Health

How to Figure Out if I’m Healthy

Published

2 months ago

July 8, 2024

This is part 2 of a 3 part series of health. Part 1 was about how to get into A+ health. This week is about how to figure out if you’re healthy. And I mean really healthy.

The motivation behind this post is that every primary care physician I’ve had has looked at my vitals and given me the thumbs up. Compared to a lot of folks, I’m doing fine. But I can be doing fine at 36 years old and be absolutely not fine 20 years later with the same exercise and diet. By the time physicians start noting issues, it can be quite difficult to get back into solid health.

So where do you need to be now in order to still be in excellent health 10, 20, or 30 years from now? This post goes into the major tests of figuring that out. And while some of this testing might seem overkill for younger folks, personally I find great value in knowing what my baseline “healthy” data looks like so I can reference it later on when I may not be as healthy. I did the vast majority of these tests last year, and wish I had done them even earlier.

And it’s hard to predict what you’ll find. Despite following what I thought was a healthy diet and exercise regime, my blood tests found I had high Lp(a) and ApoB and my heart rate recovery was nowhere near where I wanted it to be – things that could eventually contribute to heart disease. I also found my bone mineral density was relatively low, which means I’m at greater risk of breaking bones. All of these risks can take a while to mitigate and require lifestyle changes to do so, and it’s generally easier to do that earlier rather than later in life.

Note: the medical test notes referenced in this post come from Peter Attia’s book Outlive. The exercise test notes come from Andy Galpin, PhD. Similar to my last health-focused newsletter, these are the most anal retentive experts I can find when it comes to medical and exercise health tests. Absolute top-tier Protocol Daddies. You’re in good hands.

I highly recommend using a spreadsheet to track test outcomes Here’s a spreadsheet template that I use personally to track outcomes from the tests described below.

Do a blood test

Attia recommends doing a full blood test panel in addition to these non-standard markers to get baseline data. And then following up with additional blood tests the monitor the areas you’re seeking to improve every 3 – 6 months.

Heart health: Measure your Lp(a) (pronounced El-pee-little-a) and apoB. I think these cost about $50 together, albeit are non-standard measures for most blood labs.

ApoB

What it is. ApoB is the primary indicator of potential heart disease. Traditionally, most doctors look at a different indicator – LDL-C, which measured “bad cholesterol” levels. It turns out there are a few other items associated with cholesterol that are also useful to look at, and LDL-C and these other items are all encompassed in the ApoB reading (LDL and other heart indicators are all encased in apolipoprotein B, which is measured as “ApoB”).
Target range. Most doctors only get worried if your ApoB level is above 100 mg / dl. However, any increase in ApoB beyond the levels necessary for living (which ~ 20 / mg / dl) is increased risk of heart issues. Given ApoB levels tend to rise over time, if you want to have healthy ApoB levels when you’re 70, Attia recommends getting ApoB levels as low as possible, with 20 to 30 mg / dl when you’re in your 30s and 40s as the gold standard. This is extremely low compared to what most doctors request, and likely requires assistance with drugs called statins (which I personally haven’t explored yet) but the point is to get this number as low as possible with diet and cardio exercise. Without statins, Peter recommends trying to get to 60 mg / dl. For reference, the 20th percentile of ApoB is 78 mg / dl. 62 mg / dl is 5th percentile, so getting to 60 is darn aggressive relative to modern standards.
How to lower ApoB levels: Consuming less dietary fat, eating more fiber, taking statins, quitting smoking

Lp(a)

What it is. Having elevated Lp(a) levels puts you at greater risk of heart attacks. It can form plaque and get stuck. It’s a highly genetic thing that you only have to get measured once since it doesn’t move around a lot with behavioral changes. About 20 – 30% of Americans have elevated Lp(a) levels that put them at risk of heart issues.
Target range. Ideal Lp(a) levels are 14 mg / dl. The highest risk category is 50 mg / dl and above. If you do have a high Lp(a), the best way to lower risk is to more aggressively manage your ApoB levels.
How to lower Lp(a) levels: This is largely genetically determined so it’s difficult to lower through behavioral change. For most folks, you can manage heart health risks implied by elevated Lp(a) levels by keeping ApoB levels to a minimum. That said, Lp(a) seems to be lowered ~30% by PSCK9 inhibitors (Repatha, Praluent) but you’d have to pay out-of-pocket (about $600 per month) since it isn’t approved for that indication.

Cognitive / heart health: Get an Omega Fatty Acid panel. A standard part of these panels is DHA % and EPA % (aka Omega-3 Index).

What it is. DHA and EPA are two Omega 3 Fatty Acids that have been shown to have a lot of cognitive and cardiovascular benefits, including longevity. This includes protection against neurodegeneration (e.g. Alzheimer’s) and improving cardiovascular function (thereby preventing heart failures and related issues). DHA can be turned into EPA much more easily than EPA can be turned into DHA, so most supplements that provide both have more EPA than DHA.
Target Range: 8 – 12% combined for DHA % and EPA %. Average for Americans is between 4 – 5%. It takes 4 months of supplementing with fish oil or eating fish before it shows up in blood labs since that’s the lifespan of red blood cell which apparently is what’s being measured here.Note: some folks also track Omega 6 / Omega 3 ratios. In this podcast, Attia and his guest Bil Harris recommend targeting 8 – 12% combined DHA + EPA% as opposed to Omega 6 / Omega 3 ratios, as the ratio is irrelevant if Omega 3s are up.
How to improve numbers. Eat fatty fish and supplement with fish oil.

