5 habits to have a long, happy, and fulfilled life (or maybe just a long one)
A beginner-friendly longevity road map, if you will. These 5 habits will help you get 80% of the way there for 20% of the effort
Top of the morning, sapien. Welcome to Common Sense Medicine, where I try and keep you up to date on the latest and greatest in longevity science.
As I’m studying, I have a saying which helps me stay motivated: a sh**ty workout is better than no workout. Repeat it after me, a sh**ty workout is better than no workout. If you’ve never done medical boards’ style questions, I envy you. It’s a huge paragraph worth of question stem, and then the 5 answer choices that they give you are all correct, but one is ‘more correct’ than the other. Then, to make it even worse for your mental health, they put the percentage of people who chose the answer you did. If you’re anything like me, you see a very small percentage of people chose the (wrong) answer that you did, and you immediately want to chuck your computer against a wall.
But, that’s why I have this newsletter—to shout my incessant intros of progress into the void. This week, since I’m still heads down, I thought it would be good to go over some of the foundational habits which I think incorporate living healthily. I think there’s a lot of discussion about optimization in longevity spaces, while the baseline health isn’t even taken care of.
This issue is focused on the few simple habits which can get you 80% percent of the way there when thinking about how to live a “healthy” lifestyle. I like simple rules to follow because the simpler a system is, the more likely I’ll continue to do it (see this newsletter: 1 topic a week, publish on Friday mornings, etc.). Let’s get down to the five habits.
Other items on the differential:
[UPDATE] I like to say that my thinking is fluid, and that views evolve over time. That can happen in a few months or a few years. WIth this hip impingement issue, I’m trying to test out different ways to squat. I’ve been reading more about gluteus medius stretches like these and listening to a wider variety of internet voices on stretching like Squat University. Again, this is all about experimentation and creating an environment where you can get the movement that you need, day after day.
Traditional media still likes to talk a lot about health. I liked this piece by Dr. Dhruv Khullar, who’s a professor at the Weill Cornell Medical College which described the problems with the American Diet. I think it’s also an interesting illustration of of “Chad Health” and “Trad Health” perspective, focusing on the difference between the intuitive, “eat-what-grandma-ate” type advice and then the traditional, evidence-guided, RCT focused advice. I learned about the different groups of processing for foods, as well as the different randomized trials coming out of the N.I.H to study nutrition not through recall studies, but through actual calorimetry. Pretty cool!
THE WEEKLY DOSE
The Pareto Principle Prescription
One of the things which I’ve found very surprising about life is that 80% of your success is based on 20% of the things that you do. It’s either very demoralizing or very inspiring, depending on how you look at it. It depends on the day for me, but I think the goal should be to find the few things that move the needle and relentlessly execute on those few things because then success becomes sustainable. It’s much easier to find focus on the few things that work for you and then work on doing them than work on 1,000 things and none of them pan out the way that you want. It’s why I have only 3 quarterly goals (see previous issues), and just focus on them rather than focusing on everything under the sun.
I watched this interview of self-professed “death-conqueror” Bryan Johnson talking about his ideas about why longevity escape velocity (i.e., not dying) is humanity’s next achievement. Johnson is spending a LOT of money to get more life; I think that there is a happy medium where someone doesn’t have to sell a multi-million dollar company to get many of the benefits that he’s getting with hyper-optimization. At one point, the interviewer asks him about what practical takeaways (“power laws”) he would suggest for his patients to get a pareto distribution of the results that Johnson is getting.
I thought this was particularly appealing because I think it’s really easy to dive deep on topics like sleep, exercise, nutrition, and mental health (and spend a lot of money on crazy things, like a subscription for a mattress in the name of optimization) but if we could find a few simple habits which we can do consistently, then it becomes a lot easier to live a long life largely because we’ve emulated the phenotype even if we don’t have the particular genotype. As I said in the intro, a sh**ty workout is better than no workout.
Not to give up the newsletter’s roots, I’ll write about the evidence which shows that the habits that I’m writing about have high numbers-needed-to-treat (NNTs), a standard which describes how many patients need to do the habit in order for us to see an effect.
Habit 1: Don’t be a martyr
As you’ve probably gathered in this newsletter, much of the research on longevity focuses on avoiding “bad” behaviors. These include staying up late and sleeping poorly, skipping exercise, or engaging in harmful habits like drug use. Often, these are things you already know are detrimental, but they persist because present-you prioritizes short-term satisfaction over the interests of future-you. I’m not perfect (as the intros of this newsletter clearly show), but I try to focus on what I can control.
