Hi Reader,

At the Ageless Evolution Summit, I asked the packed room full of health optimizers: "How many of you are wearing a smart watch or ring?"

Dozens of hands went up.

But far fewer could say that they're sleeping, eating, or moving healthily, consistently.

This is the problem. We're obsessed with biohacking while ignoring the foundational actions that actually move the needle.

Here's the framework I shared during my keynote (and it is not everything I would recommend for longevity—but this newsletter is getting already too long!):

🎯 The 3-Tier Longevity Framework: What Actually Matters (In Order)

TIER 1 - Master These First (80% of Your Results)

If you're not dialed in on these fundamentals, nothing else matters. Period.

Know Your Numbers (limited risk):

• ApoB (not just LDL) - your real cardiovascular risk marker
• Lp(a) - genetic lottery ticket you can't change with lifestyle alone
• Blood pressure - check regularly, silent and gradual killer
• HbA1c - metabolic health snapshot
• hsCRP - inflammation marker that predicts heart disease, signals immune issues
• Liver function (ALT, AST) and kidney function (creatinine, eGFR)
• CAC score and/or CT angiogram with AI if 40+ (shows actual plaque)
• VO2 max - Best predictor of all-cause mortality (test or estimate via fitness)
• DEXA scan - Bone density + body composition (visceral fat matters)
• Cancer screening appropriate for your personal risk

Get these checked annually (some less frequently). Most longevity issues are preventable if caught early.

The Non-Negotiables:

• Sleep: 7-9 hours consistently. Your DNA repair, immune function, and cognitive health depend on it.
• Zone 2 cardio: 150-300 min/week. Easy conversational pace exercise. This is your mitochondrial insurance policy.
• Strength training: 2-3x/week. Muscle is your metabolic sink and longevity organ.
• Nutrition: Mostly whole foods with vegetables, adequate protein (~0.75g per lb bodyweight if active, 1-1.2g if older), healthy fats. Aim for ~30g fiber daily.
• Don't smoke: If you still do, this is priority #1. Nothing else comes close.
• Avoid obvious risks: Not wearing your seatbelt or helmet, drinking alcohol, etc.

The Unsexy Stuff That Works:

• Manage stress (therapy, meditation, nature time - whatever works for you)
• Maintain strong social connections - loneliness kills as surely as smoking
• Daily movement beyond exercise (walks, take stairs, avoid sitting all day)

If you nail Tier 1, you're 80% of the way to optimal longevity. Most people never get here because they're too busy chasing Tier 3 interventions.

TIER 2 - Evidence-Based Medicine for YOUR Risks (Gets You to 99%)

Once Tier 1 is dialed in, treat your specific vulnerabilities based on testing:

• Elevated blood pressure → Lifestyle first, then medication as needed (ACE inhibitors, ARBs, etc.)
• High ApoB or elevated CAC score → Statins, ezetimibe, PCSK9i as needed
• High Lp(a) → Aggressive risk factor management, consider apheresis if very high
• Perimenopause/menopause → HRT if appropriate (symptom management as well as bones, brain, heart protection)
• Low testosterone + symptoms → TRT with monitoring
• Thyroid dysfunction → Appropriate thyroid replacement
• Prediabetes/diabetes → Metformin, lifestyle, GLP-1s if needed
• Significant obesity → GLP-1 agonists after lifestyle optimization
• Sleep apnea → CPAP (underdiagnosed, wrecks cardiovascular health)
• Vitamin D deficiency → Supplementation to 40-60 ng/mL. Similar supplementation if you have other deficiencies found with testing.
• Osteoporosis/osteopenia → Weight training, adequate calcium/protein/vitamin D; medications if high fracture risk

Plus other evidence-based treatments for your specific conditions discovered through testing.

This is proven medicine for real risks. Not experimental. Not sexy. Just effective.

Now you're at 99%.

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TIER 3 - Experimental Territory (Only After Tiers 1 & 2)

Rapamycin, senolytics, NAD+ precursors, peptides, therapeutic plasma exchange, epigenetic reprogramming, continuous glucose monitors (if not diabetic), extensive genetic testing.

This is where the conference talks live. This is the cutting edge.

But here's the question: Have you actually aced Tiers 1 and 2?

Be brutally honest. If you're spending $5,000/year on experimental interventions while sleeping 5 hours a night and skipping strength training, you're not optimizing—you're deluding yourself.

The Reality Check

Most people skip to Tier 3 because it's interesting. Tier 1 is boring.

But the person who consistently masters the fundamentals will outlive the person with the perfect supplement stack who neglects sleep, exercise, and metabolic health.

Your competitive advantage isn't access to the latest biohack. It's discipline.

So before you buy that next supplement or book that next longevity clinic appointment, ask yourself:

✓ Am I sleeping 7-9 hours consistently?

✓ Am I doing 150+ minutes of Zone 2 cardio weekly?

✓ Am I strength training 2-3x/week?

✓ Do I know my ApoB, Lp(a), blood pressure, and HbA1c?

✓ Have I addressed any specific medical risks identified through testing?

If you can't check all those boxes, you know where to focus.

⚡ This Week's Longevity Speed Round

🏃‍♀️ Is 4000 steps the minimum viable dose? A large observational study of ~13,547 older women (average age 72) found that getting ≈4,000 steps on just 1–2 days per week cut all-cause mortality by ≈26% and cardiovascular disease risk by ≈27% vs. no days meeting that threshold. If the threshold was hit ≥3 days per week, mortality risk dropped ≈40%.

Take-away: Even occasional movement yields real benefit, so don't give up!

💊 Oral "Ozempic" ingredient Semaglutide Approved for Cardiovascular Risk The FDA approved oral semaglutide (Rybelsus) to lower major adverse cardiovascular events in adults with type 2 diabetes at high risk — even without prior events. The SOUL trial showed a ~14% relative risk reduction in MACE vs. placebo over 4 years.

Take-away: Moves GLP-1s beyond weight and glycemic control into deeper longevity territory. We'll see more interesting indications over the following couple years.

❤️ Rapamycin Shows Cardiac and Vascular Benefits in Older Adults A pilot study in men in their 70s found 8 weeks of rapamycin improved cardiac filling and blood-vessel dilation — suggesting reversal of some vascular aging features. However, human lifespan data remain absent (despite much excitement in the field).

Take-away: Promising early signal for mTOR inhibition and heart health, but still experimental outside trials.

Where You Can Find Me

✍️ Quality Health Creators – Oct 24, Virtual Masterclass: How Dr. David Hindin Built 65K+ Followers Across Platforms While Transforming Healthcare Innovation. I'm starting a community where we host free masterclasses and more - join us!

🚀 The Longevity Global Summit 2025 – Dec 9, Novato, CA. Clinical Panel. I'm so excited to speak at the Buck Institute with the movers and shakers of longevity! Code SUMMITSPEAKER15 for 15% off

Support The Longevity Letter via your longevity purchases

NeuroAgeTx is offering the most comprehensive and science-backed brain aging package to The Longevity Letter readers at up to 61% off (affiliate link here)

Timeline offers the patented Urolithin A for scientifically proven mitochondrial support (Code CARECORE for 10% off).

Hillary Lin, MD

Co-Founder & CEO

Care Core

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