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Comment by chaibiker | Hacker News Reader

Thank you so much, working on this issue, but didn't expect a reference this far back!

If curious, on the latest in sitting, standing, perching, alternating, a good overview recently from University of Waterloo: https://uwaterloo.ca/centre-of-research-expertise-for-the-pr...

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The most useful health advice is to get cardio and strength training in and eat real foods.

Everything else is a hyperoptimization. Some hyperoptimizations are marginally useful, some aren't actually useful at all.

Humans were built to eat real food, and they were built to use their bodies.

Reducing average sitting bout length has as big an impact as exercise. https://www.nature.com/articles/s41569-021-00547-y

> In this Review, we make a case for an approach to preventing and managing cardiovascular disease that involves ‘sitting less and moving more’.

Its not just 'Reducing average sitting bout length ' though right ?

Also this seems like self reported observational studies?

Right, both exercise and sitting bout length independently are important. You just can't completely exercise away the impact of sitting alone.

Important to get your vo2 max up, as highest as possible, because folks with elite vo2max are dramatically more likely to survive longer than baseline averages.

Also important to focus on getting strong as possible, in both bone and muscle, with some focus on fast twitch muscles. A lot of elderly death can be attribute to some sort of falls. Even if they survive the fall, it can be a road to a fast death.

Another thing not to neglect is to make sure you have movement patterns and that you focus on fortifying the body against injuries. Lifting extreme weight won't do you any good if you can't lift more, ditto for running.

I've been listening to peter attia's new audiobook too. solid stuff.

But where exactly do i find these 'medicine 3.0' doctors. My pcp still uses 'misguided' tests like LDL for cholesterol, serum creatine for renal function ect. Doesn't do host of other tests that he recommends doing by saying insurance won't cover it.

I don't even know where to get my vo2 max tested. I have apple watch which gives me wildly different number than my garmin ( 32 vs 49). I am pretty sure both those numbers are wrong. I am not paying $300 to get my vo2 max tested privately.

I think I would set a budget aside for those sort of things. Accumulating 25 dollars a month to get a vo2 max test isn't as painful as spending 300 dollars of money you don't have. That comes to exactly once a year.

I already spend 300+ dollars a month on health insurance, and I already see how much hospital bills was already costing me(I was hospitalized twice in the same year). I rather spend them on tests which are much cheaper in comparison.

That being said, it's sure a good idea to get one's finance in order, which is what I am working, to facilitate important purchases(such as a foldable bike).

The reality is that unless you can afford to pay for high-end concierge medicine you're going to have to manage most of it yourself. Regular primary care physicians don't have time to deal with non-standard preventative care for people who are basically healthy. You can order many blood tests directly from reference labs such as LabCorp without a doctor but you'll probably have to pay out of pocket.

You don't need any fancy equipment to get an accurate VO2 Max estimate. Just do a Cooper test by running as far as you can in 12 minutes and then plug the distance into a formula.

https://en.wikipedia.org/wiki/Cooper_test

Modern fitness trackers such as recent Garmin watches can also make fairly accurate VO2 Max estimates but you have to give them enough raw data to work with. That means recording several running or cycling (with a power meter) activities of varying lengths at maximum effort. If you don't hit it hard then the device will still make an estimate but it's likely to be way off.

https://www.firstbeat.com/en/science-and-physiology/fitness-...

thank you. I will try the cooper test this weekend in the gym.

That is generally correct, but I wouldn't focus too much on VO2 Max as a single metric. As Goodhart's Law states: "When a measure becomes a target, it ceases to be a good measure."

All else being equal, a higher VO2 Max is better. But in reality we have limited time to train and have to make trade-offs. As a (mediocre) endurance athlete, my race performance has improved even though my measured VO2 Max has declined. Most athletes can only sustain their VO2 Max output for 6 - 10 minutes but I am more interested in being able to hold a high percentage of VO2 Max for a much longer period. I could change my training plan to focus specifically on optimizing VO2 Max but would that actually reduce my risk of premature death relative to what I'm doing now? Doubtful.

