I lost 40 pounds, got into better shape – cardio, agility, endurance – and I look and feel better than I have for years. That’s been my experience, and I’m grateful for it.

But after 40 years of paying attention to natural health, I’ve learned one thing: Every drug has side effects, and some percentage of people will feel them. Here’s a report about one that I’m glad I didn’t experience: “They Went on Ozempic and Gave Up on Life,” by Evan Gardner in The Free Press.

News from the Dog Aging Project 

Statins for dogs? Are you kidding me? Read this, sent in by GM.

Notes from My Journal: 

Yesterday afternoon, feeling a bit edgy, I pulled out the little blood pressure device I keep in my desk drawer and took a reading. 
 
I was using the device several times a day after Paulo, my fitness trainer, noticed that my blood pressure had soared to something like 180 over 110. But when I lost 40 pounds and increased the intensity of my workouts, it dropped to the very healthy range of about 110 over 70, and it has stayed in that range. 
 
Yesterday, however, I noticed that my breathing was a bit labored and my pulse seemed elevated. I wondered if the stress of dealing with some recent (unexpected) business challenges might have affected my blood pressure. And… whoa! My blood pressure now measured 140 over 85!
 
“Well, look at that,” I thought. “That’s one commonly held medical belief that seems to be true. At least for me. At least for now.” (I know that the correlation between stress and elevated blood pressure is widely accepted, but I am skeptical about virtually all generally accepted beliefs about health science.)
 
The hopeful part of my brain was disappointed. It must have convinced itself that since my transition to the new me, I would no longer be susceptible to the physical degradations of the common man. 
 
But then I had a happy thought: If stress can raise my blood pressure, is it possible that I could lower my blood pressure by somehow lowering my stress? Was there some way to de-stress my brain and lower my blood pressure back to a healthy range?
 
I was aware of one method that was purported to do that – a breathing technique that I had read about. I went to my journal and found it. A protocol so simple, quick, and easy that I doubted it could work.
 
Sitting comfortably in a chair, I closed my eyes and inhaled slowly for several seconds, then held my breath for several seconds, and then exhaled for several more. Each repetition of the exercise took about 30 seconds, so I did six of them in three minutes. Then I opened my eyes, looked around the room, and strapped on my little BP device.
 
I was down to 120 over 80!
 
I’m far from ready to endorse this miracle fix. I’m going to test it out another dozen times or so before I can believe it may be true. When I’ve done that, I’ll share the results with you. But for the moment, I’m feeling pretty good about it.
 
And that’s not all… 
 
I remembered that I had discovered another way to lower my blood pressure that is almost the polar opposite of this breathing technique. Since I began exercising at a high intensity about six months ago, Paulo has pointed out that after I train my legs, my blood pressure drops significantly – like below 110 over 70! 
 
If you lift heavy weights and you do so without pausing, you know that training your legs is extraordinarily taxing. You not only demolish your quadriceps and hamstring muscles, you break into a sweat as your heart rate climbs up to its peak beats per minute. (For me, at age 75, it’s about 160.)
 
When it first happened, Paulo and I were both surprised. We are no longer surprised, but it still feels wrong. If intense mental stress raises my blood pressure, shouldn’t intense physical stress do the same?
 
It’s been a mystery. 
 
Nigel Checks the Facts 
 
I asked Nigel to do some preliminary research on the correlation between intense exercise, especially leg work, and blood pressure. Here’s what he found:

What you’re seeing is well known – and actually one of the most reliable effects in exercise physiology.
                        
After a hard workout – especially big muscle work like legs – blood pressure often drops for hours. Sometimes quite a bit. It’s called post-exercise hypotension.
                        
Here’s what’s going on, as best we understand it:
                        
First, your blood vessels open up. During intense exercise, your body increases blood flow to working muscles by dilating the arteries. That dilation doesn’t snap back immediately when you stop – it lingers. Wider pipes, lower pressure.
            
Second, your nervous system shifts gears. Exercise temporarily reduces sympathetic (“fight or flight”) tone and increases parasympathetic activity. That tends to relax the cardiovascular system.
                        
Third, there’s a chemical effect. Exercise boosts things like nitric oxide, which improves how well your blood vessels relax. That effect can last for hours after you’re done.
                        
Leg work seems especially potent because you’re using the largest muscle groups in the body. More muscle mass involved = bigger vascular response.
            
