This is the story of the day I almost died, and how I’m so grateful today to be writing about the event instead.
I’m a 49 year old Dad, IT professional and athlete, living in Tampa Bay, Florida. I’ve generally been healthy all my life, and as written about in my health test, I thought I was doing well.
In July 2023 we came to Helsinki, Finland to spend our vacation, to visit our family and friends. We had Penny & Liam with us, and every-one was excited about visiting Finland/Sweden and in general spend time with family & friends.
On Wednesday July 26th, we spent the day doing sauna, cold water swimming and eating Nepalese food. On Thursday July 27th 2023 – we’d decided with Sam and Liam to go jogging/ workout, so I woke up the boys and we headed out after having a small glass of water to drink.
I felt fine, except some carby bloat from the Nepalese food. Otherwise I was in excellent shape for a 49-year old (or so I thought). We jogged down the slope to Mannerheimintie, I suddenly started feeling unwell and passed out. This has been told to me later:
EVENT
Sam notices me collapse on the ground, panics and then quickly alerts a bystander to call an ambulance. He tells Liam to run to get everyone else.
I’ve been hit with ventricular fibrillation, which reduces the heart to a quivering mass of jelly, unable to pump blood. VF leads to Sudden Cardiac Death, with a mortality rate of 95% after 15 min without resuscitation. As I’m convulsing on the ground, start foaming from the mouth, Sam and the bystander start to perform CPR/ chest compressions. Minutes tick by like an eternity.
The ambulance arrives, and the Emergency medics rush to the scene. They assess the situation and give an electric shock which resets the electrical circuits in the heart. I’d spent about 10 minutes in V-Fib. I’m rushed to the hospital, in a state of shock and confusion. After a couple of hours my state is better, the confusion is lifting, and I’m able to see my family again. I spend 24h in the Cardiac Intensive Care unit, unable to sleep with the noise and beeping around me. I feel scared and anxious as I’m not sure if I will wake up if I fall asleep.
AFTER
The evening of the event the cardiac surgeon performed an angiogram, and found only mild changes related to coronary artery disease, but nothing that would explain the cardiac event.
An MRI was performed on Monday July 31st – with no indications of root cause. On Wednesday August 2nd, a electro- physiological stress test was performed on my heart – also here the heart performed well. This test though is no walk in the park – as you are given electrical shocks and chemicals to your heart, and it feels as if you are relieving the event all over again.
I was also given a neuro-psychiatric evaluation, and thankfully no loss of function/memory/ability was found.
Finally on Thursday August 3rd, an ICD (Intra Cardiac Defibrillator) was operated into my chest. The ICD monitors the heart rate, and in case the heart goes into fibrillation again, the ICD can give an electric shock to reset the heart. I was shell-shocked, very raw emotionally, but at the same time so grateful to Sam, to my family, to the first responders etc.
There are many lessons, and a journey to recovery from this, that I’ll write about in the next post.
It was July 2023 and I wanted to perform a comprehensive Health test that I would be trying every quarter. My bodyweight at the time was about #185 (86kg) and I’m a 49 year old male.
Here’s the outline and the results of the test:
Component
Type
Test day
Exercises
Result
Upper body, pull
Strength
Monday
Chin-up with Bodyweight + #70
6 reps
Upper body, push
Strength
Monday
Standing Press #125
6 reps
Run
Cardio
Tuesday
1.1 mile
7.35(about 7 min mile)
Lower body, pull
Strength
Wednesday
Dead-lift 2x Bodyweight (#370)
2 reps
Upper body, push
Strength
Friday
Bench press bodyweight (#185)
6 reps
Looking back at the test I realize I could have added some more long-form Cardio into the mix as well. There were a few lifts I had expected to lift more in – but that’s the score as it was then 🙂
OK, short update since it’s about one month since the last post. Some really interesting lessons and concrete hacks that I’m happy to share.
Results TLDR:
In short the glucose readings are getting better – focus on the days marked in yellow:
During this period we’ve mostly been at home, so it’s been easy to eat relatively clean and exercise consistently.
