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The Three Numbers That Actually Matter Now · After the Rush Podcast

• 0:00
  SPEAKER_00: My doctor printed out a summary sheet at my last physical and slid it across
• 0:04
  SPEAKER_00: the desk like she was handing me a verdict.
• 0:07
  SPEAKER_00: She wasn't.
• 0:08
  SPEAKER_00: She was doing her job, which is to give me information and let me decide what to do with it.
• 0:15
  SPEAKER_00: But I noticed that I sat with that sheet face down in my bag for two full days
• 0:20
  SPEAKER_00: before I looked at it.
• 0:22
  SPEAKER_00: I told myself I was busy.
• 0:24
  SPEAKER_00: I told myself I'd read it when I had time to really focus.
• 0:28
  SPEAKER_00: What I was actually doing was treating a piece of paper like it had the authority
• 0:32
  SPEAKER_00: to ruin something.
• 0:34
  SPEAKER_00: I'm not sure when that started.
• 0:36
  SPEAKER_00: The habit of treating health data as a report card rather than a map.
• 0:41
  SPEAKER_00: Somewhere in my 50s I noticed it happening.
• 0:44
  SPEAKER_00: A number comes back from the lab and I feel either relieved or afraid,
• 0:48
  SPEAKER_00: not curious,
• 0:50
  SPEAKER_00: not strategic,
• 0:51
  SPEAKER_00: just afraid or relieved, and then I stop thinking about it until the next time.
• 0:57
  SPEAKER_00: That is not how I approach anything else.
• 1:00
  SPEAKER_00: Not money, not work, not the decisions I've spent the last decade helping other people make.
• 1:07
  SPEAKER_00: But with health data, something in me still flinches first and asks questions later.
• 1:13
  SPEAKER_00: This episode is about three specific numbers and what I think they're actually for.
• 1:23
  SPEAKER_00: Welcome to After the Rush.
• 1:25
  SPEAKER_00: I'm Catherine McDowell.
• 1:28
  SPEAKER_00: This is the show where we talk about designing what comes next,
• 1:31
  SPEAKER_00: which includes the chapter you're in right now,
• 1:34
  SPEAKER_00: whatever age that is, whatever the lab results say.
• 1:38
  SPEAKER_00: You can start here.
• 1:40
  SPEAKER_00: You don't need any other episode first.
• 1:43
  SPEAKER_00: One note before we begin.
• 1:45
  SPEAKER_00: I'm an occupational therapist with a clinical background,
• 1:48
  SPEAKER_00: and I'm going to talk today about specific health metrics.
• 1:52
  SPEAKER_00: But I am not your clinician.
• 1:55
  SPEAKER_00: I am not prescribing anything.
• 1:57
  SPEAKER_00: What I can do is share what I've learned,
• 1:59
  SPEAKER_00: what I've watched,
• 2:01
  SPEAKER_00: and what I've come to think about these three numbers and how they fit into
• 2:05
  SPEAKER_00: the larger design of a life.
• 2:08
  SPEAKER_00: For anything specific to your own body and your own results, please talk to your own doctor.
• 2:14
  SPEAKER_00: That conversation is worth having and worth having more than once a year.
• 2:26
  SPEAKER_00: What we're actually measuring.
• 2:28
  SPEAKER_00: The wellness industry has a deep investment
• 2:31
  SPEAKER_00: in making health data feel either terrifying or triumphant.
• 2:35
  SPEAKER_00: You are either a before picture or an after picture.
• 2:39
  SPEAKER_00: You are either failing your body or winning at it.
• 2:43
  SPEAKER_00: I want to offer a different frame.
• 2:45
  SPEAKER_00: Numbers from a lab or a clinical visit are information about a system in motion.
• 2:52
  SPEAKER_00: They are not your destiny.
• 2:54
  SPEAKER_00: They are not your identity.
• 2:56
  SPEAKER_00: They are a reading, the way a weather report is a reading.
• 2:59
  SPEAKER_00: And like a weather report, they are useful for planning and nearly useless for catastrophizing.
• 3:08
  SPEAKER_00: The three numbers I'm going to talk about are not the only numbers that matter.
