UPDATED: May 18, 2025
Welcome to the Healthy Living Is Good Medicine Newsletter, a totally free, health education publication covering a wide variety of topics, with original articles intended to help people lead healthier and more fulfilling lives.
Okay, I'll admit it. The title is click-bait. Guilty, with an explanation: Because only about a third of those who receive my emailed newsletters bother to open them, I thought I’d try something more dramatic, in an effort to catch more people’s attention. Maybe I should have led with a song:
“Oh, yeah, life goes on,
Long after the thrill of livin' is gone.”
~ From John “Cougar” Mellencamp’s hit song, Jack and Diane, in 1982.
Truth be told, there aren't any “life-extension medicines” that are proven to help healthy people live longer. Be forewarned that unscrupulous businesses are taking advantage of people who want to add more years to their lives, creating a booming industry and many highly profitable scams. I make no such claims about life extension, and have always emphasized that the quality of a person’s life should take precedence over its quantity.
Don’t be taken in by the Netflix documentary, “Don't Die: The Man Who Wants to Live Forever.” It’s about a wealthy dude obsessed with extending his life beyond the current limit. As a result, he is spending a fortune on unproven treatments and most of his waking hours are devoted to his life-extension program. If you ask me, that’s no way to live.
There’s also a big problem with his “shotgun approach.” By doing a great many things all at once, we will never be able to figure out which of them are helpful, counter-productive, or neutral, should he actually be able to beat the longevity record of 122 years, which I sincerely doubt.
In many of my posts, you will notice that I offer readers information that will help them increase their health-span, and remain able-bodied and sound-minded for as long as possible. Any benefits accrued from a healthy lifestyle that contribute to greater longevity should be considered a fortuitous side-effect.
My personal choice is to not linger past the point where I'm no longer able to take care of myself, and to bow out gracefully before the infirmities and indignities of old age overtake me. Being a waste of space, and becoming a burden on my family, goes against my grain. Let my final exit be celebrated with, if not hastened by, dark chocolate.
Preventing Early Death and Disability
There are preventive lifestyle interventions and highly effective medical treatments for some of the chronic illnesses that are known to shorten people's lives. For example, a 2016 clinical trial showed that patients with type 2 diabetes and microalbuminuria (protein in the urine, an indication of kidney damage) could have their life expectancy extended by almost eight years when they receive intensive treatment, as compared to standard care.
A 2025 data analysis of lifetime risk of cardiovascular disease and death from any cause up to 90 years of age found that the presence of five risk factors at age 50 predicted a 10-year shorter life expectancy. Those risk factors are hypertension, hyperlipidemia, obesity, diabetes, and smoking. The lifetime risk of cardiovascular disease was 24 percent among women and 38 percent among men for whom all five risk factors were present. Those who lowered blood pressure and quit smoking in midlife gained the most additional years free of cardiovascular disease and death from any cause.
Another recent study across eight countries used a dose–response meta-analysis of observational cohort studies to assess the association between high ultra-processed food (UPF) consumption and all-cause mortality. Its results support a conclusion that UPF intake contributes to the overall burden of disease and results in premature deaths.
In a previous article, I mentioned that lowering the LDL-cholesterol level below 70 mg/dL is associated with a 26 percent risk reduction in all-cause dementia, and a 28 percent lower risk of dementia due to Alzheimer’s disease. In this article, I'll focus on a very common, life-shortening condition that is receiving far too little coverage.
The Metabolic Syndrome
Metabolic syndrome (MetS) refers to a cluster of medical findings that increase the risk of heart attacks, strokes, type 2 diabetes, and dementia. The syndrome is diagnosed when a person has three or more of the following signs: high blood pressure; high blood sugar; blood cholesterol high LDL and low HDL levels; high triglycerides; and abdominal obesity. If you don't know what your numbers are for each of those parameters, please get tested ASAP.
The presence of metabolic syndrome in the U.S. has been consistently estimated at around 34 percent of the adult population. That means one out of three American adults have it, and most of them don’t know it. That makes this life-shortening condition a significant public health problem.
I have it, my father had it, and so does my son, so you could say that MetS runs in the family. My initial response to that rude discovery was to shed about 30 pounds of excess belly fat. That did improve my blood tests, but not enough for me to avoid taking medications. I’ll have more to say about that later in this article.