Check your blood pressure

Attia says blood pressure is one of the most underutilized tools given many people walk around with high blood pressure and don’t know it. He recommends people knowing their blood pressure and managing it aggressively if they’re not in range. Having elevated blood pressure for long periods of time can lead to kidney damage and damage to arteries of the heart and brain. High blood pressure also seems to play a role in all chronic diseases, except for cancer.

What it is: Standard test involving a stethoscope / armband or automated cuff.
Target range: Systolic reading of 120 mm Hg or lower and a diastolic reading of 80 mm Hg or lower (also referred to as having a blood pressure of “120 over 80”). Elevated is when systolic is between 120 – 129 and diastolic is 80 or below. Having blood pressure of 130+ over 80+ is considered having hypertension. Having blood pressure of 120 over 81+ is also considered hypertension. These numbers are discussed here.Additional notes from Attia’s podcast with Huberman: Attia says most doctor readings are inaccurate. You need to sit in a chair for 5 minutes doing nothing before testing to get an accurate reading. He recommends his patients take blood pressure readings 2x/day for two weeks to get an accurate reading. Additionally, he says automatic cuff readings often given higher readings than manual readings, which are considered more accurate. That said, he recommends people start with automatic cuff readings because it’s easier. As of today, there is no watch or wearable device that provides accurate readings.

How to improve numbers: Get adequate sleep and do cardio exercise. If still not in range, there is medication available that Attia briefly mentions here.

Get a continuous glucose monitor

What it is: A sensor that sticks via tiny needle in the back of your arm or stomach and measures blood glucose levels every few minutes. Elevated blood glucose levels over long periods of time increase the risk of all 4 major types of disease/death: atherosclerotic disease, cancer, neurodegenerative disease, and type 2 diabetes.
Cost: In my experience, bare bones CGMs such as Abbot’s Libre 3 cost $40 for 14 days with a physician prescription and coupon, or $85 without the coupon. CGM services like Levels, which provide an app with more metrics and recommendations (but with the same underlying sensor, can cost a few hundred dollars a month).
Target range:
- Average glucose level of 100 mg / dl or below.
- A standard deviation of 15 mg / dl or less
- Avoiding spikes of over 160 mg / dl
- In general, the lower the average glucose, the better, and and lower variability is better.
How to improve numbers: Eat foods with a lower glycemic load. This generally means avoiding sugar and refined carbs / processed foods. Eating fiber and exercise will also blunt glucose spikes, so eating more fiber with meals will lower your average glucose levels.

Get a DEXA scan

What it is: Measures body fat %, visceral fat, and bone mineral density. Radiation exposure is super low in these scans, so you don’t have to worry about that. Body fat % is the least important of these markers. Visceral fat, or fat that accumulates around the abdomen, is considered particularly unhealthy since it creates inflammation around vital organs, and is associated with metabolic disease. Bone mineral density measures bone strength – especially important for when we age and are at risk for breaking bones due to falling. According to Attia in this podcast, women are especially at risk for lower bone mineral density.
Cost: About $200 in urban centers
Target Ranges:
- According to Attia in this podcast, we should have standards around visceral fat as a percent of total body weight, but to date we don’t. Here is a reference table of visceral fat values by gender, age, and percentiles. I imagine Attia would target the most aggressive percentile here (15%) or lower.
- Bone density: have a positive t score. A t-score of 0 would mean your bone mineral density is the same as a healthy 30 year old. Positive (such as 1.0) means I’m 1 standard deviation ahead of someone who’s 30 years old and my gender. Negative t scores indicate long term at risk of fractures
How to improve numbers
- Visceral fat: Exercise and diet.
- Bone mineral density: In short, strength training. Bone mineral density is very hard to improve after bone maturation occurs in one’s early 20s. So it’s very important for young folks to do strength training (lifting weights). This is very different than what I was told growing up, which was that lifting weights as a young man blunted one’s growth! For older folks, the goal is to slow the rate of decline, which is also achieved through strength training. This can be supported through Vitamin D supplementation and eating sufficient protein.

Get a CT angiogram by age 40

What it is: A scan to see plaque around the heart. Previously doctors recommended calcium scans for plaque issues, but these scans only measure calcified plaque, not soft plaque that later turns into calcified plaque. Around 15% of people with a calcium score of 0 have plaque issues, which is high enough in Attia’s opinion to upgrade to a CT angiogram. It’s advised to get this scan once between ages 35 to 40. These are expensive however (I haven’t gotten one as a result), and a calcium scan is recommended over no test at all.
Cost: CT Angiogram scans run $1000-1500 or so. I’m not sure if insurance might cover this if you did a cheaper CAC test first and saw issues. You could plan ahead and elect $1000 of FSA dollars to do it pre-tax to save around $250+ (depending on how much you pay in taxes) if you have to pay out of pocket. Calcium scans, on the other hand, also cost only ~$130, and are absolutely better than no test at all.
Target: Zero soft and/or hard plaque.
How to lower plaque: Everything under “How to lower ApoB levels”

Cancer scans

It’s worth noting that cancer is the hardest of the 4 major disease types to prevent. The major modifiable risks are smoking, insulin resistance, and obesity. Pollution in air and water may also be a factor but data here is less clear.

