Everyone quotes the sauna study. It is one cohort of 2,315 Finnish men, and the famous group inside it is 201 of them.
I put a full section on sauna in the fifth edition because I use one three or four times a week, twenty minutes. Then I read the literature properly and had to write it far more carefully than I wanted to.
The headline numbers come from the Kuopio cohort. Sauna habits recorded once, by questionnaire, between 1984 and 1989, then followed about 21 years. All-cause hazard ratio 0.60. Sudden cardiac death 0.37. No replication outside Finland.
Three things that are not in the podcast version.
The same research group's 2022 analysis puts frequent use at 0.86, not 0.60.
Debray 2023 randomized 41 adults with stable coronary disease to four sessions a week for eight weeks. They heat-acclimated and showed no improvement in endothelial function, arterial stiffness or blood pressure. A null trial nobody quotes.
A 2024 Swedish study measured the healthy-user problem directly. Sauna bathers were younger, less hypertensive, in less pain, better slept and happier before any sauna.
What survives at moderate certainty is blood pressure: roughly 4 mmHg systolic and 4 diastolic across 15 controlled trials.
I still sit in the sauna three or four times a week. I just cannot tell you it will add years, and neither can anyone else.
@moseskagan Thanks Moses. The "pretend" part of his advice matters too. If you choose to show anger, you're still the one deciding, and that's the whole difference.
@drgabriellelyon In Ironman racing this is the difference between finishing and the medical tent. Over 10+ hours of sweating, plain water alone can dilute sodium enough to cause hyponatremia, so the hydration plan has to be built around sodium, not just volume.
In bed at 9, up at 6, no caffeine after 2 pm. After a hard stretch in September, sleep was the first thing I went back to. When everything slips, start there. The rest gets easier once you're rested.
@moseskagan Five years in is when a gathering proves itself. I've built four peer groups from scratch, and the ones that lasted were built on the same people showing up again and again, not on the program.
After fifty I stopped chasing personal bests in one sport. Now I rotate swimming, running, the Peloton, incline walking and weights, once or twice a week each, plus 7,000 steps a day, helped by walking the dogs with my wife whenever we can.
@drgabriellelyon My own rule is grams of protein a day equal to my pounds of lean mass. With a smaller appetite on a GLP-1, hitting a number like that takes planning, and that is the conversation that should come with the prescription.
The hardest year is the one after the exit.
I watch people prepare for a liquidity event for a decade and prepare for the week after it for about an hour.
What I see, consistently:
The calendar problem arrives first. A founder's week was structured by other people's needs for twenty years. Then it is not. Most people describe the first three months as freedom and the next nine as something they do not have a word for.
The identity problem arrives second, and nobody schedules it. The company was the answer to what do you do. There is now no answer, and the wire does not supply one.
The money problem arrives last and is the easiest of the three. It is the one everyone prepared for.
The people who land well share one thing. They decided what the next thing was before the close, not after. Not a plan. A commitment with a date on it.
The ones who struggle are usually the ones who told themselves they would figure it out once it was done.
If you are twelve months from a sale, the most valuable hour you spend this quarter is not with your banker.
@EricTopol@Cell_Metabolism I eat inside a four-hour window most days, roughly 2 to 6 pm. Interesting that inflammation only came down once fasting was added to the Mediterranean diet.
@foundmyfitness I do 3 to 4 sessions a week at 20 minutes each. In the Finnish data the biggest cardiovascular benefit showed up at 4 to 7 sessions a week, so how often you go may matter as much as which type you use.
Mercedes and I just spent three days at Estate 8 in Napa Valley with my friend @JakeKloberdanz, founder of @ONEHOPEWINE.
Jake and I have been in YPO Forum together for years. ONEHOPE got its start in Manhattan Beach, three blocks from the house where I grew up. It has since sold more than 10 million bottles, donated more than $11 million to causes and supported more than 50,000 nonprofits.
We hiked past the iconic wineries of Rutherford and Oakville, did a two-hour tasting of ONEHOPE wines, and stood at the Heart of Napa, a spiral of more than 50,000 reclaimed stones at the center of the estate.
Jake's line over dinner at Bistro Jeanty: "May what lies ahead be worthy of what brought you here."
I am in bed at 9pm and up at 6. No caffeine after 2pm.
For most of my career I treated sleep as what happened after the work. Now I treat it as a capital allocation, because that is what it is.
The framing I use with executives who tell me they run on six hours: you would not accept a 25 percent haircut on your best asset and call it discipline. You would call it a loss. Sleep is the only input where people brag about taking the haircut.
Three things that made it hold.
A fixed wake time, not a fixed bedtime. The wake time is the anchor and the bedtime follows it.
The caffeine cutoff. 2pm, and it is one of the few rules I actually keep. Caffeine's half-life is long enough that a 4pm coffee is still working at 10.
Three hours between the last meal and bed. I stop eating by 6.
None of it is heroic and none of it needs a device, though I wear an Oura ring and read exactly three things off it: resting heart rate trend, HRV trend, and what time I actually went to bed.
The protocol was never the hard part. Deciding that 9pm outranks whatever else wanted the hour was the hard part.
@drjamesdinic The dog walk is how my wife and I build movement back in. A 1.5-mile loop most days, about 28 minutes, gets me most of the way to 7,000 steps and doubles as our time together.
@drjamesdinic I ate out most of the time when I was younger. Now I cook most meals at home, the same few meals most days, and that makes my protein target easy to hit.
The simplest thing most people can do for their energy is a protein shake made with whey isolate. Here is why, and here is the number that actually decides it.
Most of the argument you will read online is about bioavailability, and for whey that is the wrong argument.
DIAAS is the score that matters. Above 100 means the protein already exceeds adult requirement for its limiting amino acid. Whey isolate scores 125 against the adult pattern. Whey concentrate scores 133. Both are well past the line, which means amino acid quality decides nothing between them.
The decision is what else is in the powder. Isolate is 90 percent protein or more against 70 to 80. Under a gram of lactose against three to five. Near zero fat. More protein and more leucine per calorie.
That is why I use isolate and why I recommend it. If you are trying to hit a protein target without dragging sugar, fat and lactose along for the ride, isolate is the better powder, and the difference is largest for people who find concentrate hard on their stomach.
A disclosure, because it matters here: I sell whey isolate. The reason above is the one the book gives, and the study behind it is in the footnotes.
One shake a day. 30 to 40 grams of protein, water or milk, in the time it takes to rinse the blender. It is the least heroic thing on my list and one of the most reliable.
@EricTopol Cardiorespiratory fitness is one of the strongest predictors of all-cause mortality we have, and most adults can move it with two or three hard sessions a week. It gets far less attention than it should.