So, I’ve gotten my blood glucose at a level I want 4.9 HBA1C) and cholesterol where I want (66 LDL) and BP in range (106-115).
So what do we shoot for next? Which biomarker is the most important after the big three above? Thoughts on what the next 3 most important biomarkers are we should shoot for?
Provide a list and reasons:
Do you think it’s Metformin that brought your HA1c to 4.9? Mine is 5.7 and I’m struggling to lower it.
A lot depends upon what your other biomarkers are.
If there is one or a group that is out of kilter then those logically would be the priority.
Similarly if you have functional issues that need fixing then that is a priority.
Akkermansia brought my HbA1c down to 5.0 from 5.5 (5.8 at one point).
This is a really good question. Broadly speaking there seems to be a hierarchy of biomarkers that are likely key for longevity given what we know about reasons most people die (and of course adjusted for your own personal risk factors).
I think an important biomarker is a VO2Max of somewhere over 35 ml/kg/min for people over 50, and perhaps over 40 ml/kg/min for people over age 40 (and the higher the better).
More Here: Exercise, VO2 max, and longevity | Mike Joyner, M.D
There are some attributes I’d work on that don’t have biomarkers. Muscle mass, fast twitch muscles, balance, reaction time. All working toward fall prevention, and general health.
I am tracking:
Hours of sleep every night (circadian rhythm alignment, stress mgmt, etc)
BP / pulse pressure (NO, artery stiffness)
HbA1c (metabolic / mitochondrial health with a balanced diet)
RHR (heart “strength”, recovery status)
Hang time from a bar (or weight in suitcase carry)
Days of sunshine (see sunrise outside, 10 minutes of midday UV)
Body fatness (Dexa) — soon
Minutes with spo2 <90% (shallow breathing)
Actually, I forgot that I did a one month stint with Pendulum Akkermansia and Polyphenols a couple of months ago. That may have been part of the key. Akkermansia loves Metformin too, so it could have been a synergistic pairing that dropped my HBA1C from 5.7 to 4.9.
My HBA1C was 4.9 back in 2019 when I was taking 2 g of Metformin daily, so it really may be the Akkermansia doing it. I’m only taking 500 mg of Metformin daily now.
Also back in 2019, my LDL was 66, just as it is now. Seems that Bempedoic Acid brought me back to my youthful levels of lipids and nullified the negative effects of Rapamycin on lipids for me.
My new Levine age is 11 years younger than my chronological age. I’ll take that.
Are you following 1 rep max, or total volume (time). How are training to increase?
Bar hang — I hang for as long as I can once per workout 3X/wk. I don’t kill myself but I wait until I’m straining. I track time per hang.
Suitcase carry - I walk around an indoor track. I haven’t measured the distance or the time. I carry the weight that I can only just make it around the track. Since it’s a one handed carry i can switch hands if i need a rest while I progress upward in weight. Once per workout 3X/wk. I track max weight.
These two are harder to do in the same workout so I’ll alternate on which one I am emphasizing on a particular day. I’ll go easier on one of them each workout.
These are exercises that I particularly dread. It’s a good sign that I need it.
Any exercise is good as we all know but I want to push back a bit in the Attia outlook of trying to “pass a test” by hanging or carrying kettlebells or whatever.
I think we should remember that one gets good at whatever one trains for. So thinking you have ensured longevity by hanging from a bar is a little dumb. It ignores the “weakest link in the chain”. When you spend time optimizing one modality you are doing it at the expense of another.
The approach I prefer is to realize you need to do everything (vs great grip strength and no balance - by example). With that outlook find the activities and mix of movements that you enjoy that give you the broadest set of functional capabilities.
Next time you’re somewhere with lots of exercising people look at the young athletic ones. Look at how they move vs you. Are you as fluid? As strong? As flexible? As explosive? Have that kind of endurance? That should give you the factors you need to work on. If you’re pretty strong but inflexible reallocate some time to balance that.
You dont need to match a much younger person but do become aware that you need functionality in all domains.
These a great improvements. How has the blood pressure changed?
Can you share your bloodwork more broadly?
What are your inflammation levels, for instance last couple of hs-CRPs? Same for IGF-1 levels?
What do your glucose patterns after meals look like? Do you have CGM data.
Insulin levels and homa-IR?
Is your liver and kidney function - that is extra important when one take a lot of supplements and medicines.
Agree with VO2 max. Also knowing your zone 2 and then comparing how that changes over time.
Dexa or mri to understand body composition
Have also found it helpful to subjectively feel how I’m doing stress, mindfulness, etc wise and subjective sense of sleep quality
(very easy via eg Whoop or Oura, although at this point while good for trends, would not rely on any one metric.
I record my fitbit HRV and also the Polar/Elite HRV. I find sometimes that when I am drunk that increases the fitbit HRV (compared to sober) which to me makes me think it is not that reliable. Alternatively it might be that actually when asleep and drunk the HRV goes up, but it goes down compared to sober when I wake up.
I’d love to know how you got your BP down to that level.
In response to your original question, “What’s next”
Inflammation. C Reactive Protein
Agree that it’s the weak link that gets you. A hang or grip workout is not a gimmick if a strong grip would keep a person from falling (holding onto a railing). The hang workout is supposed to keep the should joint healthy which keeps the door open to all sorts of fun activities (with lots of health benefits to be had), and also helps with that hold-on-to-railing thing.
A strong grip and strong shoulders have saved my life (possibly) many times already.