20. How to Play the Long Game and Build for 30 Years, Not 30 Days : The Anti-Resolution Manifesto

How to Play the Long Game and Build for 30 Years, Not 30 Days : The Anti-Resolution Manifesto

Hosts: Vikas Patel, MD & Nisha Patel, MD

Episode Summary

80% of New Year's resolutions fail by February. This episode is for the other 20%—and for everyone who's tired of the annual cycle of restriction, guilt, and giving up. This is our anti-resolution manifesto. No 30-day detoxes. No white-knuckling through meals you hate. Instead, we're laying out a framework for health that actually lasts—one built on muscle, not deprivation; purpose, not motivation; and the question no one in medicine is asking: what do you want your life to look like in 30 years?

• January 19th — "Quitters Day," when most New Year's resolutions are abandoned
• 80% of resolutions fail by February 1st
• 12-15 years — average time Americans spend in decline before death
• 70% of 65-year-olds will need long-term care at some point
• 80% of healthspan is determined by lifestyle, not genetics
• 63% higher mortality risk associated with low muscle mass in older adults
• 3-8% muscle mass lost per decade after age 30
• 30% of muscle loss occurs between ages 50-70
• 1 in 4 older adults falls each year; falling once doubles your risk of falling again
• 30% one-year mortality rate after a hip fracture in those 65+
• 15-25% reduction in resting metabolic rate from aggressive caloric restriction

The Resolution Trap

• Why intensity without direction doesn't last
• Your body doesn't know it's January 1st—it only knows consistent signals over time

Lifespan vs. Healthspan

• Lifespan: how long you live
• Healthspan: how well you live
• The goal: compress morbidity into the shortest window possible

Reverse Engineering Your Future Self

• Start with the question: What do you want your life to look like at 85?
• Physical requirements for independence: getting up from a chair, catching yourself if you trip, carrying groceries, climbing stairs, recovering from illness
• Muscle as the "organ of longevity"

The Long Game Is Not Punishment

• Deprivation backfires—extreme restriction leads to worse psychological outcomes and weight regain
• Order the wine, eat the pasta in Italy, have the dessert when it's worth it
• The difference: not indulging by default

Health as the New Status Symbol

• You can't fake being fit at 50
• You can't lease a low resting heart rate or put muscle mass on a payment plan
• Unlike a Rolex, this status symbol is available to everyone

Why Quick Fixes Fail

• Your body is a skeptical investor—it needs years of consistent returns
• Crash dieting signals scarcity; your body responds by slowing metabolism and preserving fat
• Muscle loss during aggressive dieting can take years to reverse (or may never fully recover)

When Life Throws a Curveball

• Nisha's personal story: rare blood cancer diagnosis 10 years ago
• Diagnosis is not destiny—lifestyle dictates disease progression
• Higher VO2 max and muscle mass dramatically improve surgical and cancer outcomes
• Prehabilitation: one of the most powerful interventions in medicine

1. Think in decades, not days — Every health choice is a deposit in an account you'll draw from later
2. Prioritize muscle — Lift heavy things, eat enough protein, repeat
3. Don't confuse thinness with fitness — The scale is a terrible proxy for health
4. Build sustainability — If your routine requires suffering, it won't last
5. Start where you are — Five minutes of movement is a start; you don't need perfection

"The long game has room for wine, pasta in Italy, skipping the gym when life gets crazy. It just doesn't have room for decades of neglect disguised as a New Year's resolution."

Website: www.mdlongevitylab.com
Instagram: @mdlongevitylab
Location: Chicago, IL

Thank you for listening to MD Longevity Lab: Playing the Long Game. Take care of yourselves—your future self is counting on it.

Episode Transcript

(00:00):
When we're talking about longevity, we're not just
talking about adding years to your life, we're really talking
about adding life to those years, closing that gap between
lifespan and health span. It's compressing the period of
decline into as short of a window as possible, ideally just

(00:20):
the very, very last few days, right?
The technical term is compression of morbidity.
The human version is this. We want you skiing at 75 if
that's what you want, playing with your grandkids at 80,
living independently at 85. And then when the end comes, it
comes quickly. Sometimes you don't get to play
the long game cleanly. And this happened to me 10 years

(00:44):
ago. I was diagnosed with a rare
blood cancer. I didn't plan for it.
I didn't 'cause it. I didn't miss a supplement or
fail a protocol. I ate pretty much correctly,
worked out, and it still happened.
And suddenly the long game wasn't theoretical anymore.
It was personal. I live with this blood cancer.
I also have an autoimmune disease.

(01:05):
But my diagnosis is not my destiny.
Welcome to MD Longevity Lab, where we're playing the long
game. This is a podcast where science
meets real life, with expert insights, practical tips, and
real world tools to not only live longer, but live better.

(01:27):
Our aim is to radically change the way medicine is practiced
and enable individuals to age gracefully, maintaining health,
span and vitality well into their later years.
We're your host doctor, Nisha and Dr. Vikas Patel, physicians,
partners in life, and parents, balancing work, Wellness and
everything in between. Let's dive in.

(01:58):
Hi everyone, welcome back to theMD Longevity Lab podcast where
we are playing the long game. I'm Vikas and I'm joined by my
beautiful Co host and wife Nisha.
We are filming this right aroundthe holidays and they wish
everyone happy holidays and a happy New year.
This should be airing right at the right after the new year and

(02:19):
it's been a little bit of a hectic couple weeks for us with
the kids at home. For us, because you've done so
much. I mean, I had supervised.
You you taste tested, you supervised I think.
Did you even wrap one present? 1 thanks.

