The Longevity Podcast: Optimizing HealthSpan & MindSpan

Train For Your Future Self

• Dung Trinh

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We flip health planning by backcasting from the final decade of life and engineering the strength, fitness, and biomarkers needed today. From APOB and Lp(a) to DEXA priorities, strength standards, and hormone clarity, we build a practical roadmap for longer, better years.

• defining the marginal decade and backcasting
• VO2 max decay and fitness as strongest risk modifier
• strength and muscle as metabolic armor
• bloodwork that matters: APOB and Lp(a)
• lipid strategy: diet limits and effective medications
• DEXA focus on bone density, visceral fat, lean mass
• fracture risk and heavy strength interventions
• menopausal therapy reappraised after WHI
• men’s hormones, free testosterone, and fertility
• provocative frontier: rapamycin and ovarian lifespan


This podcast is created by Ai for educational and entertainment purposes only and does not constitute professional medical or health advice. Please talk to your healthcare team for medical advice.

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SPEAKER_02:

Welcome. Thanks for sharing this stack of source material with us. Today's deep dive is really for you, the person who wants to get way ahead of the curve, not just react to things.

SPEAKER_00:

That's right.

SPEAKER_02:

We're going to try and cut through some of the noise and find the uh objective markers and the philosophy that really drive health span and lifespan.

SPEAKER_00:

And it's all about being systematic. The sources really champion this idea of an engineering-based approach. We're looking at everything: exercise, nutrition, hormones, even pharmacology.

SPEAKER_02:

Trevor Burrus, Jr.: So the mission today is to figure out how to define your health trajectory right now.

SPEAKER_00:

Aaron Powell Exactly. To define it against a future that you actually want.

SPEAKER_02:

Okay, let's unpack that because we're starting with a concept that sort of flips how you think about long-term health on its head. It's called backcasting.

SPEAKER_00:

Right. And it's all about something called the marginal decade.

SPEAKER_02:

We all forecast, you know, we plan for next year, maybe five years out. But this is about starting from the end and working backwards.

SPEAKER_00:

Aaron Powell It's essential because we have to know what we're aiming for. Longevity isn't just one thing, it has two vectors. Life span, which is, you know, binary, you're live or you're not.

SPEAKER_02:

Simple enough.

SPEAKER_00:

And then there's health span. That's the quality of that life, your physical abilities, your cognitive function, your emotional well-being.

SPEAKER_02:

And the marginal decade is just the last 10 years of your life.

SPEAKER_00:

That's it. And the backcasting exercise is to define in like exquisite detail what you want to be able to do during that decade.

SPEAKER_02:

So not just be alive, but like specific actions.

SPEAKER_00:

Exactly. Do you want to be able to pick up a great grandchild from the floor, play with them without assistance? Do you want to be able to get up on your own?

SPEAKER_02:

I love that because that sets the goal. It's not this vague, I want to be healthy. It's an engineering problem.

SPEAKER_00:

It is an engineering problem. You've established the objective function.

SPEAKER_02:

Yeah. If you want to run a five-minute mile, you train for that. If you want to be a fully capable 90-year-old, you have to train for that.

SPEAKER_00:

And you have to start training now. Because backgasting forces you to quantify what's needed today to fight what the sources call the gravity of aging.

SPEAKER_01:

The gravity of aging, I like that. It's this constant pull downwards.

SPEAKER_00:

It is. Your VO2 max, for example, your body's ability to use oxygen, it declines by about 8 to 10% per decade. Every decade, starting in your 30s.

SPEAKER_02:

So wait, if I want to be functional at 90, say I need a VO2 max of 30 just to be independent. What does that mean for me at 50?

SPEAKER_00:

Well, you have to do the math backwards.

SPEAKER_02:

Yeah.

SPEAKER_00:

You might need to be at, say, 42 or even higher at 50 just to have a buffer for that predictable decay.

SPEAKER_02:

So if you're not fit now, you're basically taking out a loan against your future self's mobility.

SPEAKER_00:

You are mortgaging your future physical capabilities. That's a perfect way to put it.

SPEAKER_02:

Okay. That makes so much sense. So if we're going to engineer this, we need data. Let's talk metrics. Blood work, how often, and what are we looking for beyond the basics?

SPEAKER_00:

Everyone should get a baseline early. I mean, even in your 20s. You need to know if you have any genetic landmines waiting for you.

SPEAKER_02:

And after that baseline.

SPEAKER_00:

For someone who's already optimizing, maybe two to four times a year, mostly to track an intervention or just confirm you're stable.

