Good morning,

Happy Mother’s Day to all of the mothers and grandmothers out there.

I hope you are enjoying this spring morning. Are you more of a coffee person or a tea person?

Here’s what I have for you today:

• One big thing. You aim to grow wealth, not stay at zero. Why not do the same for your health? Here’s how to move north of neutral. 📈

• You have to check this out. From LEGOS to late night television. 📺

• Tools and tech. Swapping houses. 🏠

Are you ready to jump in? 🦘

1️⃣ ONE BIG THING

Climbing north of neutral.

Somewhere in midlife, many people meet with a financial advisor.

(Note to self: meet with a financial advisor lol.)

Whether you have or not, let’s zoom out and consider what goes on when you do. What do financial advisors aim to do?

The first step will be diagnostics—understanding your current financial picture, including debt, investments, income, and expenses.

Suppose your debt is a bit underwater (student loans, credit card debt, personal loans). In that case, the advisor will help you make a plan to shed this debt over time and get back to a neutral position.

The next step is where things get interesting. This is often a discussion about values and goals. How soon would you like to retire? What is your tolerance for risk? What do you want to be able to do as you age?

This is where a financial advisor helps you move from a neutral position to a net-positive position over time. They provide market-tested advice and teach you about the tools you’ll need to get to this position well “north of neutral”, from investment vehicles and diversification strategies to the ongoing habits you’ll need to achieve these goals.

No one is born with an accurate understanding of how to appropriately balance financial risk and reward in ever-changing markets. This is not part of the classic Kindergarten curriculum. Worse, the ways these things work often run counter to human instincts.

“In investing, what is comfortable is rarely profitable," said the investment guru Robert Arnott.

Ultimately, moving to a net-positive financial position is about asking what you want your money to do for you.

Money is a vehicle to help you live the kind of life you want to live.

Your annual physical.

Let’s compare the above to your annual meeting with your primary care physician. I mean a standard check-up or annual physical, not an appointment about a specific ailment.

What happens during these visits? The doctor will ask if you feel okay or if anything is wrong. You sit on that awkward table with the butcher's paper, and the doctor listens to your heart, pokes at your midsection, and peers into your eyes and ears. Maybe they do an EKG to make sure your heart is beating normally. And things wrap up with blood tests to be sure your blood biomarkers are within an acceptable range. Everything looks great. See you next year.

Consider what is happening here. The annual check-up matches the diagnostic portion of a meeting with a financial advisor. The doctor is making sure you don’t have any major debts that need resolving, that you aren't underwater from a health perspective, and that you don’t have anything obviously wrong with you.

If there is a problem, your doctor will recommend research-validated treatment (drugs, surgery, rest, etc.). Their goal is to get you back to neutral, to cure what ails you. If you do have an injury or illness, in many cases, the advances of modern medicine are often mind-blowing.

This is the function of what Dr. Peter Attia calls Medicine 2.0 in his book Outlive: The Science and Art of Longevity—a treatment-focused approach that moves you from a diseased state back to a healthy state, back to a neutral position.

He contrasts this with Medicine 1.0. Consider the classic Civil War medical tent scene you've seen in the movies. Lots of saws and whiskey. Most importantly, there is no understanding of the germ theory of disease.

If you’ve ever read David McCullough’s The Path Between the Seas: The Creation of the Panama Canal (definitely in my top five favorite history books), you’ve seen Medicine 1.0 at work. An estimated 30,000 people died building the canal, most of them from tropical diseases like yellow fever and malaria. The doctors of the time attributed these diseases to "miasmas", or bad air. They did not understand germs existed or that mosquitos transmitted them.

The shift from Medicine 1.0 to Medicine 2.0 occurred in part due to new technologies such as the microscope, but it was primarily fueled by a new way of thinking, including widespread use of the scientific method in medical research and treatment.

The financial consult vs. the annual physical.

Let's think back to our meeting with a financial advisor, which had two phases: a diagnostic phase and a forward-planning phase. To achieve your long-term goals, a good financial plan requires wise investments in the future. It gives you the strategies and tools you need to move beyond a balance of accounts (no debt) into a net-positive position north of neutral.

Right now, the medical field does not do this.

Attia believes it should. For one, the leading causes of death in the developed world (heart disease, cancer, neurodegenerative diseases like dementia, and metabolic diseases like diabetes) develop slowly, often over decades.

Once chronic diseases become entrenched, Attia explains, “it’s hard to make them go away. Atherosclerosis, for example, begins many decades before the person has a coronary ‘event’ that could result in death. But that event, often a heart attack, too often marks the point where treatment begins.”

In the decades before you have a heart attack, there are no outward symptoms. Your annual physical will deem you perfectly healthy. This is why heart disease is often called “the silent killer.”

I discussed this at length and described the tests you can get to gauge your risk in my two-part newsletter series The Gen X Heart Guide:

Attia is helping to launch what he calls Medicine 3.0. This does not abandon the capabilities of Medicine 2.0. Instead, it supplements the disease model of medicine with a preventative model that is far more aggressive and front-and-center than is the case today.

For example, your annual physical would be considered preventative (as are vaccines, anti-smoking campaigns, and generic advice to “eat better” or “get enough sleep”).

However, as we have seen in the heart disease example, this is the equivalent of your financial advisor checking your credit score for dings and telling you to “save a bit more if you can” before declaring, You’re in good shape. Come see me next year.

