Optimal Health
What thriving looks like — beyond just the absence of disease.
📖 The Story: Thriving vs. Surviving
There's a moment that captures the difference between surviving and thriving. You wake up before your alarm, feeling genuinely rested. Your energy is stable throughout the day—no afternoon crashes requiring caffeine. You handle stress without falling apart. Physical tasks feel easy. Your mood is generally positive. You're engaged with life, learning, connecting, building.
Most people never experience this. They settle for "not sick"—managing fatigue with stimulants, pushing through brain fog, accepting low-grade stress as normal. They have no obvious disease, so they assume they're healthy. But optimal health is a different state entirely.
The World Health Organization defines health as "a state of complete physical, mental, and social well-being, not merely the absence of disease." This isn't idealistic language—it's describing a real physiological state where your systems are functioning well, not just avoiding failure. You can measure it: good VO2 max, strong grip, low inflammation, stable blood sugar, high heart rate variability, good sleep architecture. These markers distinguish people who are thriving from those who are just getting by.
Here's what's concerning: only about 12% of American adults are metabolically healthy by even basic standards (healthy blood pressure, blood sugar, waist circumference, triglycerides, HDL). "Normal" in a population where most people are metabolically compromised doesn't mean optimal. You can have lab values in the "normal" range and still be far from thriving.
The good news? Optimal health isn't mysterious or complicated. The same factors appear repeatedly across research: exercise, sleep, whole food nutrition, stress management, social connection, purpose. These aren't wellness trends—they're physiological requirements. Get the basics right, and most people move meaningfully toward optimal function. The hierarchy matters: Level 1 basics have far more impact than Level 3 optimizations.
🚶 The Journey: From Average to Thriving (click to expand)
Most people don't know what thriving feels like because they've never experienced it. Here's the journey from "just okay" to truly optimal:
Phase 1: Awareness (Weeks 1-4)
- Recognize the difference between "not sick" and "thriving"
- Understand that "normal" in an unhealthy population isn't optimal
- Learn what optimal markers look like (not just disease thresholds)
- Assess current state honestly
Phase 2: Foundation (Months 2-3)
- Fix sleep: 7-9 hours, consistent schedule
- Start resistance training: 2-3x/week
- Improve nutrition: whole foods, adequate protein
- Begin daily stress management practice
- Notice: Energy improving, sleep better, mood more stable
Phase 3: Momentum (Months 4-6)
- All Level 1 habits now established
- Strength measurably increasing
- Body composition improving
- Blood markers trending better
- Recovery faster
- Mental clarity sharper
- Confidence building
Phase 4: Thriving (Months 7-12)
- Wake genuinely rested
- Stable energy all day
- Strong and capable physically
- Resilient to stress
- Clear thinking
- Engaged with life
- Blood markers in optimal ranges
- This is what thriving feels like
Phase 5: Mastery (12+ months)
- Optimal health is your new normal
- Habits automatic, not effortful
- Can handle occasional disruptions without derailing
- Serving as example for others
- Focus shifts from building to maintaining and refining
- Long-term healthspan foundation established
🧠 The Science: What Optimal Health Looks Like
The Health Spectrum
Health exists on a spectrum, not as a binary:
Most people settle somewhere between "Not Sick" and "Average." Optimal health is achievable but requires intentional effort.
Markers of Optimal Health
- Physical Capacity
- Metabolic Health
- Cognitive & Emotional
| Domain | Optimal Indicators |
|---|---|
| Cardiovascular | Good VO2 max for age; resting HR 50-70 bpm; quick HR recovery (>20 bpm drop in 1 min) |
| Strength | Can perform daily activities easily; maintains muscle mass; strong grip |
| Mobility | Full range of motion; no chronic pain or stiffness |
| Body composition | Healthy muscle mass; appropriate fat levels; healthy waist circumference |
| Energy | Sustained throughout day without crashes; no stimulant dependence |
| Sleep | Falls asleep easily; wakes refreshed; 7-9 hours consistently |
| Recovery | Bounces back quickly from exertion, illness, or stress |
Only ~12% of American adults are metabolically healthy. Here's what optimal looks like:
| Marker | Standard "Normal" | Optimal |
|---|---|---|
| Fasting glucose | <100 mg/dL | 70-85 mg/dL |
| HbA1c | <5.7% | <5.4% |
| Triglycerides | <150 mg/dL | <100 mg/dL |
| HDL cholesterol | >40 men, >50 women | >60 men, >70 women |
| Blood pressure | <130/85 | <120/80 |
| Waist circumference | <40" men, <35" women | Lower is better |
| Fasting insulin | Not typically measured | <5-8 μIU/mL |
Lab values in the "normal" range are defined by population distribution—often from unhealthy populations. You can have "normal" values and still be far from optimal. Look for optimal ranges, not just avoiding disease thresholds.
