Pam Peeke, MD: Hi, I'm Dr. Pam Peeke, and this is episode 569 of The Bold and the Brave Her Podcast. Now, today I'm joined by a newbie, someone I want to introduce to the entire community. His name is Dr. Howard Lux. He's a board-certified orthopedic surgeon with over 30 years of clinical experience and a long time focus on helping people remain active, strong, and capable as they age.
He's an athlete, a fellow athlete, yay and he's author of a really cool book that I really think that you will love. It's easy to read, and it's fairly straightforward, sort of the way, you know Howard is. And it's called Longevity Simplified. He also wrote Built to Move, Born to Heal. I could be wrong, but isn't that the name of your Substack?
Howard J. Luks, MD: That is
Pam Peeke, MD: There you go. He's got an awesome Substack. I always look forward to every one of his, you know, daily Substack updates because he writes so well, and he really makes you think, you know, as you're looking at this whole issue of longevity. Howard, welcome to the Her Podcast
Howard J. Luks, MD: Thank you. it's a pleasure to be here
Pam Peeke, MD: All right. Why'd you write the book?
Howard J. Luks, MD: Yeah. so a long answer. Um, I used to write about orthopedic surgery a lot. At one time, I had the busiest solo doctor's ortho site on the internet. And then I started to see things in myself, in patients, and realized that it had nothing to do with orthopedic surgery. It had to do with metabolic health.
And as I dove down each topic, when I want to learn something, I write about it. So I started to write articles about insulin resistance, hypercholesterolemia, fitness, et cetera. And a lot of people had told me along the years to write a book, to put that into book form. And then came the pandemic, and I took that opportunity to, to collate it all and write it as a book
Pam Peeke, MD: That's fantastic. I mean, it came out in 2022, and honestly, you were prescient. You know, you, you really, had looked at this whole issue of, as it were, longevity long before it became like the word of the day. You know, it's getting to a point where, you know, I, I wonder what it means anymore because it's, it's being kicked around, diluted.
You know what it reminds me of, Howard? Remember the old days when the word wellness first cropped up and everyone was like, "Oh, let's get on the wellness, train"? And next thing you knew it was diluted. And yeah, suddenly it just sort of meant anything you wanted it to mean. And, you know, I'm, I'm hoping longevity doesn't go that, that route in a big way
Howard J. Luks, MD: it's sticky online. So it's already gone that way because if you can't sell it, then, then a lot of people aren't going to talk about it. So that's why I wrote the book, because the things that pull the, the, the levers that you have to pull to live a longer, a- and healthier and better life are simple, easy, and affordable.
it doesn't require a monthly subscription to anything. Um, And influencers can't sell that
Pam Peeke, MD: Yes. How interesting is that? So one of the, you know, in this book, Longevity Simplified, you obviously look at this whole issue of longevity long before it was cool. And goals and, you know, basically why it is that we're, we should even be interested in this. I think for the longest period of time, it was always about lifespan, how long are you gonna live?
Yeah, that's really special if you're, you know, really miserable in the last third of your life, so that's not gonna help. Healthspan clearly, you know, leans into the quality of life during that period of time. And ideally, you'd like healthspan and lifespan to be kind of the same and that's kind of one of our goals here.
But, you also speak about metabolic health, not metabolic disease, which is what I think a lot of people, you know, see so much written about, but you're actually talking about metabolic health. What do you mean by that?
Howard J. Luks, MD: Yeah. Well, I want to give people the goal to strive for instead of just telling them that th- that they're sick. I think that's defeatist. So metabolic health. If you boil down a lot of the major causes of death and disability, it comes down to our metabolic health. And if you drill down on that, it comes down to the health of our mitochondria.
So everyone has heard that term by now, right? They're the powerhouse of our cells. But if you're not fit and active, you don't have enough of them, they're not working efficiently, they can't oxidize fat in, in deference to glucose. They can't handle lactate to use as fuel. So someone who's metabolically healthy is capable of doing all those things, something we've referred to as metabolic flexibility, where the mitochondria prefer to burn fat for fuel as opposed to glucose, can burn lactate when it's available with exertion.
And those who are, are metabolically flexible and have a lot of, efficient mitochondria to produce energy are metabolically fit
Pam Peeke, MD: So, you know, it's the mighty mitochondria is what it gets down to. You know, I'm kind of laughing 'cause I remember, you know, when I was a med student or even an undergrad at Berkeley, you know, every time they mentioned mitochondria, it was like, okay, you know, now we're starting to get hairy and do the hairy science thing.
And I kept saying to myself, "I wonder if we could ever explain this to consumers." You know, 'cause it, it, it does get ugly, you know, very quickly actually. but now, we even have products that start with mito, as you're well aware. And um, now people are, are recognizing this little powerhouse, as you say, but you know, kind of the engine of the cell, and all the rest of it.
You don't have to worry about what happens with ATP and the rest of it. All you have to remember is there's a little powerhouse in there. How do you take care of your mitochondria best?
Howard J. Luks, MD: Exercise. That's it. You need, you need various forms of exercise. And I link my discussions on Substack to the biology of aging too, because I f- I firmly think that our workouts need to change as we age. But exercise is the only way to build the efficiency, effectiveness, and metabolic flexibility of your mitochondria
Pam Peeke, MD: Okay. What kind of exercise?
Howard J. Luks, MD: Yeah. So specifically aerobic exercise. There are benefits to mitochondria with, with weight training but to, to focus on metabolic health, it's aerobic exercise. And as a lot of people ar- argue online, most of it sh- should be in the low heart rate domain. What a lot of influencers will say is zone two, but a lot of people don't understand what zone two is.
Zone two is not an exact heart rate. It is a metabolic state. It is where you're using fat efficiently, and you can't do it with any formula. You can't figure it out, because you can breathe through your nose. You have to be put on a machine to figure out what your a- aerobic zones actually are
Pam Peeke, MD: Okay. You know, it's interesting. There's now a big controversy about the zones, as you're well aware. So some people are saying, you know, "Enough already with the zone thing." and, "We don't need that," and back and forth. What do you think?
Howard J. Luks, MD: Yeah. No, I'm, I'm firmly in the camp that the only way to build metabolic flexibility, is through low heart rate aerobic exercise, and that's for a number of reasons. High heart rate domain work will build mitochondrial efficiency, effectiveness, and ability to burn lactate a- as fuel. It will not improve your metabolic flexibility.
So we can take a lot of fit athletes, elite athletes, and throw them on a CPAP machine, and they're not gonna have great numbers. So just because you're fast and capable, it does not mean that, that your mitochondria are functioning well. Also if you are working and if you want to build, your-- build your mitochondrial fitness, you need to do a lot of volume.
so you can't do a lot of high-intensity volume because you're gonna break. You're gonna be in my office because your Achilles tendon's gonna hurt, your hamstring's gonna pull, et cetera. So if you're working and your schedule is tight and you just don't have the time to do a lot of low h-hea-heart rate volume, then high heart rate exercise is fine, right?
You can do a Tabata workout, you can do some hill sprints, and you're gonna derive a lot of benefit. But don't kid yourself into thinking that you're gonna derive the fittest mitochondria around. They will be fit, but you can get a lot fitter if you can throw a lot of high volume, low heart rate work at it.
This is one reason why a lot of runners, predominantly I'm a runner, but I'll hop on a bike twice a week to do a lot of my exercise there, because I don't want to, to accumulate the physical pounding on my bones and tendons that, to match the volume that I desire
Pam Peeke, MD: That's actually, you know, I think what you just said, it's extremely welcoming to everyone. I think people really think that you have to go out there and kill yourself in a big way. I also think that high-intensity interval training has been taken to weird levels that it shouldn't in terms of frequency as well as duration.
Marty Jabala is a wonderful friend, and he's obviously the king of the whole thing, and he just rolls his eyes and goes, "You know, they misinterpreted what I said." So, you know, I think what, what I love about what you're saying is the fact that you can do this, lower heart rate. You don't have to be hitting some crazy, you know, heart rate and maxing out your VO2 max.
Instead just basically enjoying more frequency of the lower heart rate um, aerobic exercise. I think then what you can do is add in here and there, some high-intensity interval training. And quite frankly, y- you know, if you know how to do it well Marty Jabala wrote a fantastic book about how to do that.
I mean, you could do it in five minutes, 10 minutes, 20 minutes. and so when you wanna do a little, as it were, exercise snack just throw it in there, because I think the scientific literature really supports the fact that you get-- you derive good metabolic benefit from that let alone what's going on with training.
it's just that you don't have to kill yourself. when I started my running, you know, years ago, Jeff Galloway and I met, and, he is the famous sort of walk run guy. And, you know, I looked at him and I said, "Look, here's the deal. I'm built like a sprinter. I'm a resistance trained athlete.
I'm built like a sprinter, you know. I have no right doing marathon . I just, like, don't, like, don't go. But I really like the community, the crazy people out there, the medal at the end of the thing, and all the rest of it." So I said, "Oh, okay. So I'll go through it." He goes, "Just do it, you know, my way. I'll show you, you know, how to play with it."
