Some benchmarks from an Endurance athlete trainer Alan Couzens. They seem like reasonable targets.
The “live to 100” checklist (at the halfway point)
- Over 6hrs movement per day (PAL 2.0+)
- 7-9 hrs high-quality sleep
- VO2max >50 ml/kg/min
- ApoB <70mg/dL
- BP <115/75 mmHg
- HbA1c = 5.0
- FFMI >20 kg/m2
- Visceral Fat <1kg
- Omega-3 Index >= 8%
- Resting HR <50 bpm
No polyps.
Source: https://x.com/Alan_Couzens/status/2025662290000011493?s=20
Biomedical Analysis of the “Live to 100” Clinical Checklist
The provided parameters define an aggressive, highly optimized physiological phenotype. This checklist targets the primary drivers of all-cause mortality—atherosclerotic cardiovascular disease (ASCVD), metabolic dysfunction, neurodegeneration, and malignancy—rather than merely avoiding population-average disease states.
Below is a detailed analysis of the clinical rationale, targeted biological pathways, actionable interventions, and existing knowledge gaps for each metric.
1. >6hrs Movement per Day (PAL 2.0+)
- Clinical Rationale: A Physical Activity Level (PAL) of ≥2.0 means Total Energy Expenditure is at least double the Basal Metabolic Rate. This requires significant non-exercise activity thermogenesis (NEAT) combined with structured exercise. Sustained movement prevents the downregulation of lipoprotein lipase associated with sedentary behavior and maintains peripheral insulin sensitivity.
- Actionable Pathways: Activates AMP-activated protein kinase (AMPK), prompting mitochondrial biogenesis via PGC-1alpha.
- Scholarly Debate & Gaps: It remains debated whether 6 hours of low-intensity movement confers greater longevity benefits than shorter, higher-intensity bouts. The exact point of diminishing returns for physical activity volume regarding all-cause mortality remains poorly defined.
2. 7-9 hrs High-Quality Sleep
- Clinical Rationale: Critical for neurodegenerative disease prevention, autonomic nervous system recovery, and endocrine homeostasis (cortisol/testosterone regulation).
- Actionable Pathways: Facilitates the glymphatic system clearance of metabolic waste products, specifically beta-amyloid and tau proteins, from the brain interstitium during slow-wave sleep.
- Scholarly Debate & Gaps: “High-quality” is subjectively defined. Objective polysomnography metrics (specific percentages of REM vs. Deep sleep) required for optimal longevity are still actively researched.
3. VO2max >50 ml/kg/min
- Clinical Rationale: Maximum rate of oxygen consumption is arguably the single most powerful independent predictor of all-cause mortality. A VO2max >50 ml/kg/min places an individual in the elite category for middle age and provides a massive functional reserve against age-related cardiopulmonary decline.
- Actionable Interventions: Zone 2 training (mitochondrial efficiency) paired with Zone 5 high-intensity interval training (stroke volume and cardiac output maximization).
- Scholarly Debate & Gaps: Scaling VO2max solely to body weight (ml/kg/min) can penalize individuals with high muscle mass. Scaling to fat-free mass (ml/kg FFM/min) may offer a more precise longevity metric.
4. ApoB <70 mg/dL
- Clinical Rationale: Apolipoprotein B is the structural protein for all atherogenic lipoproteins (LDL, VLDL, IDL, Lp(a)). The concentration of ApoB particles is a superior predictor of ASCVD risk compared to LDL-C, as it dictates the probability of particle retention in the arterial intima.
- Actionable Interventions: Pharmacotherapy is often required to reach this threshold. Primary clinical levers include statins, ezetimibe, bempedoic acid, and PCSK9 inhibitors.
- Scholarly Debate & Gaps: Some aggressive longevity protocols argue for ApoB levels below 50 mg/dL or even 30 mg/dL (approximating neonatal levels), though longitudinal data on the absolute safety and marginal mortality benefit of lifelong sub-40 mg/dL ApoB is pending.
5. Blood Pressure <115/75 mmHg
- Clinical Rationale: Minimizes mechanical shear stress on the vascular endothelium, preventing microvascular damage in the brain and kidneys, and reducing the risk of left ventricular hypertrophy.
