The Atmasvasth Guide to Living Long, Healthy

The premise of Atmasvasth is that we can control our health, lengthen our healthspan and lifespan, and be atmasvasth, on our own, with just a little help, if at all, from doctors and the healthcare system. The very first article that I published last December 2020 explains this in detail. The article on atmasvasth takes this concept forward as does the one on healthspan. The site is structured like a loose book and the Index or Table of Contents and/or the Archives can help you navigate the site.

You can listen to the audio/podcast hosted on Soundcloud by clicking the Play button below within the browser itself.

It’s now been over a year since I started Matka Medicine adding the concept of atmasvasth halfway through, as a way to live long, healthy.

While I still have a lot of ground to cover, it is time to take stock of what it entails to have a long healthspan and a healthy lifespan, essentially ageing healthfully.

If this concise guide seems overwhelming…that is what living long, healthy entails. Most of us grow up believing that our health is not ours to manage, but should be left to experts like doctors and the healthcare system, which is fine when you are sick and ill, but of no help when you want to be free from disease.

We know more about our cars than we do about our own bodies and health. That needs to change.

1. Move

• 150-300 minutes of moderate physical activity per week. Walk, run, do strength training, yoga, preferably mix it up...any physical activity is better than none and every minute counts, including physical activity only on weekends. The simplest exercise is walking, the magic number being 4000 steps, or 30-45 minutes per day, if you want to do nothing else. However, while being active is good, being fit is better - aspire to reach 10 METs if you are between 50-59 years of age. Every move counts and the more vigorous the activity, even for short intervals, the better it is. Climbing stairs, especially out of compulsion, at work or at home, helps. If you run on Indian roads, run safely and face the traffic.
• Physical activity in all forms improves blood pressure control, diabetes control, reduces the rate of cognitive decline and deaths from dementia, reduces the incidence of cancers and deaths from cancers, attenuates the downsides of poor sleep and reduces the incidence of falls and falls related fractures, apart from the overall increase in healthspan and lifespan.

2. Eat smart, eat less - sensible eating

• Sensible eating with a balanced diet, within limits without agonizing over every calorie eaten. Logging food and drink a few days every month or quarter will help you understand if you need to rebalance or reassess your food and drink habits.
• 5 portions of fruits and vegetables per day.
• Plant based eating as much as possible, but affordable and local.
• Avoid and individual superfoods and sugar-sweetened beverages. While ultra-processed foods (UPFs) should be approached with care, not all UPFs are bad and you should assess each UPF on its own merit.
• Time-restricted eating may help with managing food intake.
• Not more than 2 teaspoons of salt per day. It is impractical to monitor salt intake in your food on a daily basis. The best way is to control your salt intake is to reduce your intake of UPFs, not add extra salt to food during meals and switch, if possible, to a potassium-enrich salt substitute. Pink salt, rock salt, etc. have no added health benefit.

3. Manage cardiovascular risk, including hypertension and diabetes

Measure your own risk using calculators at least once a year. You can use the QRISK3 or the LE8 score. A coronary calcium score (CAC) may help after the age of 45, if you have intermediate (not too low or too high) risk.

• The LDL should be less than or equal to 100 mg/dl and less than 70 mg/dl, if there is any risk factor.
• The blood pressure should be 130/80 mm Hg or less and definitely below 140/90 mm Hg. Measure your own blood pressure regularly.
• The HbA1c should be less than 5.6 with a fasting plasma glucose less than 100 mg/dl. Screen regularly for both.
• For these 3 points, if the values are abnormal, and if physical activity and eating sensibly do not bring them to normal, medication should be used after consulting an appropriate doctor.
• ECG yearly for cardiac issues, and definitely after 65 years of age for atrial fibrillation.

4. Sleep well

• Between 6-8 hours a day.
• If you snore, or are sleepy or groggy during the day, please see a sleep specialist to get a sleep apnea test done, but if you are otherwise fine, you do not need a sleep study.
• Daytime naps may help

5. Vitamins, minerals, supplements, stimulants - be cautious

• Vitamin D3 - you don't need testing or supplementation if otherwise healthy, unless you have a major illness that causes vitamin D deficiency. You should actively say no to such testing and supplementation, especially as part of annual health check-ups.
• Vitamin B12 - supplementation may not be needed just because you are vegetarian or Jain
• Most vitamins, minerals and herbal supplements are useless, if you are otherwise in good health and eating sensibly - they can in fact cause financial and bodily harm - self-iatrogenesis.
• A couple of cups of tea or coffee or both are worth the effort.

6. Take vaccines

• Protect from Covid-19, flu, zoster, DTP, pneumococcal and varicella.
• Make sure that the HPV vaccine is given to all under 14 girls you know in your family to prevent the occurrence of cervical cancer in adulthood.
• In the future, we will likely have vaccines for tuberculosis, dengue and malaria. They should be taken as and when available.

7. Improve balance, do not fall and do not fracture if you fall

• Physical activity as in point 1.
• Balancing exercises with yoga or tai-chi, as part of the daily/weekly physical activity routine.
• Detecting and managing poor vision, reduced hearing and polypharmacy reduce the risk of falls and fractures.
• Walking aids may not be helpful and could even increase the risk of falls.
• Falls-proof the house.

