Longevity For Everyone: 8 Fundamentals You Should Know About | Sanjai Sinha MD, Mount Sinai Health System

🧬 Longevity is everywhere right now, from wearables and supplements to expensive tests, clinics, and bold promises of optimization. But what actually helps most people live longer, healthier lives?

In this episode of The Health Curve Podcast, Dr. Jason Arora and Dr. Sanjai Sinha (MD at Mount Sinai Health System, New York City) explore longevity from a grounded, real‑world perspective, stepping back from the hype to ask what truly moves the needle for healthspan and lifespan at scale. Rather than focusing on elite diagnostics or experimental therapies, the conversation looks at why the fundamentals still matter most, and why - outside of healthy habits - traditional primary care remains the most powerful delivery system for longevity, for most people. 

Together, they discuss how good primary care has always been about healthy aging 🏥⏳ - identifying risk early, preventing disease before it takes hold, and supporting sustainable behavior change over time. Along the way, they unpack the American Heart Association’s Life’s Essential 8 as a practical framework for longevity, and explain why small, realistic changes often outperform extreme or expensive interventions.

This episode reframes longevity as something accessible and scalable 🌍 , not a luxury pursuit for the few, but a set of evidence‑based principles that can benefit almost everyone, if we build the right systems around them 💙.

Chapters

00:00 – Introduction and guest background
00:55 – What is primary care and how has it changed?
02:45 – GP vs primary care physician: why the terminology is confusing
04:40 – Why primary care acts as the “quarterback” of healthcare
07:50 – How insurance and policy shaped today’s primary care system
08:40 – The shift toward transactional, on-demand healthcare
10:55 – Evidence that primary care improves health outcomes and equity
11:50 – The growing U.S. primary care shortage explained
13:50 – Why doctors are leaving primary care (pay, burnout, debt)
14:40 – What patients experience in today’s primary care system
16:45 – Telemedicine, retail clinics, and non-physician providers
18:00 – Concierge medicine and direct primary care models
21:20 – Why primary care is critical for longevity and healthspan
23:25 – Where primary care is headed next
26:10 – Why the U.S. underinvests in primary care compared to other countries
27:45 – Final reflections and closing

Transcript

Setting The Longevity Landscape

SPEAKER_01 0:04

It's great to be back with you, Dr. Sanjay Sina. Thank you for joining me again. Great to be here. Thank you so much. So today we're going to be talking about longevity and primary care. Now, just to set the scene around longevity, as people know, there's been a surge in interest in this over the last couple of decades really, but especially in the last few years. So this concept of healthy aging in the medical community has gone from the more sort of fringe space to mainstream science. There's a lot more investment in it now. We're seeing a lot more evidence for what we can do. On the public side, people are searching for advice and information about longevity a lot more. It's more than doubled in the last five to six years in terms of online search. More and more people are wearing wearables, they're tracking steps, they're tracking their heart rate, they're investing in sleep technology. And of course, in the media and in popular culture, there's there have been documentaries, there have been books. So this is starting to become part of the conversation now, I think, outside of the medical field. And so what we have here is we're talking about health span and lifespan when we talk about longevity. And we've done episodes on this in the past, of course, very briefly, that health span is really about how long you live without disease, lifespan is simply how long you live. And there is this interest, of course, in health span, because a lot of people spend the last few decades of their life with disease and don't necessarily have a great quality of life. So that's the context we're entering here. Can you tell us a little bit about longevity and health span in particular from your perspective as a primary care physician?

Primary Care As Longevity Engine

SPEAKER_00 1:31

Sure thing. That's a great description. I think as a good primary care physician, everyone, as part of their mission, has always been focused on lifespan and health span. We just didn't have words per se for them the past several decades until recently. A good primary care environment would always include screening for diseases that haven't happened yet, trying to address, identify and address risk factors for those diseases, doing preventive screenings where there's good evidence around cancer detection, and really helping patients change their behavior such that any of these risk factors that are identified can be controlled or alleviated or even removed. So, say in the case of smoking. And so I think while there's a lot of new marketing, a lot of new branding, a lot of excitement around longevity and health span, which has a lot of positives. I'm so glad that people are more engaged now with their own healthcare because there's only so much bandwidth that people have to focus on anything these days. And so that's a good side effect of all of this media attention. I think what is a little more problematic is that a lot of what is being sort of propagated in on popular podcasts and in books and in the media are really not the primary things that people should focus on. I think that the super common things that we can talk about for longevity and health span remain the same and have actually become more problematic as people have become heavier, unfortunately, in this country and more sedentary. And so one particular thing that we can get into is a like a longevity checklist that has been discussed as life's essential eight, which is something that's been put out by the American Heart Association, which are key measures to reduce cardiovascular disease and death. But in fact, it really improves all conditions. So we can talk about that a little bit more. But you know, insofar as health span, yes, now that people are living longer, we do want to both identify and manage conditions probably earlier than we have been.