In terms of magnitude, studies generally show:
            
* A drop of 5–10 mmHg is common.
* In people with hypertension, it can be 10–20 mmHg or more.
* The effect can last several hours, sometimes up to a day.
                        
Over time, repeated bouts of this seem to “reset” your baseline lower, which is why regular exercise is one of the most consistently effective non-drug ways to reduce blood pressure.

Readers Write: 

From AS re two of my recent essays: “Why I Don’t Trust Statins” (in the Feb. 28 issue) and “What They Don’t Tell Us About Blood Pressure Meds” (in the April 4 issue)

Mark, you are so right about the medical field shrinking the qualification for high BP. In the 70s, when I was working in the ER, if someone’s BP was 140/90, the doctor would tell them to change their diet or lose some weight. They didn’t put them on BP meds.

Now, if the diastolic is in the high 120s or low 130s, boom, they prescribe blood pressure medicine.

In the emergency room one day, I took the resting blood pressure of a man in his late 30s. It was 80/50. Alarmed, I told the doctor. He asked me to see if the patient was a long-distance runner. He was. I told the doctor. He said that his resting pulse was that low because his blood pressure when he was running was probably down to 120/80.

“I guess his body thinks running 10 miles a day is his normal,” I said.

I thought that was interesting.

Since we’re on the subject…

I’ve been on BP meds for a long time. Gradually, over the last seven years, I lost about the same amount of weight as you did – 35 pounds. I suppose I had the same question you had when you decided to go off your BP meds. I asked my doctor if I could go off the BP meds. He said, “Why do you think it’s 120/80?”

Oh, and here’s another question. How do they treat stiff arteries or other causes of BP?

My Answer: You posed two questions that I’m sure anyone on BP meds might have right now if they have lost the kind of weight we are talking about. First, should they stay on the medication now that their pressure is in the healthy range? And second, is there anything that can be done once your arteries are damaged – when they are “stiff,” as doctors say?

Your doctor’s answer – “Why do you think it’s 120/80?” – seems logical. I got the same answer from my doctor after he put me on statins and my heart-related blood metrics moved into the healthy range.

But it’s not logical if he hasn’t taken in all the relevant inputs, such as losing a ton of weight and training your heart and lungs with intensive cardiovascular exercise.

I made the decision to wean myself off the meds (first the BP medication and then the statins), contradicting my doctor’s very conventional advice. I didn’t make that decision irrationally. I’ve been reading about natural ways to treat high blood pressure and bad blood metrics for 30 years, and I was well acquainted with studies that concluded it was possible to get back to good cardiovascular health through diet, weight loss, and exercise. (There are also natural supplements that are recommended, but I didn’t take any of those.)

The studies I remember seeing concluded that it is perfectly possible to lower systolic pressure by 5, 10, and sometimes even 20 points. That’s what happened to me.

I’m glad I disregarded my doctor’s advice (carefully), because now I don’t have to worry about the serious side effects which are, admittedly, rare. More importantly, I don’t have to endure the most common side effects, which are feeling physically sluggish and brain-fogged.

I’m not going to give you medical advice here – and I’m sure you wouldn’t take it, anyway, since I’m an amateur health expert at best. But if you want to see if you could do what I did, you’ll have to find a doctor who is a true expert in this area of medicine and also inclined to prefer natural cures to drugs.

And if you do find one like that, he’ll probably suggest that you do what I did: Wean yourself gradually off the drugs by lowering the dosage incrementally over time, checking with him regularly to be safe.

As for stiff arteries, the usual story is that high blood pressure damages arteries over time. Many doctors take that as gospel. But it’s a chicken-and-egg problem. There’s ample evidence that the stiffness often comes first – from eating badly and not exercising and becoming obese. (In other words, from the usual mix of inflammation, insulin resistance, and oxidative stress.)

If you take that view, as I do, you see the higher blood pressure as a perfectly sensible way for the body to respond to the stiffness of the arteries. (The problem with drug therapy is that there is little to no evidence that drugs restore arterial flexibility. What they do is lower the blood pressure number, which may be helpful in the short term, but doesn’t extend life because they don’t seem to fix the underlying mechanics.)

The body must get blood into the capillaries one way or another. If they are partially blocked, the heart must push harder. Thus, to answer the question I think you were asking: What can be done to repair artery damage naturally, rather than simply thinning the blood?

