfect.

3. Prioritize Doctor’s Curiosity and Learning

When selecting a physician, prioritize their intellectual curiosity and passion for continuous learning, asking how much time they dedicate to reading medical literature and staying updated, as this indicates a commitment to practicing modern medicine.

4. Seek a Doctor Who Welcomes Patient Engagement

Choose a doctor who is not ‘put off by a curious patient who’s showing up wanting to be actively involved in their health,’ as this indicates a collaborative approach to your well-being.

5. Lift Weights Consistently for Healthspan

Prioritize consistent weightlifting (e.g., 3 days/week) throughout life, especially after age 40, to maintain muscle mass, which is critical for preventing frailty and enhancing physical healthspan as you age, making compromises in exercise choice to avoid injury.

6. Prioritize Movement Prep for Injury Prevention

Dedicate significant time to flexibility and movement correction (‘movement prep’) to prevent injuries, recognizing its impact on long-term physical health and the absence of injury generation.

7. Embrace Total Immersion for Deep Learning

Adopt a strategy of ’total immersion’ when learning something deeply, consuming all available information (papers, lectures, cases) rather than seeking shortcuts, and engaging directly with experts.

8. Leverage Research Support for Knowledge Acquisition

Consider hiring or collaborating with skilled researchers to synthesize vast amounts of information (e.g., turning ’tens of thousands of pages into 50 or 100 pages’), allowing for a geometrically increased knowledge acquisition, even if it means sacrificing some nuance.

9. Seek Mentors Who Excel at Teaching

Identify and learn from mentors who not only possess deep knowledge but also have a natural ability to teach and explain complex topics in a way that resonates with your learning style.

10. Start Deep Learning with Review Articles

Begin deep dives into new topics by reading the most recent review articles to gain a broad overview, focusing on understanding figures first, then delving into the text, rather than starting with narrow primary literature.

11. Monitor Liver Function (ALT)

Track your ALT (transaminase) levels, aiming for below 20, as current lab ’normal’ ranges (e.g., up to 42) may not reflect optimal liver health and could indicate fatty liver disease.

12. Test LP(a) and APOE Genotype Once

Get tested once for LP(a) (lipoprotein(a)) and APOE genotype, as these are critical genetic markers for cardiovascular risk and Alzheimer’s disease, respectively, providing insights for early intervention.

13. Track LDL-P and VLDL Remnant

Monitor LDL particle number (LDL-P) and VLDL remnant (using VLDL cholesterol, aiming for <15 mg/dL), as these are crucial lipoprotein markers for assessing cardiovascular disease risk.

14. Undergo Oral Glucose Tolerance Test (OGTT) with Insulin

Take an OGTT that measures both glucose and insulin to detect postprandial hyperinsulinemia, which is an early indicator of insulin resistance, even if glucose levels appear normal. Aim for fasting glucose <90, 1-hour postprandial <120-130, 2-hour glucose <100, and fasting insulin <6.

15. Utilize CGM for Real-Time Dietary Feedback

Wear a continuous glucose monitor (CGM) to gain real-time feedback on how specific foods, exercise, and stress impact your glucose levels, serving as an ‘accountability coach’ for dietary choices and promoting healthier eating habits.

16. Prioritize Whole, Unprocessed Foods

Focus on eating whole, unprocessed foods and restrict ‘bad carbohydrates’ (e.g., anything that comes in a package) rather than strictly restricting all carbohydrates.

17. Control Your Food Environment

Actively manage your home food environment by minimizing unhealthy ‘kid food’ or processed items, as you are most vulnerable to making poor dietary choices in the environment where you eat most frequently.

18. Recognize Individual Variability in Diet Response

Understand that dietary responses, such as to a ketogenic diet, vary significantly among individuals; avoid the ‘ketosis is for everybody’ mindset and acknowledge that what works well for one person may not work for another.

19. Adopt a Fat-Adapted Feeding Strategy for Endurance

For long endurance events like open water swims, adopt a highly fat-adapted feeding strategy to minimize reliance on glycogen/glucose, potentially using supplements like UCAN and Biosteel, and reducing feeding frequency and concentration compared to high-carb approaches.

20. Limit Alcohol for Sleep Quality

Restrict alcohol consumption to one drink or less, as two or more drinks can significantly impair sleep quality by increasing resting heart rate, delaying the achievement of resting heart rate, and suppressing heart rate variability and REM cycles.

21. Purpose-Driven Alcohol Consumption

Evaluate the ‘why’ behind drinking alcohol, questioning if it’s for the sake of drinking, to soothe an issue, or if it leads to undesirable behaviors (e.g., loosening reins on eating). Opt for ‘purpose-driven drinking’ only with exceptional quality alcohol.

22. Avoid Dwelling on Unchangeable Past Events

Minimize time and energy spent ‘worrying about things that don’t matter, worrying about things I can’t change,’ such as past relationships or grudges, and instead focus on being present with important people.

23. Thoroughly Document Family Medical History

Gather a detailed family medical history, as it can provide more valuable insights into your genetic predispositions for conditions like heart disease, cancer, and dementia than a whole genome sequence, often predicting risks like elevated LP(a) before blood tests.

24. Consider Carbohydrate Refeeding Before OGTT

If on a ketogenic or very carbohydrate-restricted diet, refeed with 150 grams of carbohydrates for about three days before an Oral Glucose Tolerance Test (OGTT) to avoid misleadingly elevated glucose and insulin responses.

25. Incorporate Daily Mini Workouts

Get a ‘mini workout in’ before early commitments, such as a 5 AM train, to ensure physical activity is not missed, specifically mentioning ‘a little bit of time for squats’ to a daily max.

26. Practice Complex Skills in Simulators

Utilize high-fidelity simulators to practice and learn complex skills, such as race car driving, to gain hundreds of hours of experience and refine techniques (e.g., modulating throttle/brake, understanding lines) before engaging in real-world, high-cost, or high-risk activities.

27. Use Oura Ring for Accurate Sleep Tracking

Employ an Oura Ring for highly accurate sleep tracking, as it measures off an arterial waveform, providing reliable data on sleep quality, though it should be removed for activities like deadlifts or heavy bag work.