(02:41):
Someone also has to fall asleep on the couch right?
Like. Yeah, you're doing those
someone. Has to use the couch.
Right. Anyway, well, by the time you
guys are hearing this, it's January right now.
Which means somewhere right now,one of you is white knuckling
their way through a kale smoothie that you hate,
convincing yourself that this year is going to be your year

(03:03):
for change. And look, we get it.
There's something completely intoxicating about January 1st,
right? It's a clean slate.
Everyone's got their New Year's resolutions.
It's a fresh start. The gym is packed with newbies,
the fridge is full of vegetablesand the motivation is
Immaculate. Yeah, but here's what the data

(03:23):
says about that motivation. By January 19th, that's just 19
days in. Most resolutions are already
abandoned. There's actually a name for it.
It's called Quitter's Day, and researchers track it.
It's a real thing. 80% of New Year's resolutions have
completely failed by February 1st.

(03:45):
That's a lot, right? 80% If you've ever kind of
fallen off the wagon by Valentine's Day and thought
something was wrong with you, well, no, you're statistically
normal. Congrats.
That's kind of what most of us do, right?
This isn't really a problem of willpower.
The problem is the model that we're using.

(04:05):
Every January, the Wellness industry sells you the same kind
of story. There's urgency.
Let's reset your metabolism, reverse aging, let's transform
you in the next 30 days, hack your biology.
It's a compelling pitch, but it's also pretty much a setup
for failure because having that intensity without proper

(04:27):
direction doesn't really last. The sprints don't work when
you're really trying to run a marathon.
The other thing I think that nobody really tells you is that
your body doesn't really care what day it is on the calendar.
Biology doesn't really reset on January 1st, and it doesn't know
that it's the new year. It only knows signals and

(04:47):
patterns that are repeated steadily over months, years and
decades. Yeah.
So we wanted to do this episode to kind of emphasize this isn't
something you can fix in 30 days.
We always talk about playing thelong game.
So we wanted this episode to be really encompassing and a zoomed
out view of what playing the long game is.

(05:08):
It's about what you're building for the next 30 years, right?
Not the next 30 days. We're not here to sell you a
quick fix. And honestly, these quick fixes
are kind of bad for a business model.
We want you all around for decades like us, and that's why
we call this approach playing the long game.
It starts really with a questionthat I don't think we hear that

(05:31):
often in medicine, right? Like what do you want your life
to look like when you're 85, which is very different than how
much do you want to weigh on thescale?
What do you want your cholesterol to be?
What's your A1C going to be? This is not about any of those
things. This is about your actual life
and you know, when you're 85 or 90, what do you actually want to

(05:53):
be doing? Do you want to be traveling?
Do you want to be able to get upoff the floor off, you know, if
you happen to someone fall? Do you want to be able to
recognize your grandchildren, play with them?
Do you want to be able to live independently more than that?
Like what else do you want to dofor recreation?
Do you want to be able to go hiking?
Do you want to be able to ski? Do you want to be able to play

(06:15):
tennis? I think most people haven't
really been asked that question.Certainly when they go to the
doctor's office. I don't think that that's really
the way our current system is really designed.
And because they aren't asked that, they are planning for
that. So I think optimizing for the

(06:35):
wrong finish line is or or even worse, like no finish line.
It's just this endless cycle, endless cycle of what your new
New Year's resolution is every single year.
And that's really not the way todo this.
Yeah. So if you guys are listening to
this in January or February, or for that matter any time of
year, and you're already feelingthat familiar pull of giving up,

(07:00):
don't. But also don't double down on
that 30 day detox because it's miserable, right?
Instead, stay with us because what we're going to talk about
today might actually change how you think about health for the
rest of your life. Not because it has to be harder,
it just needs to be smarter. And honestly, it's more
forgiving when you're playing the long game.

(07:22):
The long game has room for wine pasta in Italy, skipping the gym
when life gets crazy. Life just doesn't have room for
decades of neglect disguised as a New Year's resolution.
That is not playing the long game.
I think you're right. So this is what we're going to
cover today. First, we're going to break down
the differences between lifespanand health span and why that gap

(07:46):
is really the most important number that no one's really
tracking in American healthcare.Then we're going to talk about
reverse engineering, how to workbackwards from that 85 year old
self to figure out what you're what you really should be doing
today. And then we're going to explain
why the long game is not about deprivation.
Because if your health plan requires suffering, it's already

(08:11):
failed because you're not going to stick with it.
We'll make the case that health is the new status symbol.
Forget the watch or the fancy car.
I'm gonna tell you to forget thefancy car.
Because, say my T-shirt, Yeah. For those of you that know him,
he's obsessed with cars. I call it his second wife.
For those of you who are not watching this, I have a old

(08:31):
Ferrari Testerosa T-shirt on right now.
I think my brother had a poster of a Ferrari Testarossa in his
bedroom in the 80s. Anyway, being fit at 50 is the
real flex. We're going to share stories
from patients who taught us whatthis really looks like, both
when it works and when it doesn't.
We're going to try and dig into why all the quick fixes, you

(08:54):
know failed and why your body isbasically a skeptical investor
who really just doesn't trust the 30 day promise.
And finally, we're going to get a little personal.
I'll share how my own personal cancer diagnosis changed
everything about how I think about the long game and why
building resilience isn't optional when life throws you a

(09:15):
curveball. So anyone that's listening that
already has a diagnosis or some health condition, this episode's
awesome for you. It's a lot, but I think the
conversation is worthwhile and we really wish that more people
were having it. All right, so let's play the
long game and get into it. Why don't we cover first the

(09:36):
difference between health span and lifespan?
These two terms get thrown along, thrown around a lot, and
we'll use these throughout the episode, and we use them a lot
while we're seeing patients because they're the foundation
of everything that we do at MD Longevity Lab.
Lifespan is pretty simple. It's how long you live, right?
You're either living or you're dead.