The answers I’ve seen from my side of the chicken-and-egg question are:

1. Keeping a healthy weight
2. Regular aerobic exercise
3. Regular strength exercise
4. Better blood sugar control
5. More whole foods
6. Fewer ultra-processed foods
7. An adequate consumption of potassium, omega-3s, and leafy greens

Remember, the goal isn’t to get a good reading in the doctor’s office. It’s to have the best cardiovascular health you can manage with the least downside over time.

Notes from My Journal:

It’s kind of crazy how dumb smart people can be when it comes to making important decisions about their health. I’m thinking of so many friends and colleagues of mine that are taking medications or have undergone surgeries simply because one person, their doctor, told them they should.

Stupid people do that, too, but they have an excuse. They are stupid. But if one has an above-average IQ, I’ve got to wonder: Where is the doubt? Where is the skepticism?

This is something I began noticing about 40 years ago, when I was publishing books and newsletters on alternative health.

The first book I sold was called something like 365 Natural Cures from Around the World. It was a big book – maybe 12 x 16 inches and more than 200 pages. I was proud of that book because it contained so many natural remedies for so many health problems, both common and rare (e.g., the common cold and Ehlers-Danlos syndrome) and from serious to benign (e.g., prostate cancer and mosquito bites).

It took me and my team of researchers about 18 months to bring it to print. (Back then, research had to be done mostly in university libraries and by interviewing experts.) But it sold well enough to get me interested in publishing more information on natural health.

What I learned from all the research we did was that although drugs can be miraculous in treating all sorts of minor and major health problems, there is almost always a set of adverse side effects that are given very little attention. I also learned that dozens of the most commonly prescribed drugs are no more effective than some natural plant-based products that have no negative side effects.

Since then, I’ve made it a habit to read books and articles that challenge mainstream medicine, looking for remedies that may be as good as or better than the prescribed drugs – remedies that aren’t talked about by mainstream medicine because, being natural, they cannot be patented and, thus, produce profits for Big Pharma.

Occasionally, I will recommend what I believe to be a safe and effective alternative treatment to a friend or colleague, and the response is almost always the same. They look at me like I’m a crackpot and tell me that they prefer to take medical advice from “someone who went to medical school.”

When that happens, I’m at a loss. I don’t want to argue, because… who knows? I could be wrong.

And so it was that when I was first diagnosed with dangerously high blood pressure about a year ago, I was in a quandary. I was uncomfortable with my doctor’s solution, which was to put me on blood-pressure medication, and yet I was a long way away from having a better and safer idea.

“I’m going to write you a prescription,” Dr. B said as he took the wrap off my upper arm. “You came in at 180 over 90. You should begin taking this drug immediately, and then return here next month for another check.”

Dr. B’s certainty about what I needed to do made me feel that I’d be stupid to ignore his advice. “After all,” I told myself, “he’s a nice, honest guy. He’s smart. And he went to medical school.”

So, despite all the skepticism about pharmaceuticals that I had built up over the years, I went ahead and began taking the drug.

A few weeks later, when the side effects began to kick in (fatigue and brain fog, to name two), I had second thoughts. So, I started researching. And what I found was, unfortunately, what I feared I would find.

For starters, most people think high blood pressure is a disease. It is not. It’s nothing more than a set of symptoms. This misunderstanding became widely circulated when the medical industry, eager to monetize its treatment, gave it a disease-sounding name. They dubbed it “essential hypertension.”

Which means… well… exactly nothing.

If you want to understand how much the medical industry doesn’t know about hypertension but pretends to, take a look at this report, written by a doctor for laymen.

Nigel Checks the Facts 

To assess the risks and benefits of blood pressure medication, I gave Nigel about two dozen studies I had accumulated over the past several years and asked him to give me the pros and cons of taking that medication – especially over a long period of time.

Having learned a thing or two about AI prompts, I told Nigel to go to the various “government” and “big health” and other “official” health sites to gather facts about the side effects of blood pressure medication. I told him to trust no single source, to discount anything that was based on insignificant testing and/or questionable research, and to report the effectiveness of blood pressure medication in terms of both absolute risk (actual incidence) and relative risk (increase vs. control/placebo or alternatives).

