November 28, 2025 • 12 mins
This episode reframes longevity by highlighting two underappreciated pillars—kidney function and precise blood pressure control—as major determinants of how many healthy years you actually get. We walk through the labs you should request, the lifestyle stack that consistently protects renal health, and the new evidence that overturns long-held assumptions about alcohol and sleep. The goal: give you complete clarity on what matters most and what you can control starting today.
We break down why kidney risk exceeds common cardiovascular assumptions, and how elevated blood pressure slowly erodes the kidney’s filtration membranes. We discuss the limitations of creatinine, the value of cystatin C, and why midlife declines in kidney function should never be accepted as “normal.” You’ll learn the optimal weekly dose of zone two cardio, why sleep and weight stability drive long-term renal protection, and when clinicians may add an ACE inhibitor or ARB for targeted risk reduction.
We also examine the collapse of the alcohol J-curve myth, and why sleep disruption should be treated as a non-negotiable boundary for long-term health. The episode closes with three actionable steps you can take today to protect your future.
High-volume keywords used: longevity, kidney health, blood pressure control, cystatin C, zone two cardio, alcohol risks, sleep quality, metabolic health
Listener Takeaways
- Why kidney risk is a major and underestimated longevity driver
- The true impact of elevated blood pressure on renal filtration
- The test to request: cystatin C vs. creatinine
- The lifestyle stack: zone two, sleep, weight, consistency
- Clear evidence on alcohol, sleep, and when ACEi/ARBs matter
Follow for daily longevity and wellness episodes.
This podcast is created by Ai for educational and entertainment purposes only and does not constitute professional medical or health advice. Please talk to your healthcare team for medical advice.
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Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
SPEAKER_01 (00:00):
Welcome to the deep dive.
So if you're here, you'reprobably looking for that, you
know, that shortest route tobeing really well informed about
optimizing your long-termhealth.
And today we are stripping downthe entire longevity
conversation to focus on theabsolute critical levers.
We're talking about those majorrisk factors that often get
missed in all the wellnessadvice, but but they carry the
(00:21):
most profound consequences forpeople over 40.
SPEAKER_00 (00:24):
Aaron Powell That's exactly right.
We went through a whole stack ofsources really trying to figure
out what separates, say, anaverage lifespan of 80 to 85
years from a truly optimized,healthy one that could push
toward 95.
SPEAKER_01 (00:34):
Aaron Powell And what was the takeaway?
SPEAKER_00 (00:36):
Aaron Powell Well, the consensus was clear.
It's not just about managingcholesterol or weight, it's
really about two specific, and Ithink often underappreciated
killers (00:43):
your kidney function and the precise management of
your blood pressure.
SPEAKER_01 (00:48):
Aaron Powell Right.
So our mission today is to giveyou that actionable knowledge,
focusing on where the realhazard lies and what simple
metrics you should actually bedemanding from your doctor.
Let's just jump right in becausethe first insight is something
that for me completely reordersthe priority list for
preventative medicine.
When you look at the hazardratio of all-cause mortality
(01:09):
compromised kidney function,it's actually a greater risk
factor than heart disease.
SPEAKER_00 (01:15):
Aaron Powell It is.
And it sounds socounterintuitive, right?
Because we're always toldcardiovascular disease is the
number one killer.
SPEAKER_01 (01:20):
Yeah.
SPEAKER_00 (01:21):
But the data is unequivocal.
Your kidney health is it's justparamount.
SPEAKER_01 (01:26):
The sources framed it in a pretty stark way.
SPEAKER_00 (01:28):
They did.
The goal is to die withcompromised kidney function.
Yeah.
But never ever from it.
Because once you hit those latestages, you know, end stage
renal disease where you needdialysis, your risk of death at
that point is higher than if youhad high blood pressure, higher
than if you were a smoker.
SPEAKER_01 (01:44):
Higher than cancer, even.
SPEAKER_00 (01:45):
Higher than many common forms of cancer.
SPEAKER_01 (01:47):
Wow.
That one fact alone forces youto look really closely at this
organ.
I mean, why is the kidney it'sso small?
Why is it so incrediblyvulnerable to damage?