(09:58):
That's the number of years from birth to death.
Health span is different. It's how well you are going to
live for how long. It's the years you spend
healthy, functional, independent, and cognitively
sharp out of doctor's appointments, not in and out of
the hospital, not in a nursing home.
And here's the problem. For most people, there's a huge

(10:19):
gap. Think of it this way, the
average American lives until about 78 years of age, but the
average American also spends thelast 12 to 15 years of their
life in decline, managing some form of chronic disease, whether
it is heart failure, diabetes, heart disease, dementia,

(10:41):
frailty, fractures from falls. So I think really people need to
let that sink in that if your health is declining anywhere
from 12 to 15 years before you actually die, that's almost 20%
of your life that is spent declining.
And that's the average, right? That's a period of time where

(11:04):
you are consciously aware that you're not able to do the things
that you used to do and you're suffering from a loss of quality
of life. I don't really think of that as
true living. I think of that as surviving.
And realistically, it's just kind of like a medical holding
pattern. Yeah, and here's a step that

(11:24):
should terrify everyone. A 65 year old today has about a
70% chance of needing long term care at some point.
That's crazy, 70%. So that's the majority of
Americans. The average stay in a nursing
home facility is over 2 years and leading up to that, it's
much more. So it's not just a two year

(11:45):
decline, the average cost well over six figures.
And this isn't about pessimism. This is the default trajectory
if we don't intervene now. When we're talking about
longevity, we're not just talking about adding years to
your life, we're really talking about adding life to those
years, closing that gap between lifespan and health span.

(12:09):
Really, it's compressing the period of decline into as short
of a window as possible, ideallyjust the very, very last few
days, right? The technical term is
compression of morbidity, but the human version is this.
We want you skiing at 75 if that's what you want, playing

(12:31):
with your grandkids at 80, living independently at 85.
And then when the end comes, it comes quickly, not after a
decade of slow deterioration. Here's some of the good news
that's buried in those grim statistics that we were sharing.
The research really suggests that up to 80% of your health
span is really just determined by lifestyle factors.

(12:55):
It's not related to genetics. I think we hear very frequently
from patients that, oh, diabetesruns in the family, cancer runs
in the family, heart disease runs in the family.
And when people are saying that out loud, they're already just
acknowledging that this is what's happening to me and I'm
mentally preparing for the decline associated with it.

(13:18):
And they automatically have thisthing go off in their head that
says, well, I don't want to livea long time because long time
means disability. So your genes kind of load the
gun, but it's our habits that really pull the trigger or
don't. That's the concept of
epigenetics, right? Whether the negative genes, the

(13:40):
genes that are not super adaptive for us, whether those
actually get activated or not, that has everything to do with
environmental cue and how we aretreating our bodies.
So that's really the goal. If we're treating our bodies
correctly, then we are playing the long game all.
Right, so let's get into how we actually play the long game, and
we start by reverse engineering it.

(14:02):
Instead of asking what should I do right now, we should ask
ourselves, what will my future self require?
And I think that's a question wedidn't start thinking about.
I think many of us think with our New Year's resolutions, oh,
I want this number on the scale or I want to be down 125 lbs.
Is that number on the scale going to have anything to do

(14:22):
with how well you live 30 years from now?
Absolutely not. I think this is also the power
or problem of youth, right? Like it's impossible until
you've been on the planet long enough to really recognize what
your future self may want and what your future self will
value. So I think once you get in the

(14:44):
middle age and you start really having some sort of impact to
your health, either because, youknow, close people, your
parents, yourself, that's when you really start to make this
transition. And So what playing the long
game might really mean. So if you want to be independent
at 85, what does that really demand of your body?

(15:06):
It's really important to be specific about this because this
is kind of where it gets real. You need to be able to get up
out of a chair without using your hands.
That requires leg strength, specifically the ability to do
things like single leg squats from a seated position.
You need to be able to catch yourself if you trip.

(15:28):
That requires balance and reaction time.
It requires those type 2 fast muscle twitch fibers to not have
deteriorated so much so that youcan make the quick adjustment to
prevent yourself from falling. You're going to need to carry
your groceries, climb up stairs,recover from illnesses like the
flu or urinary tract infection. All of that stuff requires

(15:51):
muscle mass. It requires cardio respiratory
reserve. It requires a good VO2 Max.
And here's a number that should reframe how you think about
fitness. A study in JAMA found that low
muscle mass in older adults is associated with a 63% higher
risk of death, Not a 10% bump, 63%.

(16:12):
So muscle isn't about vanity. That's a nice little side
effect, though. You look better.
Muscle is truly about survival. Here's another inconvenient
truth. Really, The body that you have
85 at age 85 is largely determined by what you do in
your 40s and 50s and 60s. If you've heard of, you've

(16:33):
heard, I'll say this before, that muscle is really the organ
of longevity. And after 30, most of us are
going to be losing somewhere between 3 and 8% of our muscle
mass per decade. And it's faster if you're really
sedentary and slower if you're very active.
Some studies will show that up to 30% of muscle loss occurs

(16:58):
just between the ages of 50 and 70, especially because those are
ages that we tend not to train very much.
So another one of those components of that inconvenient
truth is that bone loss follows muscle loss.
If you're not actively loading your skeletal system, then
you're going to lose bone density.