Agree with your other points.

It's probably harder to cheat a metric that's physical/biological.

I would say your race performance is different than the goal of increasing longevity. What matters more is how important vo2 max is to longevity.

I'm not talking about cheating a metric. VO2 Max is correlated with longevity but it's likely just a proxy for several other factors. I'm sure I could boost my VO2 Max by a few points if I focused on training that but I'm skeptical whether that would make me healthier than maximizing performance over longer efforts. We just don't have clear data to say one way or the other.

My personal trainer says once you lose the fast twitch muscle, it’s gone for good and most people have lost it by age 70 or so.

> eat real foods

This is kind of a meaningless statement. Those of us that already know about nutrition are going to read that and go "he means eat a small amount of meat, lots of fibrous vegetables, avoid added sugar, high gi carbs" etc etc. But you're basically communicating nothing.

Real foods to me means foods that our ancestors ate for millenia and it was perfectly clear. Another way of putting it would be, foods that don’t come in too much packaging and foods that our grandparents would recognize.

I like "prefer buying stuff from the outer ring of the supermarket" as good general advice.

Hadn’t heard that one before but that seems like good advice.

Michael Pollan wrote about this concept in In Defence of Food. He's also known for the idea of "eat food, mostly plants, not too much". His book goes on to explain what he means by "food" and mentions only eating from outer part of the super market where the fresh meat counters and vegies are.

Michael Pollan was incorrect about plants, though -- it turns out you can just cut plants out of your diet entirely and experience excellent health and fitness as a result.

I follow enough to know that you can remove plants; humans have shown they can survive (thrive even) on a large variety of diets and lifestyles. Do you have any links to something I can read about that you should? that is, the benefits of removing plants entirely outweighs consuming some of them.

I found this podcast interview with Dr. Georgia Ede convincing: https://www.peak-human.com/post/dr-georgia-ede-on-the-shocki...

although I tend to agree with this concept applied to food and diet, I must state that I find it weird to refer to our ancestors for insightful wisdom when by nearly every record-able metric things have gotten steadily better in nearly every way.

I don’t know about that. When I see the lean and fit people in photos from just 50 years ago compared to the walking inflammation I see around me in daily life, I question that assumption.

This may be bad advice for those of us whose grandparents are British, or the other European cultures whose foods are just potatoes, bread, cevapi, and other things all universally colored brown.

Most other European countries seem proud of their food heritage, so it might be limited to England although I'm skeptical about even that as I've had a damn good English breakfast in London.

London should be thought of as a different country to the rest of it.

Former Yugoslavians I've met aren't particularly dismissive of their own food, but they do admit it's not got vegetables in it.

Probably depends on where in former Yugoslavia you’re talking about. I’ve had many amazing dishes in both Slovenia and Croatia.

> he means eat a small amount of meat, lots of fibrous vegetables, avoid added sugar, high gi carbs

You understood it

And to fast. Do intermittent fasting regularly. If you can, do a 3-day fast once a month or a week fast once every 6 months. To lose weight, eat fewer normal sized meals with a larger pause from the last to the first, not smaller meals spread over a large period. Also get your vitamin D, and magnesium, calcium, zinc. I take 4k IU of VitD and have never felt better.

love this term of "hyperoptimization", something in the direction an optimization in the penny-wise/pound-foolish space, an imprudent optimization if you will.

Use the gym. Do it twice a week at least. Learn how to use the gym. Get a trainer for a while so you learn. Get a good chiropractor who can guide you as to what parts of your body need the most work.

Solid advice, apart from the chiropractor. By all means engage a physiotherapist / physical therapist, but not a chiropractor. In my experience it's all spine spine spine with those people.

It was a chiropractor who taught me what to do to be healthy in this regard. Therefore I can't badmouth chiropractors, sorry.