Out of the dozens of types of cancer, we have agreed upon and reliable screening methods for 5:

Lung cancer: MRI or CT Scans
Breast cancer: mammograms
Prostate cancer: prostate exam
Colon / colorectal cancer: colonoscopy
Cervical cancer: Pap smear

Attia did not have specific advice that strayed from normal recommendations for screenings aside from colorectal cancer.

For men

Colorectal cancer screening: Get a colonoscopy by the age of 40. A doctor puts a flexible tube in your butt with a camera at the end and looks for colorectal cancer, which is the third deadliest cancer (behind lung and breast/prostate) but easy to treat if found early. Attia recommends following up every 2 to 3 years with another colonoscopy.
Prostate cancer screening: Get a blood test for PSA (prostate-specific antigen). Normal is at or below 1 for this test. This test has had a lot of false positives and negatives, which is an issue since the next step if you think you have it is a biopsy of the colon. To be able to early detect and get higher resolution on whether prostate cancer is present, look at additional factors such as PSA velocity (change of PSA over time), PSA density (PSA value normalized to the volume of the prostate gland) and free PSA (comparing amount of PSA that is bound vs. unbound to carrier proteins). American Cancer Society recommends getting one by age 45 for men with average risk.

For women

Breast cancer screenings: Attia recommends stacking mammograms, ultrasounds, and MRIs to get the best picture of breast cancer risk and avoid unnecessary procedures. He does not go into detail about what age women should start screening – the American Cancer Society recommends starting screenings no earlier than age 40, and then start annual screenings by age 45.
Cervical cancer screening: Attia does not have non-standard advice here. Standard advice according to Mayo Clinic is to get an annual pap smear starting at age 21. A Pap smear involves collecting cells from the cervix — the lower, narrow end of the uterus that’s at the top of the vagina.

For current and former smokers:

Low dose CT scan or MRI for lung cancer: Attia does not go into how early smokers should screen. Mayo Clinic recommends screening for smokers and former smokers starting at age 50, or anyone with a “20 pack year” history – which is someone who smoked a pack a day for 20 years. Smoking two packs a day for 10 years would also be a 20 pack year history.

Exercise tests

Dr. Andy Galpin, who is a fitness coach for athletes and Founder/Director of the Biochemistry and Molecular Exercise Physiology Laboratory at Cal State Fullerton, recommends doing a battery of tests 1x / year to see how well you’re doing across strength and cardiovascular indicators. He is known for being incredibly methodical and holistic in how he thinks about fitness. His particular battery of tests, described below, covers what he lays out as the important areas to test for to assess long term fitness: power, force/strength, muscular endurance, anaerobic capacity, and maximal aerobic capacity. The full podcast that goes through his exercise test protocols is here.

Whether you do well or not on these tests or not, the prescription is still to follow an exercise regime similar to the one described in How to get into A+ health, but with a bit more focus on the weaker areas. Attia has his own version of this for his clients and tends to be more aggressive in his targets, although I have not found a source where he details exactly what to do and what targets to pursue.

Galpin’s targets are the ones I include in the fitness test tracker spreadsheet.

Power

Galpin defines power as speed x strength.

Broad jump:

How: Do a standing jump (no running). Measure from tip of toes on jump to back of heel upon landing
Target:
- Men: Your height.
- Women: 85% of your height

Vertical jump:

How: Do a standing jump (no running). Two feet on ground. Use both hands. Measure from standing height of fingertips on both hands to lower of both sets of fingertips upon jumping.
Target:
- Women: 20 inches (no age specs given)
- Men under 50: 24 inches
- Men over 50: 20 inches

Strength

Galpin defines this as well can you move something one time (not repetitively).

Leg extension:

How: This is a specialized piece of gym equipment that looks like this
Target:
- Through age 40: Body weight
- Every decade thereafter: body weight minus an additional 10%

Deadhang:

How: Literally hang from a bar, fully extended, for as long as possible
Target: Hold for 60 seconds

Goblet squat:

How: Should look like this.
Target: Hold ½ your body weight for 45 seconds.

Muscular Endurance

Galpin defines this as how many repetitions you can do of a particular movement.

Front plank

Side plank:

Pushups:

How: Chest should touch the floor when contracted and arms should be fully extended when extended.
Target:
- Women: 15 (5 or less is a red flag)
- Men: 25 (10 or less is a red flag).

Anaerobic Capacity

Galpin defines this as the maximum amount of work you can do in 30 – 120 seconds of all out work.