(17:18):
And this is generally why, like in conventional medicine, we
start getting DEXA scans for women after the postmenopause
phase because we know one, they're losing bone density
because of loss of estrogen, butthey're also just going to be
less active at that period of time.
But by the time people feel fragile, it's already pretty
late in the game, which is why we make the argument people

(17:40):
should be getting full body DEXAscans as early as possible in
their 30s and 40s. And let's be clear, it's never
too late. I think we sometimes we get
patients in their 70s and 80s that are like, wait, have I
missed the vote on this? But it is a heck of a lot easier
to put in some of that work in your 40s and 50s then wait till

(18:01):
your 60s and 70s. But we see patients that make
gains well into their 70s, right?
There's no age where you can't make gains.
This is just like a savings account that compounds over
time, so you can add to the savings account at any point.
When are you going to net the largest gain?
When you have the largest time horizon.

(18:21):
So I would never dissuade anybody from making a change at
any age. It's just the earlier you start,
the larger the compound effect is.
So we really need to think of this as a retirement account for
our body. It's fine if you're waiting
until 65 or 7, you need to startweight training and doing
resistance, but you're going to be building less wealth at that

(18:45):
point. And and then you're kind of in
the emergency savings account mode rather than a long term
planning mode. So this is really why we start
every patient relationship with that question about where do
they really want to be when they're 70, when they're 80,
when they're 90. And once you answer that, then

(19:07):
everything else, the labs, the scans of protocols, they all
kind of have a lot more contactsat that point.
Yeah, and there's another topic that let's move on to.
The long game is not a punishment.
I think sometimes people have this misconception that
longevity is about deprivation, and this is where people

(19:27):
misunderstand what the long gameactually is.
Playing the long game is not about deprivation, right?
It's not about going to bed at 8:00 PM every night wearing a
blue light, blocking sunglasses,and clutching onto your sleep
tracker. We see that a lot on social
media. It's not about skipping dessert
forever or eating organic for every single meal.

(19:48):
It's not about skipping the wineor cocktail with dinner if
that's what you enjoy and you'reout with friends.
It's not about eating perfectly optimized meals that taste like
cardboard, because that's not living.
Avoiding that stuff is not living and it's completely
unsustainable. I think you're right that people
get the wrong idea about this, that somehow long job fee is

(20:11):
about punishing ourselves to getthis gain at the end of our
life. And typically punishment
backfires, right? So the research really backs
that up. Studies on extreme dietary
restriction to show that people who follow these highly
restrictive diets long term often have worse psychological

(20:32):
outcomes. And here's a kicker, they
frequently end up just regainingmore weight than what they had
initially lost. So if your version of health
makes life smaller, fewer meals shared, fewer trips taken, fewer
celebrations, you're just not going to be capable of long term

(20:55):
sticking to that plan and it's going to end up not mattering
the way that you would want it to.
Yeah, healthspan should make your life feel bigger.
More rich, right? Not smaller.
You should order the wine when you're with people you love.
You should have the dessert whenit's worth it.
I know I basically scope out a dessert menu every time we go

(21:15):
out to dinner when I'm at work. Before that, I'm kind of scoping
out what my appetizer is gonna be My main course in my dessert.
Eat the pasta when you're in Italy, please.
It's Italy, right? The long game is not about never
indulging. It's about not indulging by
default. Side note, the second we get to
a restaurant and the waiter comes niche like orders

(21:39):
immediately. Like I haven't even looked at
the menu, but she's like, you'reready to order, right?
And she'll start like ordering because she has planned out the
meal because she's scoped out the menu like 4 days in advance.
Yes, but it's also that I've worked in the service industry
and anyone that's worked in the service industry knows that it's

(21:59):
way more efficient for a waiter to have the person ordering give
it all at the same time and not do this guesswork.
No, it's it's because your mouthis already watering because you
were not patient enough to wait until we got to the restaurant
to look at the menu. That too.
I'm just telling it telling you it's for altruistic reasons.

(22:19):
What you're thinking of them, yes, not how quickly is that
food going to be in my belly in.My belly.
I'm also impatient, that's true.Here's a kind of useful mental
model. Think about a company that has
really excellent financial discipline.
They're not cheap. They're strategic.

(22:39):
They definitely spend money, sometimes lavishly, but always
very intentionally. Biology doesn't really care
about one meal. It cares about the patterns that
we're setting. So you don't become unhealthy
because you went off the rails on one vacation.
You become unhealthy because of decades of muscle loss, decades

(23:02):
of poor sleep, inactivity, decades of chronic stress.
Yeah, lifting, eating protein, sleep, moving.
These aren't punishments. They're your insurance policy.
And those things are what allow you to live fully without being
fragile. Strong enough for the curveballs
that life throws us, Strong enough for the celebrations, and

(23:25):
you're actually with it enough to enjoy them.
Can we talk about something a little different, a little shift
in culture? I think this is really
important. For decades now, the status
symbols were were pretty obvious, right?
Having the big house or the car that you wanted or a watch or

