A new friend in Lecce recently asked me for advice about longevity. He was surprised by what he perceived as my relative youth. Others who know that I’ve worked in the field of longevity for years sometimes ask for my “secret.”

I usually joke that the secret was choosing the right parents.

That joke is partly true. Genetics matter—but they account for only about 20–30% of lifespan. The rest is something far more actionable.

Genetics Set the Ceiling but how You Live Determines the Outcome

I believe genetics determines your maximum potential lifespan. In that respect, I did win the lottery.

My father lived to 97 and remained in excellent physical condition, working out six days a week until he was 95. Had he treated his brain like a muscle as well, he might have avoided the dementia that appeared late in life. My mother, sadly, died young at 67 by taking her own life but her mother lived to 94 and her mother’s mother to 98.

So while genetics may define the ceiling, everything you do during your life subtracts from it.

Smoking at 20 may shave a decade off your lifespan. Chronic sleep deprivation quietly steals years. Poor metabolic health doesn’t announce itself early—it slowly gnaws away at your longevity. Longevity is less about adding years than about not losing them unnecessarily.

Key Drivers of Longevity.

At the population level, the major drivers are well known: sleep, nutrition and healthy weight, exercise and mobility, and social connection. Of these, sleep is the foundation, with the others as pillars. Then there are the active behaviors that reduce longevity, most notably smoking and excessive drinking.

Population data provides useful guidance. But we must remember: we are not populations. We are individuals.

That’s why regular health monitoring matters, even when you feel well. Not just isolated lab tests, but trends over time, patterns, and interactions.

AI will soon allow us to analyze decades of lab data simultaneously, uncovering relationships between markers that no physician, however skilled, can reliably see unaided. We are entering the age of personalized, preventive medicine.

Longevity isn’t just about living longer. It’s about living better, longer.

Lifespan vs. Health-Span.

Over the last 100 years, human life expectancy has increased by roughly 30 years in much of the developed world. But lifespan simply counts the years you are alive, not the years you want to be alive.

Health-Span is the number of years you live without chronic, debilitating disease. This is what we should be optimizing.

I do Pilates two to three times a week and stretch on other days because mobility is critical to healthy aging. I didn’t start paying attention to my body until I reached 40. Before that, I thought of my body as merely a socket for my brain.

Becoming a Cognitive Athlete

By age 85, roughly 40% of people show signs of dementia, rising to about 50% in the 90s. I am convinced this does not have to be inevitable.

Twenty-five years ago, I helped a startup called Posit Science get off the ground. They developed an application called BrainHQ, based on solid neuroscience and a deep understanding of neuroplasticity.

I am part of a group I call cognitive athletes. At 81, my goal is not merely to maintain cognitive function, but to improve it.

Biological Age vs. Chronological Age

Chronological age counts years. Biological age attempts to measure how your body is actually aging using blood markers, genetics, physiology, and recovery patterns.

I recently tested my biological age using an epigenetic test and was delighted to learn it was estimated to be 15 years younger than my chronological age. But the real value isn’t the number, it’s knowing what to do to stay sharp.

The Role of Biofeedback

Early in my career, I helped develop one of the first biofeedback devices for brain waves at the University of California, San Francisco. We discovered that people could learn to control things they were never conscious of—but only if they could see the data.

You cannot change what you cannot observe.

Years later, wearable technology allowed me to dramatically improve sleep quality by lowering my sleeping heart rate, increasing deep sleep, and reducing stress.

Investing in Your Own Longevity

Most doctors are trained to detect disease, not prevent it. Most tests are approved or rejected based on insurance economics, not individual risk tolerance.

Sometimes longevity means deciding that your personal risk calculus is not the same as your insurer’s. For instance several years ago I had a CT angiogram to check the status of my coronary arteries. It cost about $2,000. I am totally not at risk for coronary disease but having a friend who was only 43 die suddenly for a heat attack made me think. He too had no risk factors. In fact, for most the first indication of heart disease is death. Ruling this out, my arteries were totally clear, was certainly worth $2,000 to me. The risk for someone my age is of course much higher than for someone in their 40s. So if we found only 1% of those that needed surgical intervention, the cost of finding that one person would be $200,000. The insurance companies are not willing to pay that. They might if they were life insurance companies. But I am sure my friend, who so sadly passed, leaving behind a wife and two young children, would have been happy to have paid the $2,000,

Longevity Begins Early but It’s Never Too Late

Longevity starts at birth with food, movement, sleep, and habits. But it is never too late to start.

I was 40 when I began to consciously change how I lived. Some intervention such as exercise in particular, can have enormous benefits even when adopted later in life.

Start early if you can. But if you didn’t, start anyway.

The body is remarkably forgiving, when finally given the chance.