Heart rate recovery:

How: Wear some kind of heart rate monitor. Get your heart rate up as much as possible – and try to hit your max heart rate. A rule of thumb for what your target max heart rate is is 220 minus your age. So mine would be 220 – 36 = 184, although testing it at a fitness lab is the gold standard. I got mine tested and it’s actually 181, but close enough. Once you hit your max heart rate, stop working out and rest for 1 minute. After 1 minute, measure your heart rate. So if my max heart rate is 181, and one minute after stopping working out it’s 165, then my heart rate recovery is 16 beats / minute.
Target: You want your heart rate recovery to be 30 beats / minute.

Aerobic Capacity

Galpin defines this as how much work can you do in the 8 to 15 minute range.

VO2 max:

How: Go to a lab and get it tested with an aerobic test.
Target: Ideal is 55+ ml /kg / min for men and 50+ ml / kg / min for women. Minimum target is 35+ for men and 30+ for women.

—

This post was previously published on Newsletter.amanswork.com.

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Mpox Vaccine Rollout to Begin in Nigeria, DRC

Published

6 days ago

September 14, 2024

Sci Dev Net

Mpox Vaccine Rollout to Begin in Nigeria, DRC

[YAOUNDE] Nigeria is to begin the immediate rollout of 5,000 doses of mpox vaccines while the Democratic Republic of Congo (DRC) eyes its first shipment of 65,000 doses, as Africa steps up measures to control the multi-country outbreak.

The vaccine, administered in two doses, will go first to people at high-risk, including health workers and those living in areas with high infection rates, according to Nigeria’s National Primary Healthcare Development Agency.

Matshidiso Moeti, WHO regional director for Africa, said the delivery of 10,000 doses to Nigeria by USAID this week signified “a clear demonstration of international solidarity in the face of global public health emergencies”.

“The emergence of the new, more virulent variant (Clade Ib) and the increase in human-to-human transmission, with new routes such as sexual transmission, remains a cause for concern.”

Flaubert Mba, Centre for Research on Emerging and Re-Emerging Diseases

Nigeria became the first African country to receive the vaccine after confirming 40 cases of the disease, whose symptoms include fever, swollen lymph nodes and a rash leading to blisters.

The DRC, the country worst affected, is expecting to receive 65,000 doses of the vaccine on 1 September, announced Jean Kaseya, director-general of the African Centres for Disease Control and Prevention (Africa CDC), during an online press conference on Wednesday (28 August).

A health worker examines skin lesions that are characteristic of mpox on the back of a young child at the mpox treatment centre at the Nyiragongo General Referral Hospital, north of Goma in the DRC on 14 August 2024. Credit: Guerchom Ndebo / WHO

He said 50,000 doses would be sent by the US while 15,000 will be provided by Gavi, the Vaccine Alliance.

Kaseya said the JYNNEOS vaccine, made by Danish pharmaceutical company Bavarian Nordic, was one of the surest ways of stopping the mpox epidemic, alongside epidemiological surveillance and screening.

He stressed the vaccine was the same one used in the US and Europe to stem an outbreak of mpox – formerly known as monkeypox – in 2022.

“It has been given to millions of Americans and Europeans, which has made it possible to stop [that] epidemic,” he told the press conference.

Residents of Weta village in Maniema province, eastern DRC read information about how to avoid mpox, provided by health officials. Credit: Eugene Kabambi / WHO

In July, the emerging infectious diseases foundation CEPI announced trials in the DRC to see if vaccinating people already exposed to mpox stops them getting sick and spreading it.

Kaseya said Africa CDC would be sending 72 epidemiologists to affected areas in September to collect more data on case numbers, citing problems with the reliability of current data.

“These epidemiologists, in addition to the support they will be giving to the teams in the field, will also be focusing on the quality of the data, so that we can have data that will enable us to make good decisions,” he said.

“In the coming weeks, we will begin to provide what we believe to be quality data thanks to this support.”

Bushagara camp for displaced people in North Kivu, DRC. Identification of mpox cases in camps around Goma is concerning because the high population density can result in further spread. Credit: Guerchom Ndebo / WHO

Response plans

For the first time since its creation, Africa CDC declared on 13 August that the new mpox epidemic constituted a public health emergency of continental security (PHECS) in Africa. The next day, the WHO declared it a public health emergency of international concern (PHEIC).

Nicaise Ndembi, Kaseya’s scientific advisor and mpox response coordinator for the African Union and Africa CDC, told SciDev.Net: “This declaration marks an important moment in the history of public health in Africa and demonstrates the seriousness of the situation and the need for a unified, continent-wide response to this rapidly spreading disease.”

He stressed that it is now “urgent to take coordinated action at national, regional and international levels to stop the spread of mpox”.

Africa CDC is working to develop a “continental response plan”, which, according to Kaseya, should take into account the individual needs of each country. He said the plan will be presented to African heads of state for endorsement in the coming weeks.

The WHO has already launched a global strategic plan for mpox preparedness and response, which it says requires US$ 87.4 million over the next six months (September 2024-February 2025).

WHO director-general, Tedros Adhanom Ghebreyesus, speaking at the WHO Regional Committee for Africa in Brazzaville this week (26 August), stressed the need for more research and surveillance of the disease, as well as equitable access to vaccines.