• 3:12
  SPEAKER_00: Your own health history,
• 3:14
  SPEAKER_00: your own risk factors,
• 3:16
  SPEAKER_00: your own clinician's judgment, all of that matters more than any list I could make.
• 3:21
  SPEAKER_00: But these three tend to come up again and again in the literature on longevity
• 3:26
  SPEAKER_00: and functional capacity,
• 3:28
  SPEAKER_00: which is the term I prefer to healthy aging,
• 3:31
  SPEAKER_00: because functional capacity is about what you can do with your life,
• 3:35
  SPEAKER_00: not about how you compare to a chart.
• 3:38
  SPEAKER_00: The three, fasting blood glucose, grip strength, and VO2 max.
• 3:45
  SPEAKER_00: I'll tell you why I chose these and what I actually think they're for.
• 3:51
  SPEAKER_00: Number one, fasting blood glucose.
• 3:55
  SPEAKER_00: There is a blood sugar number most people know,
• 3:58
  SPEAKER_00: which is the diabetic threshold, the point at which a diagnosis changes.
• 4:03
  SPEAKER_00: And then there is a quieter range below that threshold
• 4:07
  SPEAKER_00: that most people don't hear much about unless they're asking.
• 4:12
  SPEAKER_00: That range is called prediabetes.
• 4:15
  SPEAKER_00: It runs roughly from a fasting blood glucose of 100
• 4:20
  SPEAKER_00: The
• 4:24
  SPEAKER_00: American Diabetes Association estimates that more than a third
• 4:28
  SPEAKER_00: of American adults fall in that range.
• 4:31
  SPEAKER_00: Most of them don't know it.
• 4:33
  SPEAKER_00: I'm not sharing that to frighten you.
• 4:35
  SPEAKER_00: I'm sharing it because it points to something structurally important.
• 4:40
  SPEAKER_00: Fasting blood glucose is a proxy for insulin sensitivity,
• 4:45
  SPEAKER_00: which is the body's ability to use glucose efficiently.
• 4:49
  SPEAKER_00: And insulin sensitivity,
• 4:51
  SPEAKER_00: it turns out,
• 4:52
  SPEAKER_00: is tangled up in a remarkable number of other things,
• 4:55
  SPEAKER_00: energy levels,
• 4:57
  SPEAKER_00: cognitive clarity, cardiovascular health, mood stability, even sleep quality.
• 5:04
  SPEAKER_00: When blood sugar regulation is working well, a lot of other systems have an easier time.
• 5:10
  SPEAKER_00: When it's dysregulated, even mildly, the noise in those other systems tends to get louder.
• 5:17
  SPEAKER_00: Here is what I find interesting from a design standpoint.
• 5:21
  SPEAKER_00: Fasting blood glucose is among the most responsive of all the major health metrics
• 5:28
  SPEAKER_00: to behavioral change.
• 5:30
  SPEAKER_00: Diet, movement, sleep,
• 5:33
  SPEAKER_00: stress, all of them have measurable effects on this number within weeks, not years.
• 5:40
  SPEAKER_00: It is not fixed.
• 5:41
  SPEAKER_00: It responds.
• 5:43
  SPEAKER_00: That responsiveness is the point.
• 5:45
  SPEAKER_00: If you want a number that tells you whether the inputs you're putting
• 5:48
  SPEAKER_00: into your daily life are working,
• 5:51
  SPEAKER_00: Fasting blood glucose is a reasonable candidate,
• 5:54
  SPEAKER_00: not because you're managing toward a number,
• 5:57
  SPEAKER_00: but because the number reflects the life you're building.
• 6:00
  SPEAKER_00: My own number has moved over time.
• 6:04
  SPEAKER_00: I paid closer attention to what I was eating and when I was sleeping,
• 6:08
  SPEAKER_00: not because I was afraid, but because I got curious.
• 6:12
  SPEAKER_00: That curiosity felt more productive than the dread.
• 6:16
  SPEAKER_00: And I'll say this.
• 6:18
  SPEAKER_00: If your number is currently in a range that concerns you or concerns your doctor,
• 6:23
  SPEAKER_00: that is not a verdict.
• 6:25
  SPEAKER_00: It is a starting point.