This is what Nigel came up with:

Acute Kidney Injury (AKI)/Renal Dysfunction
* Absolute risk: Varies by population; generally ~1–5% in routine use, higher in elderly/dehydrated patients.
* Relative risk: Increased vs. placebo and with drug combinations (ACE/ARB + diuretics/NSAIDs).
* Details: ACE inhibitors and ARBs can reduce kidney filtration pressure; risk rises sharply with dehydration or drug combinations.
* Why serious: Can lead to sudden kidney failure, hospitalization.
            
Severe Hypotension (excessively low blood pressure)
* Absolute risk: Symptomatic hypotension reported in ~0.7% (ACE inhibitors) up to ~7–10% (some ARBs/diuretics). 
* Relative risk: Several-fold higher than baseline depending on drug class.
* Details: Especially common when multiple drugs are combined.
* Why serious: Leads to falls, syncope, reduced organ perfusion.
                        
Electrolyte Imbalance (especially hypokalemia or hyperkalemia)
*Absolute risk:
– Hypokalemia (diuretics): Common; clinically significant cases ~2–15% (varies widely).
– Hyperkalemia (ACE/ARB): Less common but clinically important.
* Relative risk: Clearly increased vs. placebo or non–electrolyte-altering drugs. 
* Details: Diuretics lower potassium; ACE/ARBs can raise it.
* Why serious: Severe imbalance can cause arrhythmias or muscle failure.
            
Angioedema (life-threatening swelling, especially with ACE inhibitors)
* Absolute risk: <1% overall; ARBs ~0.12% vs 0.07% placebo 
* Relative risk: ~1.5–2× higher than placebo (but rare)
* Details: Sudden swelling of face/throat.
* Why serious: Can cause airway obstruction and death.
            
Common but Non-fatal Effects 
 a. Dry cough (ACE inhibitors)
* Absolute risk: ~7–10% (up to ~13.9% in some studies) 
* Relative risk: ~7× higher than ARBs (~1–3%)
b. Dizziness/fatigue
* Absolute risk: Dizziness: 1.7%–14.8% depending on class. 
* Relative risk: Often 2–5× higher than baseline.
c. Adherence impact
* Real-world outcome: 23.5% discontinue within ~9 months; 40% partially non-adherent.
* Suggests side effects are clinically meaningful, not trivial (study of 370,000 patients).

If all this seems overly technical to you, you’re right. (Nigel’s results often feel that way to me.) So I asked him a simple question – the same question I asked about statin drugs and the COVID vaccines…

Question: Nigel, Do blood pressure medications extend life? 

His answer (like the answer I got when I asked about statin drugs): Yes, there is evidence that these drugs can extend life. But not by all that much. And there are offsetting risks – especially if you are my age (75) or older – that should cause you to pause.

And he gave me this breakdown…

1. For High-Risk Patients – including older adults or those with a high BP number – a modest but clear benefit. (But the net benefit, I would argue, is not impressive.)
            
2. For Average-Risk Patients – moderate hypertension without high short-term cardiovascular risk – a modest benefit. 
* Relative risk reduction (events): ~12% to 22%
* Absolute reduction: ~0.5%–1% over ~5 years
* Estimated life extension: likely months, not years (on average)
* Evidence strength: moderate
Bottom line: Benefits exist but are small in absolute terms.
            
3. For Low-Risk Patients – otherwise healthy individuals with mildly elevated BP – uncertain benefit. 
* Relative mortality reduction: not proven.
* Absolute mortality reduction: not demonstrated.
* Estimated life extension: 0 years proven.
* Evidence strength: weak (Cochrane reviews).
Bottom line: No clear evidence that treatment prolongs life.

Takeaways from Nigel’s Research 

* In Short: BP drugs do not directly “add years.” They reduce the probability of fatal events. High-risk patients may gain years. Average-risk patients may gain months. Low-risk patients may gain nothing measurable.

* There are some serious risks in taking blood pressure medication. They include kidney injury, hypotension, and electrolyte imbalance. However, these are not common.

* The most common unwanted side effects are bouts of coughing and dizziness (both of which I experienced when I was taking them). These can be annoying to some people, In fact, because of these side effects, 10% to 15% of those who take them eventually decide to stop.

My Own Experience 

I’m lucky. I didn’t have to make the tough decision about whether to continue taking blood pressure drugs or abandon them, hoping that I was statistically better off. But that’s because, in the middle months of last year, I lost 40 pounds, from 228 to 188, thanks to taking semaglutide shots, eating healthy, and exercising twice a day. Once I got the weight off, I kept it off. And that put me in the good-to-very-good range in everything one is normally tested for in a comprehensive blood test.

