After 70 episodes, here’s what I’ve actually learned about living long and well

Listen on: Apple Podcasts | Spotify | Amazon Music | Podcast Index | Overcast | YouTube

After a lifetime of studying evidence, medicine, and what actually helps people — I’ve been sitting with a question: what have I really learned? What have I been trying to share with others? Not what’s trendy. Not what’s getting headlines this month. But what, after all these years, actually matters if our goal is to live long and well?

What We Actually Want

Most of us don’t want just a longer life. We want a better life — more years when we can think clearly, move well, stay independent, enjoy the people we love, and do the things that make life meaningful. So how do we make decisions that actually support that kind of life?For me, the answer keeps coming back to one word: evidence.

Evidence is our compass. It helps us decide which direction is most likely to help when there are so many voices telling us different things. But this compass isn’t always easy to read. Studies conflict. Headlines overstate findings. Experts disagree. And sometimes — often — what looks like evidence is really just a theory, or an anecdote, that feels like proof.

So the question I want to work through today is: how do we stay true to the evidence compass when it’s not always easy to read?

Two forces pull us off course. Hype makes weak evidence feel strong — it’s the detour. Perfectionism makes the journey exhausting even when we’re pointed in the right direction — it’s the parking brake. Something I have applied more times than I wish to admit.

Why Evidence Matters So Much to Me

There’s someone close to me who for years would make health claims that made my hair stand on end — when I had hair.

She’d say things like: breast cancer survivors should never eat chocolate because it will cause the cancer to recur. Or, you must eat sauerkraut to protect your microbiome. Or, never touch receipts at the grocery store because the thermal paper has chemicals that will damage your endocrine system and fertility.

And when I’d ask — what’s the evidence? — the answer was usually “I read it somewhere,” or “it was in the New York Times,” or “my friend’s cousin’s doctor told me.”

What got me upset wasn’t the claim itself. I understand that we can all get excited or frightened by something we read. What bothered me was the certainty. An almost religious conviction that what she’d heard was true and had to be acted on — completely resistant to any discussion of the actual evidence.

I have genuine sympathy for people who are suffering and looking for answers, because traditional medicine often doesn’t give them one. But I go absolutely crazy when experts try to convince those people that they have the way, when it’s almost never based on evidence.

Which is exactly why we need the compass.

My professional life was built around that question: what does the evidence actually justify? I published more than 180 peer-reviewed articles because I wanted to separate what sounds persuasive from what is actually supported. I spent decades working inside these questions — managed care, pharmaceuticals, electronic health records, health policy. My career was largely about helping people read the compass.

Not because evidence is perfect — it isn’t. But without it, we’re much more likely to follow whichever claim sounds most convincing.

How to Read the Compass

A good example of how the evidence compass works — and changes — is heart disease.

For years, we thought of stable coronary artery disease as a plumbing problem. Artery narrowed? Open it up. Sounds logical. Feels intuitively correct. Then the randomized trials came in.

In the COURAGE trial, patients with stable coronary disease who received angioplasty did not have fewer deaths or heart attacks than patients who received good medical therapy alone. The ISCHEMIA trial taught us something similar. These procedures weren’t more effective than treating the underlying risk factors aggressively.

That doesn’t mean procedures never matter — they do. But for many people with stable heart disease, the compass shifted. Less toward “fix the plumbing” and more toward blood pressure, activity, sleep, and metabolic health. And those same factors matter for cognitive decline too.

So how do we read that compass ourselves? When you hear a health claim, ask a few basic questions:

Was this tested in a randomized trial — where people were actually assigned to an intervention and compared to a control group? Or was it an observational study, where researchers noticed that people who did one thing tended to have better outcomes? How large was the study? Has it been repeated? Is there a meta-analysis summarizing the broader evidence?

And most importantly: did the study measure something that actually matters? Did people live longer? Have fewer heart attacks? Think better? Function better? Or did only a lab value change?

A biomarker is not necessarily a meaningful outcome. Changing a number on a blood test is not the same as helping someone live better.

The N-of-1 Approach

Even when the compass points in a reasonably clear direction, the evidence tells us what happens on average. But you’re not the average person. Neither am I.

That’s where the N-of-1 approach comes in.

Take melatonin and sleep. A meta-analysis of randomized trials found that melatonin improved how quickly people fell asleep, total sleep time, and sleep quality — but the average benefit was modest. A few minutes. However, how you respond might be larger, smaller, or nonexistent.

Pick one change to improve your sleep — melatonin, earlier meals, a cooler bedroom, or less alcohol before bed. Decide what you’ll measure: data from an Oura ring, a smartwatch, or just how rested you feel in the morning. Give it a reasonable amount of time. Then ask honestly: did it help?

And if the answer is yes — try stopping the intervention. See if the problem comes back. Then restart it and see if things improve again. That stop-and-restart approach gives you much more confidence that the change is actually helping, rather than just coinciding with something else going on in your life.

Hype: The Detour

Hype lives in the gap between what sounds evidence-based and what actually is. And hype is dangerous because it rarely looks foolish at first. It may sound scientific. It may come from someone credentialed. It may offer a clear explanation when you’re desperately seeking one. And, it makes you feel proactive and hopeful.

Here’s a concrete example: mitochondrial health.

