5HT: 5 Healthyish Things, including VO2 max hype and SNL’s MAHAspital

If you’ve spent any time in longevity circles over the last few years, you’ve probably heard the claim that VO₂ max is “the singular most powerful marker for longevity.” That theory has been widely popularized by Peter Attia (who, yeesh, is definitely canceled 😬). 

The viral metric refers to the maximum amount of oxygen your body can use during intense exercise. Basically, it acts as a proxy for your fitness level—testing how well your heart, lungs, blood vessels, and muscles work together under stress. I haven’t done a formal VO₂ max test, but I did something similar with my heart stress test early this year (it’s notoriously hard, but somehow this dude makes it funny).

Recently, though, Eric Topol (my fave, as you know) pushed back on what he calls a “VO₂ max craze.” His argument isn’t that measuring fitness levels is wrong, but that we’re misinterpreting the data. According to Topol, much of the data used to hype up VO₂ is actually based on METs (metabolic equivalents), not direct VO₂ max measurements. Close, but not the same. It’s also worth noting that VO₂ max is highly influenced by genetics and declines with age, no matter what you do.

Now, it is true that fitness levels are one of the strongest predictors of mortality we have. Large cohort studies (like here and here) show people in the highest fitness categories have lower all-cause mortality than those in the lowest—sometimes ~3–5x lower risk. Buuut… people with high VO₂ max also tend to exercise regularly, have low body fat, high muscle mass, and stack other healthy behaviors. 

So is it VO₂ max driving longevity? Or is it just a score of a system already performing well? 😮‍💨 IDKID. I’d argue it’s more correlation than causation. 

Topol also points out that, because lab tests are performed on treadmills or bicycles, they capture only a narrow slice of fitness, missing other important elements like strength and mobility. Ultimately, my take is that a hyper-fixation on a lab-tested, elite VO₂ max misses the point—especially if it comes at the expense of other fundamentals. Because longevity isn’t just one metric. It's a system. And IMHO, focusing on the inputs will almost always matter more than obsessing over the output.

Earlier this year, I set four general resolutions. One of them: Prioritize quality time with family and friends because it’s healthy, fulfilling, and fun.

Here’s what that looks like:

Staying socially engaged isn’t optional for me. It keeps me feeling happy, present, and sharp—and it’s one of the most tangible ways to support long-term cognitive health. 

Sometimes, those moments of connection include alcohol. I’ve considered not drinking at all—I have—but ultimately enjoy things like the following too much:

🍷 Wine with steak at a nice dinner with Sara.
🍻 A beer after an exhausting weekend rock climbing sesh.
🥃 A scotch with a fellow entrepreneur. (Fun fact: I used to host something called “Scotchrepreneur” with founders sharing their biggest challenges over good scotch. Basically group therapy.)

These touchpoints aren’t about the alcohol (though a good scotch is 🤌), but the alcohol helps! Unfortunately, if I have more than a drink or two, I pay for it the next morning 🥴. That’s why I’ve been loving having ZBiotics Pre-Alcohol Probiotic Drink on hand. 

ZBiotics Pre-Alcohol is the world’s first genetically engineered probiotic invented by PhD scientists to tackle rough mornings after drinking. (I broke the science down here.) Essentially, the goal isn’t to drink more—it’s to regret less. Since trying it, I’ve adopted a simple rule: If I think there’s a chance I’ll have 2+ drinks, I drink this probiotic first. It’s helped me optimize my evenings without compromising my mornings. 

I legit love this product (plan to buy 12 more right after this email hits) and, if you haven’t tried it yet, I think you will too. Luckily, Zbiotics is giving 5HT readers one more chance to get 15% off your first order. Use “5HT” at checkout to keep your mornings as strong as your evenings.

I have a confession to make: I've never seen Dawson's Creek. 

I knowww people really liked it, but I was just a boy at a time who could not/would not be caught watching it. Of course, I still knew James Van Der Beek, who played Dawson—and it’s really sad that he passed away last month at just 48 from colorectal cancer. 😞

I also admit: I probably haven’t taken colorectal cancer seriously enough. And it’s one of those preventative screenings more people should know about—something Van Der Beek advocated for toward the end of his life.