The prevalence of metabolic syndrome varies by age, from about 7 percent of adolescents, a fifth of those aged 20-39 years, and about half of people who are 60 years of age and older. Race and ethnicity also influence risk, with Mexican Americans having the highest prevalence of MetS, and African Americans the lowest.
Even if your body mass index (BMI) is normal, central adiposity increases the risk for developing cardio-metabolic diseases. Waist circumference (WC) is the currently recommended marker for risk screening. A 2020 study found that a waist circumference greater than 34 inches in males, and 32 inches in females, was the best anthropometric value for predicting MetS.
A 2023 study of obese adolescents found that those with a waist-to-hip ratio (WHR) greater than 0.89 had twice the risk of developing metabolic syndrome. According to the World Health Organization, a WHR of 1.0 or higher increases the risk of heart disease for adult men and women.
Prevention and Treatment
Along with a genetic susceptibility, a lack of physical activity and an unhealthy diet play major roles in developing metabolic syndrome. A MetS diagnosis carries an increased risk of developing type 2 diabetes, cardiovascular disease, and premature death. It therefore needs to be taken very seriously, and that’s what I have personally done.
For an in-depth look at the nutritional principles behind a healthy diet, plus how to make preparing healthy meals really easy, and a hundred recipes to inspire your culinary creativity, check out my recently updated eBook, “Rx for Healthy Eating.” It is available from Barnes & Noble, the Google Play Bookstore, and Amazon’s Kindle Books. It costs less than a burger and fries, and won’t clog your arteries.
If you’re new to the world of digital libraries, you don't need a special device to read eBooks. Simply download the appropriate app onto your computer, smartphone, or tablet, download the eBook that you want, and you're good to go. It’s brilliant idea to carry your personal library in your pocket.
Back to MetS
When lifestyle interventions aren't enough, there are three drugs that should be first-line treatments for patients with metabolic syndrome; statins for hyperlipidemias, angiotensin II receptor blockers (ARBs) for hypertension, and metformin for insulin resistance and pre-diabetes.
Statins are HMG-CoA reductase inhibitors that lower cholesterol and triglycerides, and stabilize arterial wall plaques. They also block EGFR (epidermal growth factor receptors), which are over-active in diseases such as pancreatic cancer, and inhibit mTOR (mammalian target of rapamycin), an enzyme involved in catabolism and immune responses. They simultaneously activate the cellular energy enzyme, AMPK (5' adenosine monophosphate-activated protein kinase), which provides protective effects against chronic diseases.
This multiplicity of beneficial results could explain how statins are able to reduce the risk of heart attacks and sudden cardiac death in patients with normal blood lipid profiles. Statins also have potent antioxidant and anti-inflammatory properties, making them one of the best drugs available for both preventing and treating cardiovascular disease. A dose of 5–10 mg daily of rosuvastatin (Crestor generic) can dramatically improve lipid profiles.
Anti-hypertensive agents known as ARBs (angiotensin II receptor blockers) are FDA-approved for reducing the risk of CVAs (cerebrovascular accidents, aka “strokes”) MIs (myocardial infarctions, aka “heart attacks”), and overall cardiovascular mortality. Telmisartan (Micardis generic) is specifically recommended for patients with insulin resistance. In addition to lowering blood pressure and protecting renal function, ARBs are also known to activate AMPK, thereby contributing to the crucial metabolic role of maintaining energy homeostasis.
The biguanide anti-diabetic drug, metformin, blocks cell membrane receptors for the epigenetic signaling molecule, ADMA (asymmetric dimethylarginine) and also activates AMPK. Its protective effects far outweigh its ability to lower blood glucose levels. I’ve been persuaded that metformin is appropriate for the first indication of insulin resistance, when it doesn’t respond to an improved diet and more exercise, because the condition will eventually progress to diabetes if left untreated.
My HbA1c had been gradually creeping upward, despite eating a healthy diet and exercising regularly. When it finally exceeded the upper limit of normal, I asked my doctor to prescribe metformin, and he agreed. What convinced both of us that my HbA1c wasn't going to improve, even with a very intensive lifestyle intervention, was a print-out of data from an over-the-counter (OTC) continuous glucose monitor (CGM). The CGM that's recommended for people with pre-diabetes is the Lingo.
Since then, I’ve been taking a 500 mg extended-release tablet twice daily after meals, which has produced a decisive lowering of my HbA1c. According to preventive cardiologist Dr. William Bestermann, metformin (Glucophage XR generic) is precision medicine for type 2 diabetes, and has the added benefit of slowing the aging process and delaying the development of chronic diseases.