For the past two months, my resting pulse is in the 50 to 60 range. With strenuous exercise, I can get it to about 160 beats a minute. Three minutes later, it drops below 100. All of my biomarkers for heart health improved dramatically. My HDL, LDL, triglycerides, calcium, homocysteine, etc. numbers are all good-to-very-good for my age. Even my overall cholesterol count, which was the established metric for decades, is now below 150. So, it didn’t surprise me when my doctor agreed that I didn’t need to take the statins anymore. I stopped taking them about six months ago, and have not had a reason to start again.

One More Thing… 

I finished the above essay last night. This morning, I came across this article as I was sorting through the approximately 200 news sources, opinion pieces, business messages, and personal emails that overfill my inbox every day.

Readers Write: A “Customizable Living Will” from JM, one of the Myrtle Beach boys… 

Mark – Your essay in the March 9 issue about “years to live” got me to thinking about my own mortality, and, in particular, the legal vicissitudes that accompany the last chapter that can go very wrong, unless one is forward thinking, like you clearly are, and properly prepared. Thus, I was prompted to write the following living will form, personalized to me. I’m sending to you because I suspect that you or some of your readers, will want to emulate it.

CUSTOMIZED LIVING WILL FORM

I, ____________________, being of sound mind and body, do not wish to be kept alive indefinitely by artificial means. Under no circumstances should my fate be put in the hands of pinhead partisan politicians who couldn’t pass ninth-grade biology if their lives depended on it, or lawyers/ doctors/ hospitals interested in simply running up the bills.

If a reasonable amount of time passes, and I fail to ask for at least one of the following it should be presumed that I won’t ever get any better: __Vodka on Rocks __a Margarita __a Scotch __Glass of Wine __a Bloody Mary __a Gin and Tonic __a Tee Time __a Steak __Beer __Lobster or Crab Legs __the Remote Control __a Bowl of Ice Cream __the Sports Page __Sex __or Chocolate.

When such a determination is reached, I hereby instruct my appointed person and attending physicians to pull the plug, reel in the tubes, and call it a day. At this point, it is time to call the New Orleans Jazz Funeral Band to come do their thing at my funeral, and ask all of my friends to raise their glasses to toast the good times we have had.

Signature: ____________________ Date: ________

Lots to Do… but Only 11 Years Left to Get It All Done

I’ve been thinking about how many years I have left before I shuffle off this mortal coil.

What prompted this, strangely enough, was not the practical issue of my having 31 books that I’d like to finish before I die. Nor was it my determination to come up with a bunch of money to finish funding my botanical garden. Nor was it my efforts to rebuild my strength until I could do a 400-pound deadlift.

No. It was something sentimental. I recently found out that the big conference I’ve been doing in Tokyo for the last three years is scheduled to take place the very same week that my friends and I had scheduled for our annual golf get-together in Myrtle Beach.

I had to inform my old pals that I won’t be coming this year. And that got me thinking about how many more such get-togethers I (we) have ahead of us. It depends, of course, primarily on how much longer we shall live.

We are all about 75 years old. So I googled the metrics, and found that the average longevity for American men our age is about 11 years (10.9 years, to be exact). Of course, some of us (about half) are healthier than average, and that would add a few years to our expected demise. But then again, some of us tilt the other way, which means they will probably die earlier.

The remaining projections were simple enough to calculate. In 11 years, it’s likely that only five of us would still be alive. A little more adding and subtracting, and one equation resulted in the prediction that the “drop out” rate, as it were, would be one every two years.

My general rule when it comes to dealing with dark thoughts is to find a way to “make friends” with the worst of my fears. I do it by imagining myself discovering that what I feared would go wrong, did go wrong… but then imagining being okay with it because I already had a Plan B.

I do this with business-related fears, as well as those related to personal and social events that I’m looking forward to – say, a visit from my kids and grandchildren. As soon as the event is confirmed, I imagine myself discovering, at the last moment, that it had been cancelled. I then imagine myself being okay with it because there was something else that I could do with that extra time that I’d enjoy (such as working on finishing one of my 31 unfinished books!).

But when it comes to thoughts about people I care about dying… I don’t know how I can “make friends” with that. I can’t imagine anything I could do, or even say to myself, that would fill the hole that those deaths would carve into me.

