One of the things I have learned after more than 30 years of practicing medicine is that most of us wait too long to think seriously about prevention.
We start paying attention when the cholesterol is suddenly too high, the blood sugar begins creeping up, we aren't sleeping well, we've gained weight around the middle, or we realize that getting up from the floor isn't quite as easy as it used to be.
But chronic disease rarely begins the day we diagnose it. The changes that eventually contribute to cardiovascular disease, diabetes, frailty and cognitive decline often develop quietly over many years. That is why I pay particular attention to what happens between roughly 40 and 60.
“Chronic disease rarely begins the day we diagnose it. The body has usually been whispering its story in your ear for years. When we don’t listen to the whispers, sometimes it has no choice but to scream. That scream is disease.” - Edison de Mello, MD, PhD
I don't see midlife as the beginning of getting old. I see it as an opportunity.
There is still time to influence the direction in which your metabolism, cardiovascular system, muscles and brain are moving. And despite the enormous industry that has grown around longevity, some of the most effective things we can do are still surprisingly basic.
Exercise your heart, but don't do the same thing every day
Walking is one of the best habits we can develop, and I recommend it constantly. But walking and cardiovascular fitness aren't exactly the same thing.
Cardiorespiratory fitness is strongly associated with lower mortality and better long-term health. So, when it is medically appropriate, we occasionally need to ask our heart and lungs to work a little harder.
You don't necessarily need another hour at the gym. Interval training can be quite simple. Walk briskly uphill for a minute and then slow down. Increase the resistance on a stationary bicycle and then recover. If you're already fit, the intervals can be more vigorous.
The intensity, of course, should match the person. Someone who has been sedentary for years or has cardiovascular disease shouldn't suddenly begin sprinting because they read an article about longevity. The goal isn't exhaustion. It is giving the cardiovascular system a reason to remain fit.
Muscle becomes increasingly important
This is something I wish more of my patients understood earlier.
We gradually lose muscle as we age, particularly if we aren't using it. Over time, that affects much more than appearance. It affects balance, metabolism, bone health, mobility and our ability to remain independent.
There is another reason muscle fascinates me. We used to think of it primarily as the tissue that moves our skeleton. We now know that active skeletal muscle releases signaling molecules called myokines, some of which participate in metabolic and inflammatory pathways.
For that reason, resistance training deserves a place alongside cardiovascular exercise.
You don't have to become a weightlifter. Dumbbells, machines, resistance bands and body-weight exercises can all work. What matters is challenging the muscles progressively and safely. Studies consistently associate resistance training with better long-term outcomes, including lower all-cause mortality.
“Muscle is not just about looking strong. It is one of the currencies of independence as we age.”
- Edison de Mello, MD, PhD
And muscle needs protein
Exercise and nutrition must work together.
As we get older, maintaining muscle becomes more difficult, and adequate protein becomes increasingly important. For healthy adults over 65, expert groups commonly recommend approximately 1.0 to 1.2 grams of protein per kilogram of body weight per day, although there is no single number that is right for everybody.
I generally like to see protein spread throughout the day rather than having very little at breakfast and lunch and then trying to make up for everything at dinner.
And no, protein doesn't have to mean a giant steak or a protein shake. Fish, eggs, yogurt, beans, lentils, tofu, nuts and seeds can all contribute. The right amount and source depend on the person, particularly when kidney disease or other medical conditions are present.
Your gut is aging with you
I couldn't write about healthy aging without talking about the gut.
We live with trillions of microorganisms in and on our bodies, and the intestinal microbiome interacts with digestion, metabolism, immunity and inflammation. We are also continuing to learn just how extensively the gut communicates with the brain.
This is one of the reasons the gut-brain connection has interested me for so much of my career.
What we eat helps shape this ecosystem. A varied diet rich in plant foods provides fibers and other compounds that intestinal microbes can use. Fermented foods such as yogurt, kefir, sauerkraut and kimchi can be useful additions for many people.
But this is also where generalized health advice can get us into trouble. I would never tell every patient with bloating or IBS to simply eat more fermented foods and fiber. Someone with SIBO, significant food intolerance or a very sensitive intestine may feel considerably worse doing that.
“We meet the patient before we meet their disease. Food should be no different. What is medicine for one person can sometimes feel like venom to another.” - Edison de Mello, MD, PhD
What you do between workouts counts
You can exercise for an hour and still spend most of your life sitting.
I often tell patients to look for opportunities to move that don't require changing clothes or going to a gym. Take the stairs. Walk to get coffee. Park a little farther away. Get up from your desk. Carry your own groceries when you can.
A large 2025 systematic review found that health benefits increase substantially as daily steps rise from very low levels, with important benefits around 5,000 to 7,000 steps a day.
But please don't get too caught up in the number. Seven thousand isn't magical, and 10,000 was never a biological requirement. The message is much simpler: moving more matters, particularly if you currently move very little.
