Part I: Preventive care
- Drink enough water
- Eat well
- Sleep long enough and sleep well
- Build meaningful social ties
- Stay physically active
- Avoid chronic stress
- Be intentional about preventing heart disease
- Build a healthy gut microbiome
- Take care of your teeth and gums
- Take care of your skin
- Eliminate and prevent allergies
- Minimize exposure to environmental allergens, toxins and harmful viruses
- Proactively monitor health
Part II: Medical care – Before you get sick or injured
- Set aside money in an FSA or HSA
- Invest in the best insurance plan you can afford
- Invest in a concierge healthcare plan
- Try to live reasonably close to high-quality emergency medical care
Part III: Medical care – When you get sick or injured
- Document symptoms and medical history
- Visit concierge doctors and top specialists
- Research illness, injury, treatment options, etc. using PubMed
Part I: Preventive Care
Drink enough water
What does drinking enough water mean? For me, it means drinking water whenever I feel thirsty and avoiding dehydration. Instead of tracking daily water intake – e.g. “X” glasses of water – I stay mindful of urine output and concentration.
Tracking water intake isn’t helpful, because it is hard to account for fluctuating variables like exercise, climate, and diet. And, yes, the 8 glasses of water rule is a myth.
The easiest approach I have found to staying hydrated is to focus on having lightly colored (diluted) urine. You do not want darkly colored (concentrated) urine, because it impairs kidney function and can lead to nasty issues like kidney stones.
What does it mean to eat well? For me, it means eating in a way that helps me avoid developing chronic diseases and live a long, healthy life. I also only want to eat food that I am excited about, so no Soylent for me.
Here is an overview of my cooking and eating habits:
- I avoid eating processed foods and refined sugars as much as possible.
- I watch my alcohol intake. Several nights a week, I have a small, 3-4oz, glass of Cannonau di Sardegna with dinner. Cannonau, a red wine grape from the island of Sardinia, has some of the highest levels of resveratrol in the world. I usually buy a case at a time.
- I keep the fridge stocked with lots of organic fruits and vegetables, wild salmon and shellfish, and eggs.
- I make meals that I enjoy eating. I routinely cook Ikarian recipes like Briam and Sardinian recipes like Fregola con Arselle (I use wild scallops or mussels when wild clams are unavailable). Both of these dishes work great paired with Sardinian Carasau, a flatbread. I also have fun experimenting with salads and breakfast and lunch sandwiches on flax bread.
Life is all about balance and avoiding extremes, so I sometimes make exceptions to the habits listed above. When I do order in or go out to eat, I try to get something fun that I would be unlikely to make at home – e.g. Nepalese momo, Ethiopian bayenetu, Japanese donburi, Vietnamese pho, etc. I also eat processed foods, refined sugars, and red meat on occasion, especially when visiting family or friends or traveling outside the US.
What matters are my daily habits.
Sleep long enough and sleep well
Getting enough sleep – Everyone has their own optimal number. I aim for seven to eight hours a night.
Getting quality sleep – Sleep issues are often a product of our modern environment. The best sleep of my life has been on climbing trips. It is the combination of cold fresh air, a hard sleeping surface, minimal screen time, being surrounded by friends, and being exhausted from a physically taxing day. I love turning in just after sunset and waking naturally at sunrise.
At home, a firm mattress is helpful. I also periodically sleep on a yoga mat on the ground and wake up naturally with the sun (my apartment windows face east).
The biggest inhibitor of quality sleep at home is the cat. He meows before the automatic feeder dispenses his food, because he is obviously hungry, and immediately after he eats, because he is ready to play.
Build meaningful social ties
It's easy to connect with people digitally, but it's more important to invest in real-life relationships. You will be happier if you do.
A lot of people find it hard to start new, meaningful friendships as an adult. I do too! The best solution I have found is to put myself in situations where I get to spend a lot of time (in person) with other people doing a shared activity or working toward a common goal. Often in these contexts – like a climbing, scuba, or sailing training course – none of the other people know each other. You are also forced to partner up and often rotate between partners. Although I have been focused on outdoor recreation, the same rationale applies to many other group activities. You can commit to a dancing course, join a choir, volunteer regularly with a specific organization, etc.
Stay physically active
The number one way I try to stay physically active is by walking a lot. Pre-pandemic, this used to be really easy – I would naturally walk 2-3 miles a day as part of my commute to and from the office. When I transitioned to remote work, I had to become more intentional about getting out of the apartment and routinely walking long distances.
In addition to walking, I do resistance exercises like squats, pushups, planks and dumbbell curls for 45 minutes to an hour five days a week. For cardio, I try to go on 2-3 mile runs three times a week or ride a Peloton at home.
Avoid chronic stress
Still working on this one.
Be intentional about preventing heart disease
To stay on top of my cardiovascular health, I bought and read Personalized and Precision Integrative Cardiovascular Medicine by Dr. Mark C. Houston.
I created the table below, using my reading notes, to remind myself of what to do and what not to do in order to prevent cardiovascular disease.
Build a healthy gut microbiome
Before you can improve your gut microbiome, you need to figure out what it looks like. The best service I have found for this is Parsley Health. Parsley’s functional medicine doctors helped me diagnose and eliminate the root causes of SIBO that I had been experiencing for nearly two years. I wasted a lot of time and money visiting unhelpful primary care doctors and gastroenterologists in Washington, D.C. before finding Parsley Health.