Mitochondria are real. They matter. They help produce energy in our cells. When someone says fatigue, aging, or brain fog is really a mitochondrial problem — the story sounds plausible. Compelling, even. And this is where hype starts to build.

On the supply side-or the person sharing the iniformation, there are often financial incentives: supplements, testing, protocols, online courses. But I don’t think hype always comes from people knowingly selling nonsense. Sometimes they genuinely believe it. They’ve seen patients improve. They have a theory that makes sense to them. Believing what you sell doesn’t mean it works.

And the message gets packaged in ways that sound persuasive. A credentialed expert says it — so it must be true. That’s an appeal to authority, or a type of logical fallacy. A patient tells a powerful story — so the treatment must work. That’s an anecdote being treated as proof. The product is natural — so it must be safer. That’s an appeal to nature.

On the receiving side, many of us have real symptoms and real frustration — fatigue, brain fog, poor sleep, pain, a persistent sense that something just isn’t right. Maybe conventional medicine hasn’t given us a satisfying answer. When that happens, we become susceptible to a whole set of cognitive biases.

Confirmation bias makes us notice evidence that supports what we want to believe, and ignore what contradicts it. Social proof makes us think: if so many people are doing this, there must be something to it. And the halo effect makes us trust someone’s health claim because they look fit, sound confident, or have expertise in a related area.

So the mitochondrial story has everything hype needs: a plausible biological mechanism, a credentialed expert, compelling anecdotes, a clear supplement or protocol, and the promise of agency. When all of those forces come together, weak evidence can feel much stronger than it is.

But here’s where we come back to the compass. What’s the actual evidence? For most mitochondria and NAD-related claims, the evidence is not where the hype suggests it is. Some supplements change NAD-related blood tests. But credible evidence that they improve meaningful clinical outcomes — aging, fatigue, wellness — just isn’t there.

How to Avoid the Detour

Pause. Hype usually wants urgency — buy now, believe now, test now. Slow down.

Follow the money. Who benefits if you believe this? That doesn’t automatically make the claim wrong. But it should make you more careful.

Look for the hype equation. Is there a cool biological mechanism? A credentialed expert? Compelling anecdotes? A promise of control? The more of those pieces you see together, the more cautious you should be.

Name the reasoning trap. Is a story being treated as proof? Is a mechanism being offered as evidence? Is an expert opinion substituting for data?

Check your own mind. Am I believing this because the evidence is strong — or because the story is satisfying and I really need an answer?

That’s how we avoid the detour. Not by becoming cynical. By returning to the compass.

Perfectionism: The Parking Brake

Even if we read the compass better and dodge the obvious detours, there’s still one more issue working against us.

If we take the evidence seriously, we quickly find there’s a lot it supports: exercise more, sleep better, eat better, manage stress, build stronger relationships, control blood pressure, improve cholesterol, drink less alcohol, track this, measure that. Many of those areas are genuinely worthwhile. But if we try to do all of them, all the time, perfectly — health becomes all-consuming.

Voltaire said it: the great is the enemy of the good.

Exercise is a good example. It reduces the risk of heart disease, stroke, diabetes, cognitive decline, falls, and premature death. The evidence on this is about as strong as it gets. But here’s what the data actually show: the largest gains go to sedentary people who start taking regular brisk walks. Going from nothing to something produces dramatic benefit. Going from a lot to more — the marginal returns drop off significantly.

A vigorous 20 to 30-minute walk most days captures most of the benefit. Doubling or tripling that is fine, but it doesn’t further reduce mortality nearly as much as you might expect.

That’s the parking brake lesson. The goal isn’t to perfect every detail. The goal is to do enough of the high-value items that actually matter.

The 80/20 principle applies here — 80% of the benefit from 20% of the effort. Some changes produce large returns. Exercise is one. Meaningfully improving very poor sleep is another. Reducing alcohol from two drinks a day to one — not necessarily zero, just one. These moves, for the right person, can be significant.

But if you’re already doing a fair bit in these areas — pause. Congratulate yourself. Then honestly ask: would more actually help? And at what cost? Life is always a balance of benefits and costs. More isn’t always better. Sometimes good enough is exactly right.

What to Actually Do

Choose the few actions most likely to matter for you, specifically. Ask where you’ll get the biggest return.

If you’re inactive, start with movement. If sleep is poor, work on sleep. If blood pressure is high, address it. If alcohol is clearly affecting your sleep, mood, weight, or relationships, reduce it.

And make the plan sustainable. A good plan you can actually follow beats a perfect plan you abandon.

The Bottom Line

That family member I mentioned at the beginning — she’s still at it. Still reading things somewhere, still holding onto them with absolute certainty. And I still find it maddening. But it also still motivates me. Because she’s not the exception. She’s the norm. Most of us are looking for answers, and the world is full of people happy to sell us ones that don’t hold up.

Here’s what I’ve learned:

How do we use evidence more wisely? We treat it as the compass. Not always easy to read, but essential for staying oriented.

How do we recognize hype before it pulls us off course? We slow down, look for the hype equation, and remember that a compelling story is not the same as proof.

How do we pursue health without turning it into a full-time job? We focus on what matters most, make it sustainable, and leave room for joy.

Follow the compass. Watch for the detours. Release the parking brake.

Health matters enormously. But it’s not the destination. It’s what keeps us living the life we actually want to live.