WHO director-general Tedros Adhanom Ghebreyesus (centre) convenes the first meeting of the Emergency Committee to discuss the upsurge of mpox, on 14 August 2024. Credit: Lindsay Mackenzie / WHO

“I am certain that with the leadership of the affected countries and the support of the WHO, partners such as CDC Africa and others, we will be able to bring this epidemic under control quickly, as we have been able to do with other epidemics in recent years,” he said.

New variants

According to the latest WHO epidemiological data, 14 African countries have reported cases of mpox so far, with Gabon confirming its first case of the virus on 22 August.

The DRC remains the country hardest hit by the epidemic, with a total of 3,244 cases and 25 deaths recorded to date this year.

Burundi has recorded 231 cases, while a number of cases have also been confirmed in Central African Republic (45); Côte d’Ivoire (28); South Africa (24), and Congo (23).

There are two main types of the virus, Clade I and Clade II. Clade I, endemic to Central Africa, causes more severe illness and disease. The less severe Clade II strain caused the global outbreak in 2022 and is the type being seen in Nigeria.

People with #mpox may experience all or only a few symptoms. Mpox illness typically lasts 2-4 weeks. Source: CDC

However, a novel, sexually transmitted strain of the virus, identified as Clade Ib, has started spreading across the DRC and neighbouring countries, causing alarm.

Flaubert Mba, wildlife specialist and One Heath focal point at the Centre for Research on Emerging and Re-emerging Diseases, told SciDev.Net: “The emergence of the new, more virulent variant (Clade Ib) and the increase in human-to-human transmission, with new routes such as sexual transmission, remains a cause for concern.”

In addition to vaccination and the recommended hygiene measures, he believes that African countries need to focus on epidemiological surveillance, particularly in areas where wildlife and people interact.

“Mpox is a re-emergent zoonosis, meaning that it is transmitted from animals to humans and vice versa,” he explained.

“Particular emphasis needs to be placed on at-risk areas associated with risk mapping and areas where there have been outbreaks in the past.”

This piece was produced by SciDev.Net’s Sub-Saharan Africa French desk and edited for brevity and clarity.

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Health

World Suicide Prevention Day 2024: Changing the Narrative For Men and Their Families

Published

6 days ago

September 14, 2024

Jed Diamond

World Suicide Prevention Day 2024: Changing the Narrative For Men and Their Families

September 10, 2024 was World Suicide Prevention Day. According to the World Health Organization,

“Every year 726,000 people take their own life and there are many more people who make suicide attempts.”

When I was five years old my mid-life father took an overdose of sleeping pills after he had become increasingly depressed because he couldn’t support his family doing the work he loved. Fortunately, he survived, but our lives were never the same. I grew up wondering what happened to my father, when it would happen to me, and what I could do to prevent it happening to other families.

Although females, as well as males, can die by suicide, males at every age are at higher risk than are females. Yet rarely is suicide discussed as a health issue for boys and men.

World Suicide Prevention Day (WSPD) was established in 2003 by the International Association for Suicide Prevention in conjunction with the World Health Organization (WHO). On September 10^th each year they focus attention on the issues, reduce stigma and raise awareness among organizations, governments, and the public, giving a singular message that suicides are preventable.

The triennial theme for World Suicide Prevention Day for 2024-2026 is “Changing the Narrative on Suicide” with the call to action “Start the Conversation”. This theme aims to raise awareness about the importance of reducing stigma and encouraging open conversations to prevent suicides. Changing the narrative on suicide is about transforming how we perceive this complex issue and shifting from a culture of silence and stigma to one of openness, understanding, and support.

The call to action encourages everyone to start the conversation on suicide and suicide prevention. Every conversation, no matter how small, contributes to a supportive and understanding society. By initiating these vital conversations, we can break down barriers, raise awareness, and create better cultures of support.

I have been writing a series of articles—”Homecoming: An Evolutionary Approach for Healing Depression and Preventing Suicide.” In Part 1, I shared statistics from the National Institute of Mental Health, comparing the suicide rates for males and females at various ages:

Even during our youth where suicide rates are relatively low, males are still more likely to die by suicide than are females. It is also clear to me as my wife and I move into our 80s, that males and females face many challenges as we age, but it is older males who more often end their lives by suicide with rates 8 to 17 times higher rates than for females.

In Part 2, I discussed the evolutionary roots of male/female differences and quoted Dr. Roy Baumeister, one of the world’s leading social scientists. Understanding his work can better help us understand a lot about why men are the way they are and specifically why men are the risk-taking gender.

In his groundbreaking book, Is There Anything Good About Men? How Cultures Flourish By Exploiting Men, he says,

“If evolutionary theory is right about anything, it’s right about reproduction. Nature will most favor traits that lead to success at reproducing. But for thousands of years, men and women have faced vastly different odds and problems in reproducing. On this basic task, women faced good odds of success, whereas men were born to face looming failure.”

Men not only take greater risks than women, but also are less resilient and more prone to feelings of failure when they don’t feel they can offer something of value to those they love.