So I did a lot of what Jeff, you know, basically, showed me and demonstrated, and, it worked like a charm. I did Boston, New York. I've done, you know, all the big guys. and I enjoy it sort of all right until I hit mile twenty, and then it was sort of like, you know, this is losing its joy right now.
But, you know, you just get through that last 10K. But, you know, it's interesting I never ever leaned into killing yourself. And I would watch a lot of my colleagues, both in, marathon and triathlon do that. And I, I said, "Why?" "Well, the harder you train..." And I'm like, "Yeah, the harder you train, the more you see people like Dr.
Lux, because you're gonna injure yourself."
Howard J. Luks, MD: That's exactly it. No, you're exactly right, and I emphasize that all the time. I never want today's workout to ruin tomorrow's because those of us who can remain consistent are, are going to win this training battle. And I'm training for life, I'm not training for a podium. I don't need to win anything.
I just want to be able to continue running. And, you know, I love our group runs. We go as slow as the slowest runner each weekend, depending on who joins us, and we can talk and chat and laugh, and before you know it, you know, eight or 10 miles is gone. Or I can sit on a bike and watch a movie, you know, or talk to a friend on the phone.
These are easy miles, and they're incredibly meaningful. You don't have to sweat and be dying for it to matter. as long as your heart rate is up your heart doesn't care whether you're riding or running. And most people, let's face it, most people cannot run and remain under their aerobic threshold.
So you have no choice. You're either walking or you're riding a bike, ' cause that's the only way that you can do low heart rate training well
Pam Peeke, MD: Yeah. So the-- as you're well aware, and I certainly am, the mass majority of people are not runners,
Howard J. Luks, MD: Great
Pam Peeke, MD: right? I mean, I really am a sprinter. I, I really should never have been running. But again, it was so much fun, I just sort of got caught up with it. But, you know, ugh, the mass majority of people don't run.
So what do we tell them? So they're saying, "No, I have no interest in running," and blah, blah, and, "Yet I want to be able to derive longevity benefits of my aerobic workouts. So what do I do?"
Howard J. Luks, MD: Yeah. So get a heart rate strap or some way to, to reliably judge your heart rate because wristwatch is just not good in many people. And get outside and walk. And if you have to increase your pace, great. If you need to find some hills, great. But you wanna get your heart rate up. If you're very fit, your, your heart rate is not going to leave the 90s when you're walking, and you wanna increase the effort a little.
So I think walking with weight in that situation is great. rucking is another ter- term for it. I enjoy rucking, on weekends. people look at me strange in the neighborhood or on the trails, but I don't really care. But walking absolutely works, and it can fit the bill, w- whether it's with a dog or your friends.
Just if your heart rate is getting up, then, then, then you're doing real work
Pam Peeke, MD: Women are wearing those weighted vests. Your thoughts?
Howard J. Luks, MD: Yeah. So, um, it depends why they're wearing it. If you're wearing it because you think you're building bone density when you're walking, no, it's not working. But if you're, if you're wearing it to add some strain and some weight, so get your heart rate up, great. Go for it Okay. All right. Very good. I also, you know, think women especially over the age of, 60 or so may have a little curvature of the spine, and it may not be the world's greatest thing to, you know, have that weighted vest on 'cause, you know, of the imbalance and, and the rest of it. I don't know. What do you think?
You know, they're not gonna-- I don't think they're going to be carrying enough weight for it to matter.
Pam Peeke, MD: Okay
Howard J. Luks, MD: Yeah. You know, I mean, if you're rucking around with thirty, forty pounds, then you need-- Right. Then you need a stable platform, a good straight, well, a well-aligned spine 'cause that can get spicy. But if you're walking around with ten, fifteen pounds around your waist or, you know, chest, I don't think that's gonna be a problem
Pam Peeke, MD: A lot of members of our community have been asking, you know, "What measurement should I start out with? Right now, I wanna know where I am now in terms of my longevity journey." The measurements being physical measurements. So for instance, I suggest hand grip. What else can they do? So with hand grip, that's a no-brainer.
I mean, just, you know, for 30 bucks you can go buy a dynamometer yourself. I use the Camry one. I'm not sure how you do it. and I've been measuring mine for a very long time, and, it, really gives you fantastic feedback on overall body strength, which is, has really nothing to do so much with the hand as it were obviously if you don't have massive arthritis and pain there.
But it's a marvelous way to be able to measure yourself, say, on a monthly basis and kind of see where you are, as you pick up strength. So that's one way. Do, do you like that as well?
Howard J. Luks, MD: I do. it is a good proxy cause in general, people who have good grip strengths are going to be doing other activities that'll build mu- that will build muscle elsewhere.
Pam Peeke, MD: Right
Howard J. Luks, MD: I like sit-to-stands, um
Pam Peeke, MD: Okay, so be specific about sit to stand. What, what is it that people have to do? Over what period of time they're timing themselves? What should they be able to accomplish?
Howard J. Luks, MD: So it's 30 seconds and I'd love to see 15 or more
Pam Peeke, MD: 15 sit-to-stands, and that basically means completely unassisted. And, basically, your little behind has to touch that chair, okay? That doesn't mean you lean into the chair and sit there for a while. You just touch the chair and up you go again, so that you're constantly got tension on yourself. I kinda, you know, level up on it a little bit, and I hold onto a, 20-pound kettlebell or something like that and see if I can nail 15 and 30.
So far so good. Knock on wood. Praise God. what else you
Howard J. Luks, MD: What about calf raises? I like calf raises
Pam Peeke, MD: Okay, now tell me about calf raises. What about
Howard J. Luks, MD: So it really depends on people's age, but I'd love to see, I'd love to see a minimum of 30 calf raises
Pam Peeke, MD: Over
Howard J. Luks, MD: 30
Pam Peeke, MD: per- period of time
Howard J. Luks, MD: yeah, before he gets tired.
I don't give him a time
Pam Peeke, MD: other words, you do it to fatigue.
Howard J. Luks, MD: Correct
Pam Peeke, MD: Ah, okay. I-- okay, I'm gonna laugh about this because I think a lot of my, you know, audience already knows this, but I was born with, Jurassic calves. You know, and I never knew calves were a thing until one day, when I was doing the, the full stack on the calf raise and some guy came over to me, tapped me on the shoulder and said, "I wish I had your calves."
And I just stood there and I said, "Why?" And he said, "Well, look at them." And then I looked at his and I realized that, you know, I had large calves. And, it was just a, a wonderful gift from my father's side of the family, which was more athletic. And, so I have like seventeen-inch calves, and those suckers can go on forever.
And I'm-- you know, so you know what this reminds me of is when we're looking at longevity and we're talking about our bodies and body composition, et cetera, you know, take a moment and do a little inventory, and what are you really proud of and, and what did God give you? You know, like a little gift.
Everyone's got something different. You know? It could be like an amazing back or abs, you know, that just cry out for, "Hey, six-pack," or whatever the issue may be. You know, your body fat distribution, anything. I think it's time to be much more aware and proud of what you already have. when you mention the calves, I just smile.
My little calves, um, and there they are. My quads are called Thelma and Louise, because they love to kill hills on a,
bike, and I discovered this in triathlon training. Everyone else is like, "Oh, another hill." And I'm like, "Yeah, you know, let's do this."
Howard J. Luks, MD: Runners love h- runners love hills. I just love hills. I, I'm a trail runner
by nature, so I just, I look at hills and smile
Pam Peeke, MD: Yeah. I really like to hike. I like to-- I like to be in nature and, you know, the rougher the hike, the better. You know, if you've got scree, if you're dancing around on stones, it, it's good with me because it helps me balance. I practice balance and get a chance to show flexibility.
Do I fall on my ass? Oh, absolutely. Epic fails right and left. You know, I've got more torn up clothes than you can shake a finger at. But you know something? It's fun.
I'm playing. I'm having a damn good time, and I continuously challenge myself. So that's something that I would wish everyone else would do.
Now, there's also some other tests that you can do. Let's just say you're someone who's been, fairly sedentary, okay? And now you're just-- you don't even know where you are. So we got the hand grip thing, we've got the sit to ska- stand we've got the, calf. What, what about just somewhat like Cooper does with his walking tests how fast does it take for you to actually walk a mile, that type of thing? I mean, does that help, too?
Howard J. Luks, MD: It does. I don't really use those tests, but I, you know, I'm, and everyone should know, I'm not a researcher. I'm just an orthopedist who's been sitting in the office with patients for 30 years. And I come up with a lot of activities that I'll ask people about. You know, can you get two bags of groceries inside?
Can you get up and down the stairs without getting short of breath? Can you do a pull-up? Can you do a pushup? How many? Can you do a wall sit? How long? Yeah. On and on. So I'll use these, these assessments as opposed to a lot of the more formal tests
Pam Peeke, MD: see. Okay. I like the plank test
Howard J. Luks, MD: How so?