SPEAKER_02:

Yeah.

SPEAKER_00:

But the standard lipid panel, it's just not enough.

SPEAKER_02:

Right. Everyone's fixated on their LDL, their bad cholesterol. Why is that an incomplete picture?

SPEAKER_00:

It's incomplete because it measures the mass of the cholesterol, not the number of particles carrying it. The real culprit is the particle number.

SPEAKER_02:

Ah, so it's not the weight of the cars, it's the number of cars on the road causing traffic jams in your arteries.

SPEAKER_00:

Perfect analogy.

SPEAKER_02:

Yeah.

SPEAKER_00:

And the metric that measures that is ACOB or apolepoprotein B. It is the single best predictor of your risk.

SPEAKER_02:

APOB. Got it. And there was another one you have to check once.

SPEAKER_00:

Yes. LPA, luboprotein, little A. It's the most common genetic driver of atherosclerosis. It affects like 8 to 20% of people. You just check it once to know if you have that risk factor.

SPEAKER_02:

And all this ties into the four horsemen of disease, right?

SPEAKER_00:

Yes, exactly. Atherosclerotic disease, so heart attacks and strokes cancer, neurodegenerative disease like Alzheimer's, and metabolic disease.

SPEAKER_02:

And those four account for what, 80% of death in nonsmokers?

SPEAKER_00:

Aaron Powell About that, yeah. And blood work is our best weapon against the atherosclerotic and metabolic horsemen. And metabolic health fuels the other two, so we start there.

SPEAKER_02:

Okay, let's move to functional testing. Blood work can't tell you about your bones or muscles. We need a DEXIS scan.

SPEAKER_00:

Right. And most people think DEX is just for body fat percentage. Trevor Burrus, Jr.

SPEAKER_02:

Which you're saying is the least important metric from that scam.

SPEAKER_00:

It is. It's number four on the list. Yeah. The big three are one, bone mineral density or BMD, two, visceral fat. That's the dangerous fat around your organs.

SPEAKER_02:

And number three.

SPEAKER_00:

Appendicular lean mass index. Basically, how much muscle you have in your arms and legs. It's your strength reserve.

SPEAKER_02:

Aaron Powell, let's talk about bone density for a second because the risk there as you age is it's terrifying.

SPEAKER_00:

You're catastrophic. If you're over 65 and you break a hip from a simple fall, your one-year mortality rate is between 30 and 40 percent.

SPEAKER_02:

30 to 40 percent from a broken bone.

SPEAKER_00:

It's the cascade. Yeah, immobility, the complications, that's what gets you.

SPEAKER_02:

And our peak bone mass is set by our mid-20s. So what's the intervention now? How do we protect ourselves?

SPEAKER_00:

Heavy strength training. Things that put sheer force on the bone, power lifting, heavy farmer carries. You have to stress the bone to make it stronger.

SPEAKER_02:

That morbidity risk is a huge motivator. But let's shift because the data on cardiovascular fitness, it's even more powerful. I mean, the numbers are just staggering.

SPEAKER_00:

They really are. To put it in context, we all know smoking is bad. It increases your all-cause mortality risk by what, about 40%?

SPEAKER_02:

40%. Okay. That's our baseline for very bad.

SPEAKER_00:

Right. Now, VO2 max. If you compare people in the bottom 25% of fitness to those in the top 2.5%, the difference in mortality risk is fivefold.

SPEAKER_02:

Wait, fivefold as in 400%.

SPEAKER_00:

A 400% difference. The sources are crystal clear. It's the single strongest predictor for any modifiable behavior we know of.

SPEAKER_02:

That is just, it's unbelievable. And strength is right up there, too, isn't it?

SPEAKER_00:

Absolutely. Low muscle mass versus high muscle mass is associated with a threefold, a 200% greater risk of dying from anything.

SPEAKER_02:

So muscle is your metabolic armor.

SPEAKER_00:

This is your metabolic sink. It's crucial for insulin signaling, glucose control. And exercise is probably the best thing you can do to prevent Alzheimer's.

SPEAKER_02:

This basically proves what you could call a Tia's rule. Until your exercise house is in order, maybe don't waste time debating niche supplements.

SPEAKER_00:

I mean, it's about priorities. Nail the big rocks first.

SPEAKER_02:

Okay, so let's give people some tangible goals for, say, a 40-year-old.

SPEAKER_00:

Yeah, some objective metrics. You should be able to do a dead hang for two minutes if you're a man, one and a half for a woman.

