to live long and well, you hear, take your supplements, don't drink alcohol, lose weight, exercise more, sleep the right amount, have social contacts, take a cold plunge, do a sauna, get your screening tests, make sure your vaccines are up to date, meditate, eat organic, free range, grass-fed, without ultra-processed ingredients, and more.

I'm exhausted just listing these.

We have lives and jobs and families and friends and hobbies.

How much health and wellness to do?

How to decide what's most important to live long and well, dr Bobby, please help.

Hi, I'm Dr Bobby DuBois and welcome.

To Live Long and Well a podcast where we will talk about what you can do to live as long as possible and with as much energy and vigor that you wish.

Together, we will explore what practical and evidence-supported steps you can take.

Come join me on this very important journey and I hope that you feel empowered along the way.

I'm a physician, ironman triathlete and have published several hundred scientific studies.

I'm honored to be your guide.

Welcome, my dear listeners, to episode number 48.

Does achieving optimal health need to be a full-time job?

In essence, how much time and money should you devote to health and how to decide what to do and perhaps what not to worry about?

Well, why, now I'm approaching the 50th episode and I've realized that I've asked so much of you, my listeners, so many things I've recommended for you to do Exercise, sleep, meditation, having proper weight, nurturing social relationships, saunas and cold plunge.

Well, to be fair, I also explored some things that you don't need to do or worry about Seed oils, red light therapy, most supplements, detox cleanses.

Unless you make it a full-time job and really none of us can it's impossible to do everything we might do to live long and well.

So what is best for you and how do you decide what to focus on and perhaps what not to worry about?

I reflected a bit on what I actually do and how did I decide what to do and what not to worry about, and I'd like to share that with you.

By the end of the episode, I hope you'll be able to look at what is a very long list of things you might do to live long and well and prioritize what matters most to you.

Before we get any further, just want to ask folks once again if you haven't had a chance to review or rate my podcast, please do so, and if you're enjoying it which I hope you are, please tell your friends, and if you're not enjoying it so much, let me know.

Love feedback of any type.

Okay, I am reminded of a gentleman by the name of Jim Fix who in the 1970s really was the individual that most popularized jogging, because before that people weren't really focused on it.

He wrote a book called the Complete Book of Running.

So Jim Fix wrote, ran about 80 miles a week and at age 52, he died of a heart attack.

So that gives us pause, that no matter what you do, you can't necessarily guarantee you're going to live long and well.

Now, he had a very tough family history of heart disease, so he may have lived a lot longer than he otherwise would, but that gives us pause.

I'm also reminded of Voltaire, the French philosopher in the 1770s, who has a line that I really, really love the best is the enemy of the good, or let not the great be the enemy of the good.

There's many translations for this.

So really, what we need to figure out is what is good enough, because we can't be perfect, we can't do everything, and that really is our focus for today.

Now, longevity and health needs to fit into our days, and our days are busy as it is but what takes time in those days and where might we find a bit of time to do what might be beneficial to us?

Well, the Bureau of Labor Statistics does a survey of regular life demands and basically, in a 24-hour day, this is how people spend their time.

Work is typically about eight hours a day.

Sleep, going to bed, getting ready for bed all of that, reading in bed about nine hours a day.

Eating takes up an hour or so.

Household, household chores and care take up about two hours a day.

And leisure relaxing, sports, playing with your kids, watching, watching television, reading books that's about four hours a day and that pretty much takes up your day.

So, part one how much could or should we do to maximize our longevity?

Well, it's a lot.

So our exercise alone, the aerobic exercise, the strength, the anaerobic, the balance and flexibility, that's probably could take a half hour to an hour a day to do all of that.

Now, if you have to drive to and from the gym, it could be an extra 30 minutes or an hour to do that.

Well, what about meditation or breath, or yoga?

Well, ideally we do 30 minutes a day, and we've talked about sauna and cold plunge.

Well, there you go, another 30 minutes.

And if you got to drive to the gym to get to the sauna or the cold plunge, you got to add that in.

So already we've consumed two and a half to four hours a day Basically all of your leisure time on those small number of activities.

What about nutrition?