Pam Peeke, MD: You know, it's just wonderful. How long can you hold a plank With appropriate form.
Howard J. Luks, MD: Yep
Pam Peeke, MD: One of my patients once, well, she's just fabulous. She was quite obese. And, she tried a plank just once when she had begun her journey, and, she was laughing so hard, she could barely contain herself 'cause she said, "Well, Dr.
Peake, you said there were four points. You know, I got my, you know, here I am with my elbows on the ground. I've got my toes over there and I'm holding the plank. But the trouble, I don't have four points, I have five because my belly touches the floor." And then I said, "Okay, maybe we should just hold off on the planks for the time being."
And then one of her proudest moments was when she showed me, she had someone in the gym show, you know, take a picture. And that picture was fabulous. It just showed her on four points. She no longer had a belly that hung down and that actually touched the ground. So to me, that was an absolute point of, celebration.
Howard J. Luks, MD: That's awesome
Pam Peeke, MD: I just love that. And you know, when you say, "I'm just an orthopedic surgeon," hell, you've got 30 years of listening to people on a daily basis. This is why I love talking to people from the front trenches who are really seeing the practical reality on a day-by-day basis. And I could hear that in your book.
You know, your book really spoke to that with the examples that you gave and, and back and forth. So when we come back, I'm gonna pick it up with your book and looking at tracking your progress
And we're back. All right, so the book is fabulous, and again, the book is Longevity Simplified. And what I love about this is it's just insanely practical. It's based upon, you know, Dr. Lux, 30 years plus of listening to people on a daily basis and taking care of them and understanding what are the biggest challenges people face oftentimes at multiple levels, whether they're an elite athlete or whether they are someone who is just beginning their journey.
Pam Peeke, MD: They've had an awakening, and they said, "Okay, you know, I'm a little bit of a mess." All right? What are the easiest things for people to do to be able to stay focused on longevity and not on just the short term, how I look, you know, how I feel this very moment but really keeping longevity as the ultimate goal?
Howard J. Luks, MD: Yeah. You have to establish a few good habits. You know, you need to cook your own food. You need to eat real food. So I don't like ultraprocessed foods. You have to set your bedtime ritual, right? So my last meal is three, three hours prior to bed, and I'm generally in bed around the same time every night.
I try to get up around the same time because your circadian rhythm, that's your body's internal clock, is really important. And if you ke-keep to those habits, it, it works. You need your aerobic exercise. You need to set a goal for that. I don't care if you start with 20 minutes a day. I don't care if you start with 10 minutes twice a day or an hour a day.
Just set a goal and hit it. But set an achievable goal, because if the goalpost is too far upfield, you're not gonna reach it, and then you failed, and now you're gonna f-feel miserable. Some sort of resistance exercise. I don't care if it's chair squats, calf raises, attempted push-ups on a kitchen counter, lifting your dog, some groceries, some gardening.
It doesn't matter. You need some resistance exercise. You have to keep your muscle, especially as you age. Friends. We all need friends. We need to see them in person b-because loneliness kills. It's equivalent to smoking half a pack of cigarettes a day in terms of its effect on our life. And for me, a big one is, having a sense of purpose.
Why am I doing this? What's getting me out of bed every morning? What's driving me? What's behind this? Because, you know, it's pushing me to, to do activities. It's pulling me out of bed in the morning. It's not, "Oh, crap, I gotta get up." It's, "Okay, let's go." You know, "I have to do this because of this." Boom. and setting those simple habits, and in 30 days, when those habits are set, it becomes a lot easier.
It's hard work. I said long-- I, you know, I tell people these are simple strategies because they're effective strategies, but they're not easy. It's very hard. And we can't pick and choose, our levers. We can't say, "Oh, well, I'll sleep better, and we'll see what happens." No. We need to sleep better. We need to eat better.
We need to move more. We need to lift some heavy things. We need to see our friends, and we need to derive a s- a sense of purpose or find our sense of purpose.
Pam Peeke, MD: What I'm hearing from you is routine and practice.
Howard J. Luks, MD: Yes. Our
body
loves routines
Pam Peeke, MD: Yeah, routine is... You know, you know one of the reasons why I love it? You stop thinking.
Howard J. Luks, MD: Yep.
Pam Peeke, MD: What's to think about? I, I mean, hello everyone, don't you brush your teeth in the morning? What do you do? Like, hold a committee meeting and discuss it?
No. You just march in there and you do the damn thing because it's a routine, right? And
so what I'm hearing from you is establishing routines, and that does not happen overnight.
Howard J. Luks, MD: No,
Pam Peeke, MD: What
happens instead is that habits take a while for the brain to wrap its head around, literally. What you're doing is you're establishing new neural pathways, and those neural pathways do not occur overnight.
You have to keep hammering, hammering, and hammering un- until finally the moment you didn't have to think about it, it became a habit. It became your routine. If you have to go, "Should I? Should I not?" Or if you're, you know, convening another committee and finding ways to get arou- No. It has not become a habit.
It is not a routine yet. All right? So slap yourself in the head and, and get back to it again and keep practicing again and again. Don't we do this for everything in life, or did I miss that part? I mean,
this is so terribly important. There's nothing in life that's worth it where we haven't done this, right?
Howard J. Luks, MD: That's right. And you got to get some, some rain boots, you got to get a raincoat, you got to get some warm gloves because we don't just do it when it's 70 and sunny in the morning. You know, I tell everyone, all my kids run and work out. I've told none of my children to run or work out. But they've seen me leave the house at the same time, whether it's sunny, cold, rainy, blah, blah, wind, it doesn't matter.
You know, I was outside. And so that's the habit that I built, and I really, and I protect it. I protect my bedtime, I protect my run times, and it's gonna take a lot for me to change that
Pam Peeke, MD: And, you know, I think that that's extremely important. Don't just be you know, fair weather. So if it's nice out and it's a gorgeous fall day and now, now we're gonna run. Yeah, but what happens when it gets a little bit colder? What happens, you know, when it's raining or there's some inclement weather going on, or whatever the issue is?
Suddenly, you know, you kinda lost the drive. What's that about, I always think of about that word that we use in science, hormesis.
Howard J. Luks, MD: Right.
Pam Peeke, MD: kill you makes you stronger,
Howard J. Luks, MD: It's true. And a lot of people think that we love every run or love every
workout. W- we don't. There are times I'm dying as I'm tying my sneakers. But when you're done, I've never regretted a run or a workout. So the feeling when you're done, that's the reward
Pam Peeke, MD: When I was training for a marathon, you know, I came up with my own little rule, and it turns out after talking to a number of my friends, you know, they felt the same way, although, you know, it was a little different on the actual metric. So the first mile is just, you know, kill me now, right? It's just, "No, this is not fun.
Why am I doing this?" And I, I always turned it into a sitcom. You're paying to do this, okay? You will get a nice medal if everything goes well, and you get a really nasty-looking T-shirt, and, and you're really... You're paying money to do this to yourself,
okay? And I just keep laughing and laughing. Okay, fine.
So the first mile's done. You know, when I start feeling the best is at mile three.
Howard J. Luks, MD: Absolutely
Pam Peeke, MD: takes me three miles before it finally kicks in, and it's like, "Okay,
Howard J. Luks, MD: Yep.
Pam Peeke, MD: We're doing it."
Howard J. Luks, MD: agree completely. I never judge a run in the first mile.
Uh, especially, look, I'm 63 years old, so something always hurts, you know, whether it's an ankle or a hip or a knee. And so I n- I need to wait at least a mile to see if it's all gonna go away and settle itself out
Pam Peeke, MD: Exactly. I- it's, it's what I call the organ recital. You know, in the morning it's like, you know, what part of me is, is not cooperating? Okay. You know, how's that going? We start with the brain and work our way down. And there it is. But yeah, I, I completely hear you. There's something else you did in your Substack that I just found to be exquisitely attractive, and that is what I don't do for longevity.
Okay, I thought that was the coolest list ever. Go for it
Howard J. Luks, MD: Yeah. So, I don't remember exact list and exact order, but right, I'm, I'm gonna get there. So, achieving longevity and a better life is about being active, being able to be active and remain independent as we get older. And so if you're not kicking ass in your 50s and 60s, you're not gonna be kicking ass in your 70s and 80s.
It's just not gonna happen. And so in our pursuit of longevity, we're reaching for, for... We're reaching for supplements, or we're getting into a sauna, or we bought a cold bath, or we bought an infrared panel, or we're stepping on a machine that shakes our legs, and we're thinking that we're building bone density, or a fanny pack that, you know, u- you know, that vibrates.
This is not money well spent. All you have to do is put your headphones on, call, call, call a friend, and go outside. you can really achieve what you need to do, with just, a minimum of effort and some time. As I tell a lot of patients I list these seven levers, quote-unquote, in my book.
