Do you feel stiff in the morning? Is it harder to stand up after sitting, and do your hips hurt? Can you get up from the floor? These are all very classic issues that most people feel should happen as they age and just accept it. However, we all know those folks that still take exercise classes, ride bikes, and hike up mountains. Today we call them proagers, and they are living with a good healthspan and longevity. What might be different, and how can we achieve this quality of life?
This is connected to what we call immunometabolic health—fancy words that mean our immune system and our metabolic health clearly intersect. Systems biology and our lifestyle choices, such as nutrition, sleeping habits, toxic exposures, and other integrative interventions, can restore balance, enhance resilience, and extend healthspan. Chronic inflammation is a symptom of an imbalanced immune system and can be seen as metabolic dysregulation. In addition, during an infectious condition, our cells may use as much as 50% of our body’s energy, driven by those powerhouses called mitochondria. The goal is to maintain immune resilience as we age, which has been proven to be a major factor in longevity.
The good news is that we do have biomarkers that will tell us where we are well before we get into chronic disease.
HRV (heart rate variability) is a marker of autonomic balance and better immune regulation and is influenced by sleep, breathwork, and fitness.
Grip strength is a predictor of longevity and correlates with mitochondrial output, reflecting systemic inflammatory burden.
Waist-to-hip ratio is another indicator of systemic inflammation, with targets of < 0.9 for men and < 0.85 for women.
The Sit-to-Stand Test measures neuromuscular resilience—how many times can you stand from sitting in a 30-second window?
VO₂ max reflects oxygen uptake and is the gold standard of cardiometabolic fitness and a powerful longevity indicator.
Daily step count correlates with immune resilience, with an optimal range of 8,000–10,000 steps per day.
Exercise should include Zone 2 training and resistance training. Excellent sleep—ideally 7–9 hours per night—restores immune function and impacts glucose control, cortisol levels, and HRV.
Nutrition is another critical factor. A diet rich in polyphenols, omega-3s from whole fish (not fish oils), prebiotics, and probiotics is essential. At least once per year, a functional stool sample should be done to assess the microbiome. Forty percent of our immune system patterning is connected to our diet.
There is even more depth to each of these indicators, including calculation of the Systemic Inflammatory Index, which can be derived from a basic CBC. These tools allow us to see how we are aging and whether we are achieving a positive healthspan.
There are no shortcuts—it requires continuous, daily effort. With wearable devices and technology to assist our dietary choices and help monitor exercise and sleep, we can do this. Understanding detailed bloodwork can be a powerful first step in providing professional lifestyle interventions to help achieve your goals of living fully.
For each patient I see, at all ages, understanding how powerful our choices are—and learning how to change—can provide a lifetime of truly feeling ALIVE. Who wouldn’t want this level of personalized care?
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