8. Recognize, prevent and reverse frailty

• Preventing and reversing frailty

9. Screen for cancers and other diseases

• Yearly mammography for all women above the age of 45 years.
• Lung cancer screening with low dose CT scan if you smoke or have been a smoker, yearly or once in two years, depending on the amount of smoking.
• HPV DNA test for cervical cancer every 5 years.
• Serum PSA test for prostate cancer - do not do if over the age of 70 and between 55 and 69 years, do only if you handle the consequences of an abnormal result.
• Screening for colorectal cancer is not advisable in India.
• Physical examination once a year to look for lumps and bumps.
• DO NOT screen for other cancers, unless you are specifically genetically at high risk, in which case your oncologist will guide you.
• Regular self-weighing is NOT required
• 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
• One-time bone density test by dual X-ray absorptiometry (DXA) if you are a woman above the age of 60, to detect osteoporosis to prevent fractures
• Chest X-ray for screening for tuberculosis - once in 3-5 years
• Do not do unnecessary tests (less is more during your health check-ups) and remember that preventing disease from occurring is better than testing to find disease and then treating it.
• Do NOT test for genetic risk of disease, unless your doctor believes it is essential for your specific situation. Remember that epigenetic factors including our exposome and our lifestyle (physical activity, sensible eating, etc) can modify the effects of these genes significantly.

10. Manage your senses (dental, vision and hearing), incidental, asymptomatic findings in the body and self-medication

• Oral hygiene matters - brush twice a day, floss once a day and see a dentist at least once in two years.
• Vision matters - see an ophthalmologist at least once in two years for cataract, glaucoma, refraction errors and macular degeneration.
• The ability to hear well matters. Protect your hearing by avoiding loud environments and using noise cancelling headphones/earphones. Test yourself using your phone for hearing loss and start using hearing aids if you have mild to moderate hearing loss. See a doctor if the hearing loss is severe or cannot be corrected by over the counter hearing aids like the AirPods Pro 2.
• Measure your body temperature when you are normal, a few times to know what your own normal is.
• Do NOT take antibiotics on your own each time you feel sick.
• Do NOT be a victim of polypharmacy - check your medication list regularly.
• You have the right and power to say no to unnecessary, un-indicated surgeries and procedures, e.g. preventive gallbladder surgery to remove silent gallstones.

11. Prevent cognitive decline and manage mental health

• Physical activity, sleep and sensible eating are the 3 main pillars to reduce cognitive decline. Optimal sleep and high PA are both equally important.
• In the future, drug treatment may be available to prevent and treat cognitive decline, at which time then genetic and blood testing for earlier diagnosis may also become routine.
• Develop coping mechanisms, learn continuously and cultivate stable, long-term relationships.
• Address loneliness.
• Build cognitive reserves through education and life-long learning and reading.
• Meditate - a stable mind helps reduce cardiovascular and other risks.
• Identify suicidal thoughts and ideation in us and those around us and help to prevent suicide attempts and death.

12. Reduce, control or eliminate addictions and stimulants

• Drink alcohol sensibly, if you have to. Don't start if you don't drink.
• Do not start smoking and if you do, then switch to e-cigarettes or just stop. It is never too late to quit.
• Do not chew gutka or similar tobacco mixes. Oral cancer, a horrendous, disfiguring cancer is preventable.
• Control caffeine intake. Generally, no caffeine in any form at least four hours prior to bed time.

13. Manage environmental exposures and stressors

• Air - air purifiers at home and work may help with reducing the short term and possibly the long term effect of air pollution. On high AQI days, staying indoors and avoiding high traffic density areas if outside may help. Running / walking outdoors though, is acceptable in high AQI settings, but within limits.
• Noise - use earphones when traveling but not when walking or driving. Don’t make noise, for e.g. don’t honk when you are driving. Move to less noisy environs if you can, e.g. away from main roads.
• Temperature - reduce exposure to extremes of heat and cold and protect yourself as best as possible in such environments.
• Digital - reduce dramatically the use of gadgets, and time spent on social media, unless that is your profession. Most of what we see on Twitter or Facebook or WhatsApp is just noise.
• Road accidents - avoid being in road accidents and follow safe practices as a driver, or when driven and as a pedestrian. If you are in the backseat being driven, always wear a seatbelt.

14. Manage the logistics of your health like you would manage any other major long-term project

• Make sure you have enough money to last till the age of 90 years, inclusive of catastrophic spending at least once in that timespan. Good financial planning and management are a must.
• Get good health insurance up to the maximum amount you can afford for yourself and the family.
• Identify a health coach who can guide you through points 1 to 12. The health coach does not have to be a doctor.
• Get your Health ID from NDHM.
• Identify a good family physician you can reach out to when sick, to guide you through the process of meeting other specialists, navigating hospitals, making sense of different reports, etc. Avoid using Google search, online aggregators and social medial platforms to choose doctors. Know when to act fast and know when to think calmly.
• If you are lucky to know a good geriatric doctor, please see them once a year and definitely once in two years.
• Get a health check-up every year based on points 1 to 12, but also manage as much as you can on your own. Remember, in India, you don’t really need prescriptions for blood tests.
• Measure your own temperature when healthy, to know your normal.
• Avoid hospitals unless absolutely necessary. As far as possible, opt for homecare.
• Create a travel medicine kit that you can easily carry in your carry-on luggage.

15. Managing the Remaining 1500 Weeks of Life

• Take stock of the remaining 1500 weeks of life (managing retirement)
• The inevitability and certainty of death and resist the option of "death as treatment"
• Make a living will

This is a dynamic guide, which keeps changing as our understanding of healthful ageing improves.

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