Cognitive Function:
| Domain | Optimal Indicators |
|---|---|
| Memory | Good recall; learns new things easily |
| Focus | Can sustain attention; not easily distracted |
| Processing | Quick mental processing; sharp |
| Executive function | Good planning, decision-making, impulse control |
| Creativity | Novel thinking; problem-solving ability |
Emotional Wellbeing:
| Domain | Optimal Indicators |
|---|---|
| Mood | Generally positive; stable; resilient |
| Stress response | Handles stress well; recovers quickly |
| Emotional regulation | Can manage emotions appropriately |
| Relationships | Connected; supportive relationships |
| Purpose | Sense of meaning and engagement |
Key Biomarkers for Deeper Assessment
Beyond standard labs, these provide deeper insight:
| Marker | What It Indicates | Optimal |
|---|---|---|
| VO2 max | Cardiovascular fitness; mortality predictor | Age-appropriate upper percentiles |
| Grip strength | Overall strength; mortality predictor | Strong for age/sex |
| HRV | Nervous system balance; recovery | Higher is generally better |
| Fasting insulin | Insulin resistance (before glucose changes) | <5-8 μIU/mL |
| hs-CRP | Systemic inflammation | <1.0 mg/L |
| Homocysteine | Cardiovascular risk; B-vitamin status | <10 μmol/L |
| Vitamin D | Bone, immune, metabolic health | 40-60 ng/mL |
| Ferritin | Iron stores | 30-150 men; 30-100 women |
Surviving vs. Thriving
| Aspect | Surviving | Thriving |
|---|---|---|
| Energy | Get through the day | Abundant energy; enthusiasm |
| Sleep | Adequate hours | Restorative; wake energized |
| Exercise | Occasional | Consistent; enjoy movement |
| Mood | Okay; frequent stress | Generally positive; resilient |
| Cognition | Functional | Sharp; learning; growing |
| Relationships | Exist | Deep; supportive; fulfilling |
| Purpose | Get by | Engaged; meaningful pursuits |
| Physical tasks | Manageable | Easy; capable |
🎯 Practical Application
The Hierarchy of Health
Not all interventions are equal. This hierarchy reflects relative impact:
Get Level 1 right before worrying about Level 3. The basics have the biggest impact. A person sleeping 8 hours, exercising regularly, and eating whole foods doesn't need to optimize supplement timing or track every biomarker.
What Promotes Optimal Health
The same factors appear repeatedly across research:
| Factor | Impact | Why |
|---|---|---|
| Regular exercise | Affects nearly every health marker | VO2 max, strength, metabolic health, brain function |
| Quality sleep | Essential for recovery, cognition, metabolism | Hormones, repair, memory consolidation |
| Nutrient-dense diet | Provides building blocks; reduces inflammation | Every system needs nutrients |
| Stress management | Prevents chronic cortisol elevation | Cortisol affects every system |
| Social connection | Buffers stress; promotes longevity | Comparable to exercise in health impact |
| Purpose and engagement | Mental and emotional health | Associated with longevity |
| Not smoking | Single biggest preventable factor | Damages nearly every organ |
| Moderate/no alcohol | Reduces damage to multiple systems | No safe level for optimal health |
Setting Specific Goals
Move from vague to specific:
| Vague | Specific |
|---|---|
| "Be healthier" | "Sleep 7-8 hours, same time daily" |
| "Lose weight" | "Reduce waist circumference by 2 inches" |
| "Exercise more" | "Resistance train 3x/week, walk 30 min daily" |
| "Eat better" | "Protein at every meal, 5+ vegetable servings/day" |
| "Stress less" | "10 min breathing/meditation practice daily" |
Tracking Progress
| Type | What to Track | Frequency |
|---|---|---|
| Subjective | Energy (1-10), mood (1-10), sleep quality | Daily |
| Simple metrics | Weight, waist circumference | Weekly |