SPEAKER_00 (01:58):
It all comes down to plumbing and pressure.
The kidney is built for highvolume filtration.
On every single pump of yourheart, this tiny organ gets a
massive amount of blood.
SPEAKER_01 (02:09):
How much are we talking?
SPEAKER_00 (02:10):
Between 20 to 25% of your body's entire blood flow,
every single pump.
Just imagine that level ofexposure day in and day out for
decades.
SPEAKER_01 (02:19):
It's like a high-traffic highway that never
ever closes.
SPEAKER_00 (02:21):
Exactly.
And that makes it acutelysusceptible to elevated blood
pressure.
High blood pressure is basicallysandblasting the kidney's
delicate internal structures.
Over time, that constantpressure just erodes the
kidney's capacity.
It's the great destroyer ofrenal function.
SPEAKER_01 (02:35):
Okay, so if the kidney is this critical, how do
we measure its health correctly?
Because the sources we looked atwere very critical of the
current medical standard.
SPEAKER_00 (02:43):
This is a huge point.
This is where you need to getcritical about your annual blood
panel.
The mistake that's commonly madeis relying almost entirely on
creatinine measurements.
SPEAKER_01 (02:52):
Which is a byproduct of muscle, right?
SPEAKER_00 (02:53):
Exactly, a byproduct of muscle breakdown.
So if you have less muscle mass,if you're older or maybe a bit
frail or female, your creatininelevels will naturally be lower.
A doctor might see a normallevel and think everything's
fine when in fact the kidney isstruggling.
SPEAKER_01 (03:09):
So it's just a really unreliable proxy.
SPEAKER_00 (03:12):
It's totally unreliable.
The far more accurate and yetconsistently underutilized
biomarker is something calledcystatin C.
SPEAKER_01 (03:19):
Systaten C.
Okay.
SPEAKER_00 (03:21):
And what's crucial about cystatin C is that it's
produced by almost all nucleatedcells in the body at a pretty
constant rate.
It's not dependent on musclemass, age, or diet in the way
creatinine is.
SPEAKER_01 (03:33):
So if you are serious about monitoring your
longevity, you need to be askingfor cystin C.
SPEAKER_00 (03:38):
You have to.
You absolutely have to.
SPEAKER_01 (03:40):
What about the tolerance issue you mentioned?
Even with the right test, yousaid medicine is tolerating too
much of a decline.
SPEAKER_00 (03:45):
Yeah, we tolerate way too low a function for a
person's age because we'refocused on the immediate, not
the 30-year trajectory.
So you take a 50-year-old whosekidney function is down to, say,
65%.
Modern medicine often calls thatfine.
SPEAKER_01 (03:58):
And for today, it is fine.
SPEAKER_00 (04:01):
For today, sure.
They don't need a specialisttomorrow.
But if that rate of declinecontinues, they are on a one-way
path to needing dialysis laterin life.
We should be targeting 80 to 90%function, even at 50 or 60.
SPEAKER_01 (04:15):
Allowing a 35% decline before ringing the
alarm, that's a massivemisalignment.
And that really sets the stagefor blood pressure management.
If high BP is the primarydestroyer, we need to fix it.
SPEAKER_00 (04:26):
And we need to fix it without causing immediate
harm.
The first rule is always seeinghow much we can lower blood
pressure without turning tomedication.
SPEAKER_01 (04:34):
Why is that?
Why do we push behavioral fixesfor blood pressure so much
harder than, say, for highcholesterol?
SPEAKER_00 (04:40):
It's all about the risk of overshooting.
For lipids, for cholesterol, ifwe overshoot the dose, well,
there's no immediate physicaldanger.
We catch it at the next bloodtest.
But if you overshoot somebody'sblood pressure medication, you
can induce orthostatichypotension.
SPEAKER_01 (04:53):
That's the sudden drop when you stand up.
SPEAKER_00 (04:55):
Exactly.
They get lightheaded, they fall,they bang their head.
That risk of a head injury,especially for an older person
getting up at night, is it's adevastating consequence.
So we push the non-pharma fixesfirst.