Improving your life by removing negatives rather than adding positives is not a revolutionary concept, even if it feels counterintuitive. This approach is closely tied to the idea of via negativa — the principle of improvement through subtraction. Empirically, it makes sense: it’s often easier to stop doing something harmful (e.g., staying up late, ordering takeout) than to initiate a new, beneficial habit (e.g., exercising regularly, cooking healthier meals).
Take weight loss, for instance. For someone with obesity, losing weight is one of the most effective ways to reduce disease risk. While there aren’t specific trials directly linking obesity reduction to decreased mortality, we can approximate the impact by examining related conditions. For example, a modest 5% weight loss can help individuals with type II diabetes stop taking oral hyperglycemic medications (NNT=9). In obese patients with hypertension, losing 10 pounds or more over three years can enable many to discontinue antihypertensive medications (NNT=3). These outcomes often come from subtracting harmful behaviors and reducing caloric intake. When hunger strikes (absent any hormonal or medical problems), it’s an opportunity to focus on adding nutritious, filling foods — like protein, fiber, and vegetables — that stave off cravings.
If you feel like you’re on a path to declining health, it’s important to remember that the biggest step forward often comes from simply stopping the harmful behaviors first. Being a martyr by prioritizing your career or other life goals over your health can be detrimental on two fronts. Paradoxically, prioritizing your health can make it easier to succeed in other areas of your life.
Habit 2: Don’t smoke
I think this is the most obvious parameter which the “common Joe” may know about health, because it’s been hammered into our collective psyche due to public health messaging. Smoking cessation is one of the most high-value interventions from a NNT perspective, and it’s not even close. Evidence shows that the NNT can be as low as 6 for patients who go on smoking cessation treatments like varenicline and can be higher for at least one controller therapy (NNT = 19). Other figures put the NNT to be more powerful, with an NNT of 15. To put the NNTs that I have discussed into perspective, let’s think about the NNT for another treatment for cardiovascular disease, aspirin. To prevent 1 excess death for cardiovascular disease in a meta-analysis of over 164,000 patients, the NNT was 265. For smoking, the association speaks volumes — smoking less is a good thing, and it’s not a contest.
This brings me to another point—the rise of smoking. There’s been a troubling trend of people rejecting “wellness culture” to pick up smoking. I hope that by now, I’ve convinced you that doing “less is more” with prevention and longevity. If not, read some of my other posts if you need a refresher. I think that this trend is happening largely because it’s a way to not care about taking care of your body, or it’s too overwhelming. But as I said, most of the things that we do to take care of our body (including these habits) are largely by taking away and not by addition.
Habit 3: Exercise 6 hours+ per week
I know you’re thinking that this is impossible. Or maybe you’re thinking that I lied to you about “subtraction” because this is clearly an “addition” to your life. The important thing that you have to remember though, is that while subtraction is easy and can be done instantaneously, adding something into your life requires a mindset shift. As someone who has come into exercise pretty recently (I haven’t been seriously training for a year yet, but it’s coming up soon), I think the way to do this is to focus on the minimal effective dose that you can do and building that up.
I think the problem isn’t the first day, second day, or even the first week of exercise. I think it’s the second or third week when you have other things to do, and your boss is making sure that you have to finish something for work, and there’s just no time at all to get to the gym. I think that’s when you make yourself a martyr again and decide that you don’t want to continue to go to the gym. Exercise has been shown to be the single most effective intervention which helps prevent mortality in multiple mechanisms. There isn’t really a NNT for exercise compared to all-cause mortality, but there are interesting cohort studies which looked at exercise and all-cause mortality associations.
In fact, another “longevity influencer,” Dr. Peter Attia, covered these associations in a blog post about the Generation 100 study. He saw that even though the 37% risk reduction of all-cause mortality wasn’t significant in the HIIT subgroup and the risk reductions weren’t meaningful in the other subgroups as well, the protocol said that they couldn’t limit the control group from exercising themselves (because it would be unethical). This might have blunted the effect exercise had as an independent variable and might have prevented the study from reaching statistical significance.
Even further, it’s hard to even do this study because there are so many types of exercises and it makes it difficult for the beginner to start. I suggest just starting to walk 3x a week for 30 minutes as a start if you’re not exercising at all, and then building it up to routine where you’re walking every day. Then (this might not be the same as others), but I would recommend finding a flexibility routine and bringing yourself up to speed with bodily awareness before touching a weight or the treadmill for a run. Then, move onto resistance training and hypertrophy workouts (muscle mass and strength is correlated with longevity). Then, add in a cardiovascular exercise for VO2 max training to round out the training (haven’t written a post yet, but it’s coming!). This is something that I’m following in my own life, and I think it could be helpful for the new beginner who’s on the same path.