Colorectal cancer starts in the colon or rectum and often begins as small, pre-cancerous polyps. The tricky part: They don’t cause symptoms early, so most people don’t feel anything until the disease is more advanced. Screening works because doctors can remove those polyps before they turn into cancer—and catch issues earlier, when they’re easiest to treat.

And it works. Like really works. Research shows colonoscopies are associated with up to a 69% reduction in new colorectal cancer cases and an 88% reduction in death from it!

Unfortunately, colon cancer is rising in younger adults. According to the American Cancer Society, colorectal cancer is now the leading cause of cancer-related death among people under age 50. WHAT. 

Until recently, U.S. guidelines didn’t recommend routine screening until age 50. It’s now 45—and even earlier if you have higher risk factors. My plan is to get screened in a couple of years when I turn 40—slightly ahead of the curve. (I’ll share more about what early detection I do/don’t do soon.) 

Of course, not all screening is created equal—and early detection as a whole is still very much a work in progress.

Recently, a promising blood test from Grail called Galleri—which aims to detect 50+ cancers from a single blood draw—failed to reduce late-stage cancer diagnoses in a large clinical trial. Basically, in a massive NHS study of ~140,000 adults, researchers tested whether Galleri could catch cancers earlier and ultimately reduce late-stage disease. The early readout: It didn’t. 👎☹️ Like didn’t at all, which is brutal.

This failure obviously calls preventative tests like it into question. I’m generally pro-information, buuut it’s a good reminder that just because something sounds promising doesn’t mean it actually works. Usually, we’re not being sold lies, but sometimes we are. Sometimes, we might just be buying optimism faster than we're buying evidence. 🤷‍♂️

My take is to get evidence-based screenings and clinically validated biomarkers. Buuut be cautious with expensive, next-gen tests where outcomes data doesn’t yet exist. And to bring it full circle, early prevention for colorectal cancer does work. So go get your colon checked, people. 👍

Obviouslyyy, I had to share this SNL sketch from last week. Part parody of The Pitt and part MAHA satire, it got some laughs in our 5HT+ community. Oh—and Harry Styles is in it. Enough said.

ICYMI: Melissa Urban, co-founder and CEO of Whole30, 7x best-selling author (including The Book of Boundaries), newsletter writer, and friend 🫶, joined 5HT for a short residency answering boundary-setting questions from the 5HT+ community. 

Last week, Melissa broke down how to set boundaries as a people pleaser 🫣. A must-read. This week, she gets into actually sticking to your boundaries once you’ve made ‘em. Take it away, Melissa! 🎤

Q: What's the best way to reiterate (a boundary) when others try to get you to do extra, and you pride yourself on DOING EXTRA?

MU: Hi, eldest daughter, Gretchen Rubin Upholder here. 🙋‍♀️ I am the poster child for gold stars. Still, I recognize that I’m of no use to anyone if I’m run down, burned out, resentful, or broke. And if “doing extra” means I’ll show up resentful, anxious, exhausted, or frustrated, am I really doing gold-star-worthy work for that person (or our relationship)? 

The real reason, however, that you have to hold firm is that if you don’t hold your boundary, people will learn that your “boundary” is merely a suggestion. Here’s the mindset shift:

In the case of setting and holding a healthy boundary, you’re “doing extra” for that person by protecting your relationship, whether they see it that way or not. (Avoiding them, blowing up at them, or snapping at them isn’t “extra” in a good way, right?) Then, when you can say yes, you’ll truly do extra by showing up authentically and enthusiastically, making for a better end result and a more trusting relationship.

Summary: Saying “no” makes your “yes” more meaningful. Either way, you’re doing extra to protect your relationship and your mental health.

Directions: Copy, paste, and fill in the prompt below to generate your own digital detox protocol. (Pro tip: here are some healthy phone hacks I’ve written about before.)

👋 Who are you again? I’m Derek Flanzraich—founder of two venture-backed startups in Greatist (👍) and Ness (👎). I’ve worked with brands like GoodRx, Parsley, Midi, Ro, NOCD, and Peloton. I now run Healthyish Content, a premium health content & SEO agency (among other things).

Every Thursday, I share 5 health things I feel strongly about so you can live healthyish. (Disclaimer: I’m more your friend with health benefits. None of this is medical advice.) Also some links are affiliate links, but they influence my decisions zero.

Oh, you also feel strongly about some health things? Hit reply—I’d love to hear it.