SPEAKER_01 (05:06):
So what are those actionable lifestyle changes
that really move the needle?
SPEAKER_00 (05:10):
It really boils down to three core things.
One, get your sleep right, two,get the exercise dosage right,
and three, correctovernourishment, which is
basically weight management.
The sources show you can seegreat effects from just losing
10 pounds and exercising everysingle day.
SPEAKER_01 (05:25):
Let's get specific on the exercise, because
exercise every day is a bitvague.
What's the actual dose?
SPEAKER_00 (05:31):
The prescription is for zone two cardio.
This is that low-intensity,sustainable exercise where you
can still hold a conversation,but you're not gasping.
And the recommended dosage ispretty substantial.
A minimum of 180 minutes perweek, but really pushing up to
240 or 250.
SPEAKER_01 (05:47):
So three to four hours a week.
SPEAKER_00 (05:49):
Three to four hours a week of zone two, yes.
SPEAKER_01 (05:51):
That sounds like a big commitment.
Is 180 minutes enough to get,say, 80% of the benefit?
Is that a realistic lowerboundary for people?
SPEAKER_00 (05:57):
That's a great practical question.
And yes, you see significantbenefits starting at that
180-minute mark.
If you consistently hit that,say, 36 minutes five days a
week, you're capturing most ofthe blood pressure and
mitochondrial benefits.
The whole point of zone two isconsistency.
It's low intensity enough to besustainable year after year.
SPEAKER_01 (06:18):
Okay.
But what if someone does allthat?
They fix their sleep, they losethe weight, they do the zone
two, and their blood pressure isstill high.
The sources call that essentialhypertension.
SPEAKER_00 (06:28):
Right.
Essential hypertension justmeans high blood pressure, where
we can't find a single clearroot cause that we can fix.
It's kind of the defaultdiagnosis.
At that point, the next step ismedication.
But the good news is that modernmeds, especially ARBs and ACE
inhibitors, are so much bettertolerated today than the old
drugs.
SPEAKER_01 (06:45):
So we have good tools if behavior fails, but
behavior always has to comefirst.
SPEAKER_00 (06:50):
Always.
Because of that fall risk.
SPEAKER_01 (06:52):
Okay.
So if blood pressure is thegreat destroyer of the kidney,
let's turn to a great behavioraldebate that has shifted so much
recently.
Alcohol.
I mean, we all grew up hearingabout the French paradox and
this idea of the J curve.
SPEAKER_00 (07:07):
Oh, for decades.
I operated under that assumptionmyself.
The J curve suggested that, youknow, total abstinence was
slightly riskier than having onedrink a day.
It was basically gospel.
SPEAKER_01 (07:16):
But the research has completely flipped that on its
head, right?
Mostly due to these new geneticstudies.
SPEAKER_00 (07:22):
It really has.
You basically have to throw allthat old observational data out
the window.
Recent, really elegant analyses,especially the ones using
genetic techniques published inplaces like JMA have given us a
definitive conclusion.
And that is there is no dose ofethanol that is healthy.
SPEAKER_01 (07:37):
No dose at all.
So the J-curve was just astatistical artifact, a
confounder.
SPEAKER_00 (07:42):
It was.
The problem was selection bias.
The abstainers in those oldstudies weren't just people who
chose not to drink.
They were often people withunderlying health problems who
had to stop drinking.
So you were comparing apopulation of sick abstainers to
a generally healthier populationof moderate drinkers.
It was a flawed comparison fromthe start.
SPEAKER_01 (08:01):
And the genetic studies get around that.
SPEAKER_00 (08:03):
They do.
They use random geneticvariations that make someone
less likely to drink as a kindof perfect control group.
And when you look at that data,the conclusion is just crystal
clear.
Zero is best.
SPEAKER_01 (08:15):
Okay, zero is best, period.
But practically, how high is therisk between zero drinks and one
drink per day?
Because this is where thequality of life argument comes
in.
SPEAKER_00 (08:25):
That's the key nuance.
And I would argue that for mostpeople, the actual harm between
zero and one drink per day isprobably very difficult to
discern.
However, the data is also clearthat once you cross that one
drink a day threshold, the riskstarts to climb pretty steeply
and not in a straight line.
