The 15-Point Guide - Detailed

The detailed 15-points guide to live long, healthy

The Book

The Detailed Guide

This is the detailed guide and a companion to the book. Since this is a dynamic guide, it will keep changing as and when there is new data or new knowledge. If the information is new compared to the latest edition of the book (currently 1st edition), I will use italics to highlight the addition.

If you feel like logging your health details in the book, then the guide also explains how often to do so (daily, weekly, monthly, yearly, etc.)

1. Move - be physically active - daily

At least 30-45 minutes of moderate to brisk walking every day, 6 days a week. Anything more is better. If you are able to, then running works wonders.
Add strength training.
Add yoga or tai-chi or similar exercises to improve balance.
Use stairs instead of lifts and add short bursts of brisk walking as part of your daily routine.
If you are already active, then improve your cardiorespiratory fitness (CRF) to the appropriate level for your age by increasing the level / amount of your physical activity. You can measure your CRF using your tracking device (Apple Watch, etc) or with a treadmill stress test.
Remember, every move counts and any activity is better than none.

2. Eat less, eat smart - eat sensibly - daily

Aim for a balanced diet with a variety of foods.
Aim for 4-5 servings of fruits and vegetables per day.
Add 1 portion of non-salted mixed nuts.
Avoid sugar-sweetened beverages including packaged fruit juices. Approach ultra-processed foods (UPFs) with care...not all UPFs are bad and you have to evaluate each UPFs on its own merit.
Some form of intermittent fasting, e.g. time-restricted eating (TRE), at least 5 days a week and/or some form of portion control may help.
Aim for not more than 1-2 teaspoons of salt a day and switch to a potassium-enriched substitute if possible. Try not to add additional salt during mealtimes. It is practically almost impossible to control salt intake, so don’t over-sweat it.
You don’t need to count calories daily, but once a month for 5 consecutive days will help you understand how many calories you are consuming. Using an online app such as MyFitnessPal helps.

3. Sleep well - daily

Sleep for at least 6-8 hours a day.
Daytime naps of 30-45 minutes help.
If you snore or feel groggy during the day, see your physician and if necessary, a sleep specialist. Do not however do a sleep test if you are otherwise normal.

4. Calm your mind and build cognitive reserves to prevent/delay cognitive decline/dementia - daily (meditation, downtime, learning, reading).

Calm your mind

Meditate for 10-30 minutes - a stable mind helps in the long run.
Set limits to the time spent on social media including WhatsApp - not more than a total of 1-2 hours per day, not more than 30 minutes per session, etc. Don’t get into arguments or debates with people online. Aim for digital minimalism.

Prevent/delay cognitive decline/dementia

Physical activity, good sleep, sensible eating, not smoking and minimal to no alcohol - help reduce cognitive decline.
Read - preferably a book, else a long article, daily.
Learn a new skill - language, musical instrument, singing, dancing, gardening, etc.
Maintain social connections - to prevent loneliness, which can accelerate cognitive decline.
In the future, if robust drugs become available to prevent/treat cognitive decline, then genetic and blood testing will also become routine.

5. Manage your medications, supplements, vaccines - daily, once in six months, yearly, one time

Take as few medicines as absolutely necessary, preferably not more than five. Do not become a victim of polypharmacy - regularly check your medication list to optimize it. Question your doctors or do your own research, each time you are prescribed drugs including ayurveda and homeopathic drugs.
Do not take supplements or superfoods - there is no need for vitamin D and B12 and mineral supplementation if you are eating adequately and are physically active. Unnecessary supplementation can potentially cause harm.
Take your vaccines - zoster, pneumococcal, flu, TDP, COVID, etc. Ensure that all under 14 girls in your family take the HPV vaccine to prevent cervical cancer in adulthood.
Do not take antibiotics unnecessarily and definitely not on your own.

6. Moderate your addictions and stimulants (smoking, alcohol, caffeine, marijuana) - daily

Do not smoke. If you do, then switch to e-cigarettes or just stop. Do not chew tobacco/gutka. Period.
Drink alcohol in moderation, if you have to. Don’t start if you anyway don’t drink.
Two-three cups of tea or coffee may improve many health parameters.
Marijuana may make you feel good, but has hidden health effects, which are only now seeing the light of day.

7. Do not fall (improve balance, take care not to fall) - daily and assess frailty - yearly

Physical activity and strength training improve muscle and bone strength.
Yoga and tai-chi help improve balance.
Using walking aids like canes and walkers are double-edged swords - use them only if they can be monitored and only if absolutely necessary.
Make sure you can see and hear well and avoid polypharmacy.
Improve your household, building and other environmental factors to minimize falls…in effect, falls-proof your home and surroundings.
Assess and manage frailty.

8. Manage your senses (oral, vision, hearing) - daily, yearly

Good oral hygiene is important - bad teeth and gums are linked to many disease conditions.
Good vision is necessary for daily activity and should be checked regularly once in a year, not later than two.
Good hearing is necessary for daily activity. Test yourself using your phone and earphones and use products like the AirPods Pro 2 as hearing aids if you have hearing loss.