| Functional | Strength benchmarks, reps, times | Per workout |
| Lab work | Metabolic panel, lipids, inflammation | Annually (or per protocol) |
| Advanced | DEXA, VO2 max testing | Every 6-12 months if desired |
👀 Signs & Signals: Optimal vs. Suboptimal Health (click to expand)
| Domain | Optimal Health | Suboptimal (but not diseased) |
|---|---|---|
| Morning | Wake naturally refreshed; energy within 30 min | Need alarm; groggy for 1+ hours; need caffeine immediately |
| Energy | Stable 7-8/10 all day; no crashes | Fluctuating 4-6/10; afternoon crashes; depend on stimulants |
| Sleep | Fall asleep in 10-20 min; 7-9 hours; wake refreshed | Take 30+ min to fall asleep; <7 or >9 hours; wake unrefreshed |
| Physical | Daily tasks easy; no chronic pain; good stamina | Daily tasks tiring; chronic aches; low stamina |
| Mental | Sharp thinking; good memory; sustained focus | Brain fog; forgetfulness; easily distracted |
| Mood | Generally positive; resilient; stable | Irritable; anxious; mood swings |
| Stress | Handle well; recover within hours | Overwhelmed easily; takes days to recover |
| Exercise | Enjoy it; recover well; improving | Dread it; always sore; plateaued or declining |
| Illness | Rare colds; fast recovery | Frequent colds; slow recovery |
Optimal Biomarker Ranges:
| Marker | Standard "Normal" | Optimal | What You Feel |
|---|---|---|---|
| Fasting glucose | <100 mg/dL | 70-85 mg/dL | Stable energy; no cravings |
| HbA1c | <5.7% | <5.4% | Metabolic flexibility |
| Fasting insulin | Rarely checked | <8 μIU/mL | No reactive hypoglycemia |
| Triglycerides | <150 mg/dL | <100 mg/dL | Good metabolic health |
| HDL | >40 men, >50 women | >60 mg/dL | Cardiovascular protection |
| hs-CRP | <3.0 mg/L | <1.0 mg/L | Low inflammation; good recovery |
| Vitamin D | >30 ng/mL | 40-60 ng/mL | Strong immune function; good mood |
| Resting HR | 60-100 bpm | 50-70 bpm | Good cardiovascular fitness |
Functional Capacity Markers:
| Test | Average | Optimal |
|---|---|---|
| VO2 max (30-39 male) | ~42 mL/kg/min | >50 mL/kg/min |
| VO2 max (30-39 female) | ~38 mL/kg/min | >45 mL/kg/min |
| Grip strength (male) | 40-50 kg | >50 kg |
| Grip strength (female) | 25-35 kg | >35 kg |
| Push-ups (male, continuous) | 10-20 | >30 |
| Push-ups (female, continuous) | 5-15 | >20 |
What Thriving Feels Like:
- Wake up feeling genuinely rested
- Energy you can count on throughout the day
- Physical confidence—body feels capable
- Mental sharpness—learning, creating, problem-solving easily
- Emotional resilience—stress doesn't crush you
- Engaged with life—not just getting through it
- Rare illness; fast recovery when it happens
- Enjoying movement; body responds to training
- Optimistic about the future; sense of vitality
📸 What It Looks Like: A Day in Optimal Health (click to expand)
6:30 AM: Wake
- Eyes open 5 minutes before alarm
- Feel genuinely rested, not groggy
- Excited to start the day
7:00 AM: Morning Routine
- 10-minute walk outside (sunlight, movement)
- Breakfast: eggs, avocado, berries, coffee (protein, healthy fats, antioxidants)
- Energy building naturally, no crash later
9:00 AM - 12:00 PM: Work
- Sharp focus; deep work flows easily
- No mid-morning energy dip
- Creative problem-solving feels effortless
12:30 PM: Lunch & Movement
- Balanced meal: grilled chicken, quinoa, large salad
- 15-minute walk after eating
- Afternoon energy stable
3:00 PM: Afternoon
- Still clear-headed (no caffeine needed)
- Handle unexpected stressor calmly
- Recover emotional baseline quickly
5:00 PM: Exercise
- Resistance training session: squats, deadlifts, presses
- Body feels strong; lifting more than last month
- Challenging but energizing, not depleting
- Recovery heart rate drops quickly post-workout
7:00 PM: Evening
