How long do you and will we spend from now until you're 90 talking about this?
Well, there's a risk of that. So let's start with a couple of the things that you've already highlighted. So smoking, how much does smoking increase your risk of all-cause mortality? And the reason we like to talk about what's called ACM or all-cause mortality is it's really agnostic to how you die. And that doesn't always make sense. I mean, if you're talking about a very specific intervention, like an, uh, anticancer therapeutic, you really care about cancer-specific mortality or heart-specific mortality. But when we talk about these sorts of broad things, we like to talk about ACM. So using smoking, smoking is approximately a 40% increase in the risk of ACM.
What does that translate to?
And, um, that means I'm shortening my life by 40%? No, it means at any point in time, there's a 40% greater risk that you're going to die relative to a nonsmoker and an ever-smoker. So it's important to distinguish it doesn't mean your lifespan is going to be 40% less. It means at any point in time, standing there, your risk of death is 40% higher. Um, and by the way, that'll catch up with you, right? At some point that catches up high, um, blood pressure, it's about a 20% to 25% increase in all-cause mortality. Um, you take something really extreme, like end-stage kidney disease. So these are patients who are on dialysis waiting for an organ. And again, there's a confounder there.
what's the underlying condition that leads you to that?
It's profound hypertension and significant type two diabetes that's been uncontrolled. That's enormous. That's about a 175% increase in ACM. So the hazard ratio is like 2.75. Um, type two diabetes is probably about a 1.25 as well. So a 25% increase. So now the question is, like, how do you improve? So what are the things that improve those? So now here, we do this by comparing low to high achievers on other metrics. So if you look at low muscle mass versus high muscle mass, what is the improvement? And it's pretty significant. It's about three times. So if you compare low muscle mass people to high muscle mass people as they age, the low muscle mass people have about a, uh, three x hazard ratio, or 200% increase in all-cause mortality.
Now, if you look at the data more carefully, you realize that it's probably less the muscle mass fully doing that, and it's more the high association with strength. When you start to tease out strength, you can realize that strength could be probably three and a half times a hazard ratio, meaning about 250% greater risk if you have low strength to high strength. High strength is the ability to move loads at 80% to 90% of one repetition. It's all defined by given studies. So the most common things that are used are actually, they're used for the purposes of experiments that make it easy to do. And I don't even think they're the best metrics.
So they're usually using like, grip strength, um, leg extensions and wall sits, squats, things like that. So how long can you sit in a squatted position at 90 degrees without support would be a great demonstration of quad strength, a leg extension, um, how much weight can you hold for how long relative to body weight, things like that. Um, we have a whole strength program that we do with our patients. We have something called the SMA. So it's the strength metrics assessment, and we put them through eleven tests that, um, are really difficult. Like a dead hang is one of them. Like,
how long can you dead-hang your body weight?
Stuff like that. So we're trying to be more granular in that insight, but tie it back to these principles. If you look at cardiorespiratory fitness, it's even more profound. So, um, if you look at people who are in the bottom 25% for their age and sex in terms of vo two max, and you compare them to the people that are just at the 50th to 75th percentile, um, you're talking about a two X difference, roughly. Um, in the risk of ACM, if you compare the bottom 25% to the top 2.5%, you're talking about the bottom quarter to the elite for a given age. Um, you're talking about a five x 400% difference in all-cause mortality. That's probably the single strongest association I've seen for any modifiable behavior.
Incredible. So, uh, when you say elite, these are, uh, people that are running marathons at a pretty rapid clip? Not necessarily. It's just like what the VO two max is for that. My vo two max would be in the elite for my age group, uh, my vo two max. But again, I'm training very deliberately to make sure that it's in that. So I wouldn't consider myself elite at anything anymore, but I still maintain a VO two max that is elite for my age. I consider you an elite, uh, physician and podcast and guy all around, but true. Um, but the point is, you don't have to be a world-class athlete to be elite here. Yeah. Got it.