And if you're pulling all those and you wanna strive for the extra 0.1% or 1%, great. Go jump in a sauna, do a cold plunge every now and then if your brain wants it. Do it for no other reason 'cause it's not a longevity benefit. A- and take a few supplements maybe, although there's so few that survive the science um, other than creatine.
Other than that, save your money and buy some good walking shoes
Pam Peeke, MD: One of the things that I really, um, love with this whole issue about, you know, what not to do was you kept it so damn simple.
Howard J. Luks, MD: Right
Pam Peeke, MD: It was just simple. It was like, no, you don't have to do what Bryan Johnson did. Isn't it interesting that after all the millions he spent on, you know, the lab testing and the equipment and, you know, tricking out his entire life, it, it-- then he ends up with,
you know, some autoimmune
gastrointestinal issue.
It's like you can't buy your way out of life.
It, it just doesn't work that way. I, I sincerely hope he does well, and I'm sure with all of his resources, he's gonna have the, the best healthcare, you know, to deal with this issue. it's just one of those things. You can't do that. You know, most of the people I know who-- You know, a years ago, I met some people that, I now hang out with all the time.
I was the, chief medical correspondent for Discovery Health Television, and they'd asked me to go to the National Senior Games. And they were in, Carnegie Mellon. so, you know, they kind of go around to the various universities 'cause of the need for the, you know, track and field and all the rest of it.
So there I was at Carnegie Mellon, and I, I'd never in my life, right? I didn't even know this Senior Olympics thing existed, but it sounded so damn cool. And what's really amazing is I've made extraordinary friends with these athletes, and in November, I'm actually joining their board. I am a, a Senior Olympic triathlete competitor, and it was a lot of fun, right?
And so these people that I've met, I mean, you'd think, you know, are they drinking, like, really wild, expensive, you know, beverages in the morning that will cost you a monthly $125 or what? No. No. You know, they'll say, "Yeah, I have my Cheerios, I throw some strawberries on it. yeah, I have a banana and, and whatever before I go out and some peanut butter and, you know, and then I train, and I do my thing.
And, oh, and then I have a little fish and some veg stuff." I mean, I'm like, "What?" This is so clean and so simple, yet these are world record holders in everything from the, you know, from swim meets to track and field, and on and on. They just kept it in-- They actually look at you cross-eyed if you try to make it more complex
Howard J. Luks, MD: Correct. 'Cause it's just the consistency. They trained. They showed up for their training every day
Pam Peeke, MD: Yeah. And, and they're very humble about it. They're just, you know ... So I had on my podcast, back in the fall Natalie, Grabow. Now, Natalie Grabow became very famous because she is 80, and she went on to, be the first 80-year-old woman to ever successfully complete the Ironman Kona Triathlon.
and, and the best part was her face plant right as she was getting up to the arch, you know, the finish arch. And I talked to her about that. I said, you know, we'd become good friends, and I said, "Natalie, you had that look on your face." You know, 'cause what it was was someone had kicked up the, computer carpet, and, she didn't see it 'cause my God, it was 16 hours and 44 minutes, and she was a little dark out there, and she was just trying to get under the damn arch so that she can clock her time.
She never saw the little wrinkle, and so she face-planted. And when she r- when she came up, when you look at her face, it, it had that look that says, "I'm gonna kill the SOB who did this." You know, it wasn't like, "Oh my gosh, I fell and I'm a delicate..." No. "I'm gonna sock the guy who did this," you know, because there have been so many people before her who had, you know, finished, in under 17 hours.
So when I was talking to her, I said, you know, here she is. She didn't even know how to swim until she was 59 years old. What, what's the message there, ladies and gentlemen? You know, you just never know when the adventure's gonna show up in your lifetime.
Howard J. Luks, MD: You can do it
Pam Peeke, MD: not me, I've never done that."
Stop that.
Howard J. Luks, MD: Right. We-- You're right. We tend to lose the abilities we don't train. And we can train to do a lot of things no matter how old we are
Pam Peeke, MD: It's just amazing.
Howard J. Luks, MD: Yep. I start- I started rock climbing in my late 50s. now, now I'm a decent climber.
Pam Peeke, MD: Yeah
Howard J. Luks, MD: sport. So, you just, you just have to try
Pam Peeke, MD: I know. I did the same thing with triathlon. I was like, you know, after a while the marathon was like, "Okay, I'm kind of done with this." and I ended it with Boston. and that was, my goodness the year before, the bomb. And so, you know, I, it, it was kind of like very interesting that way. And I, maybe I have ADD or something because I just got tired of doing one thing.
So they said, "Why don't you do three things? How about we do swim, bike, run?" And I said, "Okay, let's do that." And I just had a blast. I didn't even know how to clip onto a bike, you know? I mean, I'm, got very strong legs, but I just never got around to doing anything. And then suddenly, you know, I clipped on, I'm like, "I'm flying.
Kind of liking this. this.
is kind of cool." And Thelma and Louise, my quads, were kind of loving it. Calves were loving it. You know, and there you go. So what are, what are you gonna do? Oh my goodness gracious. So how can people find out more about you and how to follow you?
Howard J. Luks, MD: Yeah. So the only places where I'm active is on X, and you find me H-J-L-U-K-S, and on Substack, howardluks, L-U-K-S, md@substack.com
Pam Peeke, MD: And that's, Built to Move, Born to Heal.
And, and the last name is Lux, and that's L-U-K-S, just so you make sure you know. And you know something? Keep writing the way you do. You do so beautifully. You know, I love in your book how you ended it. You know, in closing, my best longevity simplified advice to you is, here it comes: create a calorie deficit, then stay lean.
And that, when we say calorie deficit, that doesn't mean, like, you know, you lop it down to nothing. What it means is just a gradual decrease over time, allowing your body to metabolically adjust and, and something that's quite reasonable. You know what you can eliminate every day. Don't give me that look.
All
right. The next one is get sleep, and high-quality sleep. It's not just, you know, clocking eight hours. It's, it's very much like that lifespan, healthspan thing. It's not just the quantity, it's the quality of your sleep. Pay attention to your sleep hygiene. Eat real food, as you had said before. Please, this ultraprocessed stuff, enough already.
Move often throughout the day. Boy, is that a bitch. So for all of us who are working away, doing our thing here, and standing, you know, in our studios and our, you know, Versa Desks and, up and down we go. And what I do, what I keep near me is I keep a kettlebell. I could just, you know, kinda nail that little sucker.
And I keep a nice light one, so I could just do a number of things with it real quick that kind of opens me up. I keep a band near me so I can open myself up, and then I do hip opening exercises if I have to sit, because my body cannot stand to sit. Ugh.
Howard J. Luks, MD: Great
Pam Peeke, MD: Can't stand it. Ugh. All right. Push and pull heavy things.
I think that that's totally cool. You know? People forget that. Push and pull heavy things. If you wanna know what that looks like, go to an airport.
Howard J. Luks, MD: Sure.
Pam Peeke, MD: and pull
Howard J. Luks, MD: But also, you know, so many people when they're working out, they do leg extensions, they do bench press, they do shoulder press, so their back is getting nothing. And their whole posterior chain, which supports the spine, just atrophies and looks awful on an MRI. And then they start to hunch forward, and then their back starts hurting, and then they rest.
So it's just gonna get worse. So you have to do a lot of posterior chain work, and that's where the pulling comes in
Pam Peeke, MD: This is why I love my go-to, which is the kettlebell deadlift.
You can really nail your posterior chain by doing that. I mean, it is, oh, I feel so good. Just so long as you get perfect form. You have to have a straight back. You have to hip hinge. And you know why I love it so much? When you lift as a woman in life, I know what you're doing.
You're humping over. Ah. The worst thing you could do. Hip hinge. Sit almost like you're on an invisible chair. And oh my gosh, your back is gonna love it. It's such a great feeling. All right. Push and pull heavy things. Socialize. You just said that. And here's the thing I love. Have a sense of purpose. And, you know, I like to add the word meaning. Have meaning
and purpose in your life, because otherwise, why the hell get out of bed in the morning?
Howard J. Luks, MD: Exactly.
Pam Peeke, MD: Seriously.
Howard J. Luks, MD: correct. Correct
Pam Peeke, MD: That's exactly where it is. Howard, I cannot thank you enough for being on the podcast. Everyone out there, Longevity Simplified by Howard Lux, L-U-K-S. And run on over to his Substack, which is Built to Move, Born to Heal.
Built to Move, Born to Heal. I so thoroughly enjoy it every single day, so I know that you will too. If you like me, then you're gonna like Dr. Lux. Come on now, you know? And there it is. All right, 30 years of experience says he knows what he's doing. All right. Now, I also want to take a moment to thank my sponsor, and my sponsor is SkinSafe.
SkinSafe is an app developed by the Mayo Clinic, and it takes the guesswork out of shopping for skincare and personal care products based on decades of clinical research to analyze ingredients and match products to your unique skin profile. You know me, I'm evidence-based. Mayo Clinic, hello. All right.