In Part 3, I show that suicide is the most prevalent form of violence and is the cause of more death than either war or homicide. We don’t often think of suicide as a form of violence or depression as an underlying cause of violence, but they are intimately related. The World Health Organization (WHO) produced an in-depth analysis of violence and published the information under the title, “The World Report on Violence and Health.” The report is the result of 3 years of work, during which WHO drew on the knowledge of more than 160 experts from more than 70 countries.

The report detailed estimated global-related deaths as follows:

These numbers vary in different years and rates of violent deaths also vary according by country and within each country with different groups. But clearly violence from suicide accounts for nearly as many deaths as war-related violence and homicides combined. All forms of violence are tragic and many have come to believe that violence is simply a part of human nature. But this is not true.

Violence of all kinds can be understood and prevented.

“Violence thrives in the absence of democracy, respect for human rights and good governance,”

said Nelson Mandela. We often talk about how a ‘culture of violence’ can take root. This is indeed true—as a South African who has lived through apartheid and is living through its aftermath, I have seen and experience it. No country, no city, no community is immune. But neither are we powerless against it.”

As we approach another presidential election in the United States, most everyone is aware of the threat to democracy we are facing and the conflicts that divide our country.

In Part 4, I offered guidance for all those who are ready to see the truth about the times in which we live and how we can live, love, and work, for good in the world.

For most of my professional life I believed that treating depression and preventing suicide involved helping individuals, couples, and families. A new perspective opened for me in 1993 at a men’s leadership conference in Indianapolis, Indiana. I’ve written a number of articles about my experience over the years, including my most recent, “Transformations: The End of the U.S. and the World as We Know It and The Truth About Our Collective Future.”

I said that an old kind of masculinity was on the way out. My colleague Riane Eisler describes two competing systems that humans have been engaging with that she calls the dominator system and the partnership system. Throughout the world emotionally wounded men who ascend to power have chosen a dominator approach to asserting power.

The old dominator systems were ruled by frightened men who came to believe that the only way to survive was to rule by force. Historian Ruth Ben-Ghiat describes these men in her book, Strongmen: Mussolini to the Present. She says,

“For ours is the age of authoritarian rulers: self-proclaimed saviors of the nation who evade accountability while robbing their people of truth, treasure, and the protections of democracy.”

Among the seventeen protagonists in her book she includes: Adolph Hitler, Saddam Hussein, Benito Mussolini, Vladamir Putin, and Donald J. Trump. Pulitzer-Prize winning journalist Anne Applebaum describes the way modern-day autocrats support each other in her book, Autocracy Inc.: The Dictators Who Want to Run the World.

“Nowadays, autocracies are underpinned by sophisticated networks composed across multiple regimes…The autocrats are rewriting the rules of world trade and governance as their propagandists pound home the same messages about the weakness of democracy and the evil of America.”

At MenAlive I have been supporting men and their families to embrace the partnership system and have recently created a way for organizations and individuals to belief in these ideas and practices to stay connected. You can learn more at our website, MoonshotforMankind.org and get news you can use on our substack, substack.com/@moonshotformankind.

If you’d like to read more articles on men’s mental, emotional, and relational health, you can subscribe for free at https://menalive.com/email-newsletter/.

Every suicide is a tragedy that affects families, communities and entire countries and has long-lasting effects on the people left behind.

Suicide does not just occur in high-income countries but is a global phenomenon in all regions of the world. In fact, close to three quarters (73%) of global suicides occurred in low- and middle-income countries in 2021.

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Health

Considering the 75 Hard Challenge? Read This First

Published

6 days ago

September 13, 2024

Rachel MacPherson

Considering the 75 Hard Challenge? Read This First

Sticking to new habits isn’t easy, especially when they mean giving up old ones that make you feel good—at least temporarily—like binging talking dog videos or inhaling a burger on the way home from work. But there comes a time when making a change in the name of your health and happiness is more attractive than another night spent plastered to your couch. That’s where a program like the 75 Hard Challenge comes in. It’s not a weight-loss app, although followers do tend to shed some pounds. Instead, it’s a “mental toughness” protocol that helps instill new habits in fewer than three months. That’s not to say it’s without flaws.

This challenge is not easy to stick to. People often believe the more intense something is, the better the results. But this is a mistake if you aren’t careful. It’s important to learn about any new routine that overhauls your diet, exercise, and entire life and really evaluate if the pros and cons make it worthwhile. Learn all about 75 Hard, including 75 Hard Challenge rules and what you might stand to gain—or lose—if you try it.

What Is the 75 Hard Challenge?

The 75 Hard Challenge is primarily a mental toughness program with physical and behavioral habits created by entrepreneur and author Andy Frisella in 2019. In short, the challenge aims to build discipline and resilience—physically and mentally—by adopting a set of daily rules that you complete without fail for 75 days straight. Frisella sells a book about the challenge, but you can also learn about it from his podcast and all over the internet.

75 Hard Challenge Rules

There are five 75 Hard rules to follow during the 75 Hard Challenge. Here’s where it gets particularly tough: If you skip any of the items on the 75 Hard checklist on any given day, you need to start over from day one as a practice in forging mental toughness and self-control.