SPEAKER_01 (08:42):
And it's important to stress, one drink daily is
not the same as saving them allfor the weekend.
SPEAKER_00 (08:46):
Not at all.
Seven drinks in one sitting isknown to be immediately
detrimental, especially for thebrain.
That's a whole differentcategory of risk.
SPEAKER_01 (08:55):
Aaron Powell Beyond the direct damage, what about
the indirect risks?
Things that tie back to thelongevity levers we've been
talking about.
SPEAKER_00 (09:01):
Aaron Powell The indirect effects are profound.
And number one is sleep.
I think the impact of ethanol onsleep quality is just vastly
underappreciated.
Even a moderate amount ofalcohol disrupts your deep and
REM sleep cycles.
And as we know from the work ofpeople like Matt Walker, poor
sleep just wreaks havoc on yourcardiovascular and
cerebrovascular health.
(09:22):
Trevor Burrus, Jr.
SPEAKER_01 (09:22):
So if you disrupt your sleep, you're disrupting
your entire health trajectory.
SPEAKER_00 (09:26):
Absolutely.
And the second big indirect riskis neurodegenerative disease.
Ethanol has a heavy, heavyimpact on the dementia and
cognitive decline side ofthings, they're neurotoxin.
And then finally, there's thecancer risk.
The link between ethanol andcertain cancers, particularly
breast cancer in women, is veryconcerning.
Some of the most conservativeguidelines are now suggesting a
limit of just two drinks perweek.
SPEAKER_01 (09:47):
Two per week?
Wow.
SPEAKER_00 (09:49):
Total, yes.
SPEAKER_01 (09:50):
This all leads to a really critical, almost
philosophical question.
If optimizing every singlemolecule means you have a lower
quality of life, then what's thepoint?
This is that trade-off betweenhealth span and lifespan.
SPEAKER_00 (10:03):
Exactly.
Longevity has to include both.
You have to maximize thequantity of years and the
quality of those years.
If you go so far down the rabbithole that you eliminate all
pleasure, well, you might livelonger, but maybe not better.
SPEAKER_01 (10:16):
Aaron Powell So how do you personally square this?
You know, the the evidence sayszero is best, but there's also
the desire for, you know, aquality moment.
SPEAKER_00 (10:24):
Aaron Powell You have to make conscious
trade-offs.
I know the data.
I know zero is best.
But for me, it's rooted inacknowledging the pleasure.
I'll drink occasionally, but Ican go weeks without it.
I have to weigh the pleasure Iget from a really high quality
Spanish wine or a specificBelgian beer that I love against
the known consequences.
SPEAKER_01 (10:42):
Aaron Powell So the pleasure has to justify the
known risk.
It's an intentional choice, nota habit.
SPEAKER_00 (10:47):
Precisely.
It's no different than eating anamazing brownie your kid made.
There's no upside from amolecular health perspective,
except for the pleasure of thatmoment, the quality of life it
provides, that intent changeseverything.
SPEAKER_01 (11:01):
And based on the data, especially around sleep,
where do you personally draw theline?
SPEAKER_00 (11:05):
For me, the threshold is sleep.
I know from tracking it that ifI have two standard drinks with
dinner, my sleep architecturewill suffer.
It's measurable.
And because I know how bad poorsleep is for my brain and my
heart, that's a threshold I justvery, very rarely cross.
That's my practical boundary.
SPEAKER_01 (11:22):
That's a fantastic personal metric for people to
consider using.
Monitor your own sleep.
SPEAKER_00 (11:27):
Okay, let's wrap this up with the three critical
takeaways for you, our listener,focus on what you can do right
now.
SPEAKER_01 (11:32):
First, you have to shift your perspective on what
matters most.
Recognize that kidney health isa top mortality concern.
And if you ask for just oneextra test this year, make it
cystin C, not just creatinine.
Second, the effective drug-freepath to controlling your blood
pressure.
Commit to that behavioral stack.
Optimize sleep, manage weight,and target a 180 to 240 minutes
(11:54):
of zone two cardio every singleweek.