So you have a sample size of one and you are using that as the basis for your advice to a group of people who are not you? Not to rag on you, but this is a common problem with health advice. As soon as we move away from studies people have a thing that works for them that they swear by. We need actual studies and science before we decide one thing is better than something else. Anecdotal evidence is pretty worthless - not totally worthless cause when you are struggling you'll try anything, but pretty worthless.

But just for fun, to balance your one chiropractor I'll give you a different chiropractor story. I hurt my back playing rugby when I was younger, my mum had a chiropractor who she swore by and brought me to. After about 8 weeks of treatment with no improvement I insisted we go to a real doctor. Turned out I'd broken bones in my back. The chiropractor was just treating me for a slipped disk "because 90% of people who come in have them".

I was in a torso cast for 3 months. Needless to say I'm not a huge fan of chiropractors.

You'll find tons of stories of malpractice by all sorts of doctors. (I wouldn't go to a chiropractor if there was a chance that x-rays might be necessary for diagnostics.)

A chiropractor isn't a doctor though, does malpractice even apply to them? It's just quackery from start to finish isn't it? That'd be like suing your palm reader for fraud because they made some prediction that turned out wrong.

Chiropractice is not quackery from start to finish. A chiropractor solved my rsi with simple adjustments and some home stretching and joint exercises. A chiropractor fixed my mom's debilitating back pain after pregnancy. But there are many quacks in the field because it is unregulated, and many practitioners also hold metaphysical or folk beliefs that are totally unscientific at best. I have stories about those too. But a good chiropractor will simply diagnose the level of adjustment needed and provide it, and show you how your muscles and skeletal structure are causing you pain.

The chiropractor I'm talking about asked a lot of questions and gave me a lot of advice about what to do at the gym:

- get a trainer for a while and

- work on stabilizer muscles

- pull 3x as much as pushing

- warm up before the training session so as to get the most of the trainer

- stretches to do after the workout

- etc.

I've never had a doctor of any kind be as helpful as that. All GPs nowadays see you for just 5 minutes. Specialists see you for a bit longer, and even then there's barely enough time to cover half of what the chiropractor I'm talking about did. Now, one of the things about that chiropractor is that she speaks really fast, so there's that.

> Chiropractice is not quackery from start to finish.

I would say it is. The wiki page is quite enlightening.

    vertebral subluxation leads to interference with an "innate intelligence" exerted via the human nervous system and is a primary underlying risk factor for many diseases.

It goes on.

Your fortune teller could tell you they predict your health will improve if you lose weight and eat better, or you might get a real psychological benefit from acupuncture that helps your health for example. It is not that no "alternative medicine practitioner" or snake oil salesman can ever give good advice or help anybody in any way, it is that their practice is not based on science.

I'd never ridicule someone for using alternative medicine, or even doubt they get benefits. And I completely understand the draw of trying alternatives when people are desperate with health problems or have been failed by the medical system one way or another. I can't say I wouldn't try alternatives myself, and I know for a fact the whole medical system can be a shit show and is not always aligned to getting the best outcome for the patient. But I am happy to make people aware that chiropathy is not a field of medicine or based in science if it is being recommended, so they can make an informed choice. It masquerades as being a legitimate medical field, which is the real problem with it and is why I call it quackery.

And many many chiropractors do not subscribe to those kooky theories created over 100 years ago. They just focus on maintaining your spinal and skeletal (and muscular) health and examine the impact on your body. Those are the good ones.

It's still pseudoscience. Some remedial massage and stretching and exercise techniques they do may happen to help, but the rigorous scientific medical disciplines for that kind of thing comes under physiotherapy, orthopedics, etc.

An astrologist could tell me the passage of Jupiter indicates I should maintain a healthy weight and exercise, and while they don't really believe in the kooky theories I should still take the advice. It is good advice and it would help my health if I follow it, and it might work for me and I might be happy. That doesn't mean astrology is a legitimate practice or that I should recommend other people seek out astrologers for their health issues.

You had a bad chiropractor, who probably would have made a bad doctor as well by the sounds of it (just assuming a rugby injury is a slipped disk? did he even check? was he even able to check?)

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