1. Follow a Diet

During the entire challenge, you should stick to a specific meal plan without cheat meals or alcohol. There’s no 75 Hard diet, per se. You get to choose. If you’re hoping to drop body fat, we recommend the best diets for weight loss. But if you’re just trying to adhere to a lifelong habit of healthy eating, stick to the best diets recommended by experts. Something like the Mediterranean Diet is more sustainable for life than, say, the keto or Paleo diet. Get more tips below.

2. Two Daily Workouts

Every day, you have to complete two 45-minute workouts with one being outdoors. Unfortunately, you can’t count activities like mowing the lawn, yard work, or leisure sports into the 75 Hard workout plan like golf, because they’re considered “daily chores” or “routines.” Typically, we don’t recommend two-a-days, especially if you’re not a professional athlete. To ensure you don’t overtrain, keep one akin to an active recovery, like steady-state cycling or yoga. If it starts to diminish your physical and mental well-being, stop.

3. Drink a Gallon of Water

Drink one gallon of water every day. This doesn’t include any other fluid intake, just clear H2O. Hydrating is obviously important. Drinking a gallon is likely unnecessary, but it won’t necessarily hurt you. If it helps up your intake, great.

4. Read Nonfiction

Part of the mental fortitude aspect of the challenge is reading 10 pages of a nonfiction book each day. Unfortunately, audiobooks don’t count, nor do magazines or sports pages. Sorry—there’s a reason this is called the hard 75 challenge.

5. Take a Daily Progress Picture

Take a photo of your body to track your progress each day. This could be a mirror selfie or one you loop your partner or roommate into taking for you. Just be sure to keep the lighting, location, time of day, and clothing items similar for each shot. For some, this is helpful over time to see incremental progress, however a daily log can be detrimental to others’ self-esteem if their body image isn’t positive.

75 Hard Diet

Diet just might be the worst four-letter word in the English language. The good news is that you can choose your own diet structure for the 75 Hard Challenge.

Choose a Diet Plan

While you can pick your ideal diet, it has to be one that fosters positive physical change. Whether you’re losing fat, gaining muscle, building strength, boosting your intake of a specific micro or macronutrient (like protein), or improving overall diet quality for skin health, just pick something you think you can stick to for the entire 75 days without falling off the wagon.

Here are some of the best structured diets to consider:

Mediterranean diet
DASH diet
MIND diet
Mayo Clinic diet
Flexitarian
WeightWatchers diet
Volumetrics diet
Dr. Weil’s Anti-Inflammatory diet
TLC diet
Vegan diet

No Cheat Meals

Can you go 75 days without a hot slice of pizza or a burger? If you want to complete the 75 Hard Challenge, you’ll have to give up all of your normal cheat meals for the duration. That’s right—zero cheat meals (what would Dwayne “The Rock” Johnson say?). Instead, make some healthier swaps that are still tasty but easier on the waistline.

No Alcohol

There’s a strict no-booze rule for the 75 Hard Challenge, so plan accordingly. If you know you’ll be in a high-pressure social situation like a bachelor party or Super Bowl gathering, and you don’t have the willpower of steel, you might want to forego the plan until you know you can stick to it. Might we suggest nonalcoholic drinks like NA spirits, wine, and beer.

75 Hard Workout Plan

If you aren’t currently very physically active or have a difficult time sticking to a consistent routine, this may be a wallop: For the 75 Hard Challenge, you have to do two 45-minute workouts each day, and one of them has to be in the great outdoors. Luckily, the types of workouts you can do are pretty flexible so long as they are physically challenging and aren’t part of your regular daily routine. Here are some examples:

Cardio Workouts

Cardio should be part of your workout routine during 75 Hard, but you don’t have to go hell-for-leather every day. Many of the best cardio workouts can double up as your outdoor workout session.

Running or jogging
Cycling
Swimming
Power walking
Rowing
Hiking
Jump rope
Martial arts

Resistance Training

Resistance training is a must for any serious training plan, so pick a style you enjoy or one you’re excited to try and stick to it for 75 days. Be sure to plan out your sessions in advance, increase the challenge as you go, and track your progress.

Strength training
Hypertrophy training
Bodyweight exercises (like pushups, pullups, and squats)
Powerlifting

Recovery and Flexibility Training

Including some low-key workouts into your routine is the ultimate overtraining prevention strategy. The less fit you are, the more of these sessions you should include—maybe four to five per week counting toward the 45-minute sessions. Scale down from there if you are more fit or as you progress throughout the challenge.

Yoga
Pilates
Mobility work
Walking
Stretching

High-Intensity Interval Training (HIIT)

If you plan to include HIIT training, do it sparingly. Too much high-intensity work will burn you out in no time. It’s not possible to do true HIIT training for a full 45 minutes, so if you’re going to add this modality to your routine, stick to 10 to 15 minutes at the end of a cardio session or after resistance training two to three times a week.

Pro tip: Skip high-intensity training altogether if your diet plan includes cutting calories. It’s a recipe for burnout.