SPEAKER_01 3:25

And some of the rumblings out there are that we're investing billions in advanced diagnostics, biomarker testing, there's full body imaging. Should I do this? These expensive longevity clinics, experimental therapies, all that sort of stuff. We've covered in a previous episode where that should fit in based on the science into a person's approach to longevity, like what where are the big levers and where are the the optional ones that don't necessarily have as much of an effect? But access is going to be an ongoing problem with all of these things because they're all expensive. They're all going to be difficult for people at large to access. But we have primary care. And it seems to me like there's an interesting irony here that in our last episode, we talked about primary care almost starting to dwindle in some ways. But there is this surge in interest in longevity now. Can you talk a bit about that? Like, how is primary care a longevity engine or a potential one for, let's say, billions of people around the planet? Because that's essentially who could have access to this if we did it right.

Life’s Essential Eight Overview

SPEAKER_00 4:22

Absolutely. I think that our ability as primary care physicians to detect many of these chronic diseases somewhere along their spectrum, maybe even before they become problems, but where you're on the cusp of those becoming problems is crucial. And it's really foundational, it's really primary. If you really want to think about what you need to prioritize, it's these kinds of things. So let's get into it. So I had mentioned life's essentially, these are key measures to reduce cardiovascular disease and death that the American Heart Association said are the most important metrics. So what are they? There's four behavioral factors and there's four health factors that are sort of empirically measured. So the health factors that are empirically measured are A1C, a blood test for diabetes and pre-diabetes, blood pressure, which of course can be measured at home, but is always measured in the office when you go to your primary care doctor, cholesterol, a blood test, and some other tests around cholesterol that have become risk modifying tests, and weight. Everyone talks about weight all the time in America, but it has its importance as an empirical measurement and its associations with different disease states. In terms of the health behaviors, diet, exercise, sleep, and not smoking are four of the sort of modifiable lifestyle issues and behaviors that deserve an enormous amount of time and attention. Now, many people may think, oh, yeah, of course, those are the things, everybody knows that. And yet the resources, the attention, the guidance, the counseling, the accountability, all of these things really often falls by the wayside because we have so little time with patients. Or many people just become completely frustrated because they're shooting for the moon. They're saying they're hearing that they need to do 30 minutes of moderate intensity exercise a day and they don't have the time. So instead of trying to do five minutes or even get up for two minutes every 15 minutes from their desk, they just do nothing. And so I think as primary care providers, one of the takes that I personally have is let's go for small wins. Let's look at these eight factors. Let's risk stratify you. Let's see where we can help you reduce your risk for these chronic diseases that are gonna lead to problems with your health span, lead you to having a poor quality of life down the road. Uh, where can we make changes? Now, of course, there's a lot there. So let's talk about it. What kinds of things do you think people buy and don't buy when it comes to that list?

SPEAKER_01 6:40

Well, let's get into that a bit more because this is it's something, like you said, people hear about it a lot, but getting it done is quite hard. I mean, you've seen thousands of patients over the years from all kinds of backgrounds. When you try to translate this into something actionable for your patients, how do you approach it? And how would you advise our listeners to think about this? You know, there are eight things. How do you start to do something with this information?

Turning Data Into Actionable Habits

SPEAKER_00 7:01

Right. So the four things that we mentioned, the A1C, the blood pressure, the cholesterol, and the weight, we can all do in the office. And so that's often a very non-controversial simple data collection exercise that we can do with some blood work and of course taking your vital signs. That is often a wonderful launching pad for discussion about the other four behaviors that impact those things. In fact, those four behaviors are 100% impactful on the four empirical factors. For instance, when people are physically active, I won't even use the word exercise, but just having some physical activity, you know, right after you eat, during the day, breaks that you can take. There's an exercise snack mentality where instead of getting up for a snack every 30 minutes from your desk when you're working or even watching TV, get up and walk around for five minutes. So there are lots of little nudge behaviors that we can introduce. But what I like to do is there's no point in being terminalistic in the discussion with a patient. You want to find out, okay, here's some data we have about you. You've given me your history. We've talked about your family history, we've talked about your environment, what kind of social life you lead, what kind of work life you lead, what are your priorities in life? And I think that kind of opening in the conversation really allows a person, hopefully, to become comfortable with their doctor, that the doctor's not being judgmental. The doctor's not just saying, oh, you got to lose 20 pounds, man. Look at this. Like that's not gonna fly. Nobody wants to hear that. And so what I like to do is I like to kind of collect a lot of that baseline information, uh, be as non-judgmental as possible in laying results, letting them know what my best advice might be. But clearly, this requires multiple conversations, takes time for a lot of patients, they don't have the resources to do a lot of the things that I might say. And so we have to meet people where they're at. And then we can delve into each problem and look at the data behind even small wins, even small changes around sleep, around movement, around diet, which is an enormous topic, of course. And then it's also my job to debunk myths because just as there's a lot of tension to, you know, certain genetic tests or full body MRIs or mTOR and things of that nature, xenolytics and what have you, that's more tertiary. That's more like, okay, once you've mastered, and almost nobody has mastered these eight things, but once you've mastered these eight things, then we can go to that level. And I think that's where the irony is, or the complexity of this discussion is. A lot of my patients will come in and ask for these very advanced highfalutin tests or procedures or what have you before really even hutting the surface, breaking the surface of tackling some of the problems we may have with some of these eight factors. A ninth factor, which is not in this list, is chronic stress. And chronic stress and anxiety will worsen all of these issues as well. And that may be the hardest, frankly, to tackle. But I'll digress there.