- Dinner: salmon, sweet potato, roasted vegetables
- Social connection: dinner with friend or family
- Laughter, conversation, genuine engagement
9:00 PM: Wind Down
- Light dimming; phone away
- Reading or light stretching
- Stress of day fully released
10:00 PM: Sleep
- Fall asleep within 15 minutes
- Deep, restorative sleep
- No middle-of-night waking
Weekly Rhythm:
- Mon/Wed/Fri: Resistance training
- Tue/Thu/Sat: Walking, yoga, or light activity
- Sunday: Rest or active play
- Meals mostly whole foods; occasional treats enjoyed without guilt
- 7-9 hours sleep every night
- Stress managed daily (not accumulated)
- Social connection regular
- Engaged in meaningful work or projects
Monthly/Yearly:
- Strength steadily improving
- Body composition optimizing
- Annual physical: doctor impressed with all markers
- No chronic conditions developing
- Energy and function maintaining or improving despite aging
- Living, not just surviving
🚀 Getting Started: 16-Week Optimal Health Protocol (click to expand)
Week 1-4: Sleep Foundation
- Consistent bed/wake time (within 30 min, even weekends)
- 7-9 hours in bed
- Dark, cool room (65-68°F)
- No screens 1 hour before bed
- Morning sunlight within 30 min of waking
- Track: Sleep quality (1-10), morning energy (1-10)
Week 5-8: Movement Baseline
- Continue sleep consistency
- Add resistance training: 2-3x/week (full body, compound movements)
- Add daily walking: 20-30 min
- Track: Strength (weights/reps), daily steps
Week 9-12: Nutrition Optimization
- Continue sleep and movement
- Protein at every meal: 1.6-2.2 g/kg total daily
- 5+ vegetable servings daily
- Minimize ultra-processed foods
- Track: Energy stability, afternoon crashes
Week 13-16: Integration & Optimization
- All habits now established
- Add stress management: 10 min daily practice
- Increase training intensity or volume slightly
- Consider baseline blood work:
- Fasting glucose, HbA1c, insulin
- Lipid panel (including triglycerides, HDL)
- hs-CRP (inflammation)
- Vitamin D
- TSH (thyroid)
Assessment at Week 16:
| Metric | Baseline | Week 16 | Goal |
|---|---|---|---|
| Energy (1-10) | __ | __ | 7-8 consistently |
| Sleep quality (1-10) | __ | __ | 7-8 consistently |
| Waist circumference | __ | __ | <40" men, <35" women |
| Strength (pick 1 exercise) | __ | __ | 20-50% improvement |
| Fasting glucose | __ | __ | 70-85 mg/dL |
| hs-CRP | __ | __ | <1.0 mg/L |
Beyond 16 Weeks:
Months 5-8: Refinement
- Level 1 habits automatic
- Add Level 2 optimizations:
- Circadian optimization (meal timing, light exposure)
- Exercise periodization
- Stress resilience building (cold exposure, sauna)
- Retest blood work at 6 months
Months 9-12: Mastery
- Living in optimal health feels normal
- Fine-tune based on individual response
- Consider advanced testing if desired (DEXA, VO2 max)
- Shift from building to maintaining
Long-term (Year 2+):
- Annual check-ups show maintained or improved markers
- Physical capacity maintaining or improving despite aging
- Focus on longevity and healthspan
- Serve as example for others
🔧 Troubleshooting: When Optimal Health Feels Out of Reach (click to expand)
Problem: "I'm doing everything right but still feel terrible."
Investigate:
- Sleep quality vs. quantity: Get sleep study to rule out apnea
- Hidden stressors: Work, relationships, finances may be overwhelming homeostasis
- Overtraining: More exercise isn't always better; try reducing volume 30-40%
- Nutritional deficiencies: Check Vitamin D, B12, iron, magnesium
- Thyroid dysfunction: Check full panel (TSH, Free T3, Free T4, antibodies)
- Chronic inflammation: Check hs-CRP; if elevated, investigate sources
- Timeline: Dysfunction that took years to develop takes months to heal; patience required
Problem: "My blood markers won't improve."