Circuit training
Tabata workouts
Sprints

75 Hard Pros

There’s a lot going for the 75 day Hard Challenge. Here are some of the main pros.

Builds Habits

We all know that consistency is king when it comes to results, and that’s the main tenant of 75 Hard: to build and maintain a consistent routine that includes five daily tasks every day without fail. Habits are automatic behaviors triggered by specific cues and learned through repetition, strengthening every time you complete the behavior—think brushing your teeth every night before bed or locking up when you leave the house, according to 2021 research published in Social Psychology.

Good habits help you keep up desirable behaviors over time since you’ll start to automatically perform them without having to rely on conscious motivation—something that’s notoriously fickle, according to the study.

Tracks Progress

Tracking your progress is the best way to see how far you’ve come and it’s also a great way to get a motivational buzz when you start seeing a difference in how you look, feel, and act. Progress tracking with a photo is one of the Hard 75 rules, so it’s built into the routine.

Gets You Active

Obviously, physical activity is a huge part of the challenge and a behavior many people struggle to maintain. If you’re doing 75 Hard, you’ll definitely get your daily movement in through the two 45-minute workouts each day.

Includes Time in Nature

While you don’t explicitly have to go on a nature walk, even cityscape fresh air and sunlight are better than nothing. Since the challenge requires you to complete one 45-minute workout outdoors each day, you’ll get benefits from sunlight exposure (which improves sleep), stress relief, and a brain boost.

75 Hard Cons

Aside from giving up your favorite tasty snacks and foregoing a beer during the game, the 75 Hard Challenge has other practical issues.

Not for Everyone

Although 75 Hard has consistency built in, if you don’t include your own context cues for each habit you want to keep once the challenge is over, you likely won’t stick to it. In other words, if you don’t incorporate the habits into your everyday routine in a way that you’ll stick to once the challenge ends, you’ll probably revert to the same old habits—good or bad—that you were doing before. This is the exact reason why most people regain all the weight they lose during diets.

Easy to Overdo It

Without any actual professional nutritional or fitness guidance (Frisella is not a health expert), you can easily go overboard trying to meet the steep expectations of the challenge. You might not pair the ideal diet with your exercise program—such as a muscle-building calorie surplus with your hypertrophy training—unless you know what you’re doing.

You can accidentally choose habits that do more harm than good if you attempt high-intensity training alongside a low-carb diet or push past your body’s signals for rest in order to get in that second 45-minute workout.

Very Strict

Rigidity is the entire point of the 75 Hard Challenge. In fact, Frisella says in an interview with Megyn Kelly, “The whole point of the program is to put yourself in the most inconvenient, non-compromising situation that you possibly can,” with no room for substitutions.

He goes on to say that giving yourself a break or a “mental day” is a no-go because “letting yourself off the hook is the reason you are where you are in this state of unhappiness and unfulfillment.” If you get sick, sore, or have an emergency—too bad—you’ve failed.

Can Lower Confidence

Battering yourself into submission is not always the best for your mental health and certainly won’t work for everyone. Plus, not everyone who wants to improve their health is unhappy or unfulfilled.

In reality, positive thinking can boost self-confidence by helping you see challenges as temporary and conquerable. Overcoming setbacks and still working toward your health goals is a fast track to becoming more resilient and increases internal motivation and confidence. And for the record, internal motivation is stronger than the kind you’ll get from any challenge.

Final Verdict: What Do Experts Say About the 75 Hard Challenge?

As a personal trainer and nutrition coach, I believe that most people, even those with advanced fitness levels, shouldn’t attempt two workouts every single day. Combining cardio and strength training can interfere with recovery and overall results and is a recipe for burnout. Physically, mentally, and socially, two-a-day workouts can be draining and unsustainable and put you at risk of overtraining, which requires lengthy recovery.

If you’re set on following the two-workouts rule, make sure one is recovery-based—light yoga, walking, or stretching. Organized activities like jiu-jitsu or gym classes can count as one workout, with walking or something gentle for the second. For strength training, limit it to three to five days a week and always pair with recovery exercises.

I don’t recommend avoiding rest days, as even lighter workouts can be mentally exhausting and, on a practical level, can get in the way of other areas of your life, like relationships, work, and family responsibilities. Missing a session and starting over can feel defeating, which I’d never want for my clients. If you miss a workout you had intended to complete, it’s better to reassess and adjust instead of stressing over rigid plans.

In my opinion, the idea that “mental toughness” comes from strict workout rules is absurd. True consistency comes from internal motivation, doing what you enjoy for reasons that matter to you. Building skills in activities you love—whether yoga, strength training, running, or a new sport—will make you proud and boost your confidence in the long term.

Real toughness also means listening to your body. Sometimes, backing off is harder than following a rigid plan. Focus on consistency and finding joy in what you do rather than chasing the next challenge.

Why You Should Trust Us

I’m a certified personal trainer, strength and conditioning specialist, and nutrition coach, among other fancy titles—but my passion is communicating the countless benefits of being active and striving toward a healthier mind and body through attainable action. I use a hefty dose of science to guide the advice I give, along with the real-world experience I’ve gained over the last 15 years.

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