(23:46):
the perfect vacation with photosdocumented on social media.
But I think to some degree that's changing now.
At least we see it in some of the circles that we run in, and
increasingly we see it more evenin the news and social media
now. I think health is really
becoming a new status symbol andit isn't really money that

(24:12):
people are cherishing. I think that's a shift in the
culture that we are recognizing that time is a real commodity
and if you're not able to enjoy your time through health, then
what's the point? Definitely think about it.
Anyone can finance a nice car and then you can swap it out

(24:33):
when you get bored with it or you run it dry.
Anyone can put a vacation on a credit card.
Those things can be faked right?But you cannot fate being fit at
age 50, you can't lease a low resting heart rate, you can't
put muscle mass on a payment plan, and you can't take a
medication to mimic all this. So when you see someone in their

(24:55):
40s, fifties and 60s who's visibly strong, right energetic,
moving, well, you know that is earned.
That's years of discipline made visible.
It's not a quick fix. One of the things about being
young and attractive, right? Like, sure, you should be at

(25:15):
that age. That's just biology doing its
job. Evolution wants you looking your
best, feeling your best during your peak reproductive years.
Congrats, that's, you know, likejust a functional normal mammal.
But evolution is kind of done with us by the age of 4045.
And so if you're still fit, if you're 55 and you're strong, if

(25:40):
you're 65 and you're keeping up with the 40 year olds, right,
that's not biology. That's really a choice.
That's the work that someone hasput in to maintain their
reserves. And that's really what I think
deserves a metal. Amen.
That's my mantra at work. Seriously, I tell patients like

(26:00):
you're cute in your 20s, good for you.
Like that's happened before Gravity's hit.
You haven't pushed out any kids?Great.
Call me in 20 years when things are still holding up.
Then you'll get a high 5 from me.
And my staff knows this too. Because to be fit in your 40s,
fifties, sixties, 70s and beyond, that's the real prize.

(26:22):
After 30, everything in your corner, right?
Physiology is just trying to slow down.
And after 30, your muscles want to atrophy.
If they're not used, your metabolism wants to drop.
If you're not challenging yourself, that wants to
accumulate in your viscera, that's the default.
Your joints want to stiffen. So to stay fit after 40, you

(26:44):
have to actively fight entropy every single day.
And that's not about vanity. That's defiance.
And if there's one thing you knew about me when we met, it's
that Defiance was my middle nameor my second middle name, among
others. Austin Danger Powers, Yeah.

(27:04):
Dangerous in my middle name too.Just look at in culture right
now, the most successful executives, entrepreneurs,
investors. What do they kind of have in
common? Increasingly, obviously wealth,
but it's really health. You see them make this
transition like now they've worked really hard and they're

(27:26):
recognizing what they don't have.
And then they make a concerted effort.
And, you know, like, you see Mark Zuckerberg is like growing
out now and like, he's becoming masculine.
Jeff Bezos has a six pack. I could probably do more pull
ups than Mark Zuckerberg. I mean, he's kind of a weenie,
but that's another story. We're gonna get shut down for

(27:47):
this. That's probably true, yeah.
These guys are, you know, they're doing triathlons,
they're tracking their glucose, they're lifting heavy things,
they're sleeping 8 hours when they probably used to get by on
four or five. It's really that they've just
figured out what the rest of theworld is still kind of learning
that health is the ultimate competitive advantage.

(28:10):
Yeah. $100,000 watch doesn't give you more energy in your
4:00 PM meeting. A sports car will not help you
keep up with your kids or grandkids.
A vacation home doesn't prevent you from needing a hip
replacement or long term care, but being strong, being
metabolically healthy and flexible, having a VO2 Max in

(28:32):
the top quartile for your age, that's wealth you can actually
use in every department, every day, every moment.
And really, this is kind of the democratizing part.
Unlike A Rolex, this status symbol is available to pretty
much everyone. You don't have to be rich to
deadlift. You don't need connections to go

(28:53):
for a run. You don't need a trust fund to
eat protein and vegetables. It really just requires showing
up consistently for years. It doesn't.
It doesn't mean that you have toknock it out of the park on
January one with a, you know, 4 hours of exercise and the
perfect diet. It means incremental change over

(29:14):
time. So there are definitely
barriers, right? Time is a barrier income
disparity, but we see so many people who drive really nice
cars but are in the fast lane when it comes to decline and
this is a total mismatch in how to prioritize.

(29:35):
Yeah. So PSA, if you guys listening
are in your 40s, fifties or 60s and you're putting in the work,
you're lifting, you're moving. If you're prioritizing your
sleep and recovery, you are not just taking care of yourself,
you are building something that most people never will.
That's the top 1% and that's impressive, right?

(29:57):
That's rare. That's the real flex.
You are killing it. And for those that are listening
that aren't quite on that trajectory yet, the good news is
you can change it. You have agency and most of this
stuff is completely reversible and you can get on a totally
different trajectory. Yeah.
I mean, I think this kind of reminds me of a patient that I

(30:20):
think about sometimes. Early 70s, very thoughtful,
engaged cognitively, totally with it.
Still driving yourself to appointments.
But physically, she was on the fragile side.
She had fallen twice in the lastyear, struggled to be able to
get up from a chair. Her bone density was on the low
side. Her muscle mass was like at the

(30:42):
second percentile for her age. You know, she looked at me and
she said, I don't understand. I've always been thin.
I've eaten well. I've taken my vitamins and
really from my standpoint, that's kind of the moment when
you realize like this is how we've, we in medicine have kind