Assess:
- Insufficient time: Metabolic markers need 3-6 months minimum to shift meaningfully
- One missing piece: Often sleep is the overlooked factor; truly 7-9 hours quality?
- Genetics: Some markers (LDL) more genetically influenced; focus on modifiable ones (triglycerides, HDL, glucose, CRP)
- Medication needed: Some people need medication plus lifestyle; not failure
- Stress: High allostatic load prevents healing despite perfect habits elsewhere
Problem: "I don't have time for all this."
Reframe:
- Sleep is non-negotiable: Sacrifice other things, not sleep
- Exercise can be efficient: 3x 30-min sessions beats complicated routines
- Nutrition can be simple: Same healthy meals repeated; batch prep
- Time vs. priority: You have time for what you prioritize
- Future time: Investing 4-5 hours/week now saves hundreds of hours of disease management later
Problem: "Optimal seems unrealistic for my life situation."
Reality check:
- Optimal isn't perfect: It's the best YOU can do in YOUR context
- Progress over perfection: 80% consistency beats 0%
- Life happens: Optimal health includes resilience to handle disruptions
- Modify, don't abandon: Adjust to your constraints, don't give up entirely
Problem: "I plateau—can't get from good to optimal."
Advanced optimization:
- The last 10-20% is hardest: Requires precision and patience
- Track meticulously: 3-7 days of detailed tracking (food, sleep, stress, training)
- Consider professional help: Coach, functional medicine doc, dietitian
- Assess if necessary: Is 85% optimal good enough? Chasing perfect may not be worth the effort/stress
- Genetics: Some people's "optimal" is different from population averages
Problem: "Optimal health seems to require expensive tests/supplements."
Truth:
- Basics are free/cheap: Sleep, walking, bodyweight training, whole foods, stress management
- Testing useful but not essential: Standard annual labs cover most needs
- Supplements rarely necessary: Whole foods provide most nutrients
- Expensive ≠ effective: Marketing often exceeds evidence
- Focus on Level 1: Basics have 80% of impact at 20% of cost
When to Seek Professional Help:
- Persistent symptoms despite 3-6 months of verified lifestyle optimization
- Abnormal blood markers not improving
- Suspected thyroid, hormonal, or metabolic disorder
- Chronic pain or dysfunction affecting quality of life
- Mental health declining (depression, anxiety)
- Want personalized optimization based on your specific markers and goals
🎯 For Mo (click to expand)
User Assessment & Coaching Approach
When users ask "Am I healthy?":
- Most people conflate "not sick" with "healthy"
- Help them distinguish between absence of disease and optimal function
- Use functional markers (energy, sleep, performance) alongside objective data
Key questions to ask:
- "How's your energy throughout the day? Do you need caffeine to function?"
- "How's your sleep? Do you wake refreshed?"
- "Can you handle physical tasks easily? How about stairs or carrying groceries?"
- "How quickly do you recover from workouts or stressful days?"
Common patterns:
- The "I'm fine" user: Lab values normal, but energy low, sleep poor, stress high → Help them see the gap between "not sick" and thriving
- The overachiever: Already doing well but seeking optimization → Guide toward diminishing returns; validate their current state
- The biomarker obsessed: Tracking everything but ignoring fundamentals → Redirect to Level 1 basics before Level 3 optimizations
Hierarchy reminder for users:
- Sleep 7-9 hours consistently
- Move daily + strength train 2-3x/week
- Eat mostly whole foods, adequate protein
- Manage stress daily
- Social connection
Everything else is optimization on top of this foundation.
Red flags requiring medical referral:
- Persistent symptoms despite lifestyle optimization
- Abnormal lab values
- Chronic pain or dysfunction
- Mental health declining
- Suspected underlying condition
Coaching principles:
- Progress over perfection (80% consistency beats 0%)
- Function over numbers (how you feel matters)
- Long-term sustainability over short-term heroics
- Celebrate wins (even small improvements matter)
❓ Common Questions (click to expand)
How do I know if I'm actually healthy vs. just not sick?
Look at function, not just absence of symptoms. Do you have good energy? Sleep well? Handle stress? Recover from exercise quickly? Have strong cardiovascular fitness and strength? These functional markers distinguish thriving from merely surviving.