SPEAKER_00 (11:57):
And third, the new reality about alcohol.
Zero is genetically better.
But if you choose to drink, justbe aware that the risk starts
climbing sharply after one drinka day.
And use the impact on your sleepas your own personal
quantifiable boundary.
SPEAKER_01 (12:11):
Invaluable insights.
So given that the sourcesconfirm the risk of end-stage
renal disease is higher thanthat of smoking or even cancer,
here's a final thought to chewon.
How does that singular factchange your immediate daily
priorities regarding hijaction,diet, stress, all those things
that impact that highlysensitive 20 to 25% of your
blood flow every minute of everyday?
(12:32):
It's really worth digging deeperinto your own personal kidney
function metrics.
SPEAKER_00 (12:36):
Focus on what you can control today to protect
your tomorrow.
SPEAKER_01 (12:39):
Thanks for diving in with us.
We'll see you next time.
Welcome to the deep dive.
So if you're here, you'reprobably looking for that, you
know, that shortest route tobeing really well informed about
optimizing your long-termhealth.
And today we are stripping downthe entire longevity
conversation to focus on theabsolute critical levers.
We're talking about those majorrisk factors that often get
missed in all the wellnessadvice, but but they carry the
(00:21):
most profound consequences forpeople over 40.
SPEAKER_00 (00:24):
Aaron Powell That's exactly right.
We went through a whole stack ofsources really trying to figure
out what separates, say, anaverage lifespan of 80 to 85
years from a truly optimized,healthy one that could push
toward 95.
SPEAKER_01 (00:34):
Aaron Powell And what was the takeaway?
SPEAKER_00 (00:36):
Aaron Powell Well, the consensus was clear.
It's not just about managingcholesterol or weight, it's
really about two specific, and Ithink often underappreciated
killers (00:43):
your kidney function and the precise management of
your blood pressure.
SPEAKER_01 (00:48):
Aaron Powell Right.
So our mission today is to giveyou that actionable knowledge,
focusing on where the realhazard lies and what simple
metrics you should actually bedemanding from your doctor.
Let's just jump right in becausethe first insight is something
that for me completely reordersthe priority list for
preventative medicine.
When you look at the hazardratio of all-cause mortality
(01:09):
compromised kidney function,it's actually a greater risk
factor than heart disease.
SPEAKER_00 (01:15):
Aaron Powell It is.
And it sounds socounterintuitive, right?
Because we're always toldcardiovascular disease is the
number one killer.
SPEAKER_01 (01:20):
Yeah.
SPEAKER_00 (01:21):
But the data is unequivocal.
Your kidney health is it's justparamount.
SPEAKER_01 (01:26):
The sources framed it in a pretty stark way.
SPEAKER_00 (01:28):
They did.
The goal is to die withcompromised kidney function.
Yeah.
But never ever from it.
Because once you hit those latestages, you know, end stage
renal disease where you needdialysis, your risk of death at
that point is higher than if youhad high blood pressure, higher
than if you were a smoker.
SPEAKER_01 (01:44):
Higher than cancer, even.
SPEAKER_00 (01:45):
Higher than many common forms of cancer.
SPEAKER_01 (01:47):
Wow.
That one fact alone forces youto look really closely at this
organ.
I mean, why is the kidney it'sso small?
Why is it so incrediblyvulnerable to damage?
SPEAKER_00 (01:58):
It all comes down to plumbing and pressure.
The kidney is built for highvolume filtration.
On every single pump of yourheart, this tiny organ gets a
massive amount of blood.
SPEAKER_01 (02:09):
How much are we talking?
SPEAKER_00 (02:10):
Between 20 to 25% of your body's entire blood flow,
every single pump.
Just imagine that level ofexposure day in and day out for
decades.
SPEAKER_01 (02:19):
It's like a high-traffic highway that never
ever closes.
SPEAKER_00 (02:21):
Exactly.
And that makes it acutelysusceptible to elevated blood
pressure.
High blood pressure is basicallysandblasting the kidney's
delicate internal structures.
Over time, that constantpressure just erodes the
kidney's capacity.
It's the great destroyer ofrenal function.