(31:02):
of culturally failed a huge subset of the population.
No one ever really told her thatbeing thin is not protective,
that she also needs to be strong, that muscle isn't really
a cosmetic endeavor, It's a functional endeavor.
And that being independent requires having a physical

(31:25):
presence. So she really did everything
that she was told and it still wasn't enough.
And that's really because we didn't do a good job of telling
her what the right things to do were.
So it's, you know, one of these stats that I think is a little
bit haunting that among 65 year olds, falls are really the

(31:49):
largest injury related cause of death.
One in four older adults is going to fall every single year.
And once you fall in once, your risk of falling again.
Double S in the ERI see the downstream version of this
constantly, and we've talked about this a little bit before,
that in the first year after a fall causing a hip fracture,

(32:12):
there's a 30% chance you're not surviving that year.
That's crazy. Just because you took a fall and
broke your hip after the age of 65, three out of 10 people are
not going to live out that wholenext year.
Yeah, that fall that breaks the hip, the hospitalization itself,
that is going to accelerate yourphysical decline as well as your

(32:32):
cognitive decline. And that's the moment someone
loses confidence, right? They feel helpless in their
body, and most often they never quite get it back.
And it feels sudden, but it's not right.
It's this result of decades of under preparing.
And it's not their fault becausein medicine, you know, we're

(32:52):
tracking blood pressure. We're not having these
conversations about insuring ourbodies for the long run.
And we've had decades of really tracking the wrong metrics,
right? I think that's the key point,
that we have not been tracking correctly.
Because we haven't been trackingcorrectly, we haven't been able
to advise correctly. Part of it is cultural.

(33:13):
Also, I think that we've accustomized the population to
expect that most treatments are a pill and not like mental
discipline on this is how I should actually be structuring
my life so. Absolutely.
That woman that you're referringto, she didn't need to be

(33:35):
thinner. She needed to be stronger and
when I was growing up, I know that was this was in the 80s and
90s and the emphasis was cardio and calorie restriction.
Our generation lived through every bad diet.
It was low fat diet, then it wasthe South Beach Diet, then low

(33:55):
carb. We have literally survived
everything. And I think all of these, if
we've learned one thing, it's that these are fads.
None of this is protecting us, right?
Someone that follows a low fat diet is completely missing out
and they are not playing the long game.
So I think it's a good lesson and it's a realization for all

(34:18):
of us that playing the long gameis about balance, and it is one
of those important shifts in howwe think about aging.
Yeah, the quick fixes, they're seductive.
They do actually typically make you look better in the short
term, but what they're really promising doesn't come to
fruition in the long run. You know the pill, the protocol,
the 21 day juice cleanse, the blood test that tells you what

(34:41):
your biological age is. It's really not telling you
whether you're winning this longer game.
It's just giving you a snapshot right now and psychologically
making you feel like you're doing something.
But really, in the long run, I don't think it's doing much at
all. Your body is essentially a very
skeptical investor. It's not going to make major

(35:03):
changes based on on 1/4 of good performance.
It really needs years of consistent returns before it
believes that you're serious about your investment.
And this is part of why that crash dieting, it doesn't work.
It's sending a signal to your body of scarcity and your body

(35:24):
responds by slowing down metabolism, preserving fat.
It literally is preparing you for famine.
Our body is evolved for efficiency.
So if you are depriving yourselffrom sleep, your body is getting
the signal that there's there must be danger.
That's why you're not sleeping. And your body responds by

(35:47):
sending a bunch of inflammatory markers through your system and
developing insulin resistance. Because in the short term, that
is adaptive for stress. It's not good for a long term.
And that's where I think people don't realize what they're doing
when they're compromising on some of these fundamentals.

(36:07):
Chronic stress sends a signal ofthreat and your body stays in
this survival mode, not in repair mode.
And I think it being beginning of the year, there's a lot of
folks that want to start these crash diets.
And here's some data on crash dieting specifically.
Studies show that aggressive caloric restriction reduces your

(36:29):
resting metabolic rate by 15 to 25%.
And your resting metabolic rate is that metric of how many
calories you're burning by doingabsolutely nothing.
And so by you extreme calorie restricting, you're lowering
your metabolism and it that's actually backfiring for the long
haul. And this can take years for your

(36:53):
metabolism to recover from that one month crash diet or it may
not recover at all. So you're not failing the diet.
The diet is failing you. And we want to emphasize all the
stuff you see on Instagram, Tiktok, buy this pill, buy this
crash diet. Like that's not how you win the
long game. I think muscle loss is the

(37:15):
clearest example of why the crash diet thing seems to
backfire. If you are aggressively
restricting your calories in your 40s without adequate
protein intake and without adequate resistance training,
really what happens is yes, you'll lose fat, but your body
says muscle is very expensive for me to maintain, much more

(37:38):
expensive than fat is to maintain.
Let me get rid of muscle too. And when you start getting rid
of muscle, you're lowering your metabolic rate.
That's what you're referring to,that you're resting metabolic
rate declines. The reason why it takes such a
long time to restore your resting metabolic rate is
because you have to increase muscle mass.
And if you lost 30% of your muscle, then you're resting

(38:02):
metabolic rate cannot recover towhere it really should be until
you replace that muscle again. So that's part of this kind of
hard truth here, that you generally don't regain muscle as
you age. And that's not just because, you
know, you don't want to regain it.
It's because we develop this anabolic resistance as we get

(38:23):
older. It takes more stimulus and more
proper fueling for us to put on muscle as we age.
A 20 year old can go to the gym and not even pay attention to
how they're eating and they willput on muscle.
As long as they're putting in enough effort, they will put on
muscle because they don't have that anabolic resistance.