What's the single most important factor?
If forced to choose: regular exercise (both cardio and strength). It positively affects nearly every marker of health. But in reality, sleep, nutrition, and stress management are also essential—they're synergistic.
Do I need all these tests?
No. For most people, standard annual labs plus self-assessment of energy, sleep, and function are sufficient. Advanced testing is valuable for troubleshooting or optimization, but the basics matter more than biomarker obsession.
Can I be metabolically healthy at any weight?
To some degree—a fit person at higher weight can be healthier than a sedentary person at "normal" weight. However, excess visceral fat increases risk regardless of fitness. Waist circumference and metabolic markers matter more than scale weight.
How long does it take to see improvement?
Depends on the marker. Energy and sleep often improve within days to weeks. Fitness improves over weeks to months. Metabolic markers improve over weeks to months. Chronic disease risk takes years to meaningfully shift.
⚖️ Where Research Disagrees (click to expand)
Optimal Diet Composition
Whether low-carb, Mediterranean, or other approaches are "best" is debated. What's consistent: whole foods, adequate protein, and avoiding ultra-processed foods. The "best" diet is the healthy one you'll actually follow.
Alcohol: Any Safe Amount?
Recent research suggests no level of alcohol is optimal for health, though moderate consumption's harms may be small. Previous claims of benefit (red wine, etc.) are being reconsidered as methodologically flawed.
Sleep Duration
Whether 7, 8, or 9 hours is "optimal" varies by individual. 7-9 hours is the range; individual needs differ. Consistency and quality matter as much as duration.
✅ Quick Reference (click to expand)
Level 1 Priorities (Get These Right First)
| Factor | Target |
|---|---|
| Sleep | 7-9 hours, consistent schedule |
| Exercise | 150+ min cardio + 2-3x strength weekly |
| Nutrition | Whole foods, adequate protein, vegetables |
| Stress | Daily recovery practice |
| Connection | Regular meaningful relationships |
Signs You're Moving Toward Optimal
- Wake feeling rested without alarm
- Stable energy throughout day
- Good mood most days
- Handle stress without falling apart
- Recover quickly from exertion
- Clear thinking and good memory
- Enjoy physical activity
- Feel engaged with life
Optimal Biomarker Ranges
| Marker | Optimal |
|---|---|
| Fasting glucose | 70-85 mg/dL |
| HbA1c | <5.4% |
| Triglycerides | <100 mg/dL |
| HDL | >60 mg/dL |
| Blood pressure | <120/80 |
| hs-CRP | <1.0 mg/L |
| Vitamin D | 40-60 ng/mL |
💡 Key Takeaways
- Health is more than not being sick — Optimal health means thriving, not just surviving
- Only ~12% of adults are metabolically healthy — "Normal" in an unhealthy population doesn't mean optimal
- The basics matter most — Sleep, movement, nutrition, stress management, connection
- Physical capacity predicts longevity — VO2 max and strength are strong mortality predictors
- Metabolic health is foundational — Blood sugar, insulin, inflammation affect everything
- Cognitive and emotional health count — Thriving includes mental sharpness and emotional wellbeing
- Get Level 1 right first — Advanced optimization matters less than consistent basics
- You can measure and improve — Track functional markers, make changes, reassess
📚 Sources (click to expand)
Primary:
- WHO Health Definition — "Complete physical, mental, and social well-being"
- Metabolic health statistics — Only ~12% of American adults metabolically healthy — NHANES data
- Guyton and Hall Textbook of Medical Physiology (Hall, 2020) —
— Physiological function
Key Concepts:
- VO2 max and grip strength as mortality predictors — Multiple cohort studies
- Metabolic syndrome criteria — American Heart Association
- Biomarker optimal ranges — Various clinical and research sources
Supporting:
- Peter Attia, MD —
- CDC, NIH health guidelines —
— Population health data
See the Central Sources Library for full source details.
🔗 Connections to Other Topics
- Aging — Optimal health extends healthspan
- Metabolism & Energy — Metabolic health is central
- Common Dysfunctions — When optimal health breaks down
- Pillar 7: Goals — How to work toward specific health outcomes
- Pillar 8: Personalization — How to tailor the approach to you
- Biomarkers — Measuring your health status