9. Address abnormal environmental exposures (your exposome) and stressors at a personal level (air pollution, noise pollution, extremes of temperature, digital noise, accidents - intended and unintended, management of incidental findings when asymptomatic) - daily, one time

Stay at home on highly polluted days if possible. Use air purifiers at home to improve the air quality. Extreme exercise on days with high AQI outdoors may be avoided, but the data on this is not definite.
Avoid extremes of temperature exposure. Reduce exposure to extremes of heat and cold and protect yourself as best as possible in such environments.
Try not to live next to railway tracks or main roads with high volume traffic. If you don’t have a choice, soundproof your house as much as possible.
Wear earphones with some noise cancellation like the AirPods Pro in loud areas such as weddings, concerts, especially if indoor.
Set limits to the time spent on social media including WhatsApp - not more than a total of 1-2 hours per day, not more than 30 minutes per session, etc. Don’t get into arguments or debates with people online. Most of this is just noise (digital noise). Aim for digital minimalism.
Avoid being in road accidents at all costs. In India, riding a two-wheeler is the most common cause of a fatal road accident, followed by being a pedestrian. Use safe practices to avoid being in a road accident and to mitigate the risk of injury and death, if you do get into one, e.g. wear a seatbelt at all times, even if you are in the backseat being driven.
Recognize and manage suicidal thoughts in us and those around us. Understand the causes, how to identify red flags and how to help and seek help.
Say no to unnecessary procedures and surgeries for incidental findings when asymptomatic, e.g. preventive gallbladder surgery for silent gallstones.

10. Be aware of your weight - monthly and log calories for 4-5 days in a month - monthly

Do not weigh yourself daily. If you are concerned, then once a month is the best, definitely not more than once a week and not less than once a quarter.
Check your calorie intake for a few days each month or quarter to ensure you are not overstepping your normal range.
Physical activity trumps overweight and obesity BMIs. Overweight-fit and obese-fit people live longer than normal-BMI-unfit people.

11. Manage your cardiovascular risk yourself - quarterly, yearly

Measure your blood pressure yourself once a quarter, if normal, less or more frequently if abnormal.
Check your blood sugar and HbA1c once a year if normal, more frequently if abnormal. Motivate others around you to do the same. Start at age 30.
Check your lipid levels once a year, more frequently if abnormal.
Check your QRisk3 score yourself - if the cardiovascular risk is found high, see your doctor. If normal or low, then repeat once a year.
Also check your AHA LE8 score - along with the QRisk3 score, it gives you a sense of your health. Repeat once a year.
One ECG during an annual health check-up and definitely after the age of 65 is important, to check for atrial fibrillation.
A coronary calcium score (CAC) test may help after the age of 45, if you have intermediate risk (not too low and not too high) or QRISK3 or AHA LE8 testing.
Follow your doctor’s advice on management of high blood pressure, diabetes and high lipid levels, but do your own research on the medications and question the treatment rationale, if it seems irrational.

12. Screen for cancers and diseases, where screening actually makes a difference - yearly, biennially, every 5 years

Cardiovascular screening as in point 11 for high blood pressure, diabetes (starting at age 30), lipids yearly, if not more frequently. Other tests (ECG, calcium score) as mentioned by your doctor.
Annual or biennial screening mammography in women between 40-75 years of age picks up breast cancer early.
HPV DNA test for cervical cancer in women every 5 years saves lives.
Lung cancer screening with low dost CT scan if you smoke or have been a smoker, yearly or once in two years, depending on the amount of smoking picks up lung cancer early.
One chest X-ray once in 3-5 years, mainly for tuberculosis.
One-time USG of the abdomen for abdominal aortic aneurysm (AAA), between 65-75 years of age if you are a smoker or have smoked in the past or have first degree relatives diagnosed with AAA makes a difference.
One-time bone density test by DXA if you are a woman above the age of 60, to detect osteoporosis is recommended.
Serum PSA for prostate cancer - between 55 and 69 years of age once, but only if you can handle the issues related to the diagnosis of a cancer, which perhaps may not be relevant, but whose treatment can make you miserable. In most instances, it is best to avoid doing it. Definitely, do NOT do a serum PSA if you are over 70 years of age.
Unlike in the Western countries, there is no data to support the use of screening colonoscopy or sigmoidoscopy for colorectal cancer in India.
DO NOT screen for other cancers, even if the tests are cheap or glamorously advertised. These tests cause more harm than good. Screening is only to be done if you are high risk for a specific cancer, in which case, a geneticist or oncologist will guide you.
DO NOT test for genetic risk of disease, unless your doctor believes it is essential to for your specific clinical or disease situation.

13. Get/renew good health insurance - yearly

Get good health insurance up to the maximum you can afford. In India, it is best to start before the age of 60, ideally at the youngest age you can, and make sure it never lapses.

14. Identify doctors and health systems around you and work out the associated health and disease logistics in advance - one time

Learn how to manage and reduce healthcare costs.
Identify a good family physician to help you navigate the system if you fall ill.
Identify a health coach who can do the same.
Be aware of acute conditions where speed is important and of non-acute conditions where you have to think calmly and move slowly.
Know the names and contact numbers of all your physicians. Write them in this book or have them easily available for your near and dear one.
It is best to avoid hospitals unless absolutely necessary, including for preventive tests. Opt for homecare and find physicians in your neighborhood or who provide homecare.
Get your ABHA health ID from ABDM.
Avoid generic drugs for all the pills you have to take. Use branded drugs from known companies.
Create and carry your own travel medicine kit separate from the pills you need daily for the diseases you may have.

Taking Stock of the Remaining 1500 Weeks (Between Ages 60 and 90) - yearly

Set aside enough money to take care of your health till the age of 90 or more - work with a financial planner if you are not sure how to do this.
You have to age healthfully, not gracefully.
Set up your wills (regular will, living will) - one time
- A regular will is a must to make it smooth for your near and dear ones when you die.
- A living will, though not legally cumbersome in India, still allows your near and dear ones to take decisions on your behalf regarding the extent of treatment, if you become unconscious or are incapable of making medical decisions.
- Understand the concept of "death as treatment" in detail and resist it, if you are not fine with it.