Well, of course, there's protein to worry about.

There's five fruits and veggies a day to worry about.

We want to minimize highly processed foods.

We need to eat fiber, eat organic, eat fish, reduce our sugar, don't eat before bed, minimize alcohol and worry about your microbiome.

A lot of time and focus there.

If you want to do all these things.

And, of course, sleep, the unsung hero we need to get our seven to eight hours a night if possible.

And we talk about social relationships, social connections, strong connections, but that isn't everything.

We want to worry about our blood pressure, make sure it's under control, our cholesterol is good, our weight is where it should be, we got to get our cancer screenings, our vaccines.

We need to visit the doctor yearly, go to the eye doctor, perhaps the dermatologist, the dentist and if we have any medical illnesses, of course we got to deal with those as well.

And as we get older, people say we need to do mind active games or brain games, and the list goes on and on.

This clearly is more than a full-time job, and for each item you focus on whether it's doing the sauna, whether it's doing that strength training each one of these comes with an opportunity cost.

While you're focused on those, you're not playing with your kids, you're not working on your hobbies or travel.

So everything you do has a cost that we need to be aware of and to remind ourselves.

Voltaire tells us let not the best be the enemy of the good.

So that's part of the laundry list of everything you could do, and it's probably getting pretty clear to you that unless you spend most of your day trying to do it, you're not going to be able to do it all.

All right, part two how much should you do?

Well, ultimately, of course, it's a personal choice.

Now, for some, you may have heard of Brian Johnson.

He basically has a goal to live forever.

He basically has a goal to live forever and it is, in fact, his full-time job to try everything he can think of and test out to do that.

Well, most of us don't have the resources or the time, clearly, to focus on that, and we have other things in our life.

Now, you might have heard of the Pareto principle or the Pareto optimization.

If you haven't heard of that, you've probably heard of the 80-20 rule, meaning you can get 80% of the benefit with 20% of the effort.

For example, you don't necessarily need to read a whole book, which might take you five, six, seven hours.

A nonfiction book about Benjamin Franklin.

You might be able to read the synopsis or read an executive summary of a certain document, which takes a lot less time and you get much of the benefit.

So that's, I think, how we want to begin to look at our health options and try to figure out where is the 20% of effort that might give us so much more benefit, and then not worry about the other benefit.

That might take a long time and a lot of effort.

Okay, so how do you begin to build the list of things to worry about?

I'd like to walk through two different ways to think about it.

One, objective what does the evidence tell us that would make the most impact in your life?

And then we're going to round it out with what I call the personalized approach.

So that's the plan.

So, on the objective side, what are the most powerful levers or items that might help your lifespan and your health span.

So we've talked in many episodes in the past about kind of what risk factors have great impact and when I think about what you might worry about, for me there are three elements.

The problem you're trying to avoid, say, a heart disease or a stroke or cancer it's a common thing, a common thing.

Second, there is a risk factor associated with it and that risk factor matters a lot.

And finally, the risk factor is actually pretty common.

So the poster child used to be cigarettes.

Cigarettes are a problem related to heart disease.

It's a true giant risk factor and up until the last 20 or 30 years, many, many people smoke.

Fortunately, fewer do today.

Obesity today probably fits into it.

It affects many diseases.

It's an important risk factor and the risk factor is common.

All right, so let's take a few diseases and figure out what are some of the factors you might want to build into your list of how to live long and well.

So in episode 18 and 37, I talked about how to reduce our risk of heart disease and many of the critical factors included blood pressure getting that under control.

Cholesterol getting that under control, diabetes avoiding it or managing it and, of course, exercise and being overweight.

All of these are known powerful risk factors.

In another episode, we talked about stroke and reducing our risk of stroke, and we talked about something called population attributable risk.

But, once again, many of the factors that help us reduce the risk of stroke are the ones we just talked about Get your blood pressure under control, make sure you're getting your exercise.

So if you're worrying about your heart, you're probably simultaneously worrying about your brain and strokes.

Okay, third thing that's very important to us dementia.

One in nine people above the age of 65 will have dementia.

Now, when we talked about cardiovascular, that's one in two men or one in three women.