SPEAKER_02:

Okay.

SPEAKER_00:

You should be able to hold a deep air squat, like a wall sit, for two minutes, and a farmer carry with your body weight for men, or 75% for women, for two minutes.

SPEAKER_02:

If you can hit those, you're building that reserve capacity for the future.

SPEAKER_00:

You're building that buffer against the decline.

SPEAKER_02:

Okay. We have to talk about cholesterol. There's so much confusion. Let's start with what we eat.

SPEAKER_00:

Right. Let's get some cholesterol clarity. The cholesterol you eat in eggs or whatever has almost no impact on the cholesterol in your blood.

SPEAKER_02:

It's not the dietary cholesterol.

SPEAKER_00:

No. It's saturated fat that for many people raises those dangerous APOB particles.

SPEAKER_02:

So if APOB is the target, what's the goal? I mean, average isn't good enough if average people get heart disease.

SPEAKER_00:

That is the key insight. To be essentially immune to heart disease, you'd need to keep your APOB incredibly low. Ideally, below 30 milligdl.

SPEAKER_02:

30. The lab reports say under 100 is good.

SPEAKER_00:

Right, but under a hundred just means you'll probably get heart disease in your 70s instead of your 50s. 30 is the level you see in newborn babies in populations that don't get heart disease.

SPEAKER_02:

And there is no way you can get that low with diet alone.

SPEAKER_00:

For almost everyone, no. Diet won't get you there. This is where pharmacologic intervention often becomes necessary if you're serious about prevention.

SPEAKER_02:

So what are the tools?

SPEAKER_00:

The main ones are statins, which slow down production in the liver, azetamebe, which blocks reabsorption in the gut, and then the big guns, PCS canine inhibitors, which basically supercharge your liver's ability to clear apopey out of your blood.

SPEAKER_02:

That clarifies the lipid landscape a lot. Now hormones. This is another area of massive confusion, largely thanks to one study.

SPEAKER_00:

The Women's Health Initiative, or WHI, probably the biggest screw up in modern medical history. It turned an entire generation of doctors and women off of hormone therapy.

SPEAKER_01:

And it was flawed, how so?

SPEAKER_00:

Deeply flawed. They started women 10 years after menopause. The women were already less healthy, many were smokers, and crucially they use synthetic hormones.

SPEAKER_02:

Not the bioidentical ones used today.

SPEAKER_00:

Not at all. They use CEE, which is estrogen from horses, and MPA, a synthetic progestin. And that MPA is likely what caused the slight negative signals.

SPEAKER_02:

And the headlines about breast cancer risk were terrifying.

SPEAKER_00:

They were, but they were about relative risk. The absolute risk increase was tiny, like one extra case per thousand women per year. The benefits for bone health and quality of life were huge.

SPEAKER_02:

So the lesson isn't HRT is bad, it's the right molecule at the right time is critical.

SPEAKER_00:

Exactly. Start it as you enter menopause, not decade later, and use bioidentical hormones. It's a totally different risk-benefit conversation.

SPEAKER_02:

Okay, let's shift to men in TRT. The focus is always on total testosterone.

SPEAKER_00:

Which is almost meaningless on its own. The number you have to focus on is free testosterone or free T. That's the portion that's biologically active.

SPEAKER_02:

And the goal is to get that into the upper end of the normal range.

SPEAKER_00:

The upper end of the physiologic normal range? Yes. Usually with a low dose approach, like 100 milligrams a week, split into two shots, to mimic the body's natural rhythm.

SPEAKER_02:

Aaron Powell What about men who want to preserve their fertility?

SPEAKER_00:

That's a huge consideration. Exogenous testosterone shuts down your own production. So for those men, you'd use something like HCG, which stimulates the testes directly to produce their own testosterone, keeping everything online.

SPEAKER_02:

We've covered a ton of ground here. From uh backcasting your 90-year-old self to measuring APOB, clarifying the WHI study, and hitting those really tough strength metrics.

SPEAKER_00:

It really provides an objective, actionable roadmap you can use to influence your own health span.

SPEAKER_02:

Absolutely. We've laid out the tools based on what's proven, but the frontiers are always moving, which leads to a really provocative final thought for you to consider.

SPEAKER_00:

Right. So there is compelling animal data that a molecule called rapamycin can preserve and even extend ovarian life dramatically. So the question is what might the future of female fertility look like if that research translates to humans?

SPEAKER_02:

Just think about the implications of that. Keep measuring, keep training, and above all, keep learning. Thank you for joining us for this deep dive.