The Atmasvasth Guide to Living Long, Healthy
The premise of Atmasvasth is that we can control our health, lengthen our healthspan and lifespan, and be atmasvasth, on our own, with just a little help, if at all, from doctors and the healthcare system. The very first article that I published last December explains this in detail. The article on atmasvasth takes this concept forward as does the one on healthspan. The site is structured like a loose book and the Index or Table of Contents and/or the Archives can help you navigate the site.
You can listen to the audio/podcast hosted on Soundcloud by clicking the Play button below within the browser itself.
It’s now been over a year since I started Matka Medicine adding the concept of atmasvasth halfway through, as a way to live long, healthy.
While I still have a lot of ground to cover, it is time to take stock of what it entails to have a long healthspan and a healthy lifespan, essentially ageing healthfully.
If this concise guide seems overwhelming…that is what living long, healthy entails. Most of us grow up believing that our health is not ours to manage, but should be left to experts like doctors and the healthcare system, which is fine when you are sick and ill, but of no help when you want to be free from disease.
We know more about our cars than we do about our own bodies and health. That needs to change.
- 150-300 minutes of moderate physical activity per week. Walk, run, do strength training, yoga, preferably mix it up...any physical activity is better than none. The simplest exercise is walking, if you want to do nothing else. However, while being active is good, being fit is better - aspire to reach 10 METs if you are between 50-59 years of age. Every move counts and the more vigorous the activity, even for short intervals, the better it is. If you run on Indian roads, run safely and face the traffic.
2. Eat smart, eat less - sensible eating
- Sensible eating within limits without agonizing over every calorie eaten. Logging food and drink a few days every month or quarter will help you understand if you need to rebalance or reassess your food and drink habits.
- 5 portions of fruits and vegetables per day.
- Plant based eating as much as possible, but affordable and local.
- Avoid ultra-processed foods and individual superfoods and sugar-sweetened beverages.
- Some form of intermittent fasting, preferably time-restricted eating at least 5 days a week or else portion control.
- Not more than 1-2 teaspoons of salt per day. Switch to a potassium-enrich salt substitute. Try not to add extra salt to food during meals.
3. Manage cardiovascular risk, including hypertension and diabetes
Measure your own risk using calculators at least once a year. One CT calcium score study after the age of 45.
- The LDL should be less than or equal to 100 mg/dl and less than 70 mg/dl, if there is any risk factor.
- The blood pressure should be 130/80 mm Hg or less and definitely below 140/90 mm Hg. Measure your own blood pressure regularly.
- The HbA1c should be less than 5.6 with a fasting plasma glucose less than 100 mg/dl. Screen regularly for both.
- For these 3 points, if the values are abnormal, and if physical activity and eating sensibly do not bring them to normal, medication should be used after consulting an appropriate doctor.
- ECG yearly for cardiac issues, and definitely after 65 years of age for atrial fibrillation.
4. Sleep well
- Between 7-9 hours a day.
- If you snore, or are sleepy or groggy during the day, please see a sleep specialist.
- Daytime naps may help
5. Vitamins, minerals and supplements - be cautious
- Vitamin D3 - you don't need testing or supplementation if otherwise healthy, unless you have a major illness that causes vitamin D deficiency. You should actively say no to such testing and supplementation, especially as part of annual health check-ups.
- Vitamin B12 - supplementation may not be needed just because you are vegetarian or Jain
- Most vitamins, minerals and herbal supplements are useless, if you are otherwise in good health and eating sensibly - they can in fact cause financial and bodily harm - self-iatrogenesis.
- Protect from Covid-19, flu, zoster, DTP, pneumococcal and varicella.
- In the future, we will likely have vaccines for tuberculosis, dengue and malaria. They should be taken as and when available.
7. Improve balance, do not fall and do not fracture if you fall
- Physical activity as in point 1.
- Balancing exercises with yoga or tai-chi, as part of the daily/weekly physical activity routine.
- Walking aids may not be helpful and could even increase the risk of falls.