So these are pretty common things we want to worry about.

Again, the good news for cognitive decline, which was episode 13,.

If you want to listen a bit more about how we reduce our risk of cognitive decline, again, many of those factors are the same Our blood pressure, our exercise, our sleep.

So if you're working on it for one area, you're getting the benefit that it helps others.

Well, what about cancer?

That's a really important area we'd like to avoid.

Four in 10 people will get cancer at some point in their life.

For colon cancer, it's about colon and rectal cancer, it's about 4%.

For breast cancer, for women, it's about 13%.

So these are real issues to be concerned about.

Fortunately, screening tests like colonoscopy reduce the risk of colon cancer.

Mammograms reduce the risk of breast cancer.

So, again, these might be things you want to fold into your plan.

Action item number one start a list.

A list not of everything you're going to do, but a list of what you might do.

And some of these on your list could be those risk factors.

Make sure your blood pressure is under control, your cholesterol you've got a proper weight, diabetes is taken care of and you're not smoking.

And you might add to that list some of these critical activities and behaviors like sleep, like exercise and like social relationships, and you might add specific interventions.

Get your screening for cancer, like I talked about.

Get your vaccines for flu or pneumonia or shingles.

Covid is a discussion for another day.

All of these elements are evidence-based and really, really impactful.

So that might be what we call our first tier list, where the evidence says these half a dozen or so things will really make a difference and you might want to make sure that you prioritize those.

Okay, at the beginning of the episode I rattled off a list of a zillion things you might do, and on my first tier list you did not hear sauna cold plunge list.

You did not hear sauna, cold plunge.

Nutrition other than just good weight, meditation, breath work, microbiome yes, for each of these there's evidence that they will help us live long and well.

I have episodes on each one.

So of course I believe it.

But in the grand scheme of things, the benefit of a cold plunge, the benefit of breath work, are not nearly as powerful, in my opinion, as the ones we just had above.

So my first tier list may be a place for you to begin.

Of course, as we'll get to in the personalized approach.

If these other elements are important to you, then Of course, as we'll get to in the personalized approach, if these other elements are important to you, then you should add them as well.

Okay, so to develop now the second approach.

So the first approach was the objective one.

What does the evidence tell us will make the biggest impact on living long and well?

Based on the evidence?

So now we need to modify that with the personalized approach, which is built around what matters to you most?

In essence, it's a personalized cost-benefit assessment.

So before we get to what to do and how to do it.

In the personalized area, let's talk about a few terms.

So, when you think about what's important to you, there are two common words.

We talk about lifespan and healthspan.

Lifespan is how long you aim to live or hope to live.

Health span is how many of those years are you active, functional, don't have a lot of pain, your spirits are good, and those are the things we think about.

And so, as we've talked about what might be on your list or your top tier list, that's what we're thinking about, but there's a third concept that I recently ran across, called joy span.

So we have lifespan, we have health span and we have joy span, and this was put together by a woman by the name of Carrie Burnight, a gerontologist.

She has a book on this with that title, and basically what she's putting out is that, as we think about what we want to maximize in our life, yes, years of life are important, and being very functional and healthy is very important, but ultimately, it may be about how much joy we have in our life.

So it may not be we have to have the most years.

It may not be that we have to be able to run a marathon when we're 65 years old, that it may be a lot about joy.

Now you can define joy in many ways.

Some elements consist of contentment or gratitude, or meaning and purpose, and she has four elements in a matrix, which are that you want to continue to grow, you want to adjust as things change or happen, you want to connect to others and you want to give back.

So, as you think through this, one way of personalizing it is to decide how important is lifespan versus healthspan, versus joy span, because that's going to help refine your list.

Another piece of the puzzle is we talked in episode 21 about health type.

Now, what is health type, health type?

There are five of them that I've put together and there's a quiz.

I'll have the link in the show notes.

Many of you have taken it, but it does change over time.

You might want to retake it, and your health type tells you how you acquire information about health, how much information you acquire and how you make decisions.

Some of the health types include the holistic health hacker that's me, who wants to learn everything about it and do as much as possible.

Then you have the single-minded achiever.