(38:44):
But as we get older, we developed that and we have to be
much more thoughtful about how much protein we're taking in and
how much effort we're putting inwhen we actually do go to the
gym. Yeah, we have to start thinking
about muscle as our metabolic checking account, right?
It Muscle is the site for glucose disposal.
It's where blood sugar goes after a meal.

(39:07):
Less muscle means higher blood sugar, more insulin resistance,
more fat storage, and more diabetes risk.
And, and aside from the metabolic health portion, muscle
is fall prevention. It's what catches you when you
stumble. As you mentioned, those type 2
fast switch muscle fibers. If we are not actively training

(39:28):
for those fast compound movements, you are not going to
be able to catch yourself when you fall in your 70.
So muscle is metabolic health. It is the engine that keeps
everything running, and the muscle is synonymous with
independence. There's just no like supplement
that replaces it. There's no injection, there's no

(39:48):
shortcut. I often hear people ask me like,
well, what are your thoughts on testosterone replacement and
people taking growth hormone or testosterone analogs?
My thought is that if you see somebody who is looks like
they're in really good shape, they have a lot of good muscle
and you ask them are they on testosterone replacement and

(40:10):
they say yes. I will tell you that they still
put in a ton of work to look like that.
Just taking the testosterone shot does not make you have
muscle. It doesn't work that way.
So if they're using it as a tool, like we can have a debate
about medical indications for those things, but any person who
looks good really looks good. They have a lot of lean muscle

(40:32):
mass. They put in a lot of work.
There is just no replacement forputting in the work to get that
phenotype, to have that look. And those people generally are
metabolically very healthy and protected from those things like
falls and injuries. So every year someone tries to,

(40:53):
you know, sell some sort of pill, you know, that mimics
exercise, some sort of supplement.
And every year, every year I think, you know, those
treatments quietly disappear andthey're replaced by something
new. Evolution spent millions of
years fine tuning the benefits of physical activity.

(41:13):
And truly there's, there's no pharmacist, some no black market
pharmacist in China that's goingto be able to replace that yet.
Not yet, Not yet. All right, let's get into the
curveball of life when life doesn't go as planned and we've
all been there, right? So we always have a plan, but

(41:37):
then sometimes the plan doesn't happen.
And this is a part of the long game that no one talks about.
Sometimes you don't get to play the long game cleanly.
And this happened to me. So this is what, 10 years ago, I
was diagnosed with a rare blood cancer.
I didn't plan for it. I didn't 'cause it.
I didn't miss a supplement or fail a protocol.

(41:58):
I ate pretty much correctly worked out, and it still
happened. It was a curveball, a huge 1,
and it was a kind of curveball that reshapes your life and
changes everything. And suddenly the long game
wasn't theoretical anymore, right?
It was personal. I think a lot of people look at
me and assume that I'm healthy, and the truth is I live with

(42:22):
this blood cancer. I also have an autoimmune
disease that affects my the big joints in my body, my hip, my
spine. I've got a ton of skeletons in
my proverbial health closet, right?
But my diagnosis is not my destiny.
And I've learned that lifestyle largely dictates how quickly

(42:44):
cancer progresses, how significant an autoimmune
disease flares. Which is why for people like me
who already have an existing chronic condition, if any of you
are listening, it's even more important to play the long game
and focus on these things ratherthan the short term.
I think watching you or someone you love go through something

(43:05):
like that, it really strips awaya lot of the noise of life.
I think at first, obviously it was really tough and I felt
helpless because on the surface level, there's nothing I can do
to really help, right? You start to transition how
you're thinking about so many different things and you start
asking some of these questions of like, well, how do we

(43:29):
preserve what we have energy, strength, our cognition,
clarity, just our ability to keep living really fully even in
the presence of this large uncertainty?
And I think this was a real testfor us and playing the long game
and a huge catalyst for why we went down this longevity route

(43:51):
after years of being in the traditional medical model.
There had to be other things that factor into cancer and
other diseases. And at least personally, I
didn't want Nisha to be just this statistic, right?
Like we're just playing the oddsof what the oncologist says.

(44:12):
Like these are success rates andadverse reaction rates and
whatnot. So we kind of leaned into the
same sort of sorts of concepts that we discuss on this podcast,
right? It turns out that a really good
VO2 Max, high lean muscle mass, good metabolic health, these are

(44:33):
huge stop gaps for the diseases,which is why Nisha and I are so
locked in. As our kids would say, locked
into playing the long game. Yeah, that diagnosis was a low
point for us. I think our third was only one
years old, so we had three kids under age 4.

(44:55):
But over time, we made lemonade out of lemons and use that
adversity to propel us in a completely new trajectory.
And what I realized was I don't want to be known as a cancer
patient. I'm not defined by my diagnosis.
I have so much more to offer in life to my patients, you, our

(45:17):
kids, loved ones, friends. And that bone marrow biopsy 10
years ago really changed the trajectory of our life.
I also don't want my kids to have to take care of me.
I don't want to be a burden. I don't want them rearranging
their lives, their careers, their families because I didn't
do my part, the part that I actually had a hand in.