- Actionable Interventions: Sodium restriction, optimized potassium intake, Zone 2 exercise. Pharmacological interventions often utilize Angiotensin II Receptor Blockers (ARBs) like telmisartan, which may have secondary PPAR-gamma activation benefits.
- Scholarly Debate & Gaps: The SPRINT Trial demonstrated the superiority of a target systolic BP <120 mmHg. Pushing below 115 mmHg must be weighed against the risk of orthostatic hypotension, particularly in older adults.
6. HbA1c = 5.0%
- Clinical Rationale: An HbA1c of 5.0% translates to an estimated average glucose of ~97 mg/dL. This aggressively limits the formation of Advanced Glycation End-products (AGEs), which cross-link collagen and accelerate tissue aging.
- Actionable Interventions: Carbohydrate restriction, exercise timing, and potential use of insulin-sensitizing compounds (e.g., Metformin, Acarbose, or SGLT2 inhibitors).
- Scholarly Debate & Gaps: HbA1c is confounded by red blood cell turnover. Individuals with rapid RBC turnover (e.g., athletes) may show artificially low HbA1c. Continuous Glucose Monitor (CGM) metrics, specifically Time-In-Range (70-100 mg/dL) and glycemic variability, are emerging as superior metrics.
7. FFMI >20 kg/m2
- Clinical Rationale: Fat-Free Mass Index (FFMI) is a measure of lean mass relative to height (FFMI=LeanMass/Height2). Muscle acts as a critical metabolic sink for glucose disposal (via GLUT4 translocation) and defends against age-related sarcopenia and frailty.
- Actionable Interventions: Progressive resistance training, adequate dietary protein (typically >1.6 g/kg/day), and optimization of anabolic signaling pathways (mTOR).
- Scholarly Debate & Gaps: An FFMI >20 is easily attainable for adult males but borders on the physiological limit for adult females without exogenous androgens. The target must be sex-stratified to be clinically valid.
8. Visceral Fat <1kg
- Clinical Rationale: Visceral adipose tissue (VAT) is highly metabolically active and pathological. It secretes inflammatory adipokines (IL-6, TNF-alpha) and directly deposits free fatty acids into the portal vein, driving hepatic insulin resistance and non-alcoholic fatty liver disease (NAFLD).
- Actionable Interventions: Caloric deficit, elimination of fructose, and potentially GLP-1/GIP receptor agonists(e.g., tirzepatide) which show profound efficacy in depleting VAT.
- Scholarly Debate & Gaps: Precise quantification requires Dual-Energy X-ray Absorptiometry (DEXA) or MRI.
9. Omega-3 Index ≥ 8%
- Clinical Rationale: Represents the percentage of EPA and DHA in red blood cell membranes. An index ≥8% is associated with optimal erythrocyte deformability, reduced platelet aggregation, and maximal production of specialized pro-resolving mediators (resolvins) that actively terminate inflammation.
- Actionable Interventions: High-dose dietary supplementation of EPA/DHA (often requiring 2-4 grams daily) and reduction of competitive Omega-6 fatty acids (linoleic acid) in the diet.
- Scholarly Debate & Gaps: The isolated cardiovascular benefit of Omega-3 supplementation is contested in modern clinical trials (e.g., REDUCE-IT vs. STRENGTH trials), often dependent on the exact formulation (icosapent ethyl vs. mixed formulations) and placebo design.
10. Resting HR <50 bpm
- Clinical Rationale: A proxy for high parasympathetic (vagal) tone and excellent cardiac stroke volume. It indicates a highly efficient myocardium.
- Actionable Interventions: High volumes of aerobic conditioning.
- Scholarly Debate & Gaps: While low resting heart rate correlates with longevity, extreme bradycardia (<40 bpm) in athletes can sometimes induce arrhythmias or atrial fibrillation over decades of exposure.
11. No Polyps
- Clinical Rationale: Colorectal cancer typically follows a predictable adenoma-carcinoma sequence spanning 10-15 years. The complete absence of polyps during screening directly halts this mechanical pathway to malignancy.
- Actionable Interventions: Regular screening colonoscopy. Dietary fiber optimization, limiting processed meats, and maintaining adequate Vitamin D levels.
- Scholarly Debate & Gaps: The exact etiology of isolated benign polyps versus those destined for malignant transformation remains a subject of genomic research; therefore, blanket excision remains the current gold standard.
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