They're very focused on one aspect of health and may not be focused on all the other areas.

Then you have something, a type called the contentment creator.

Life matters, health matters, but the health issues need to fit into life, so they're not going to turn their life into a pretzel to do everything.

Action item number two take the quiz.

Retake the quiz.

You'll get a report all about your type and how you might approach health.

This could be a way for you to begin to refine your list of what to do.

The third piece of the framework puzzle is think about your context.

Why do you want to be healthy?

Why do you want to have health span?

Well, you might want to be a very active grandfather, and so you want to stay in shape and be around as long as possible.

For that you may be an avid skier or golfer or play pickleball.

Or you love to go backpacking Okay, that's critical to you.

Love to go backpacking?

Okay, that's critical to you.

And as you think about the many things you could do or not, do keep that in mind.

You may be someone who loves to travel, wants to have the energy, wants to have the strength to take your suitcase and put it in the overhead bin on the plane.

Okay, action item number three what matters to you most?

Lifespan, healthspan, joy span or a blend?

Now we're on to part three, the next steps.

So you develop the beginnings of your list, maybe use the objective approach.

Maybe you pulled together those six or eight items that objectively seem to have the greatest impact and you're going to put that on your list.

Now you may think about your life and you might say from a personalized standpoint boy, if you fell and broke your hip, that would be a real problem and really upset your life.

So you might add more strength work or more balance work.

You may feel like you don't have as much energy as you like and when you do a cold plunge you do feel energetic.

Well, of course, you're going to want to add that to your list.

You may be someone who faces and experiences anxiety a lot.

All right, meditation may be something to put on your list.

Or if you have digestion problems, discomfort in your belly, bloating, you might want to emphasize nutrition or the microbiome.

So now you're going to take the basic tier one list and add some other items to it.

Now we're back to the Pareto optimization the 20% of things that get you 80% of the benefit and that may be what you can do in your life and it may fit in.

So as you think about the 80-20, fit in so as you think about the 80-20, what is really important, what's going to give you the most benefit, what's not?

You might look at your alcohol intake.

You might say you know, I know I'm supposed to have less than three or five drinks a week.

I'm going to drink a little bit more alcohol because that's very important to me.

Obviously, I'm not saying drink 20 drinks a week or have three or four a night.

But you might edge towards a little bit more understanding.

Yeah, there's an increase in some risk, but again, life is about enjoyment.

You might say that's okay.

Or you might say, look, I know Dr Bobby says that a cold plunge would be really good for me, but I don't enjoy it, I don't want to do it.

Okay, maybe that's something you don't include because from a Pareto optimization standpoint it isn't going to give you as much benefit as the other things.

So, ultimately, you take your longer list of what you would ideally like to do, pare it back to meet your reality and your preferences.

Now, if you're going to continue to be able to do this, day in, day out, week in, week out.

You need to enjoy what you're doing.

So, as part of your exercise, as an example, you may enjoy going to the gym Great, maximize that.

You may enjoy cooking.

That may be something you love.

So nutrition will maybe be a bigger part than it might be for somebody else.

Ultimately, you need to lay out a realistic plan.

Action item number four finalize a list that works for you.

Finalize it and perhaps once every quarter, every three months or so, review it, update it, modify it as you need.

Okay, so I've given you a whole lot of things to think about and ways to think about it.

Now it might be helpful for you to know where do I net out?

So, as I went through this exercise, what did I come up with?

Because I realize, even though I talk about all these things, you know I don't have the time to do everything every day or every week, because I have a ranch to run, I have a bed and breakfast to run, I have athletic events like triathlons, ironmans to train for, I have a family, I have lots of things I'd love to do on the ranch.

So when I reviewed all this, I realized for me, living long is really important, of course.

But first and foremost I want to maintain my function.

I want to be able to be on the ranch, I want to be able to be active, I want to be able to compete in races.

That I do so it doesn't mean I'm ignoring lifespan, but I'm emphasizing what will help me maintain function, which often fits into the health span.

Now, as I've thought through the joy span element, I'm going to reflect a bit more and see are there ways I can incorporate more of that into my life as well.

So ultimately I have the big six, dr Bobby's big six.