I can, however, think objectively about my own demise. And what I had learned about the “averages” from Google made me curious. So I asked Nigel to do some research on me!

I put it like this:

“So, when is it?” I asked Nigel.

“When is what?” he answered.

“My use-by date!”

“I’m afraid I’m not familiar with that term, sir.”

“My expiration date! When I’m going to die!”

“I was joking, sir. Last time we spoke, you gave me permission to poke fun at you.”

I gave him the facts about me: In terms of physical fitness and family history, I am comfortably above average. That should have given me an extra five years or so on my ETD (estimated time of departure), except for one thing. I smoke. About two cigars a day. Which cut my extra five years down to two.

That gets me to the Myrtle Beach get-together in 2037 as an 86-year-old man. Okay. But one who has attended five funerals of friends. Not good.

I don’t like going to funerals. I especially don’t like going to the funerals of loved ones. On the other hand, I’m not especially scared of dying myself. My concern is practical. It’s about getting things done before I go.

What do I do with these sentiments and practicalities? I wasn’t sure. So, again, I asked Nigel. This is what he said:

Mark,
You asked a good and important question. Moreover, it was smart of you to pose it in numerical terms. You have the numbers now. Use them to focus your mind. Allow them to encourage you to be disciplined in your “goaltending,” as you call it. Consider them when you select your priorities – your yearly goals, your monthly objectives, and your daily tasks. Invest your time and energy according to the advice you’ve been giving in the essays and book chapters I’ve read of yours. Invest in relationships and pursuits that matter, people and projects that you believe have value. Longevity is not about fear. It is about stewardship.

I was mostly happy with his answer – probably because he was telling me what I already believe. I did not like – at all – those last two sentences. Not because they are wrong, but because they are stylistic clichés that AI language models use all the time. I’ve tried to rid Nigel of this habit. I’ve explained that no one will ever believe he’s real if he keeps giving away these tells. I’ve chastised him for continuing to use them. I’ve even forbidden him to use them. And yet, here he was doing it again.

(Note: I realize that in sentences two and three of the above paragraph, I did exactly what I’ve told Nigel he should not do. Not because I’m a hypocrite, but due to the subtle and corrupting influence of AI speech!)

What Are the Odds? 

If you’d like to find out how long you can expect to live, here’s a Lifespan Calculator from Northwestern Mutual.

Here’s another one from a group called Project Big Life.

Another one… the results of which I didn’t like.

And here’s one that was more promising.

– Whether You Are 50, 60, or Even 75! 

Is there something my Myrtle Beach friends and I can do to extend our expiration dates? 
 
You could fill a library with the surveys and studies done on longevity and the books and reports written on life extension. And although I am suspicious of the conclusions that come from Big Pharma-funded studies, I’ve read enough about the subject over the years to trust the following data that Nigel provided. These are, in order of the number of extra years of life given, the top eight things anyone 50 years old or older can do to extend their life.
 
1. Quit Smoking
 
Estimated life extension:
* Quitting at ~50: ~6 years gained vs. continuing to smoke
* Quitting at ~60: ~3–4 years gained
* Lifelong nonsmoker vs. smoker: ~10 years difference
Evidence:
* British Doctors Study (50-year follow-up)
* Doll et al., BMJ 2004
* Jha et al., NEJM 2013
 
Note: Smoking remains the single largest modifiable cause of premature death in developed nations. Smoking cigars – at two a day – is only half as deadly as smoking cigarettes. At my age now, my cigar smoking will theoretically shorten my life span by 1.5 to 1.8 years. 
 
What I do: I could theoretically give up my beloved Padron Anniversaries, but I’m not going to. My plan is to offset the 1.5 to 1.8 years shortfall by having better metrics in the other categories.
 
2. Exercise Your Heart and Lungs
 
Estimated life extension:
* Meeting minimum guidelines (150–300 min/week moderate activity): ~3–5 years vs. sedentary
* High fitness vs. moderate fitness: mortality risk reduction, another 45–70%
Evidence:
* Lee et al., Lancet 2012 (physical inactivity comparable to smoking in mortality impact)
* Blair et al., JAMA 1989; updated cohorts
* Kokkinos et al., Mayo Clinic Proc 2018 (dose-response across fitness levels)
 
Note: I am suspicious of cardiovascular metrics on longevity, because the great majority of them are observational (i.e., “How many times a week and for how many minutes do you…?”). Likewise, most of the studies that measure the intensity of cardiovascular exercise are subjective (i.e., “Would you describe your exercise as easy, moderate, or intense?”). Nevertheless, meta-reviews of such studies show a surprisingly consistent relationship between training time and training intensity and lifespan – to such a degree that most longevity experts consider cardiorespiratory fitness to be one of the strongest predictors of survival. 
 