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Now, take a moment and leave us a review because we love to hear from you. It's been a production of Podcast Health, and I have something to share with you. You know how I love little quotes. Well, this is kind of based upon what Dr. Lux and I were talking about, routine, and it came from Aristotle. "We are what we repeatedly do.
Excellence, then, is not an act, but a habit." Do remember that, everyone. Now, get on out there and carpe diem, seize the day, and thanks for listening.
He's an athlete, a fellow athlete, yay and he's author of a really cool book that I really think that you will love. It's easy to read, and it's fairly straightforward, sort of the way, you know Howard is. And it's called Longevity Simplified. He also wrote Built to Move, Born to Heal. I could be wrong, but isn't that the name of your Substack?
Howard J. Luks, MD: That is
Pam Peeke, MD: There you go. He's got an awesome Substack. I always look forward to every one of his, you know, daily Substack updates because he writes so well, and he really makes you think, you know, as you're looking at this whole issue of longevity. Howard, welcome to the Her Podcast
Howard J. Luks, MD: Thank you. it's a pleasure to be here
Pam Peeke, MD: All right. Why'd you write the book?
Howard J. Luks, MD: Yeah. so a long answer. Um, I used to write about orthopedic surgery a lot. At one time, I had the busiest solo doctor's ortho site on the internet. And then I started to see things in myself, in patients, and realized that it had nothing to do with orthopedic surgery. It had to do with metabolic health.
And as I dove down each topic, when I want to learn something, I write about it. So I started to write articles about insulin resistance, hypercholesterolemia, fitness, et cetera. And a lot of people had told me along the years to write a book, to put that into book form. And then came the pandemic, and I took that opportunity to, to collate it all and write it as a book
Pam Peeke, MD: That's fantastic. I mean, it came out in 2022, and honestly, you were prescient. You know, you, you really, had looked at this whole issue of, as it were, longevity long before it became like the word of the day. You know, it's getting to a point where, you know, I, I wonder what it means anymore because it's, it's being kicked around, diluted.
You know what it reminds me of, Howard? Remember the old days when the word wellness first cropped up and everyone was like, "Oh, let's get on the wellness, train"? And next thing you knew it was diluted. And yeah, suddenly it just sort of meant anything you wanted it to mean. And, you know, I'm, I'm hoping longevity doesn't go that, that route in a big way
Howard J. Luks, MD: it's sticky online. So it's already gone that way because if you can't sell it, then, then a lot of people aren't going to talk about it. So that's why I wrote the book, because the things that pull the, the, the levers that you have to pull to live a longer, a- and healthier and better life are simple, easy, and affordable.
it doesn't require a monthly subscription to anything. Um, And influencers can't sell that
Pam Peeke, MD: Yes. How interesting is that? So one of the, you know, in this book, Longevity Simplified, you obviously look at this whole issue of longevity long before it was cool. And goals and, you know, basically why it is that we're, we should even be interested in this. I think for the longest period of time, it was always about lifespan, how long are you gonna live?
Yeah, that's really special if you're, you know, really miserable in the last third of your life, so that's not gonna help. Healthspan clearly, you know, leans into the quality of life during that period of time. And ideally, you'd like healthspan and lifespan to be kind of the same and that's kind of one of our goals here.
But, you also speak about metabolic health, not metabolic disease, which is what I think a lot of people, you know, see so much written about, but you're actually talking about metabolic health. What do you mean by that?
Howard J. Luks, MD: Yeah. Well, I want to give people the goal to strive for instead of just telling them that th- that they're sick. I think that's defeatist. So metabolic health. If you boil down a lot of the major causes of death and disability, it comes down to our metabolic health. And if you drill down on that, it comes down to the health of our mitochondria.
So everyone has heard that term by now, right? They're the powerhouse of our cells. But if you're not fit and active, you don't have enough of them, they're not working efficiently, they can't oxidize fat in, in deference to glucose. They can't handle lactate to use as fuel. So someone who's metabolically healthy is capable of doing all those things, something we've referred to as metabolic flexibility, where the mitochondria prefer to burn fat for fuel as opposed to glucose, can burn lactate when it's available with exertion.
And those who are, are metabolically flexible and have a lot of, efficient mitochondria to produce energy are metabolically fit
Pam Peeke, MD: So, you know, it's the mighty mitochondria is what it gets down to. You know, I'm kind of laughing 'cause I remember, you know, when I was a med student or even an undergrad at Berkeley, you know, every time they mentioned mitochondria, it was like, okay, you know, now we're starting to get hairy and do the hairy science thing.
And I kept saying to myself, "I wonder if we could ever explain this to consumers." You know, 'cause it, it, it does get ugly, you know, very quickly actually. but now, we even have products that start with mito, as you're well aware. And um, now people are, are recognizing this little powerhouse, as you say, but you know, kind of the engine of the cell, and all the rest of it.
You don't have to worry about what happens with ATP and the rest of it. All you have to remember is there's a little powerhouse in there. How do you take care of your mitochondria best?
Howard J. Luks, MD: Exercise. That's it. You need, you need various forms of exercise. And I link my discussions on Substack to the biology of aging too, because I f- I firmly think that our workouts need to change as we age. But exercise is the only way to build the efficiency, effectiveness, and metabolic flexibility of your mitochondria
Pam Peeke, MD: Okay. What kind of exercise?
Howard J. Luks, MD: Yeah. So specifically aerobic exercise. There are benefits to mitochondria with, with weight training but to, to focus on metabolic health, it's aerobic exercise. And as a lot of people ar- argue online, most of it sh- should be in the low heart rate domain. What a lot of influencers will say is zone two, but a lot of people don't understand what zone two is.
Zone two is not an exact heart rate. It is a metabolic state. It is where you're using fat efficiently, and you can't do it with any formula. You can't figure it out, because you can breathe through your nose. You have to be put on a machine to figure out what your a- aerobic zones actually are
Pam Peeke, MD: Okay. You know, it's interesting. There's now a big controversy about the zones, as you're well aware. So some people are saying, you know, "Enough already with the zone thing." and, "We don't need that," and back and forth. What do you think?
Howard J. Luks, MD: Yeah. No, I'm, I'm firmly in the camp that the only way to build metabolic flexibility, is through low heart rate aerobic exercise, and that's for a number of reasons. High heart rate domain work will build mitochondrial efficiency, effectiveness, and ability to burn lactate a- as fuel. It will not improve your metabolic flexibility.
So we can take a lot of fit athletes, elite athletes, and throw them on a CPAP machine, and they're not gonna have great numbers. So just because you're fast and capable, it does not mean that, that your mitochondria are functioning well. Also if you are working and if you want to build, your-- build your mitochondrial fitness, you need to do a lot of volume.
so you can't do a lot of high-intensity volume because you're gonna break. You're gonna be in my office because your Achilles tendon's gonna hurt, your hamstring's gonna pull, et cetera. So if you're working and your schedule is tight and you just don't have the time to do a lot of low h-hea-heart rate volume, then high heart rate exercise is fine, right?
You can do a Tabata workout, you can do some hill sprints, and you're gonna derive a lot of benefit. But don't kid yourself into thinking that you're gonna derive the fittest mitochondria around. They will be fit, but you can get a lot fitter if you can throw a lot of high volume, low heart rate work at it.
This is one reason why a lot of runners, predominantly I'm a runner, but I'll hop on a bike twice a week to do a lot of my exercise there, because I don't want to, to accumulate the physical pounding on my bones and tendons that, to match the volume that I desire
Pam Peeke, MD: That's actually, you know, I think what you just said, it's extremely welcoming to everyone. I think people really think that you have to go out there and kill yourself in a big way. I also think that high-intensity interval training has been taken to weird levels that it shouldn't in terms of frequency as well as duration.
Marty Jabala is a wonderful friend, and he's obviously the king of the whole thing, and he just rolls his eyes and goes, "You know, they misinterpreted what I said." So, you know, I think what, what I love about what you're saying is the fact that you can do this, lower heart rate. You don't have to be hitting some crazy, you know, heart rate and maxing out your VO2 max.
Instead just basically enjoying more frequency of the lower heart rate um, aerobic exercise. I think then what you can do is add in here and there, some high-intensity interval training. And quite frankly, y- you know, if you know how to do it well Marty Jabala wrote a fantastic book about how to do that.
I mean, you could do it in five minutes, 10 minutes, 20 minutes. and so when you wanna do a little, as it were, exercise snack just throw it in there, because I think the scientific literature really supports the fact that you get-- you derive good metabolic benefit from that let alone what's going on with training.
it's just that you don't have to kill yourself. when I started my running, you know, years ago, Jeff Galloway and I met, and, he is the famous sort of walk run guy. And, you know, I looked at him and I said, "Look, here's the deal. I'm built like a sprinter. I'm a resistance trained athlete.
I'm built like a sprinter, you know. I have no right doing marathon . I just, like, don't, like, don't go. But I really like the community, the crazy people out there, the medal at the end of the thing, and all the rest of it." So I said, "Oh, okay. So I'll go through it." He goes, "Just do it, you know, my way. I'll show you, you know, how to play with it."