(45:40):
And that's not the legacy I wantto leave.
And here's a sobering step. The average family caregiver
spends 24 hours per week providing care to loved ones.
Over 60% of caregivers report significant emotional stress.
40% suffer from depression. When we don't invest in our own
health, the bill gets paid by the people we love.

(46:03):
And this isn't a guilt trip, right?
It's physics. Someone has to absorb the cost
of dependency. And there's something else.
My disease might progress one day, right?
I might need a stem cell transplant at one point.
And that's a brutal procedure. The recovery is grueling.
It's a one year process and I made a conscious decision.

(46:27):
If that day ever comes, I'm walking into that in the best
damn shape of my life, right? Not because I can control the
cancer, I can't. But I can control my fitness, my
VO2 Max, my muscle mass, my resilience.
And I am giving myself by training for those things, the

(46:49):
best chance of fighting my disease.
And I'm not just in namesake fighting cancer.
I'm not like the survivor fighter.
I'm fighting cancer through my day-to-day habits.
I absolutely love my oncologist.She knows that she's at
University of Chicago. She does her part to keep me
healthy with all the latest research in this bone marrow

(47:10):
cancer that I have. But I have to do my part too.
Yeah, I mean, I think that's super powerful, right?
And that's the biggest take homemessage that I think we want
everyone to feel empowered with.Really the data backs up what
you're saying. Surgical outcomes and cancer

(47:31):
outcomes are dramatically betterin patients who have a higher
VO2 Max and just in general higher fitness levels.
Studies show that patients with a higher cardiorespiratory
fitness have a 50% lower mortality rate after major
surgery. Prehabilitation, getting fit
before a procedure is one of themost powerful interventions in

(47:52):
medicine and most patients nevereven really hear about it.
Like when I had shoulder surgery, I had basically full
reconstructive surgery of my shoulder.
Like my orthopedic surgeon didn't get it.
He's like you're you should not be able to do what you're doing
six weeks out from surgery. And I was like, but I'm fine.
Like I and he's trying to slow me down.

(48:14):
But functionally I felt just fine.
But it was because I was functionally fine beforehand and
I made it a point to stay in as good shape as I could leading up
to the surgery. Modern medicine, I think really
is extraordinary. It can do things that we just
would not have imagined possibleeven a one generation ago.

(48:36):
But it can't do the part that isours to do, which are the things
that we can actually control. And that's really the stakes of
the long game. We've learned that life is far
from perfect and you aren't always held delta, a fairer hand
or a good hand. But really, it's not about

(48:57):
perfection of that hand, it's about preparing for that hand.
So here we are. If you're listening to this in
January or February or whenever for that matter, maybe you came
here to look for resolution, a plan, a spark of motivation to
get through until spring. We hope this gave you something
different, different mindset, something a little more

(49:20):
sustainable. I think motivation fades over
time. Statistics really prove that.
Remember, 80% of people are going to fail that New Year's
resolution by February. But purpose, purpose compounds
over time. And the purpose we're proposing
is it's really not look better at the beach.

(49:42):
It's be there for the moments that really matter that would
matter to you. And I think that's the big take
home. Yeah, we want to be at our
grandkids wedding. We want to be able to chase
after them, right and keep up with them.
There's all these trips we have left to take and you have to
picture what you want your life to look like at 758085 and

(50:07):
beyond. That's worth more than any 30
day transformation or sales pitch.
So here's what we want you to take away.
First, you have to think in decades, not days.
Every health choice is a small deposit in an account that
you're going to draw from later.Second, you have to prioritize.
Muscle is truly the organ of longevity.

(50:30):
You have to lift heavy things, you have to eat enough protein,
and you have to repeat this overand over again.
Doesn't matter if you miss one exercise day or you go off the
rails and have overeat Christmas.
Like you should do those things because you can't be perfect
every day, but then the day after you got to, you know, reel

(50:50):
it back in. 3rd, don't confuse thinness with fitness.
I think the scale is just a terrible proxy for health and
it's not a way to, we just should be living and dying by
what the number is on the scale.4th, we have to build a life
that makes health sustainable for us.

(51:12):
So if your routine really just requires suffering to maintain
it, it's just not going to last.And that's partially why you
need to start slow. Like from my standpoint, if you
don't exercise, exercising for 5minutes a day where you just get
on the, you do some air squats, you do some crunches, attempt a

(51:33):
couple push ups and do that all for 5 minutes, that's a start.
That's something that can work. And then you can build off of
that. If your idea is I need to go to
the gym for two hours, five daysa week, you're likely going to
fail if that was not something that you're accustomed to doing.
Yeah, we have to be OK with starting where we are.
We do not need to be perfect. You do not need to overhaul

(51:56):
everything. As we said, longevity and health
span optimization is not about deprivation.
You just need to start. Start building consistently,
patiently, with your future selfin mind.
That's what playing the long game is.
And unlike New Year's resolution, it doesn't expire on

(52:17):
February 1st. Right Purpose does not expire.
Thank you guys for listening to this episode.
We will see you next time on Playing the Long Game.
Take care of yourselves and as always, your 85 year old self is
counting on it. Take care.
Happy New Years. Thank you for playing the long

(52:40):
game with MD Longevity Lab. You can visit us at
www.mdlongevitylab.com to learn more about how we can support
you on your dream. Stay connected with us on social
media at MD Longevitylab for tips, updates and behind the
scenes insights. If you enjoyed today's episode,
we'd love it if you subscribe, left us a rating, or shared it

(53:01):
with someone you know who's alsoplaying the long game.
Thanks for listening, We'll see you next time.