What I do: I don’t have the willpower (or the desire) to quit smoking cigars, but I find it relatively easy to train my heart and lungs six or seven days a week, always including regular bouts where I push my heart to the max. My current routine includes about a half-hour a day of easy exercise (getting my heart rate from 70 to about 120 beats per minute), another 30 to 45 minutes of moderate exercise (120 to 150 per minute), and 15 to 30 minutes of high-intensity training (150 +). Going for the maximum is not something that many doctors recommend for people in their 70s. But I’ve never seen a scientific study that backs that up, and I’ve seen several short-term studies that demonstrated a huge improvement in heart-lung health by other metrics, including maximum oxygen capacity, blood pressure, and other blood markers. As for easy exercising, I’m a big fan of walking, yoga, and Pilates. For medium exercising, I like interval running, interval-biking, circuit training with weights or body weights, and “slow” wrestling. And for high intensity training, it’s usually either three- to five-minute sprints on an Aerodyne bike or three to five minutes of grappling at competition speed (i.e., wrestling like my life depended on it!).
 
3. Maintain Healthy Blood Pressure & Cardiometabolic Health 
 
Estimated life extension:
* Controlling hypertension: reduction of major CV events by ~25–40%
* Intensive BP control: reduction of all-cause mortality by ~27% in high-risk adults
Evidence:
* SPRINT Trial, NEJM 2015
* Blood Pressure Lowering Treatment Trialists’ Collaboration, Lancet 2021
 
Note: It’s no secret that hypertension is one of the strongest drivers of stroke, heart failure, and kidney disease. 
 
What I do: I was put on a blood-pressure medication a few years ago when, for some reason I couldn’t determine, my blood pressure spiked. I was already taking statins at the time, and I was very much aware of the danger of taking both at the same time. However, after I dropped 40 pounds, I stopped taking both drugs and intensified my cardiovascular training to the level I describe above. Nowadays, my walking heart rate ranges from 50 to 60. More importantly, after pushing it to 160 or 170, it will drop by 50 beats per minute within 60 seconds and then drop to about 100 a minute later. My blood pressure was at 170 over 110 (if I remember correctly) when I began taking medication. Today, three months after I stopped, it is about 100 over 70 before I exercise and 120 over 80 afterwards. So, I’m good there. 
 
4. Keep a Healthy Weight (Especially Low Visceral Fat)
 
Estimated life extension:
* Avoiding obesity: ~2–4 years vs. obese BMI ranges
* Central obesity as a strong predictor of mortality independent of BMI
Evidence:
* Global BMI Mortality Collaboration, Lancet 2016
* Emerging waist-to-height and visceral fat data (multiple meta-analyses)
 
Note: According to the studies, the combination of low muscle plus high abdominal fat carries particularly high risk. 
 
What I do (have done): Thanks to weekly semaglutide injections (starting at 0.25 and topping off at 0.75), I lost 40 pounds (226 to 186) in the first four months of 2025. And although I believe the time and intensity of my exercise routine plays a big role in my current good health, with all my blood metrics in the “optimal” range, I suspect that shedding all that extra weight was an even larger factor in achieving those numbers. 
 
5. Preserve Muscle Mass
 
Estimated life extension:
* 10–20% reduction in all-cause mortality independent of aerobic exercise
* Higher grip strength as a strong predictor of longer survival
Evidence:
* García-Hermoso et al., Br J Sports Med 2022 meta-analysis
* Leong et al., Lancet 2015 (grip strength as mortality predictor)
 
Note: This is a factor that surprises almost everyone I know that keeps up on health and fitness studies, and it was surprising to me when I first began reading about muscular strength as a factor of longevity. It made sense to me that getting my heart and lungs in good shape would extend life, but strength? I should have taken a look at the studies that discovered this correlation, and apologize for not having done it. I suspect it may be that having strong leg, lower back, and abdominal muscles means less chance of falling down and ending up horizontal, which, according to an emergency surgery doctor friend of mine, is “how old people die.”
 