Taking the three drugs together (as I am doing) is optimal medical therapy for MetS. The effectiveness of pharmacotherapy can be enhanced by lifestyle changes, such as the adoption of a plant-based, low-carb diet. Time-restricted eating with extended overnight fasting can enhance insulin sensitivity and promote visceral fat loss. Physical activity such as daily aerobic exercises that include high-intensity intervals, plus strengthening exercises with 6-12 repetitions per set to build muscle mass, can improve glucose metabolism and increase insulin sensitivity.
Calorie restriction at mealtimes, and no snacking between meals and after dinner, can help with weight loss, as does increasing the amount of high-quality protein and dietary fiber. Further lifestyle modifications may be needed to address chronic stress and inadequate amounts of restorative sleep, which increase cortisol levels that contribute to insulin resistance. Unhealthy habits, such as smoking tobacco and drinking alcohol, also play a part in developing insulin resistance and increasing one's cardiovascular risk.
Summary
Metabolic syndrome is a cluster of conditions that include central obesity, hypertension, an abnormal lipid profile, and insulin resistance, increasing the risk of cardiovascular disease, diabetes, and dementia. The most effective strategies for alleviating and even reversing metabolic syndrome include:
1. Dietary Changes:
Adopt a Mediterranean-style or low-carb omnivorous diet, with a focus on whole, plant-based foods, healthy fats (extra-virgin olive oil, tree nuts, avocados, fatty fish), less saturated fat, complete proteins, and fiber-rich whole fruits and vegetables (legumes, whole grains, salads). Reduce refined carbs and sugars (white bread, white rice, pastries), red meat, and ultra-processed foods. Include foods that contain probiotics and support a healthy gut microbiome (yogurt, sauerkraut). Avoid excess salt, and if necessary, rehabilitate your sense of taste.
2. Physical Activity:
Strength training builds muscle mass, which improves glucose metabolism and increases insulin sensitivity. Aerobic exercises with high-intensity intervals (jogging, cycling, swimming) help regulate blood sugar and lower blood pressure. Avoid prolonged sitting, and take frequent short walks or exercise breaks from your chair. Playing more increases health-span.
3. Weight Management:
Gradual, sustainable weight loss, with as little as a five percent reduction in excess body fat, can significantly improve metabolic parameters. Reduce calories, while avoiding malnutrition. Focus on nutrient-dense foods, and track your progress using apps or a journal to record food intake and health markers. Time-restricted eating can enhance insulin sensitivity and promote fat loss. Consult with a physician about weight-loss drugs.
4. Stress Reduction and Sleep Optimization:
Chronic stress increases cortisol, which contributes to insulin resistance. Try meditation, yoga, deep breathing, or mindfulness practices. Make your close relationships healthier. Aim for 7-9 hours of high quality sleep each night, preferably in sync with the sun (early to bed, early to rise). Seek medical assistance for chronic insomnia and obstructive sleep apnea.
5. Other Lifestyle Modifications:
Don't smoke, limit alcohol consumption, and avoid sodas and diet beverages. Drinking adequate amounts of plain water supports metabolism and appetite control. Social support for a healthy lifestyle is important. Hang out with like-minded people by joining an exercise class. Limit the influence of people who have unhealthy lifestyles. Avoid watching commercials for food and alcohol.
6. Medical Support:
Get regular medical checkups that include lab tests for hemoglobin A1c (average blood sugar) and a lipid panel (cholesterol and triglycerides). Monitor blood pressure and track improvements. Consider using an over-the-counter continuous glucose monitor (CGM) for immediate feedback on the effects of diet and exercise. Your doctor might prescribe statins, blood pressure medications, or metformin, depending upon your test results.
What's Love Got to Do with It?
I wonder, who wrote the Book of Love? Is love really a secondhand emotion? Does a man appear taller and more attractive when standing on his wallet? Should we ask Annie Hall for relationship advice? I really don’t know. Perhaps “love” is best defined as a zero score in a tennis match.
The serious point I want to make here is that if you love your life, or are loved by others who would grieve your death, please don't unwittingly commit installment plan suicide with an unhealthy lifestyle. Instead, invest your time, money, and energy in things that are known to enhance people’s physical health and mental wellbeing. Learn to love what's truly good for you.
If you care about someone who is obviously big around their middle, and therefore might have metabolic syndrome, please share this article with them. That kind of gentle intervention could actually save their life.
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