• 6:27
  SPEAKER_00: That distinction matters more than it sounds.
• 6:30
  SPEAKER_00: Number two, grip strength.
• 6:34
  SPEAKER_00: I want to spend a little more time on this one because I think it's
• 6:37
  SPEAKER_00: the least expected of the three,
• 6:39
  SPEAKER_00: and it's the one that shifted something for me most concretely.
• 6:43
  SPEAKER_00: Grip strength,
• 6:44
  SPEAKER_00: the force you can generate squeezing a device called a dynamometer,
• 6:48
  SPEAKER_00: has been a research subject for decades.
• 6:52
  SPEAKER_00: And the findings are, at this point, fairly consistent across large study populations.
• 6:59
  SPEAKER_00: Grip strength correlates with all-cause mortality,
• 7:03
  SPEAKER_00: with cardiovascular outcomes with functional independence later in life.
• 7:08
  SPEAKER_00: It correlates in some studies more strongly than resting blood pressure
• 7:14
  SPEAKER_00: with certain cardiac outcomes.
• 7:16
  SPEAKER_00: That is a surprising finding.
• 7:19
  SPEAKER_00: It surprised me.
• 7:21
  SPEAKER_00: What's going on is that grip strength is not really measuring your hand.
• 7:26
  SPEAKER_00: It's measuring the overall integrity of the musculoskeletal system.
• 7:31
  SPEAKER_00: It's a proxy for lean muscle mass,
• 7:33
  SPEAKER_00: for the quality of connective tissue, for the body's structural reserves.
• 7:39
  SPEAKER_00: The hand is just the convenient place to measure all of it.
• 7:43
  SPEAKER_00: And this is where my occupational therapy background shows up
• 7:47
  SPEAKER_00: because I spent years working with people whose functional capacity was limited
• 7:52
  SPEAKER_00: by exactly this kind of systemic decline.
• 7:56
  SPEAKER_00: The thing that determined whether
• 7:57
  SPEAKER_00: a 78-year-old could live independently was not usually one dramatic diagnosis.
• 8:04
  SPEAKER_00: It was the accumulation of small structural losses,
• 8:07
  SPEAKER_00: the grip that couldn't manage a jar lid,
• 8:10
  SPEAKER_00: the core that couldn't manage stairs without holding both rails,
• 8:14
  SPEAKER_00: the balance that had gotten quiet and unstable without anyone noticing.
• 8:20
  SPEAKER_00: Those losses are not inevitable.
• 8:23
  SPEAKER_00: That is the part the wellness industry gets right, even when it gets everything else wrong.
• 8:29
  SPEAKER_00: The structural deterioration that limits function in later life is largely,
• 8:34
  SPEAKER_00: not entirely, but largely modifiable.
• 8:39
  SPEAKER_00: Resistance training,
• 8:40
  SPEAKER_00: progressive loading,
• 8:42
  SPEAKER_00: the kind of intentional physical work that used to happen automatically
• 8:46
  SPEAKER_00: when lives involved more physical labor,
• 8:49
  SPEAKER_00: these are the inputs that maintain structural reserves.
• 8:53
  SPEAKER_00: I started paying attention to grip strength because I understood,
• 8:58
  SPEAKER_00: after enough years in clinical settings,
• 9:00
  SPEAKER_00: that I was watching what the future looked like.
• 9:04
  SPEAKER_00: I wanted a different design.
• 9:06
  SPEAKER_00: I'm not going to tell you what your number should be.
• 9:09
  SPEAKER_00: Reference ranges vary by age and sex,
• 9:13
  SPEAKER_00: and your clinician can tell you more than I can about where you stand.
• 9:17
  SPEAKER_00: What I'll say is this.
• 9:20
  SPEAKER_00: If you've never had your grip strength measured, it's worth asking.
• 9:25
  SPEAKER_00: Not because the number is the point, but because the conversation it opens is worth having.
• 9:32
  SPEAKER_00: What does it take to maintain function in my 60s, my 70s, my 80s?
• 9:39
  SPEAKER_00: What am I building right now that will matter then?
• 9:42
  SPEAKER_00: Those are design questions.
• 9:45
  SPEAKER_00: And grip strength is one of the more honest entry points into them.