Um, so maybe we could talk a little bit about the specifics around the training to get into that top two tiers there, because it seems that those are enormous positive effects of cardiovascular exercise, uh, far greater than the sorts of numbers that I see around. Let's just say supplement A or supplement B. And, you know, like, this is my whole pet peeve in life, right? It's like, I just can't get enough of the machinating and arguing about this supplement versus that supplement. And I feel like you shouldn't be having those arguments until you have your exercise house in order.
Um, you shouldn't be arguing about this nuance of your carnivore diet, versus this nuance of your paleo diet, versus this nuance of your vegan diet. Until you can deadlift your body weight for ten reps, then you can come and talk about those things or something. Let's just come up with some metrics until your VO two max is at least to the 75th percentile, and you can dead hang for at least a minute, and you can wall sit for at least two. Like, we could rattle off a bunch of relatively low-hanging fruit.
I wish there was a rule that said, like, you couldn't talk about anything else health-related. We can make that rule. No one will listen to it. I don't know about that. We can make whatever rules we want. We can call it ETIA's rule. One thing I've done before in this podcast and on social media is just borrowing from the tradition in science, which is it's inappropriate to name something after yourself unless you were a scientist before 1950. Um, but it's totally appropriate to name things after other people. So I'm going to call it Tia's rule until you can do the following things. Um, don't talk about it. Please refrain from talking about supplements and nutrition. There it is. Hereafter thought of, referred to, and referenced, um, as Atea's rule.
I coined the phrase, not him. So there's no ego involved, but it is now Atea's rule. Watch out. Hashtag Ateas rule. Oh, God. Um, Wikipedia entry. Atea's rule. In all seriousness, and I am serious about that, um, dead hang for about a minute seems like a really good goal for a lot of people. At least that's our goal. I think we have a minute and a half is the goal for a 40-year-old woman. Two minutes is the goal for 40 year 40-year-old man. So we adjust them up and down based on, uh, age and gender. Great. And then, uh, the wall sits. What are some we don't use a wall sit? We do it as just a straight squat, air squat at 90 degrees. Um, and I believe two minutes is the standard for both men and women.
At 40. Great. Uh, because for some people, thinking in terms of Vo Two Max is a little more complicated. They might not have access to the equipment or to measure it, et cetera. Um, what can we talk about? Think about it in terms of cardiovascular? So run a mile at seven, uh, minutes or less. Eight minutes or less? That's a good question. So there are really good Vo Two Max estimators online, and you can plug in your activity de jour. So be at a bike run or rowing machine, and it can give you a sense of that. And I used to know all of those, but now that I just actually do the testing, I don't recall them. But it's exactly that line of thinking, like, can you run a mile in this time? If you can, your Vo Two Max is approximately this great.
And I think somewhere in my podcast realm, I've got all those charts posted off, like, this is by age, by sex. This is what the Vo Two Max is in each of those buckets. Terrific. We'll provide links just to those. We'll have our people find those links. And then, um, you mentioned deadlifting body weight ten times. I just made that one up. That's not one that we include, but something like that. Um, we use Farmer Carries. So we'll say for a male, you should be able to farm carry your body weight for I think we have two minutes. So that's half your body weight in each hand. Um, you should be able to walk with that for two minutes.
Um, for women, I think we're doing 75% of body weight or something like that. Yeah. Great. I love it. Um, as indirect measures of how healthy and huge we are and how long we're going to live, it's basically grip strength. It's mobility. I mean, again, walking with that much weight for some people initially is really hard. Um, we use different things like vertical jump, ground contact time, if you're jumping off a box, things like that.
So it's really trying to capture and it's an evolution. Right. I think the test is going to get only more and more involved as we get involved because it took us about a year. Beth Lewis did the majority of the work to develop this. Beth, um, runs our strength and stability program in the practice. And basically, I just tasked her with, like, hey, go out to the literature and come up with all of the best movements that we think are proxies for what you need to be, like, the most kick know, what we call centenarian decathlete, which is the person living in their marginal decade at the best.
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