So I did a lot of what Jeff, you know, basically, showed me and demonstrated, and, it worked like a charm. I did Boston, New York. I've done, you know, all the big guys. and I enjoy it sort of all right until I hit mile twenty, and then it was sort of like, you know, this is losing its joy right now.
But, you know, you just get through that last 10K. But, you know, it's interesting I never ever leaned into killing yourself. And I would watch a lot of my colleagues, both in, marathon and triathlon do that. And I, I said, "Why?" "Well, the harder you train..." And I'm like, "Yeah, the harder you train, the more you see people like Dr.
Lux, because you're gonna injure yourself."
Howard J. Luks, MD: That's exactly it. No, you're exactly right, and I emphasize that all the time. I never want today's workout to ruin tomorrow's because those of us who can remain consistent are, are going to win this training battle. And I'm training for life, I'm not training for a podium. I don't need to win anything.
I just want to be able to continue running. And, you know, I love our group runs. We go as slow as the slowest runner each weekend, depending on who joins us, and we can talk and chat and laugh, and before you know it, you know, eight or 10 miles is gone. Or I can sit on a bike and watch a movie, you know, or talk to a friend on the phone.
These are easy miles, and they're incredibly meaningful. You don't have to sweat and be dying for it to matter. as long as your heart rate is up your heart doesn't care whether you're riding or running. And most people, let's face it, most people cannot run and remain under their aerobic threshold.
So you have no choice. You're either walking or you're riding a bike, ' cause that's the only way that you can do low heart rate training well
Pam Peeke, MD: Yeah. So the-- as you're well aware, and I certainly am, the mass majority of people are not runners,
Howard J. Luks, MD: Great
Pam Peeke, MD: right? I mean, I really am a sprinter. I, I really should never have been running. But again, it was so much fun, I just sort of got caught up with it. But, you know, ugh, the mass majority of people don't run.
So what do we tell them? So they're saying, "No, I have no interest in running," and blah, blah, and, "Yet I want to be able to derive longevity benefits of my aerobic workouts. So what do I do?"
Howard J. Luks, MD: Yeah. So get a heart rate strap or some way to, to reliably judge your heart rate because wristwatch is just not good in many people. And get outside and walk. And if you have to increase your pace, great. If you need to find some hills, great. But you wanna get your heart rate up. If you're very fit, your, your heart rate is not going to leave the 90s when you're walking, and you wanna increase the effort a little.
So I think walking with weight in that situation is great. rucking is another ter- term for it. I enjoy rucking, on weekends. people look at me strange in the neighborhood or on the trails, but I don't really care. But walking absolutely works, and it can fit the bill, w- whether it's with a dog or your friends.
Just if your heart rate is getting up, then, then, then you're doing real work
Pam Peeke, MD: Women are wearing those weighted vests. Your thoughts?
Howard J. Luks, MD: Yeah. So, um, it depends why they're wearing it. If you're wearing it because you think you're building bone density when you're walking, no, it's not working. But if you're, if you're wearing it to add some strain and some weight, so get your heart rate up, great. Go for it Okay. All right. Very good. I also, you know, think women especially over the age of, 60 or so may have a little curvature of the spine, and it may not be the world's greatest thing to, you know, have that weighted vest on 'cause, you know, of the imbalance and, and the rest of it. I don't know. What do you think?
You know, they're not gonna-- I don't think they're going to be carrying enough weight for it to matter.
Pam Peeke, MD: Okay
Howard J. Luks, MD: Yeah. You know, I mean, if you're rucking around with thirty, forty pounds, then you need-- Right. Then you need a stable platform, a good straight, well, a well-aligned spine 'cause that can get spicy. But if you're walking around with ten, fifteen pounds around your waist or, you know, chest, I don't think that's gonna be a problem
Pam Peeke, MD: A lot of members of our community have been asking, you know, "What measurement should I start out with? Right now, I wanna know where I am now in terms of my longevity journey." The measurements being physical measurements. So for instance, I suggest hand grip. What else can they do? So with hand grip, that's a no-brainer.
I mean, just, you know, for 30 bucks you can go buy a dynamometer yourself. I use the Camry one. I'm not sure how you do it. and I've been measuring mine for a very long time, and, it, really gives you fantastic feedback on overall body strength, which is, has really nothing to do so much with the hand as it were obviously if you don't have massive arthritis and pain there.
But it's a marvelous way to be able to measure yourself, say, on a monthly basis and kind of see where you are, as you pick up strength. So that's one way. Do, do you like that as well?
Howard J. Luks, MD: I do. it is a good proxy cause in general, people who have good grip strengths are going to be doing other activities that'll build mu- that will build muscle elsewhere.
Pam Peeke, MD: Right
Howard J. Luks, MD: I like sit-to-stands, um
Pam Peeke, MD: Okay, so be specific about sit to stand. What, what is it that people have to do? Over what period of time they're timing themselves? What should they be able to accomplish?
Howard J. Luks, MD: So it's 30 seconds and I'd love to see 15 or more
Pam Peeke, MD: 15 sit-to-stands, and that basically means completely unassisted. And, basically, your little behind has to touch that chair, okay? That doesn't mean you lean into the chair and sit there for a while. You just touch the chair and up you go again, so that you're constantly got tension on yourself. I kinda, you know, level up on it a little bit, and I hold onto a, 20-pound kettlebell or something like that and see if I can nail 15 and 30.
So far so good. Knock on wood. Praise God. what else you
Howard J. Luks, MD: What about calf raises? I like calf raises
Pam Peeke, MD: Okay, now tell me about calf raises. What about
Howard J. Luks, MD: So it really depends on people's age, but I'd love to see, I'd love to see a minimum of 30 calf raises
Pam Peeke, MD: Over
Howard J. Luks, MD: 30
Pam Peeke, MD: per- period of time
Howard J. Luks, MD: yeah, before he gets tired.
I don't give him a time
Pam Peeke, MD: other words, you do it to fatigue.
Howard J. Luks, MD: Correct
Pam Peeke, MD: Ah, okay. I-- okay, I'm gonna laugh about this because I think a lot of my, you know, audience already knows this, but I was born with, Jurassic calves. You know, and I never knew calves were a thing until one day, when I was doing the, the full stack on the calf raise and some guy came over to me, tapped me on the shoulder and said, "I wish I had your calves."
And I just stood there and I said, "Why?" And he said, "Well, look at them." And then I looked at his and I realized that, you know, I had large calves. And, it was just a, a wonderful gift from my father's side of the family, which was more athletic. And, so I have like seventeen-inch calves, and those suckers can go on forever.
And I'm-- you know, so you know what this reminds me of is when we're looking at longevity and we're talking about our bodies and body composition, et cetera, you know, take a moment and do a little inventory, and what are you really proud of and, and what did God give you? You know, like a little gift.
Everyone's got something different. You know? It could be like an amazing back or abs, you know, that just cry out for, "Hey, six-pack," or whatever the issue may be. You know, your body fat distribution, anything. I think it's time to be much more aware and proud of what you already have. when you mention the calves, I just smile.
My little calves, um, and there they are. My quads are called Thelma and Louise, because they love to kill hills on a,
bike, and I discovered this in triathlon training. Everyone else is like, "Oh, another hill." And I'm like, "Yeah, you know, let's do this."
Howard J. Luks, MD: Runners love h- runners love hills. I just love hills. I, I'm a trail runner
by nature, so I just, I look at hills and smile
Pam Peeke, MD: Yeah. I really like to hike. I like to-- I like to be in nature and, you know, the rougher the hike, the better. You know, if you've got scree, if you're dancing around on stones, it, it's good with me because it helps me balance. I practice balance and get a chance to show flexibility.
Do I fall on my ass? Oh, absolutely. Epic fails right and left. You know, I've got more torn up clothes than you can shake a finger at. But you know something? It's fun.
I'm playing. I'm having a damn good time, and I continuously challenge myself. So that's something that I would wish everyone else would do.
Now, there's also some other tests that you can do. Let's just say you're someone who's been, fairly sedentary, okay? And now you're just-- you don't even know where you are. So we got the hand grip thing, we've got the sit to ska- stand we've got the, calf. What, what about just somewhat like Cooper does with his walking tests how fast does it take for you to actually walk a mile, that type of thing? I mean, does that help, too?
Howard J. Luks, MD: It does. I don't really use those tests, but I, you know, I'm, and everyone should know, I'm not a researcher. I'm just an orthopedist who's been sitting in the office with patients for 30 years. And I come up with a lot of activities that I'll ask people about. You know, can you get two bags of groceries inside?
Can you get up and down the stairs without getting short of breath? Can you do a pull-up? Can you do a pushup? How many? Can you do a wall sit? How long? Yeah. On and on. So I'll use these, these assessments as opposed to a lot of the more formal tests
Pam Peeke, MD: see. Okay. I like the plank test
Howard J. Luks, MD: How so?