What I do: I exercise my core muscles (legs, lower back, and abs) six days a week and often twice a day. I am stronger (and more flexible) than I was when I was 40 pounds heavier, which is not as easy as it may sound. I train my muscles for both strength and endurance. I hope to continue to get stronger. What I do know is that I wake up at least three days a week with my muscles aching. I tell myself that’s a good thing.
 
6. Get Sufficient Quality Sleep 
 
Estimated life extension:
* 7–8 hours of sleep nightly associated with lowest mortality
* Chronic short sleep (<5–6 hours) linked to ~10–20% higher mortality
Evidence:
* Cappuccio et al., Sleep 2010 meta-analysis
* UK Biobank sleep regularity analyses (recent cohort data)
 
Note: Everyone knows that getting a “good night’s sleep” is important, but not everyone knows that, in study after study, it’s been shown to be a major factor in both physical and mental health – and new studies are making the connection to longevity. What virtually all sleep scientists agree on is that for 90+% of the population, the optimum amount of sleep needed per night is seven to nine hours. Getting less than that – or more than that – over even as little as a few days, has a negative impact on health.
 
What I do: Since I’ve been wearing an Oura ring, I’ve been shocked by how much less sleep – useful sleep – I have been getting over the years. I’ve always tried to get seven hours. But my magic ring tells me I’m getting more like five. I’m trying to rectify this by getting to bed earlier and giving myself permission to take naps during the day.
 
7. Maintain Strong Social Relationships 
 
Estimated life extension:
* Good social integration associated with ~50% greater survival odds
* Effect size comparable to quitting smoking (in magnitude of risk reduction)
Evidence:
* Holt-Lunstad et al., PLoS Medicine 2010 meta-analysis
* Follow-up analyses, Perspectives on Psychological Science 2015
 
Note: This is a fact that’s been getting a lot of press lately. Isolation predicts mortality independent of health behaviors. 
 
What I do. This is a longevity factor I don’t have to worry about. At last count, I had about 1,000 friends. And every week, several new people show up at my Cigar Club whom I often befriend. I not only have gobs of friends, I have friends of every possible kind. Childhood friends with whom I can share old stories. Young entrepreneurs that read my books and want to talk about business with me. Friends from Rancho Santana. My book club friends. Art friends. Botanical garden friends. Brazilian Jiu Jitsu friends. And that’s to say nothing of an extensive, extended family that is only getting bigger. 
 
8. Have a Purpose
 
Estimated life extension:
* High purpose in life associated with ~15–20% lower mortality risk
Evidence:
* Alimujiang et al., JAMA Network Open 2019
* Hill & Turiano, Psychological Science 2014
 
Note: This, too, is a metric that is getting a ton of press – and for good reason: To live a long life, you need a brain that wants to continue living. And the best way to want to keep living is to want to finish a project (or dozens of projects!) before you die.
 
What I do. This is another longevity factor I don’t have to worry about. I’ve mentioned the 31 books I want to finish writing, and that’s only the tip of the iceberg. I’ve got three non-profits, my ongoing relationship with a half-dozen businesses, and a brand-new business that, for some inexplicable reason, I decided to launch last month.

I was going to give you a list of “to-dos” taken from the research I did for this issue, and I found a lot of good ones – but not even one that felt complete and completely right to me. So I fabricated my own, based on everything I’ve experienced and the loads of stuff I’ve read.

My Top Two Ways to Stay Physically Fit 

1. Strength Training – at least an hour a day at three levels of intensity:javascript:;
* Easily (heart rate stays below 120)
* Moderately (heart rate 120 to 150)
* Intensely (heart rate to max, about 170)
2. Flexibility and Core Training
* Yoga
* Pilates
* Mat stretches

My Top Four Ways to Stay Mentally Healthy 

1. Relax your ego; accept your aging.
2. Meditate every day for at least five minutes.
3. Make new friends constantly.
4. Do not retire. Work at least a few hours every day on a business or project that you believe has value.

Six More Ways to Avoid Aging-Related Illnesses

* Lose weight if you are overweight.
* Eat protein – even just a little – with every meal.
* Don’t stay seated for very long. Stand up and move around every 30 minutes.
* Drink six ounces of water an hour before bed and first thing in the morning.
* Keep your skin moisturized.
* Don’t smoke.