← Back to Kevin's newslettersPublished: 2024 June 9

I haven’t had a regular doctor’s checkup since I was in college. I’ve been fortunate to have never needed one, and my frequent moving the past few years has kept me ahead of what (if any) regular checkups the Taiwanese, British, and now Dutch national health systems might offer.

After my partner ordered some blood work for herself during a trip in the US and I saw how easy it was:

I decided to collect some baseline measurements, just so that if I become ill in the future I’ll at least have trend lines starting at 35-year-old-Kevin.

Of course, without specific ailments or concerns, I wasn’t sure which of the 300+ tests to order. To avoid risking an unbounded number of hours falling down the Google/Reddit rabbit-hole, I did the obvious thing: Ask ChatGPT.

For background, I consider myself fairly healthy:

However, I’ve never had specific weight or fitness/training goals, so the most I’ve thought about diet is what I absorbed ambiently: “don’t drink sugar” and “don’t eat too much processed/packaged foods”. My understanding of cardiovascular disease was limited to “don’t smoke or be overweight”.

As it turns out, these heuristics don’t seem to be cutting it: My lab results came back with little yellow triangles next to my high LDL cholesterol and apoB levels.

So I’ve decided to put in a bit of deliberate effort to learn the basics of nutrition/healthspan.

And by “a bit”, I mean:

If you’ve done a deeper dive or feel I’m far off the mark on anything I say below, I’d love to hear from you!

So far, the two most useful conceptual findings are:

  1. Atherosclerosis (arteries clogging up) is cumulative, so casual factors should be reduced as soon as possible.
  2. Strength declines ~15%/decade starting in your 50’s, so get as strong as possible before then.

I’ve written previously about financially saving for retirement and am thinking of these findings similarly:

For background on atherosclerosis, see this 20m video or read this well-titled Less Wrong post: Preventing atherosclerosis, the easiest way to improve your life expectancy?

Most of the actionable advice I’ve found comes from Peter Attia (summaries of his book Outlive: short; mostly excerpts; overview of medical tests).

For preventing atherosclerosis, Attia emphasizes reducing apoB levels by:

There’s broad scientific consensus on the first two points; see this short Nutrition Made Simple video and this more in-depth one.

The cardiovascular disease risk from saturated fat appears to be sigmodial (fun analysis), with most of the risk increase happening when saturated fat makes up more than 8–10% of caloric intake. For a 2500 calorie diet, that’s about 30g saturated fat daily, which is about 3–4 tablespoons of butter. The American heart association recommends a 5% target, so half that — really not much at all, especially considering the other dietary sources of saturated fats (meat, cheese, tiramisu, etc.)

Beyond avoiding saturated fats, there seems to be consensus on soluble (dietary) fiber having benefits, which strikes me as a great excuse to make “overnight oatmeal”. This is both fun to prepare (satisfyingly arranging bunch of single-serving jars in the fridge) and to eat (I have a demitasse spoon shaped like a shovel).

Aside: the glycemic index of oats varies widely depending on processing/cooking, which explains why it seems quite polarizing in the health blogosphere. FWIW, I’m eating steel-cut oats soaked overnight in almond milk together with peanut butter together with lunch/dinner (or immediately before, while I’m cooking). See also “are we pathologising normal glucose homeostasis?”.

All that said, according to Attia (video interview):

if you were on a really low carbohydrate, really low saturated fat diet, you would indeed lower your apoB. Would you lower it to the levels that I think are necessary to make ASVCD irrelevant? For most people probably not.

Hence his third strategy: Drugs.

Statins have been the big ones (literally the most prescribed drugs for decades) and cheap generics are available: A quick glance at Amazon has rosuvastatin, pravastatin, and stimvastatin all at about $5/month without insurance.

Statins also have minor side-effects; see this overview video, which does a great job explaining various meta-analyses using relationship of statins and diabetes as an example.

Given the cumulative nature of atherosclerosis and the high-efficacy, low-cost, and low side-effects of statins, it seems quite reasonable to me to start taking them before I have a heart attack.

That said, statins are still prescription medications and I have no sense about whether Dutch and American general practitioners:

  1. understand the cumulative risk prevention evidence
  2. would be willing to write a statin prescription to someone with “not that high” numbers

Research doctors seem quite agreed on the first question based on genetic variation in lipid metabolism:

long-term exposure to lower LDL-C is associated with up to a three-fold greater proportional reduction in the risk of cardiovascular disease per unit reduction in LDL-C, when compared with shorter term treatment with a statin started later in life after atherosclerosis has developed.

For the second question, I suspect it depends (for both doctors and patients) on:

  1. the individual’s prior on pharmacological vs. behavioral interventions (an ever-popular moral battleground), and
  2. whether they’re framing the question as an absolute or population-relative risk (personally, I’d like to wear a seatbelt regardless of my relative driving skill)

As for exercise, the Outlive summaries linked above and this summary suggest about 2.5 hours of cardio and 2.5 hours of strength training weekly. Luckily I already enjoy running and learned the basics of lifting back at Crossfit Portland in 2015 (my 150 pound self even managed to deadlift 300 pounds a few times!), so I’m not focusing on this aspect as much. For my routine, I’ll:

Beyond that, I’ll try to come up with a handful of simple exercises that I can track every 6–12 months and watch Number Go Up for a decade or so before I can watch Number Go Down (hopefully slowly). Things like lifting PRs, dead hang time, mile time, etc.

I haven’t done as much research on the exercise side, so if you have any resources / thoughts / suggestions on this (or the atherosclerosis discussion), I’d love to hear from you!

Misc. stuff