Make room for other people
This part of longevity medicine doesn't get nearly enough attention.
We spend a remarkable amount of time discussing supplements, glucose monitors, biological age and laboratory values, while sometimes overlooking the person who is eating dinner alone every night.
The evidence connecting social isolation and health is substantial. Large studies have associated both social isolation and loneliness with increased mortality.
And midlife can make maintaining friendships surprisingly difficult. We are working, raising children, caring for parents and, somewhere in the middle of all of that, trying to find an hour for ourselves.
So don't make connection another chore. Walk with somebody. Cook together. Meet a friend for coffee. Call someone you love while you're taking your evening walk.
Human connection is part of health too.
“We can measure cholesterol, glucose and biological age, but sometimes one of the most important questions is much simpler: Who is the foundation in your life?”
- Edison de Mello, MD, PhD
Learn your family history while you still can
When I take a patient's history, I don't ask about parents and grandparents simply to fill another box in the chart. I really want to know what happened to them and when.
Who developed diabetes? Who had a heart attack? Was there colon, breast or prostate cancer? Osteoporosis? Alzheimer's disease? And did these conditions appear at 80 or at 48?
Genes aren't destiny, but family history can tell us where we need to pay closer attention. Sometimes it changes when screening should begin. Sometimes it tells us which risk factors we should take more seriously.
There is also a very practical reason to do this now: ask your parents and older relatives while they are still here to tell you.
An interesting story about the shingles vaccine
This is an area of research I find particularly intriguing.
A 2025 study published in Nature took advantage of a vaccine-eligibility policy in Wales that created what researchers call a natural experiment. The results suggested that receiving the shingles vaccine was associated with a meaningful reduction in new dementia diagnoses over the subsequent years.
This doesn't mean we should prescribe the shingles vaccine as a treatment for dementia. We don't yet know exactly what explains the association, and more research is needed.
But it does raise an interesting question about the relationship among viral infections, inflammation, the immune system and the aging brain.
There is already a very good reason to receive the vaccine: preventing shingles and its complications. In the United States, the CDC recommends two doses of Shingrix for adults 50 and older, as well as certain immunocompromised adults beginning at 19.
If protecting the brain eventually proves to be another benefit, all the better.
Sleep is not optional maintenance
People sometimes talk about sleep as though it were the part of the day when nothing is happening. In reality, quite a lot is happening.
Sleep affects metabolism, immune function, hormonal regulation, memory and brain function. Chronic inadequate sleep is associated with numerous adverse health outcomes.
But there is another piece of the sleep conversation that deserves more attention: regularity.
A large prospective study using objective sleep measurements found that people with more regular sleep-wake schedules had lower mortality risk, and sleep regularity was a stronger predictor of mortality than sleep duration in their models.
That doesn't mean the number of hours no longer matters. It simply means that our bodies care about rhythm too. Going to sleep and waking at roughly similar times each day is a good place to begin.
What are we trying to accomplish?
This is the question I keep coming back to whenever we talk about longevity.
Living longer is not enough.
I'm much more interested in helping someone reach 80 or 90 and still be able to walk, think clearly, travel if they want to, enjoy food, maintain relationships and participate in their own life.
Medicine has become very good at extending lifespan. The harder, and to me more meaningful, challenge is extending health span, the years during which we remain healthy and functional.
There are exciting developments in longevity medicine, and I follow many of them closely. But none of them gives us permission to ignore the fundamentals.
Move your body. Maintain your muscle. Eat food that nourishes you and your microbiome. Sleep. Stay connected to other people. Know your risks. And pay attention to what your body is telling you.
If you are 45, 55 or 65 and thinking you should have started ten years ago, don't waste energy regretting those ten years.
Start with today. “What you do in midlife doesn't stay in midlife. Your changing body is already listening.”
— Edison de Mello, MD, PhD
About the Author
Edison de Mello, MD, PhD, is a physician, psychotherapist, author, and founder of the Akasha Center for Integrative Medicine in Santa Monica, California. For more than 30 years, he has worked at the intersection of conventional and integrative medicine, with a particular interest in digestive health, the gut-brain connection, stress, metabolism, and healthy aging.
His approach to medicine is rooted in a simple philosophy: “We meet the patient before we meet their disease.” Dr. de Mello believes that understanding how a person eats, sleeps, moves, thinks, feels, and connects with others is an essential part of understanding their health.
He is the author of BLOATED: How to Eat Without Pain, which explores the often-overlooked connections between digestive symptoms, the microbiome, food, stress, and emotional health. His new book, INCHAÇO: Retome Sua Vida, written for Brazilian readers and expanding on many of the ideas first explored in BLOATED, will be published in Portuguese by the end of 2026.
Through his clinical work, lectures and writing, Dr. de Mello continues to explore a question that has guided much of his career: how can we help people not simply live longer, but live healthier, more connected, and more fully engaged lives?
