​ by Hillary Lin, MD

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Secret to Longevity? Part 1 of the VO2 Max Series

Diving into scientific secrets of deep health and longevity.

“I want to be sick for a long time and die young,” said no one ever. Absolutely every human wants to enjoy great health for as long as possible. But longevity is an area that contains extreme noise - competing only with the misinformation around how to cure cancer (and no, baking soda does not cure cancer).

To start, I want to emphasize that I am a “normal” person when it comes to exercise. Despite my MD, I was a stalwart non-exerciser until a couple of years ago. I tried no fewer than eight sports throughout my childhood, due to repeated failures to improve significantly at any of them.

I'm writing about VO2 max and cardiovascular fitness because it took me decades to make the connection between fitness and living a good life. Not to mention it is at least one of the secrets to longevity, and the one most within our grasp. If I inspire even one person to start training up your VO2 max, I would be incredibly proud (and you'd be incredibly healthy)!

The body’s transportation system

Unless you’re a cardiologist or pulmonologist, you probably have not thought deeply about your heart, lungs, or cardiovascular system recently. This system, also called the circulatory system, includes your heart, blood vessels, and blood.

The heart is the pump in the middle of it all, pushing the blood throughout the body. Blood vessels are a fancy term for the pipes and tubes that hold and carry blood like a plumbing system or highway of sorts. The blood itself is filled with goodies, from red blood cells to white blood cells to nutrients of all kinds that your organs need.

Fun fact: You might be wondering how nutrients get from the blood vessels to your other cells. Think of the pipes as tree branches that get smaller and smaller. At the very ends, they're so small that the walls of the pipes are only a cell thick. These delicate vessels, called capillaries, allow nutrients to simply flow in and out of the circulatory system and into the organs' cells where they get used for life functions.

I mention all this to highlight that your cardiovascular system is vital to your life at every moment. The nutrients carried include electrolytes, energy molecules, and, perhaps most importantly, oxygen that your cells require to continue functioning and be alive. This is why dramatic life-and-death moments on TV emphasize CPR with shocks and pumping to the chest in an attempt to revive the ever-so-vital heart.

When there’s a traffic jam

What is a heart attack? It is when a pipe feeding oxygen and nutrients to your heart itself gets clogged, and the heart starts to die. A massive heart attack is when a more significant part of the heart dies. A stroke is when a part of the brain is cut off from oxygen and dies. Clots to the lungs can also be fatal, given their close relationship to the heart. Other organs can suffer clots without dying for the most part, but sometimes bad events like strangulation of an organ (like testicular torsion) can result in immense pain and loss of the organ.

We experience everyday “failures” when we push our bodies to the limit by making our hearts pump harder. This might happen when we run at top speed, push against heavy weights, or even suffer a panic attack. These moments are not necessarily bad for the cardiovascular system, but they highlight the limit to which our cardiovascular system can perform.

What is VO2 max?

What is this magical thing?? You might have heard longevity experts Rhonda Patrick or Peter Attia talk about this measurement called the VO2 max.

VO2 max = maximal oxygen uptake = ceiling of cardiac performance

Your VO2 max indicates your aerobic or cardiovascular fitness and endurance capacity. In other words, it is the maximum power of your body’s engine.

But VO2 max is not only significant for performance athletes - it is relevant for the everyday human being as well. The oft-quoted 2018 JAMA study conducted by Cleveland Clinic Foundation researchers shows this compelling relationship between heart health and longevity: “Cardiorespiratory fitness is inversely associated with long-term mortality with no observed upper limit of benefit.”

This graph shows that the higher a subject's cardiovascular health, the less likely they die (due to any cause). The difference is more significant the longer/older you get!

Greater heart and lung fitness is directly related to greater longevity!

This is kind of a duh but also surprising conclusion. It essentially means there’s an increasing benefit of longevity associated with increasing cardiovascular and respiratory (heart and lung) health with no diminishing returns whatsoever.

VO2 max is simply a straightforward measurement representing cardiovascular fitness, which is why we care so much about it. The study mentioned above used something else called MET (or metabolic equivalent) for measurement, but since it's a similar idea, I'll cover it in a separate post for clarity.
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tldr; Gotta get fit.

No matter your life goals, you’ll be better off with better cardiovascular fitness, which is easily summed up using VO2 max as a metric.

That’s all for today! I’m trying something new - writing more frequently but with shorter posts to capture the attentions of all your distracted minds. Let me know what you think.

The next post will be on how to test your VO2 max. There are a dozen ways to do this, for every budget (even $0!). It’s a fantastic way to take charge of your cardiovascular fitness and live better and longer.

Cheers to your health,

Hillary Lin, MD