SPEAKER_01 (02:35):
Okay, so if the kidney is this critical, how do
we measure its health correctly?
Because the sources we looked atwere very critical of the
current medical standard.
SPEAKER_00 (02:43):
This is a huge point.
This is where you need to getcritical about your annual blood
panel.
The mistake that's commonly madeis relying almost entirely on
creatinine measurements.
SPEAKER_01 (02:52):
Which is a byproduct of muscle, right?
SPEAKER_00 (02:53):
Exactly, a byproduct of muscle breakdown.
So if you have less muscle mass,if you're older or maybe a bit
frail or female, your creatininelevels will naturally be lower.
A doctor might see a normallevel and think everything's
fine when in fact the kidney isstruggling.
SPEAKER_01 (03:09):
So it's just a really unreliable proxy.
SPEAKER_00 (03:12):
It's totally unreliable.
The far more accurate and yetconsistently underutilized
biomarker is something calledcystatin C.
SPEAKER_01 (03:19):
Systaten C.
Okay.
SPEAKER_00 (03:21):
And what's crucial about cystatin C is that it's
produced by almost all nucleatedcells in the body at a pretty
constant rate.
It's not dependent on musclemass, age, or diet in the way
creatinine is.
SPEAKER_01 (03:33):
So if you are serious about monitoring your
longevity, you need to be askingfor cystin C.
SPEAKER_00 (03:38):
You have to.
You absolutely have to.
SPEAKER_01 (03:40):
What about the tolerance issue you mentioned?
Even with the right test, yousaid medicine is tolerating too
much of a decline.
SPEAKER_00 (03:45):
Yeah, we tolerate way too low a function for a
person's age because we'refocused on the immediate, not
the 30-year trajectory.
So you take a 50-year-old whosekidney function is down to, say,
65%.
Modern medicine often calls thatfine.
SPEAKER_01 (03:58):
And for today, it is fine.
SPEAKER_00 (04:01):
For today, sure.
They don't need a specialisttomorrow.
But if that rate of declinecontinues, they are on a one-way
path to needing dialysis laterin life.
We should be targeting 80 to 90%function, even at 50 or 60.
SPEAKER_01 (04:15):
Allowing a 35% decline before ringing the
alarm, that's a massivemisalignment.
And that really sets the stagefor blood pressure management.
If high BP is the primarydestroyer, we need to fix it.
SPEAKER_00 (04:26):
And we need to fix it without causing immediate
harm.
The first rule is always seeinghow much we can lower blood
pressure without turning tomedication.
SPEAKER_01 (04:34):
Why is that?
Why do we push behavioral fixesfor blood pressure so much
harder than, say, for highcholesterol?
SPEAKER_00 (04:40):
It's all about the risk of overshooting.
For lipids, for cholesterol, ifwe overshoot the dose, well,
there's no immediate physicaldanger.
We catch it at the next bloodtest.
But if you overshoot somebody'sblood pressure medication, you
can induce orthostatichypotension.
SPEAKER_01 (04:53):
That's the sudden drop when you stand up.
SPEAKER_00 (04:55):
Exactly.
They get lightheaded, they fall,they bang their head.
That risk of a head injury,especially for an older person
getting up at night, is it's adevastating consequence.
So we push the non-pharma fixesfirst.
SPEAKER_01 (05:06):
So what are those actionable lifestyle changes
that really move the needle?
SPEAKER_00 (05:10):
It really boils down to three core things.
One, get your sleep right, two,get the exercise dosage right,
and three, correctovernourishment, which is
basically weight management.
The sources show you can seegreat effects from just losing
10 pounds and exercising everysingle day.
SPEAKER_01 (05:25):
Let's get specific on the exercise, because
exercise every day is a bitvague.
What's the actual dose?
SPEAKER_00 (05:31):
The prescription is for zone two cardio.
This is that low-intensity,sustainable exercise where you
can still hold a conversation,but you're not gasping.
And the recommended dosage ispretty substantial.
A minimum of 180 minutes perweek, but really pushing up to
240 or 250.
SPEAKER_01 (05:47):
So three to four hours a week.
SPEAKER_00 (05:49):
Three to four hours a week of zone two, yes.