• 9:50
  SPEAKER_00: Number three, VO2 max.
• 9:53
  SPEAKER_00: VO2.
• 9:54
  SPEAKER_00: Max is the measure of how much oxygen your body can use during maximum effort.
• 10:00
  SPEAKER_00: It's been used in athletic training for decades,
• 10:03
  SPEAKER_00: and it has, more recently, become a subject of serious longevity research.
• 10:09
  SPEAKER_00: The finding that made it land for me was this.
• 10:14
  SPEAKER_00: Cardiorespiratory fitness,
• 10:15
  SPEAKER_00: measured by VO2max,
• 10:18
  SPEAKER_00: is among the strongest predictors of longevity in the studies that have looked
• 10:22
  SPEAKER_00: at it.
• 10:24
  SPEAKER_00: People in the lowest fitness quintile
• 10:26
  SPEAKER_00: for their age have dramatically higher all-cause mortality risk than people in
• 10:31
  SPEAKER_00: the middle quintiles.
• 10:33
  SPEAKER_00: And the gap between middle and high fitness is smaller than the gap between low and middle.
• 10:39
  SPEAKER_00: In other words,
• 10:40
  SPEAKER_00: the biggest gains in longevity risk come from moving out of the lowest category,
• 10:46
  SPEAKER_00: not from becoming an elite athlete.
• 10:49
  SPEAKER_00: That is genuinely good news for those of us who are not planning to become elite athletes.
• 10:55
  SPEAKER_00: There's a related concept called the last decade argument,
• 10:59
  SPEAKER_00: and it shows up in several places in the longevity literature.
• 11:03
  SPEAKER_00: The physical capacity you have in your last decade of life,
• 11:08
  SPEAKER_00: whatever that decade turns out to be,
• 11:11
  SPEAKER_00: is substantially determined by the capacity you're building now.
• 11:15
  SPEAKER_00: If you're in your 50s and you want to be able to walk, lift, carry, travel,
• 11:21
  SPEAKER_00: and do the things that make life feel like yours in your 80s,
• 11:26
  SPEAKER_00: the time to build those reserves is now.
• 11:29
  SPEAKER_00: Not because it will be too late otherwise, but because the body responds to input over time.
• 11:35
  SPEAKER_00: And the earlier the input, the more reserves you have to draw from.
• 11:40
  SPEAKER_00: VO2 max can be measured precisely with clinical equipment or a maximal exercise test
• 11:48
  SPEAKER_00: or estimated more roughly through walking tests
• 11:51
  SPEAKER_00: and formulas your doctor can help you with.
• 11:54
  SPEAKER_00: The number itself matters less than the direction.
• 11:58
  SPEAKER_00: Is this moving?
• 11:59
  SPEAKER_00: Staying stable?
• 12:01
  SPEAKER_00: Declining?
• 12:02
  SPEAKER_00: And if it's declining, what are the inputs that reverse the direction?
• 12:07
  SPEAKER_00: Walking.
• 12:09
  SPEAKER_00: Sustained effort that elevates your heart rate, time.
• 12:14
  SPEAKER_00: These are not revelations,
• 12:16
  SPEAKER_00: but they take on a different shape when you understand
• 12:19
  SPEAKER_00: that you are not just exercising for this year.
• 12:23
  SPEAKER_00: You are building what you'll have available in 10 years, 15 years, 20.
• 12:30
  SPEAKER_00: This is not a report card.
• 12:32
  SPEAKER_00: I want to come back to something I said at the beginning,
• 12:35
  SPEAKER_00: because I think it's the thing that actually matters most.
• 12:39
  SPEAKER_00: I sat with that summary sheet face down for two days,
• 12:42
  SPEAKER_00: and what I've been working to understand in the years since is what
• 12:47
  SPEAKER_00: that avoidance was costing me.
• 12:49
  SPEAKER_00: It wasn't protecting me from anything.
• 12:52
  SPEAKER_00: The number was what it was, whether I looked at it or not.
• 12:56
  SPEAKER_00: What the avoidance was doing was keeping me in a posture of fear rather
• 13:00
  SPEAKER_00: than curiosity, and fear is a genuinely terrible tool for design.