Habit 4: Eat a non-sh**ty diet, aka a Mediterranean Diet
Before I get smacked to the ends of the nutritional social media hell, let me qualify. I think that there are many diets which can be healthy. However, the best one is one which you can stick to. Looking at the evidence though, it’s pretty clear that there is a diet which has evidence behind it specifically for cardiovascular mortality, and that’s the Mediterranean Diet. So, I’m not endorsing this ONE particular diet, but I’m saying it has worked for me and there is evidence to guide that decision. This doesn’t mean that if my olive oil isn’t extra virgin I’m going to freak out, but it does mean that I’m going to try and focus on consuming vegetables, fruits, legumes, fish, nuts, and olive oil, while limiting red meat, processed foods, and sugary items.
The trial which I’ve always referred to when thinking about diet is the PREDIMED study, which has been retracted and then republished due to some concerns about randomization variability. I think that it is a large scale trial which we haven’t really seen in the nutrition world, and it provided some evidence at interim endpoints that it was helpful for weight loss. At the end of the trial (which was stopped early), it showed a significant decrease in a composite outcome for cardiovascular outcomes (although this was only significant for strokes and not for myocardial infarctions or CVD-related death).
In the study, they were provided free supplies of extra virgin olive oil (EVOO) (Bryan Johnson, is that you?) and nuts , supported by regular individual and group dietitian sessions. Compliance is assessed through yearly food frequency questionnaires (FFQs), biological markers (e.g., plasma fatty acids, urinary polyphenols), and additional validation studies.
The takeaway here is that the NNT for diet is a lot less understood than the other things on this list. I think a safe bet would just be to eat a lot of fruits and vegetables, get at least 1g / lb of body weight of protein, and then moderate complex carbohydrates (i.e., brown rice, legumes, beans) and healthy monounsaturated fats (i.e., EVOO). I suspect via negativa will play a huge role here as well if you’re not monitoring this closely. In the beginning, I would suggest using a calorie tracker (I use LoseIt but there’s also other ones like MacroFactor) and a scale, and just monitor what’s going on.
Are you gaining weight? Are you losing weight? What are you eating every day?
Over time, it becomes easier to stomach changes because you have the habit of logging everything you eat and being honest with yourself. When you have the check in the next day, then you’re focused on making sure that you’re hitting the daily macronutrients which you need. It becomes a lot easier when you have templates for each meal that you’re cooking rather than inputting the foods in manually. This remains one of the hardest things that I do day to day. I think it’s worth putting together a list of ways that it could be helpful for you, but I think this post would be too long if I was to do that.
Habit 5: BMI 18.5 - 22.5
This is another simple statement but hard to do. It’s been shown that caloric restriction (which means just restricting what goes in) is positive for longevity. When losing weight, in the scientific world we focus on caloric deficits, which cause weight loss due to the increased burn of calories relative to the ones which you are consuming. This causes you to lose weight until you hit the equilibrium of staying at the same weight. I talked about losing weight in the previous example, on how being a martyr can cause you to sabotage your health in ways that can be insidious at the time but can compound over time. I think that this habit is more of a lagging metric to see whether you’re at a good weight for longevity. I think this isn’t a hard and fast rule— if you have significantly more muscle mass, you might blow way past this benchmark.
I think there’s no publication which supports this, nor is there a NNT for achieving this BMI, but I think it’s a good goal to shoot for if you’re around this BMI (which people should be, at least in the US, ~60-70% of each state is between normal and overweight BMI). I think this is an achievable goal for most people, barring crazy abnormalities, in this particular bracket in 0.5-1 year, with the caveat that they are focused on these few habits, they are focused on making this their primary goal for the next year, and really creating a new identity around health (for context, my BMI right now is 21.9, I’m creeping up due to the bulk but still keeping this as a rough outline even though I know the nuance around using this as a general metric).