Pam Peeke, MD: You know, it's just wonderful. How long can you hold a plank With appropriate form.
Howard J. Luks, MD: Yep
Pam Peeke, MD: One of my patients once, well, she's just fabulous. She was quite obese. And, she tried a plank just once when she had begun her journey, and, she was laughing so hard, she could barely contain herself 'cause she said, "Well, Dr.
Peake, you said there were four points. You know, I got my, you know, here I am with my elbows on the ground. I've got my toes over there and I'm holding the plank. But the trouble, I don't have four points, I have five because my belly touches the floor." And then I said, "Okay, maybe we should just hold off on the planks for the time being."
And then one of her proudest moments was when she showed me, she had someone in the gym show, you know, take a picture. And that picture was fabulous. It just showed her on four points. She no longer had a belly that hung down and that actually touched the ground. So to me, that was an absolute point of, celebration.
Howard J. Luks, MD: That's awesome
Pam Peeke, MD: I just love that. And you know, when you say, "I'm just an orthopedic surgeon," hell, you've got 30 years of listening to people on a daily basis. This is why I love talking to people from the front trenches who are really seeing the practical reality on a day-by-day basis. And I could hear that in your book.
You know, your book really spoke to that with the examples that you gave and, and back and forth. So when we come back, I'm gonna pick it up with your book and looking at tracking your progress
And we're back. All right, so the book is fabulous, and again, the book is Longevity Simplified. And what I love about this is it's just insanely practical. It's based upon, you know, Dr. Lux, 30 years plus of listening to people on a daily basis and taking care of them and understanding what are the biggest challenges people face oftentimes at multiple levels, whether they're an elite athlete or whether they are someone who is just beginning their journey.
Pam Peeke, MD: They've had an awakening, and they said, "Okay, you know, I'm a little bit of a mess." All right? What are the easiest things for people to do to be able to stay focused on longevity and not on just the short term, how I look, you know, how I feel this very moment but really keeping longevity as the ultimate goal?
Howard J. Luks, MD: Yeah. You have to establish a few good habits. You know, you need to cook your own food. You need to eat real food. So I don't like ultraprocessed foods. You have to set your bedtime ritual, right? So my last meal is three, three hours prior to bed, and I'm generally in bed around the same time every night.
I try to get up around the same time because your circadian rhythm, that's your body's internal clock, is really important. And if you ke-keep to those habits, it, it works. You need your aerobic exercise. You need to set a goal for that. I don't care if you start with 20 minutes a day. I don't care if you start with 10 minutes twice a day or an hour a day.
Just set a goal and hit it. But set an achievable goal, because if the goalpost is too far upfield, you're not gonna reach it, and then you failed, and now you're gonna f-feel miserable. Some sort of resistance exercise. I don't care if it's chair squats, calf raises, attempted push-ups on a kitchen counter, lifting your dog, some groceries, some gardening.
It doesn't matter. You need some resistance exercise. You have to keep your muscle, especially as you age. Friends. We all need friends. We need to see them in person b-because loneliness kills. It's equivalent to smoking half a pack of cigarettes a day in terms of its effect on our life. And for me, a big one is, having a sense of purpose.
Why am I doing this? What's getting me out of bed every morning? What's driving me? What's behind this? Because, you know, it's pushing me to, to do activities. It's pulling me out of bed in the morning. It's not, "Oh, crap, I gotta get up." It's, "Okay, let's go." You know, "I have to do this because of this." Boom. and setting those simple habits, and in 30 days, when those habits are set, it becomes a lot easier.
It's hard work. I said long-- I, you know, I tell people these are simple strategies because they're effective strategies, but they're not easy. It's very hard. And we can't pick and choose, our levers. We can't say, "Oh, well, I'll sleep better, and we'll see what happens." No. We need to sleep better. We need to eat better.
We need to move more. We need to lift some heavy things. We need to see our friends, and we need to derive a s- a sense of purpose or find our sense of purpose.
Pam Peeke, MD: What I'm hearing from you is routine and practice.
Howard J. Luks, MD: Yes. Our
body
loves routines
Pam Peeke, MD: Yeah, routine is... You know, you know one of the reasons why I love it? You stop thinking.
Howard J. Luks, MD: Yep.
Pam Peeke, MD: What's to think about? I, I mean, hello everyone, don't you brush your teeth in the morning? What do you do? Like, hold a committee meeting and discuss it?
No. You just march in there and you do the damn thing because it's a routine, right? And
so what I'm hearing from you is establishing routines, and that does not happen overnight.
Howard J. Luks, MD: No,
Pam Peeke, MD: What
happens instead is that habits take a while for the brain to wrap its head around, literally. What you're doing is you're establishing new neural pathways, and those neural pathways do not occur overnight.
You have to keep hammering, hammering, and hammering un- until finally the moment you didn't have to think about it, it became a habit. It became your routine. If you have to go, "Should I? Should I not?" Or if you're, you know, convening another committee and finding ways to get arou- No. It has not become a habit.
It is not a routine yet. All right? So slap yourself in the head and, and get back to it again and keep practicing again and again. Don't we do this for everything in life, or did I miss that part? I mean,
this is so terribly important. There's nothing in life that's worth it where we haven't done this, right?
Howard J. Luks, MD: That's right. And you got to get some, some rain boots, you got to get a raincoat, you got to get some warm gloves because we don't just do it when it's 70 and sunny in the morning. You know, I tell everyone, all my kids run and work out. I've told none of my children to run or work out. But they've seen me leave the house at the same time, whether it's sunny, cold, rainy, blah, blah, wind, it doesn't matter.
You know, I was outside. And so that's the habit that I built, and I really, and I protect it. I protect my bedtime, I protect my run times, and it's gonna take a lot for me to change that
Pam Peeke, MD: And, you know, I think that that's extremely important. Don't just be you know, fair weather. So if it's nice out and it's a gorgeous fall day and now, now we're gonna run. Yeah, but what happens when it gets a little bit colder? What happens, you know, when it's raining or there's some inclement weather going on, or whatever the issue is?
Suddenly, you know, you kinda lost the drive. What's that about, I always think of about that word that we use in science, hormesis.
Howard J. Luks, MD: Right.
Pam Peeke, MD: kill you makes you stronger,
Howard J. Luks, MD: It's true. And a lot of people think that we love every run or love every
workout. W- we don't. There are times I'm dying as I'm tying my sneakers. But when you're done, I've never regretted a run or a workout. So the feeling when you're done, that's the reward
Pam Peeke, MD: When I was training for a marathon, you know, I came up with my own little rule, and it turns out after talking to a number of my friends, you know, they felt the same way, although, you know, it was a little different on the actual metric. So the first mile is just, you know, kill me now, right? It's just, "No, this is not fun.
Why am I doing this?" And I, I always turned it into a sitcom. You're paying to do this, okay? You will get a nice medal if everything goes well, and you get a really nasty-looking T-shirt, and, and you're really... You're paying money to do this to yourself,
okay? And I just keep laughing and laughing. Okay, fine.
So the first mile's done. You know, when I start feeling the best is at mile three.
Howard J. Luks, MD: Absolutely
Pam Peeke, MD: takes me three miles before it finally kicks in, and it's like, "Okay,
Howard J. Luks, MD: Yep.
Pam Peeke, MD: We're doing it."
Howard J. Luks, MD: agree completely. I never judge a run in the first mile.
Uh, especially, look, I'm 63 years old, so something always hurts, you know, whether it's an ankle or a hip or a knee. And so I n- I need to wait at least a mile to see if it's all gonna go away and settle itself out
Pam Peeke, MD: Exactly. I- it's, it's what I call the organ recital. You know, in the morning it's like, you know, what part of me is, is not cooperating? Okay. You know, how's that going? We start with the brain and work our way down. And there it is. But yeah, I, I completely hear you. There's something else you did in your Substack that I just found to be exquisitely attractive, and that is what I don't do for longevity.
Okay, I thought that was the coolest list ever. Go for it
Howard J. Luks, MD: Yeah. So, I don't remember exact list and exact order, but right, I'm, I'm gonna get there. So, achieving longevity and a better life is about being active, being able to be active and remain independent as we get older. And so if you're not kicking ass in your 50s and 60s, you're not gonna be kicking ass in your 70s and 80s.
It's just not gonna happen. And so in our pursuit of longevity, we're reaching for, for... We're reaching for supplements, or we're getting into a sauna, or we bought a cold bath, or we bought an infrared panel, or we're stepping on a machine that shakes our legs, and we're thinking that we're building bone density, or a fanny pack that, you know, u- you know, that vibrates.
This is not money well spent. All you have to do is put your headphones on, call, call, call a friend, and go outside. you can really achieve what you need to do, with just, a minimum of effort and some time. As I tell a lot of patients I list these seven levers, quote-unquote, in my book.
And if you're pulling all those and you wanna strive for the extra 0.1% or 1%, great. Go jump in a sauna, do a cold plunge every now and then if your brain wants it. Do it for no other reason 'cause it's not a longevity benefit. A- and take a few supplements maybe, although there's so few that survive the science um, other than creatine.