Attia's vision for Medicine 3.0 is more than adding an additional "ounce of prevention" to your health-related thinking. It’s about very long-term planning and teaching you the scientifically verified strategies and tools you need to invest in a robustly healthy future.

Just like complex financial diversification strategies, no one learns the best way to transform their health from "not sick" to "north of neutral" in everyday life. It is not taught in school, and your primary care physician doesn't have the time, skill, or financial incentive to teach you.

Doing this well requires a data-based understanding of long-term risk and, most importantly, investing your limited time and energy in the right places.

Here are two examples:

EXAMPLE 1. Blood tests show your results on a “reference interval”. For LDL cholesterol, for example, Johns Hopkins calls a result of 100 to 129 mg/dL "near optimal", which most would interpret as “normal” or even quite good. I don’t think I’d refuse an offer for a “near optimal” night on the town.

There are two problems here. First, risk is individual. An LDL of 125 can mean very different things to different people based on their other risk factors. Two, a result that is “normal” is not a result that is safe. Attia believes reductions in LDL to a target of 10-25 mg/dL, for example, would essentially end heart disease altogether. He works with his patients to bring their LDL closer to 50. If you want to feel good about your LDL levels, compare them to other people (to population averages). If you want to avoid cardiovascular disease and live longer, you need a clearer understanding of risk and a more proactive approach to investing in your long-term health.

EXAMPLE 2. If I asked you to guess the top thing someone could do to reduce their overall risk of dying, what would you guess? For example, you might smartly say “stop smoking” or “maintain a healthy blood pressure." Thinking bigger, you might say, "to not have coronary heart disease or type 2 diabetes.”

A study of 122,000 people (average age 53) published in the Journal of the American Medical Association provided the answer to this question in 2018. The factor that actually leads to the greatest reduction in “all-cause mortality risk” is a high VO2 max score (this is a score of your cardiorespiratory fitness). For comparison, if you move from a low to a high VO2 max score, you will see a 3.9X reduction in your risk of dying (from any cause). If you stop smoking or eliminate type 2 diabetes, the risk reduction is 1.4X. If you eliminate high blood pressure, the risk reduction is 1.2X.

Now, if you show up for your annual physical with high blood pressure (as I have), what happens? This is cause for appropriate concern. Your doctor may suggest reducing salt intake, followed by additional tests. Ultimately, they may prescribe medication. Doing all of these (very wise) steps will reduce your overall risk of dying by 1.2X. I mean, I'll take it.

But if you were investing for retirement, would you find an investment vehicle that was three times better than the others appealing? Certainly.

But when was the last time you heard of someone getting a VO2 max test as part of their annual physical? Improving your cardiorespiratory fitness from poor to very good decreases your risk of dying three times more than eliminating hypertension, but Medicine 2.0 does not see this as part of its work.

Much like the shift from Medicine 1.0 to Medicine 2.0, the shift to Medicine 3.0 requires a new way of thinking.

A north of neutral framework.

Attia and others are moving medicine into a new "north of neutral" paradigm. They ask the question: If medicine can take you from sick to healthy, how can it take you from healthy to thriving? How can it reframe the goal from "healthy today" to "prepared to be healthy long-term"?

Attia is more focused on healthspan (the number of years you are healthy and able to enjoy your life) than lifespan (the number of years you are alive).

As I noted above, this requires teaching people the best strategies and tools to invest in their long-term health. For example, I have been aware of this VO2 max research for a few years. Then I started to write a detailed newsletter about it, and I realized my understanding was pretty fuzzy. That led me on a deep dive to understand it in detail. More importantly, it led me to learn much more about the most effective ways to increase your VO2 max over time. (This will show up soon in a future issue of this newsletter.)

This is a health investment model that parallels the way we are accustomed to thinking about financial investments. It is a way to ask what you want your body to be able to do for you long-term.

Like financial planning, your answer should be unique and personal. Good financial planning is not generic. A long-term financial plan doesn’t merely say “save more.” It is based on your life and what you want to be able to do. For some, this may mean leaving a legacy for their children. For others, it will mean dying with zero (as Bill Perkins advises).

The concepts apply to planning for your long-term physical health. What types of things do you want to be able to do in your final decade of life? If you're going to be able to play with grandchildren and lift them off the floor, you can prepare for that now with targeted strength training. This is an investment in strength you can make now. If you want to be able to hike, you can prepare for that now with cardio, leg strength, and balance training.

The central point is that if you want your body to allow you to live the life you want—both today and in the future—being “not sick” is insufficient.

We all understand this in our financial lives. You need to climb north of neutral today to live the life you want to live in the future. The same investment-minded approach, the same north of neutral approach, applies to your physical health.

This is a new way of thinking about physical health.

New ways of thinking about what makes life worth living are also emerging. This adds a third layer to our discussion, in addition to financial and physical health planning. What about your mental health? What about your sense of meaning and purpose in life? How do you create a life that makes you excited to get out of bed in the morning?

If the psychology field can reliably treat or cure many mental health illnesses—if they can take people from negative to neutral—could psychologists also help people thrive, to move north of neutral?

Much like Attia’s shift from Medicine 2.0 to Medicine 3.0, a similar shift has occurred in psychology.

I'll cover this next week in Climbing North of Neutral: Part II.

I hope you’ll come back for the rest of this story.

Thank you for reading.

See you next Sunday,

Kevin

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