Bonus Habit: Moderate to no alcohol
I will say in no uncertain terms that alcohol is killing you. It’s a poison, and many people know that. However, it’s a great social lubricant, which is why it’s so pervasive in all social settings. I’m not saying to not use alcohol, but the evidence is stark that any alcohol is associated with an increased in cardiovascular mortality, and all-cause mortality. The risk is exponentially increased, however, for >7 drinks per week and it increases non-linearly from there. The upshot is that, while alcohol isn’t great for you, people still drink prevalently. 1 glass of wine per day isn’t particularly good for you, but it’s not terribly bad if you’re drinking for social reasons. It’s easy to be a moderate drinker (6 glasses of wine + 2 on the weekend), but again, it’s all about the mindset shift — if you’re focused on making this a habit, then it can pay off in dividends.
Practical takeaways and concluding thoughts
I'll conclude by saying that these 5 habits + bonus habit are not supposed to be done all at once. They are more of guidelines on how to live your life, and they're supposed to be pervasive, permeating throughout your life, rather than prescriptive (one-and-done). I think that it's really easy to forget something that's happening in your life and fall off track, but the key is to build these habits gradually and sustainably.
Start with the easiest changes first - the "via negativa" approach of removing harmful behaviors. If you smoke, focus on quitting. If you're regularly staying up late, work on fixing your sleep schedule. These subtractions often require less active effort than adding new habits, making them excellent starting points.
Once you've tackled the obvious negatives, begin incorporating positive habits one at a time. Maybe start with daily walks, then gradually build up to a more comprehensive exercise routine. Remember, consistency beats perfection - it's better to do a modest workout three times a week for a year than to burn out after two weeks of intense daily training.
For diet changes, begin with small adjustments like adding an extra serving of vegetables to your meals or swapping out processed snacks for nuts and fruits. The Mediterranean diet doesn't have to be an overnight transformation - it can be a gradual shift in your eating patterns.
The BMI target should be viewed as a long-term outcome rather than an immediate goal. Focus on building sustainable habits around nutrition and exercise, and let your weight naturally settle into a healthy range over time.
As for alcohol moderation, start by being more mindful of your drinking patterns. Perhaps begin by eliminating weekday drinking or setting clear limits for social occasions. Remember, you don't need to completely eliminate alcohol to see benefits—even reducing consumption can make a significant difference.
The beauty of the Pareto Principle is that it reminds us we don't need to be perfect in everything to see meaningful results. These habits represent the 20% of actions that can drive 80% of your health outcomes. They're not about optimization to the nth degree like Bryan Johnson's protocol - they're about finding sustainable, evidence-based practices that can fit into a normal life.
Start small, be consistent, and remember that health is a marathon, not a sprint. The goal isn't to transform your life overnight but to gradually build habits that will serve you for decades to come. Focus on progress over perfection, and celebrate the small wins along the way. After all, the best health protocol is the one you can actually stick to for the long haul.
THE PRESCRIPTION
Q1 2025: Hypertrophy Cycle Progress
The upshot: I was studying for my test, and I didn’t track weight.
More information: My weight did stabilize, but I wasn’t being very mindful about it. I think that this week I’m focused on getting back on track. I think it’s not as bad as it looks like, but I think that the weight is still going up. I’m focused on creating the surplus this week as I’m getting back in the gym after the weekend. Still targeting 3-5 times a week of training hard with the busy schedule, as I have a few trips planned around a busy medical rotation schedule. Still on track for 1 lb / week of the bulk.
JOURNAL CLUB
There are a couple of essays worth reading this week on Substack about wellness, particularly Don’t Not Die by Spencer Klavan and Exploring fringe wellness trends by Christine Mineart. I think they both explore different perspectives on how health can dip from “live a little bit more mindfully” to, on one extreme, “let’s hyper-optimize everything!” and on the other extreme, “everything is killing us, our doctors are lying to us, and therefore I need to pay $1000 to do a juice cleanse and smear my face in tallow.” I think that each of these points has merit.
On one hand, as Klavan writes, there’s merit to saying that health enables a good life, and we shouldn’t deprive ourselves of experiences just to live longer. I tend to agree with this statement, which is why I write about what I’m doing week-to-week to show that I’m infallible, I get off track, because I too want to live my life, and not just extend it.
Now, let’s talk about the other piece. I’m a medical conservative — I think generally if there is a zero cost endpoint which I should be incorporating, I’d love to try it. But some of the trends that Christine wants to explore in 2025 only have intuitive hunches behind them (no RCTs, no NNT, just preclinical / observational studies and vibes), which makes it hard to justify shelling out
REMEMBER, IT’S JUST COMMON SENSE.
Thanks so much for reading! Let me know what you thought by replying to this email.
See you next week,
Shree (@shree_nadkarni)