8. Recognize, prevent and reverse frailty
- Preventing and reversing frailty
9. Screen for cancers and other diseases
- Yearly mammography for all women above the age of 45 years.
- Lung cancer screening with low dose CT scan if you smoke or have been a smoker, yearly or once in two years, depending on the amount of smoking.
- HPV DNA test for cervical cancer every 5 years.
- Serum PSA test for prostate cancer - do not do if over the age of 70 and between 55 and 69 years, do only if you handle the consequences of an abnormal result.
- Screening for colorectal cancer is not advisable in India.
- Physical examination once a year to look for lumps and bumps.
- DO NOT screen for other cancers, unless you are specifically genetically at high risk, in which case your oncologist will guide you.
- Regular self-weighing is NOT required
- One-time USG of the abdomen for abdominal aortic aneurysm (AAA) between 65-75 years of age, if you are a smoker or have smoked in the past, or have first degree relatives diagnosed with AAA
- One-time bone density test by dual X-ray absorptiometry (DXA) if you are a woman above the age of 60, to detect osteoporosis to prevent fractures
10. Maintain good hygiene, including dental, vision, hearing and time
- Oral hygiene matters - see a dentist at least once in two years.
- Vision matters - see an ophthalmologist at least once in two years for cataract and macular degeneration.
- Good hearing is important - see a doctor if you can’t hear well and use appropriate hearing aids. Avoid areas and situations that are loud.
- Time - use your time wisely.
- Measure your body temperature when you are normal, a few times to know what your own normal is.
- Do NOT take antibiotics on your own each time you feel sick.
- Do NOT be a victim of polypharmacy - check your medication list regularly
11. Prevent cognitive decline and manage mental health
- Apart from physical activity and eating smart and less, keep the mind active.
- Meditate - a stable mind helps reduce cardiovascular and other risks.
- Develop coping mechanisms, learn continuously and cultivate stable, long-term relationships.
- Address loneliness.
- Build cognitive reserves through education and life-long learning and reading.
12. Reduce, control or eliminate addictions
- Drink alcohol sensibly, if you have to. Don't start if you don't drink.
- Do not start smoking and if you do, then stop. It is never too late to quit.
- Control caffeine intake. Definitely no caffeine in any form at least four hours prior to bed time.
13. Reduce the pollution in our lives
- Air - in whichever way possible by reducing the pollutants in hour homes and offices and mitigating risk by wearing masks and avoiding high traffic density areas, on bad AQI days. Running / walking outdoors is acceptable even in high AQI settings, but within limits.
- Noise - use earphones when traveling but not when walking or driving. Don’t make noise, for e.g. don’t honk when you are driving.
- Digital - reduce dramatically the use of gadgets, and time spent on social media, unless that is your profession. Most of what we see on Twitter or Facebook or WhatsApp is just noise.
14. Manage the logistics of your health like you would manage any other major long-term project
- Make sure you have enough money to last till the age of 90 years, inclusive of catastrophic spending at least once in that timespan. Good financial planning and management are a must.
- Get good health insurance up to the maximum amount you can afford for yourself and the family.
- Identify a health coach who can guide you through points 1 to 12. The health coach does not have to be a doctor.
- Get your Health ID from NDHM.
- Identify a good family physician you can reach out to when sick, to guide you through the process of meeting other specialists, navigating hospitals, making sense of different reports, etc.
- If you are lucky to know a good geriatric doctor, please see them once a year and definitely once in two years.
- Get a health check-up every year based on points 1 to 12, but also manage as much as you can on your own. Remember, in India, you don’t really need prescriptions for blood tests.
- Measure your own temperature when healthy, to know your normal.
- Avoid hospitals unless absolutely necessary. As far as possible, opt for homecare.
15. Manage death, dying and ageing
This is a dynamic guide, which keeps changing as our understanding of healthful ageing improves.
In case you know anyone who would benefit from reading this, especially above the age of 45-50 years, please do share. The site and all posts are free but subscription with an email ID is needed for most of the posts.
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