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I’m turning 70 in July. That number feels different. Not bad. Not a tragedy. But different-like a threshold I’ve been approaching without fully acknowledging it.

So I’ve been asking myself some honest questions: What am I actually doing to preserve the life I want? What am I not doing? What do I worry about? And what have I decided to let go?

Maybe you’ve had a moment like that. A milestone birthday. A health scare. Or just a quiet evening where you realized you want to be more intentional about how you’re living. That’s what led me to write this.

I want to share my actual health plan — not as a template you should copy, but as a case study in how to think. I have my own genetics, preferences, risks, and limitations. You have yours. But sometimes it helps to see how someone who has spent decades reviewing health evidence actually lives.

After two years of podcast episodes examining what does and doesn’t work, I’ve come to organize my thinking around three categories: what I can influence directly, where I need support from others, and where medication is the right tool. The mix differs for everyone. But most of us have something in all three buckets.

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What I Can Influence Directly

Aerobic exercise is the easy one for me. I genuinely enjoy it. I like endurance training, being outside, feeling that my body can still do something hard. I’ve completed four full Ironman triathlons, and I’m still at it in my late 60s. I don’t need extra discipline here — it fits my life because it fits my personality.

The evidence is unambiguous: aerobic exercise lowers risk of heart disease, reduces overall mortality, and helps us keep doing what we love as we age. When something is both evidence-supported and enjoyable, you hold onto it.

Sleep is entirely different. Unlike exercise, sleep doesn’t come naturally to me — at least not in the right amounts. Here’s my particular challenge: I wake up at 5 a.m. every single morning, no matter when I went to bed. My brain has no interest in compensating for a late night. I’ve accepted that this is simply how I’m made.

So if I need seven and a half to eight hours — and the evidence says I do — the morning can’t save me. I have to protect my bedtime. That means making an active, sometimes difficult choice every evening to wind down and be in bed around 9 p.m. It means leaving parties early. It means turning off things I’m enjoying. The evidence tells me sleep matters; knowing myself tells me exactly where the effort has to go.

Alcohol required some honest accounting. I like wine. I really enjoy whiskey. But I’ve learned — from my own experience and from the evidence — that alcohol disrupts my sleep and affects how I feel the next morning. And the research on alcohol and dementia risk gave me another reason to pay attention.

Where I landed: once or twice a week works for me. More than that doesn’t. Weeks when I don’t drink at all, I sleep better and wake up more energized. That’s the data from my own life, and I’ve chosen to act on it.

Food, weight, and protein are pretty straightforward in my approach. I’m not a nutrition obsessive. I don’t chase the perfect diet. I try to maintain a healthy weight, eat a reasonably balanced diet, and get enough protein. What it requires is honesty — which is harder than it sounds. It’s easy to tell yourself “I’m eating pretty well” or “this is just temporary.” Sometimes that’s true. Sometimes it’s a story. Knowing thyself — as Socrates would say — means being willing to tell the difference.

Avoiding injury has become a genuine priority. When you’re younger, you can sometimes push through aches and tweaks and get away with it. As you get older — and I’d put that threshold somewhere around 40 — a significant injury can stop your exercise routine entirely, and the fitness you lose becomes increasingly hard to regain. So I think about recovery. I think about not letting ego push me into an accident. The goal isn’t to prove I can still suffer. The goal is to stay in the game.

N-of-1 testing is my term for paying attention to what actually happens in my own body when I try something. The evidence on magnesium for muscle cramps, for example, is imperfect. But in the summer heat, training hard and sweating, I’ve found it useful enough to keep taking. My own experience is data — not perfect data, but real data worth taking seriously.

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Where I Need Support from Others

This category is a little humbling, because it requires admitting that knowing what matters isn’t the same as actually doing it.

I’ve spent my career reviewing evidence. I understand study design. I know perfectly well why strength training matters — it helps with balance, reduces injury risk, and supports functional capacity as we age. And knowing all that wasn’t enough to make me do it.

Aerobic exercise comes naturally to me. Strength training does not. I find it boring. I find reasons to skip it. Left to my own devices, it doesn’t happen.

So I hired a trainer. Nina shows up at my front door twice a week. I can’t send her away. And I already paid, which provides its own powerful incentive. Problem solved — not through willpower, but through structure.

The lesson I take from this isn’t “everyone needs a trainer.” It’s that sometimes the most realistic move isn’t to demand more discipline from yourself. It’s to build the conditions that make the desired behavior more likely.

The same principle applies to emotional health. I dealt with a fear pattern around exercise for decades, and I tried to solve it on my own — through meditation, through reflection, through sheer willpower. It didn’t work. Eventually I sought EMDR therapy, and it helped in ways that years of solo effort hadn’t. Getting help wasn’t a failure. It was what actually worked.

Where do you need support from others? Is there something you already know matters, but you can’t seem to make it happen alone? That gap between knowing and doing is real. Support is often what bridges it.

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Where Medication Is the Right Tool

In some wellness circles, medication is treated almost as a moral failure — as if the goal of healthy living is to optimize yourself to the point where you never need a prescription. I find this view both wrong and harmful.

Medication can be one of the most appropriate, evidence-based interventions we have. As a physician, it’s one of the primary ways I help people.

I take medications for high blood pressure, high cholesterol, and blood sugar. I have all three conditions. I’ve also taken Wellbutrin for decades — it resolved a persistent low-grade depression that affected my quality of life for years. These aren’t failures. They’re solutions.

The concern I have with the “optimize your way out of medication” message is that it implies that people who need medication simply haven’t tried hard enough. For many people, that’s simply not true. It hasn’t been true for me. And it’s worth asking whether it’s true for you.

The right question isn’t “Am I disciplined enough to avoid medication?” The right question is: “What problem am I trying to solve? What are my options? What are the expected benefits and harms? And what does the evidence suggest for someone with my specific situation?” Medication may or may not be the answer — but it deserves to be evaluated honestly, not avoided out of pride.

Putting It Together

My health plan doesn’t include everything. Not every supplement, not every emerging protocol, not every study that crosses my feed. It includes the things that, as best I can tell, are most likely to matter for me specifically.

In the first category — what I can influence directly — that means aerobic exercise, sleep, alcohol in moderation, honest attention to food and weight, injury prevention, and self-experimentation.

In the second category — where I need support — that means a trainer for strength work and professional help for emotional health.

In the third category — where medication is appropriate — that means treating real conditions with real tools.

That’s my mix. It’s not yours. Your genetics, your preferences, your risks, and your limitations are different. But here’s what I think does generalize:

What can you influence directly? Which healthy behaviors come naturally to you, and which ones require deliberate decision-making?

Where do you need support from others? Is there something you know matters but can’t seem to do alone?

And where might medication be the right tool? Have you been avoiding a conversation worth having?

The goal isn’t a perfect plan. It’s a realistic, honest, evidence-informed one — built around who you actually are.