SPEAKER_01 (05:51):
That sounds like a big commitment.
Is 180 minutes enough to get,say, 80% of the benefit?
Is that a realistic lowerboundary for people?
SPEAKER_00 (05:57):
That's a great practical question.
And yes, you see significantbenefits starting at that
180-minute mark.
If you consistently hit that,say, 36 minutes five days a
week, you're capturing most ofthe blood pressure and
mitochondrial benefits.
The whole point of zone two isconsistency.
It's low intensity enough to besustainable year after year.
SPEAKER_01 (06:18):
Okay.
But what if someone does allthat?
They fix their sleep, they losethe weight, they do the zone
two, and their blood pressure isstill high.
The sources call that essentialhypertension.
SPEAKER_00 (06:28):
Right.
Essential hypertension justmeans high blood pressure, where
we can't find a single clearroot cause that we can fix.
It's kind of the defaultdiagnosis.
At that point, the next step ismedication.
But the good news is that modernmeds, especially ARBs and ACE
inhibitors, are so much bettertolerated today than the old
drugs.
SPEAKER_01 (06:45):
So we have good tools if behavior fails, but
behavior always has to comefirst.
SPEAKER_00 (06:50):
Always.
Because of that fall risk.
SPEAKER_01 (06:52):
Okay.
So if blood pressure is thegreat destroyer of the kidney,
let's turn to a great behavioraldebate that has shifted so much
recently.
Alcohol.
I mean, we all grew up hearingabout the French paradox and
this idea of the J curve.
SPEAKER_00 (07:07):
Oh, for decades.
I operated under that assumptionmyself.
The J curve suggested that, youknow, total abstinence was
slightly riskier than having onedrink a day.
It was basically gospel.
SPEAKER_01 (07:16):
But the research has completely flipped that on its
head, right?
Mostly due to these new geneticstudies.
SPEAKER_00 (07:22):
It really has.
You basically have to throw allthat old observational data out
the window.
Recent, really elegant analyses,especially the ones using
genetic techniques published inplaces like JMA have given us a
definitive conclusion.
And that is there is no dose ofethanol that is healthy.
SPEAKER_01 (07:37):
No dose at all.
So the J-curve was just astatistical artifact, a
confounder.
SPEAKER_00 (07:42):
It was.
The problem was selection bias.
The abstainers in those oldstudies weren't just people who
chose not to drink.
They were often people withunderlying health problems who
had to stop drinking.
So you were comparing apopulation of sick abstainers to
a generally healthier populationof moderate drinkers.
It was a flawed comparison fromthe start.
SPEAKER_01 (08:01):
And the genetic studies get around that.
SPEAKER_00 (08:03):
They do.
They use random geneticvariations that make someone
less likely to drink as a kindof perfect control group.
And when you look at that data,the conclusion is just crystal
clear.
Zero is best.
SPEAKER_01 (08:15):
Okay, zero is best, period.
But practically, how high is therisk between zero drinks and one
drink per day?
Because this is where thequality of life argument comes
in.
SPEAKER_00 (08:25):
That's the key nuance.
And I would argue that for mostpeople, the actual harm between
zero and one drink per day isprobably very difficult to
discern.
However, the data is also clearthat once you cross that one
drink a day threshold, the riskstarts to climb pretty steeply
and not in a straight line.
SPEAKER_01 (08:42):
And it's important to stress, one drink daily is
not the same as saving them allfor the weekend.
SPEAKER_00 (08:46):
Not at all.
Seven drinks in one sitting isknown to be immediately
detrimental, especially for thebrain.
That's a whole differentcategory of risk.
SPEAKER_01 (08:55):
Aaron Powell Beyond the direct damage, what about
the indirect risks?
Things that tie back to thelongevity levers we've been
talking about.
SPEAKER_00 (09:01):
Aaron Powell The indirect effects are profound.
And number one is sleep.
I think the impact of ethanol onsleep quality is just vastly
underappreciated.
Even a moderate amount ofalcohol disrupts your deep and
REM sleep cycles.
And as we know from the work ofpeople like Matt Walker, poor
sleep just wreaks havoc on yourcardiovascular and
cerebrovascular health.