These are the things that are first and foremost for me.

Number one rigorously control my heart disease risk and my brain risk.

So for me critical make sure my blood pressure is under control, make sure my cholesterol is under control, so risk factors that I can absolutely measure, monitor and do something about.

First and foremost for me.

Fortunately, with medications I'm doing great on those.

Second of the big six sleep.

I am very focused on getting a good night's sleep, which for me means getting to bed around 9 or 9.30 because I'm always going to wake up early in the morning.

So that's critical.

Third exercise and strength.

Those are two that are critical for me for what I'm hoping to maintain and accomplish Now.

I could do more balance work, I could do more flexibility work, I could do more interval training and I will try to do more of those, but exercise the aerobic and the strength first and foremost.

That's number three.

Number four weight.

I want to maintain a good and healthy weight.

Fortunately, genetically and because I'm active, that's been okay for me.

But that will be front and center if at any point I feel like I'm gaining weight.

Number five alcohol.

I am mindful of the issues related to cognitive impairment with alcohol over time, the thinning of the brain.

I have an episode on alcohol little or none, that is the question, and so I try to limit my intake of alcohol to two, three, maybe four drinks per week.

Three, maybe four drinks per week.

And finally, number six very focused on getting my screening tests done, my regular colonoscopies, my PSA levels and vaccines, because I do believe those are a good way to prevent preventable illnesses.

So those are the six that are front and center for me.

They may work for you, they may not work for you.

Now there are lesser ones, of course.

Meditation is something I try to do the sauna and cold plunge Intermittently.

I do it a lot, I do it a little bit, and social relationships are important, but I have enough in my life right now.

I think I'm doing okay there and I generally eat healthy.

Now there are a bunch of things I don't worry about because I have my tier one list.

I don't worry about eating fermented foods or having enough fiber in my diet or seed oils, or being obsessive about the number of fruits and veggies per day or supplements or my microbiome.

Of course I may eat these foods, I may do some of these things, but I do pretty much what feels right.

It's not front and center for me.

All right, let's wrap things up.

Some general thoughts.

To live long and well, to do all the things that we might want to do, is a marathon, not a sprint.

We can't do everything.

Choose the things that matter most to you.

I hope I've given you a framework for how to think about that.

Find, from an exercise standpoint, things that you enjoy H hiking or pick a ball, or maybe you love being at the gym.

That will be more maintainable if it's something you love.

Perhaps, since time is limited, double up.

Go to the gym with a friend.

Go for a walk and have coffee with a friend while you're walking.

That will allow you to do more things with a shorter amount of time.

Give yourself grace to say, no, I'm not going to worry about, you know, doing a sauna or a cold plunge.

I am going to have that you know, croissant on the weekend, or maybe two of them.

So have the grace to say I'm not going to worry about it.

It's not worth it enough compared to all the other things that truly are important.

You may decide some alcohol is okay for you.

You may decide that's not the case.

You may be willing to give up certain foods you enjoy.

You may not be.

You may be trying to lose weight and you may say, gosh, that last 10 or 15 pounds is just almost impossible to lose.

Okay.

So maybe you give yourself the grace to say, look, I don't want to be 30 or 40 pounds overweight, but the 10, 15 pounds may not be impactful enough to upend the rest of my life.

You may have a blood pressure issue and getting it down to the ideal 120 over 80, less than that may not work for you because you may get dizzy, you may not feel right.

So again, you're going to get close to the target, but if you can't get there, that's okay too.

That's okay too.

So, as we begin to say goodbye, what do you think?

Is it too much work to do everything in the live long and well space?

How are you going to frame it?

What are you going to do?

What are you going to perhaps not do?

Please let me know and I will share it with others in a follow-up episode and, again, as always, share the podcast with others.

And until next time, let's all aim to live long and well, but do it from a vantage point of what's feasible, maintainable and gives us ultimately a whole lot of joy span and gives us ultimately a whole lot of joy span.

If you want to continue this journey or want to receive my newsletter on practical and scientific ways to improve your health and longevity, please visit me at drbobblivelongandwellcom.

That's, dr, as in D-R Bobby live long and wellcom.