Debunking Biohacks And Advanced Testing

SPEAKER_01 9:40

We'll get back to this conversation in just a moment. But if you're finding this episode helpful, here's a quick ask. Take a second to follow or subscribe to the Healthcare podcast wherever you're listening. And if someone else in your life would benefit from this episode, or any of the others you've heard, please send it their way. All right, let's get back to it. No, I mean, we should call out how common this gap is. So a statistic I came across was that fewer than one in five adults in the US actually meet what we would call optimal scores for this list of eight things that people can do to improve their longevity and their health span that most people have access to, if not everyone. And so four out of five people, 80%, can do more. So, what would you say to the general public on this to say, hey, look, we have the evidence. There are eight things that you can focus on. Here's how you should start.

Stress And Sleep As Hidden Drivers

Listener Ask And Subscribe Prompt

Where To Start And Low-Cost Wins

SPEAKER_00 10:31

So hopefully get to your doctor, right? Don't just look up stuff incessantly on social media and online and then talk to your friends and go out and get creatine or go out and get X, Y, or Z. At least establish a relationship with the doctor, hopefully, that you can discuss all of these topics with. So that's one. Two, get some of the regular blood tests, the evidence-based blood tests around diabetes, get your vitals taken, get your cholesterol taken. Discuss, so what are the biggest killers, right? Cancer and heart disease. So discuss your risk factors. You may or may not know what they are, but that's what the doctor is there for, to ask you the appropriate questions to really understand, hey, did you have a member of your family to come down with one of these chronic illnesses at a younger age, or is there something atypical about your history? Oftentimes you're not going to get that when you go to urgent care or when you go to teledoc, they're not gonna ask me these questions. They're gonna be transactional, get it done. No one's gonna ask you these questions. So, except in general, except your primary care doctor. So we establish a baseline. Then we look and say, okay, what are some real simple things that don't require money necessarily, don't require an expensive gym membership, don't require a meal plan. Now, these are all behaviors that you have to change. And far be it for me to minimize how hard it is to change behaviors. But what I like to do is to say, okay, what's the lowest hanging fruit for you? And people will often tell me right away, without even thinking, it's my late night snacking, it's my inability to get up early to do what I used to do 20 years ago in terms of going for a run or doing push-ups or doing something. So I like to use people's prompts and really understand, okay, where do they feel, I don't want to say worst about themselves, or what do they feel they really want to work on first. Now, smoking is something, fortunately, that has decreased somewhat in this country for sure over the past few decades, but it still kills 500,000 people a year. And it's intricate in terms of its lethality, leads to cardiovascular disease, leads to cancer, leads to chronic lung problems like asthma and COPD. And so something like that might be a very low-hanging fruit. Of course, easier said than done in terms of tackling that problem. Sleep. Sleep is very complicated, and chronic stress and some anxiety are probably two of the main sort of factors leading to sleep. But many people, probably a third of surveyed Americans, would say that they don't feel like they get good sleep. And I'm not saying that they need to necessarily evaluate their sleep rigorously with some kind of wearable, but if they don't feel well rested or there's some other obvious things that are happening, they can't get to sleep, or they wake up, maybe they can't get to sleep for an hour or something like that, or they wake up in the middle of the night and you can't get back. It's like talk to your doctor about it. There are lots of sleep hygiene behavior changes that we can discuss. It's not, oh, a right to a medication or right to X, Y, or Z testing necessarily. I think diet and exercise are probably the two bigger one, biggest ones where there's both an enormous amount of information, some misinformation out there about this absolute home run of a diet or home run of a typical exercise that's going to work for you. So I would say run it by your physician, talk about what things you like doing. I think when it comes to exercise, something that's actionable is if you find something you like to do. There's no point in hearing about running and cycling if all you want to do is dance or swim. Dancing is fantastic. It's a moderate intensity activity. If you like dancing, go dance for five days a week at 30 minutes if that's what you like doing. Could be free, just listening to some music. So I would say people can get a lot of simple, small wins just by discussing some of these very evidence-based recommendations that don't cost a lot of money are not hard to implement. The hardest thing about them is changing your habits. And that I think requires, again, time. Most things are trigger, thought, action, consequence when it comes to behavior. And so, you know, what is your trigger that leads to that thought that makes you not want to eat better, that makes you not want to get up and be a little more active? And then it's also my job to show you the consequences of those actions.

SPEAKER_01 14:07

Absolutely. Well, this has been really helpful. Thank you so much for walking us through that. We have something actionable here for people. We'll put it in the show notes so you can see what are these eight or nine things, what can you do about them? And hopefully this will help a few of our listeners at least. Thank you so much for joining me again.

SPEAKER_00 14:22

Thank you so much for having me. It's been my pleasure.