• 13:05
  SPEAKER_00: The wellness industry,
• 13:07
  SPEAKER_00: and a lot of clinical communication accidentally teaches people
• 13:11
  SPEAKER_00: to experience health data as judgment.
• 13:15
  SPEAKER_00: You are good or bad, passing or failing, ahead of the curve or behind it.
• 13:20
  SPEAKER_00: And for people in their 50s and 60s who have spent
• 13:23
  SPEAKER_00: a lifetime being evaluated professionally,
• 13:27
  SPEAKER_00: financially, relationally, that framing is exhausting.
• 13:32
  SPEAKER_00: It asks you to bring performance anxiety to the one domain
• 13:36
  SPEAKER_00: where performance anxiety is least useful.
• 13:39
  SPEAKER_00: Curiosity is more useful.
• 13:41
  SPEAKER_00: Strategic attention is more useful.
• 13:44
  SPEAKER_00: The question is not, how did I do?
• 13:47
  SPEAKER_00: The question is, what does this tell me about what I'm building?
• 13:52
  SPEAKER_00: And what would I like to build instead?
• 13:55
  SPEAKER_00: These three numbers,
• 13:56
  SPEAKER_00: glucose,
• 13:58
  SPEAKER_00: grip strength,
• 13:59
  SPEAKER_00: VO2 max, are useful because they are all, to varying degrees, responsive.
• 14:07
  SPEAKER_00: They are not fixed.
• 14:08
  SPEAKER_00: They change with input.
• 14:10
  SPEAKER_00: And knowing roughly where you are on each of them opens a design conversation that
• 14:16
  SPEAKER_00: a vague intention to take better care of myself simply cannot.
• 14:21
  SPEAKER_00: The woman who taught me the most about this was a patient I worked with
• 14:24
  SPEAKER_00: in my early years of clinical practice.
• 14:28
  SPEAKER_00: She was in her mid-70s,
• 14:30
  SPEAKER_00: living independently, doing things that people 20 years younger weren't doing.
• 14:35
  SPEAKER_00: I asked her once what she attributed it to.
• 14:38
  SPEAKER_00: She said she had decided in her 50s that she was going to be useful for as long
• 14:43
  SPEAKER_00: as possible, and she'd been making decisions accordingly ever since.
• 14:47
  SPEAKER_00: She didn't say healthy.
• 14:49
  SPEAKER_00: She said useful.
• 14:51
  SPEAKER_00: And I have thought about that word and what it actually means to her ever since.
• 15:00
  SPEAKER_00: There's a line in a notebook I kept during a particularly difficult stretch
• 15:04
  SPEAKER_00: of my clinical career.
• 15:06
  SPEAKER_00: I wrote it after a day that involved too many conversations about things
• 15:10
  SPEAKER_00: that had gone too long unattended.
• 15:13
  SPEAKER_00: It says, you can't build reserves in the middle of a crisis.
• 15:18
  SPEAKER_00: You build them beforehand, in the ordinary time.
• 15:21
  SPEAKER_00: The ordinary time is now.
• 15:24
  SPEAKER_00: The number on the page,
• 15:25
  SPEAKER_00: whatever it is, is a piece of information about the system you're working with.
• 15:31
  SPEAKER_00: It is not the final word on anything.
• 15:34
  SPEAKER_00: What you do with it,
• 15:35
  SPEAKER_00: the conversation you have,
• 15:37
  SPEAKER_00: the question you bring to your next appointment,
• 15:40
  SPEAKER_00: The small choice you make on an average Tuesday, that is the design.
• 15:49
  SPEAKER_00: Thank you for spending this time with me.
• 15:51
  SPEAKER_00: After the Rush publishes new episodes on Thursdays,
• 15:55
  SPEAKER_00: and you can find everything,
• 15:57
  SPEAKER_00: the show,
• 15:58
  SPEAKER_00: the articles,
• 15:59
  SPEAKER_00: and the store at aftertherushletter.substack.com and aftertherush.store.
• 16:07
  SPEAKER_00: If this episode was useful,
• 16:09
  SPEAKER_00: Share it with someone who might be sitting with a piece of paper face down.
• 16:14
  SPEAKER_00: I'll see you next week.