(09:22):
Trevor Burrus, Jr.
SPEAKER_01 (09:22):
So if you disrupt your sleep, you're disrupting
your entire health trajectory.
SPEAKER_00 (09:26):
Absolutely.
And the second big indirect riskis neurodegenerative disease.
Ethanol has a heavy, heavyimpact on the dementia and
cognitive decline side ofthings, they're neurotoxin.
And then finally, there's thecancer risk.
The link between ethanol andcertain cancers, particularly
breast cancer in women, is veryconcerning.
Some of the most conservativeguidelines are now suggesting a
limit of just two drinks perweek.
SPEAKER_01 (09:47):
Two per week?
Wow.
SPEAKER_00 (09:49):
Total, yes.
SPEAKER_01 (09:50):
This all leads to a really critical, almost
philosophical question.
If optimizing every singlemolecule means you have a lower
quality of life, then what's thepoint?
This is that trade-off betweenhealth span and lifespan.
SPEAKER_00 (10:03):
Exactly.
Longevity has to include both.
You have to maximize thequantity of years and the
quality of those years.
If you go so far down the rabbithole that you eliminate all
pleasure, well, you might livelonger, but maybe not better.
SPEAKER_01 (10:16):
Aaron Powell So how do you personally square this?
You know, the the evidence sayszero is best, but there's also
the desire for, you know, aquality moment.
SPEAKER_00 (10:24):
Aaron Powell You have to make conscious
trade-offs.
I know the data.
I know zero is best.
But for me, it's rooted inacknowledging the pleasure.
I'll drink occasionally, but Ican go weeks without it.
I have to weigh the pleasure Iget from a really high quality
Spanish wine or a specificBelgian beer that I love against
the known consequences.
SPEAKER_01 (10:42):
Aaron Powell So the pleasure has to justify the
known risk.
It's an intentional choice, nota habit.
SPEAKER_00 (10:47):
Precisely.
It's no different than eating anamazing brownie your kid made.
There's no upside from amolecular health perspective,
except for the pleasure of thatmoment, the quality of life it
provides, that intent changeseverything.
SPEAKER_01 (11:01):
And based on the data, especially around sleep,
where do you personally draw theline?
SPEAKER_00 (11:05):
For me, the threshold is sleep.
I know from tracking it that ifI have two standard drinks with
dinner, my sleep architecturewill suffer.
It's measurable.
And because I know how bad poorsleep is for my brain and my
heart, that's a threshold I justvery, very rarely cross.
That's my practical boundary.
SPEAKER_01 (11:22):
That's a fantastic personal metric for people to
consider using.
Monitor your own sleep.
SPEAKER_00 (11:27):
Okay, let's wrap this up with the three critical
takeaways for you, our listener,focus on what you can do right
now.
SPEAKER_01 (11:32):
First, you have to shift your perspective on what
matters most.
Recognize that kidney health isa top mortality concern.
And if you ask for just oneextra test this year, make it
cystin C, not just creatinine.
Second, the effective drug-freepath to controlling your blood
pressure.
Commit to that behavioral stack.
Optimize sleep, manage weight,and target a 180 to 240 minutes
(11:54):
of zone two cardio every singleweek.
SPEAKER_00 (11:57):
And third, the new reality about alcohol.
Zero is genetically better.
But if you choose to drink, justbe aware that the risk starts
climbing sharply after one drinka day.
And use the impact on your sleepas your own personal
quantifiable boundary.
SPEAKER_01 (12:11):
Invaluable insights.
So given that the sourcesconfirm the risk of end-stage
renal disease is higher thanthat of smoking or even cancer,
here's a final thought to chewon.
How does that singular factchange your immediate daily
priorities regarding hijaction,diet, stress, all those things
that impact that highlysensitive 20 to 25% of your
blood flow every minute of everyday?
(12:32):
It's really worth digging deeperinto your own personal kidney
function metrics.
SPEAKER_00 (12:36):
Focus on what you can control today to protect
your tomorrow.
SPEAKER_01 (12:39):
Thanks for diving in with us.
We'll see you next time.
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