Other than that, save your money and buy some good walking shoes
Pam Peeke, MD: One of the things that I really, um, love with this whole issue about, you know, what not to do was you kept it so damn simple.
Howard J. Luks, MD: Right
Pam Peeke, MD: It was just simple. It was like, no, you don't have to do what Bryan Johnson did. Isn't it interesting that after all the millions he spent on, you know, the lab testing and the equipment and, you know, tricking out his entire life, it, it-- then he ends up with,
you know, some autoimmune
gastrointestinal issue.
It's like you can't buy your way out of life.
It, it just doesn't work that way. I, I sincerely hope he does well, and I'm sure with all of his resources, he's gonna have the, the best healthcare, you know, to deal with this issue. it's just one of those things. You can't do that. You know, most of the people I know who-- You know, a years ago, I met some people that, I now hang out with all the time.
I was the, chief medical correspondent for Discovery Health Television, and they'd asked me to go to the National Senior Games. And they were in, Carnegie Mellon. so, you know, they kind of go around to the various universities 'cause of the need for the, you know, track and field and all the rest of it.
So there I was at Carnegie Mellon, and I, I'd never in my life, right? I didn't even know this Senior Olympics thing existed, but it sounded so damn cool. And what's really amazing is I've made extraordinary friends with these athletes, and in November, I'm actually joining their board. I am a, a Senior Olympic triathlete competitor, and it was a lot of fun, right?
And so these people that I've met, I mean, you'd think, you know, are they drinking, like, really wild, expensive, you know, beverages in the morning that will cost you a monthly $125 or what? No. No. You know, they'll say, "Yeah, I have my Cheerios, I throw some strawberries on it. yeah, I have a banana and, and whatever before I go out and some peanut butter and, you know, and then I train, and I do my thing.
And, oh, and then I have a little fish and some veg stuff." I mean, I'm like, "What?" This is so clean and so simple, yet these are world record holders in everything from the, you know, from swim meets to track and field, and on and on. They just kept it in-- They actually look at you cross-eyed if you try to make it more complex
Howard J. Luks, MD: Correct. 'Cause it's just the consistency. They trained. They showed up for their training every day
Pam Peeke, MD: Yeah. And, and they're very humble about it. They're just, you know ... So I had on my podcast, back in the fall Natalie, Grabow. Now, Natalie Grabow became very famous because she is 80, and she went on to, be the first 80-year-old woman to ever successfully complete the Ironman Kona Triathlon.
and, and the best part was her face plant right as she was getting up to the arch, you know, the finish arch. And I talked to her about that. I said, you know, we'd become good friends, and I said, "Natalie, you had that look on your face." You know, 'cause what it was was someone had kicked up the, computer carpet, and, she didn't see it 'cause my God, it was 16 hours and 44 minutes, and she was a little dark out there, and she was just trying to get under the damn arch so that she can clock her time.
She never saw the little wrinkle, and so she face-planted. And when she r- when she came up, when you look at her face, it, it had that look that says, "I'm gonna kill the SOB who did this." You know, it wasn't like, "Oh my gosh, I fell and I'm a delicate..." No. "I'm gonna sock the guy who did this," you know, because there have been so many people before her who had, you know, finished, in under 17 hours.
So when I was talking to her, I said, you know, here she is. She didn't even know how to swim until she was 59 years old. What, what's the message there, ladies and gentlemen? You know, you just never know when the adventure's gonna show up in your lifetime.
Howard J. Luks, MD: You can do it
Pam Peeke, MD: not me, I've never done that."
Stop that.
Howard J. Luks, MD: Right. We-- You're right. We tend to lose the abilities we don't train. And we can train to do a lot of things no matter how old we are
Pam Peeke, MD: It's just amazing.
Howard J. Luks, MD: Yep. I start- I started rock climbing in my late 50s. now, now I'm a decent climber.
Pam Peeke, MD: Yeah
Howard J. Luks, MD: sport. So, you just, you just have to try
Pam Peeke, MD: I know. I did the same thing with triathlon. I was like, you know, after a while the marathon was like, "Okay, I'm kind of done with this." and I ended it with Boston. and that was, my goodness the year before, the bomb. And so, you know, I, it, it was kind of like very interesting that way. And I, maybe I have ADD or something because I just got tired of doing one thing.
So they said, "Why don't you do three things? How about we do swim, bike, run?" And I said, "Okay, let's do that." And I just had a blast. I didn't even know how to clip onto a bike, you know? I mean, I'm, got very strong legs, but I just never got around to doing anything. And then suddenly, you know, I clipped on, I'm like, "I'm flying.
Kind of liking this. this.
is kind of cool." And Thelma and Louise, my quads, were kind of loving it. Calves were loving it. You know, and there you go. So what are, what are you gonna do? Oh my goodness gracious. So how can people find out more about you and how to follow you?
Howard J. Luks, MD: Yeah. So the only places where I'm active is on X, and you find me H-J-L-U-K-S, and on Substack, howardluks, L-U-K-S, md@substack.com
Pam Peeke, MD: And that's, Built to Move, Born to Heal.
And, and the last name is Lux, and that's L-U-K-S, just so you make sure you know. And you know something? Keep writing the way you do. You do so beautifully. You know, I love in your book how you ended it. You know, in closing, my best longevity simplified advice to you is, here it comes: create a calorie deficit, then stay lean.
And that, when we say calorie deficit, that doesn't mean, like, you know, you lop it down to nothing. What it means is just a gradual decrease over time, allowing your body to metabolically adjust and, and something that's quite reasonable. You know what you can eliminate every day. Don't give me that look.
All
right. The next one is get sleep, and high-quality sleep. It's not just, you know, clocking eight hours. It's, it's very much like that lifespan, healthspan thing. It's not just the quantity, it's the quality of your sleep. Pay attention to your sleep hygiene. Eat real food, as you had said before. Please, this ultraprocessed stuff, enough already.
Move often throughout the day. Boy, is that a bitch. So for all of us who are working away, doing our thing here, and standing, you know, in our studios and our, you know, Versa Desks and, up and down we go. And what I do, what I keep near me is I keep a kettlebell. I could just, you know, kinda nail that little sucker.
And I keep a nice light one, so I could just do a number of things with it real quick that kind of opens me up. I keep a band near me so I can open myself up, and then I do hip opening exercises if I have to sit, because my body cannot stand to sit. Ugh.
Howard J. Luks, MD: Great
Pam Peeke, MD: Can't stand it. Ugh. All right. Push and pull heavy things.
I think that that's totally cool. You know? People forget that. Push and pull heavy things. If you wanna know what that looks like, go to an airport.
Howard J. Luks, MD: Sure.
Pam Peeke, MD: and pull
Howard J. Luks, MD: But also, you know, so many people when they're working out, they do leg extensions, they do bench press, they do shoulder press, so their back is getting nothing. And their whole posterior chain, which supports the spine, just atrophies and looks awful on an MRI. And then they start to hunch forward, and then their back starts hurting, and then they rest.
So it's just gonna get worse. So you have to do a lot of posterior chain work, and that's where the pulling comes in
Pam Peeke, MD: This is why I love my go-to, which is the kettlebell deadlift.
You can really nail your posterior chain by doing that. I mean, it is, oh, I feel so good. Just so long as you get perfect form. You have to have a straight back. You have to hip hinge. And you know why I love it so much? When you lift as a woman in life, I know what you're doing.
You're humping over. Ah. The worst thing you could do. Hip hinge. Sit almost like you're on an invisible chair. And oh my gosh, your back is gonna love it. It's such a great feeling. All right. Push and pull heavy things. Socialize. You just said that. And here's the thing I love. Have a sense of purpose. And, you know, I like to add the word meaning. Have meaning
and purpose in your life, because otherwise, why the hell get out of bed in the morning?
Howard J. Luks, MD: Exactly.
Pam Peeke, MD: Seriously.
Howard J. Luks, MD: correct. Correct
Pam Peeke, MD: That's exactly where it is. Howard, I cannot thank you enough for being on the podcast. Everyone out there, Longevity Simplified by Howard Lux, L-U-K-S. And run on over to his Substack, which is Built to Move, Born to Heal.
Built to Move, Born to Heal. I so thoroughly enjoy it every single day, so I know that you will too. If you like me, then you're gonna like Dr. Lux. Come on now, you know? And there it is. All right, 30 years of experience says he knows what he's doing. All right. Now, I also want to take a moment to thank my sponsor, and my sponsor is SkinSafe.
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Now, take a moment and leave us a review because we love to hear from you. It's been a production of Podcast Health, and I have something to share with you. You know how I love little quotes. Well, this is kind of based upon what Dr. Lux and I were talking about, routine, and it came from Aristotle. "We are what we repeatedly do.
Excellence, then, is not an act, but a habit." Do remember that, everyone. Now, get on out there and carpe diem, seize the day, and thanks for listening.