Take care of your teeth and the gums
Beyond brushing my teeth twice a day, flossing once a day and visiting the dentist twice a year for cleanings, I use a toothbrush with soft bristles and Sensodyne to promote gum health.
I don’t use antiseptic mouthwash, because it kills the bacteria in your saliva that are key to nitrate reduction (and nitric oxide production) in your stomach. Your body needs nitric oxide to keep your heart healthy.
Take care of your skin
Growing up, I suffered a lot from eczema. Every primary care doctor visit went the same way – the doctor prescribed a steroid cream to clear up my breakout and vaseline to keep my skin moisturized. The steroid use was actually harmful; it made my skin thinner.
When I was 26, I searched for a way to end the breakout <> treatment cycle once and for all. At the recommendation of a One Medical physician, I visited a well-known DC-based allergist. The allergist told me to throw away any petroleum-based products – like vaseline – that I might be using and switch to a lotion called Vanicream. I took his advice. My lifelong eczema issue was completely resolved within a year. I have basically been eczema free – save for the occasional wetsuit rash – for over five years.
Eliminate and prevent allergies
In addition to ezcema, I suffered from seasonal allergies. The same allergist who prescribed me Vanicream also tested my body’s reaction to a number of common allergens. He recommended weekly personalized allergy shots (this lasted almost 18 months). For short-term relief, he prescribed Zaditor eye drops and a Xyzal pill once a day – both worked great.
At the beginning of the pandemic, I shifted from personalized allergy shots to once-a-day sublingual (applied under the tongue) liquid drops. The only downside to the drops was that they were not covered by insurance and cost about $150/month. My shots were covered, but I had to pay the copay for weekly specialist visit.
Minimize exposure to environmental allergens, toxins and harmful viruses
- I lüften – ventilate – the apartment every day by opening the windows for an hour or two. The most environmentally-friendly version of this practice is Stoßlüften – shock ventilation. This method involves opening your windows for five to 10 minutes a day, or three minutes when it is windy.
- I use two air purifiers with HEPA filters.
- I always take off my shoes at the door.
- I clean the house using a robot vacuum – Roborock S7 – once a week.
- I avoid exercising outside on days with bad air quality or near traffic.
- I buy organic, even though the US certification system leaves a lot to be desired.
- I filter my tap water.
- I wash my hands with soap and water (avoiding antibacterial soap) before preparing food and eating.
- I store food and liquids in glass, rather than plastic, containers.
- I use natural household cleaning products.
Proactively monitor health
Get a routine physical and talk with your physician about recommended screenings and preventive care.
I take annual blood tests with InsideTracker to give me a better picture of my biomarkers, like glucose and cholesterol, over time. These tests helped me identify and address a significant Vitamin D deficiency and pretty elevated cortisol levels. Bloodwork performed as part of a physical would probably have caught my Vitamin D deficiency as well, but I find it valuable to see the fluctuations visually mapped out over multiple tests.
Part II: Medical care – Before you get sick or injured
Set aside money in an FSA or HSA
I try to budget for covering all of my co-pays, medical supplies, and bi-annual trips to the dentist with FSA dollars. I have used an FSA to pay for allergy shots, doctor-prescribed physical therapy, and, of course, sunblock.
Invest in the best insurance plan you can afford
Your health is more important than anything else. Always buy the best. Don’t try to save money by picking the plan with the smaller network that requires a referral to see a specialist. I have done this. It was a horrible experience that significantly delayed treatment, wasted many hours of my life, and cost me hundreds of dollars.
Invest in a concierge healthcare plan
I will always try to live in an area serviced by One Medical or a similar concierge healthcare provider. One Medical is simply phenomenal compared with the average physician’s practice. Stop wasting hours of your life waiting for an appointment to start. Stop going to unhelpful appointments that last a maximum of ten minutes.
Try to live reasonably close to high-quality emergency medical care
I will always try to live in an area that has a world-class hospital. After experiencing a kidney stone in the middle of the night, you will want to live near a good hospital as well.
IMPORTANT – Figure out which hospital you want to use before there is an emergency. Also have a plan for how you will get there, assuming you do not need an ambulance.
Part III: Medical care – After you get sick or injured
Document symptoms and treatment history
Whenever I have a specific health issue that lasts weeks or months, I try to keep a record of my symptoms, doctor visits and treatments in a Google Doc. Recording this information has helped me identify underlying causes of health issues and figure out which treatment approaches worked best.
Use concierge healthcare services
After using One Medical for primary care and Parsley Health for functional medicine, I will never go back to normal healthcare providers, if at all possible. If only there were concierge hospitals!
Research illness, injury, treatment options, etc. on PubMed
It is important to stay informed but also not become a hypochondriac. Common is common. You are more likely to have the flu, COVID-19, or the common cold than a rare respiratory illness. The goal of research should simply be to help you navigate the healthcare system - to better understand who to speak with, what to talk about and how to advocate for yourself. I used PubMed to figure out that I likely had SIBO and ask a gastroenterologist for a SIBO breath test. I also used PubMed to help me make more informed decisions regarding my SIBO treatment options.