The 24h average glucose (last column) is trending down nicely.
I’ve lost about 6 lbs since starting this journey – without really ‘trying to diet’.
Habits that have worked for me:
Doing 16-8 intermittent fasting – eating lunch around 11.30AM and finishing dinner by 7.30PM.
Going for a walk after meals. This really helps to level out any glucose spikes that would result from a big/ carby meal.
Eating less carbs. I’m not doing keto / no-carb, but I do eat less carbs during meals. Replace with more veggies, protein and healthy fats.
Being consistent – it’s pretty rewarding to see how the average glucose slowly comes down from ‘slightly alarming’ levels, very happy about this progress.
Doctor Peter Attia is one of the foremost thinkers and communicators re: health, longevity and preventive medicine – you can find his work e.g on his website, podcast, Youtube etc. He published in March 2023 his book – “Outlive – the science and art of longevity”.
Others have written thorough reviews of the book (e.g. on Amazon) so I won’t try to do that as the extensive material in the book could end up overwhelming. Instead this post focuses on a few key concepts from the book.
Concept #1 – Health-span
Instead of focusing on Lifespan – where the last years of a long life can be plagued by tiredness, sickness and low energy – our Objective should be on increasing Health-span. This means we could live a slightly longer life, but also have the energy and strength to be able to do our favorite activities in our last decade. Whether that is hiking with friends, learning new skills, picking up a grandchild or just living independently, I think that is an admirable goal.
Concept #2 – the Four Horsemen
With the Objective of increasing our Healthspan in mind – what are the main causes of death in modern societies that we need to focus on preventing? Those are what Peter calls the Four Horsemen of chronic disease, which combined account for about 80% of all cause mortality (ACM):
#1 – Cardiovascular disease (CVD):
Is the leading cause of death for both men and women, accounting for about 25% of ACM
Common types are: Coronary heart disease, stroke and heart failure.
Causes and factors include: High blood pressure, High cholesterol, Smoking, Diabetes, Obesity, Physical inactivity, Family history
# 2 – Cancer
Is the second leading cause of death for both men and women, accounting for about 22% of ACM
Common types are: Lung, Breast, Colorectal, Prostate or Pancreas cancer
Causes and factors include: Age, Smoking, Diabetes, Obesity, Physical inactivity, poor diet, Family history/genetics, Environmental toxins
# 3 – Neurodegenerative disease, dementia
Is the third leading cause, accounting for about 8% of ACM
Common types are: Alzheimer’s, Lewy Body Dementia, Parkinsons
Causes and factors include: Age, Head injury, Diabetes, Obesity, excessive alcohol, poor diet, Family history/genetics, Environmental toxins
#4 – Metabolic syndrome and insulin resistance
“insulin resistance itself is associated with huge increases in one’s risk of cancer ( up to twelvefold ) , Alzheimer’s disease ( fivefold ), and death from cardiovascular disease ( almost sixfold ) — all of which underscores why addressing, and ideally preventing , metabolic dysfunction is a cornerstone of my approach to longevity”
Metabolic syndrome is a group of risk factors that increase your chance of developing CVD (#1), cancer (#2), neurodegenerative disease (#3), diabetes, obesity.
Causes and factors include:
Abdominal obesity. This means having a waist circumference of more than 35 inches for women and more than 40 inches for men.
High blood pressure. Blood pressure of 130/80 mm Hg (millimeters of mercury) or higher is considered high.
High blood sugar. Blood sugar levels of 100 to 125 milligrams per deciliter (mg/dL) after fasting overnight are considered prediabetes. Levels of 126 mg/dL or higher on two separate occasions are considered diabetes.
High triglycerides. Triglycerides are a type of fat found in the blood. Triglyceride levels of 150 milligrams per deciliter (mg/dL) or higher are considered high.
Low high-density lipoprotein (HDL) cholesterol. HDL cholesterol is often called “good” cholesterol because it helps remove bad cholesterol from the blood. HDL levels of 40 mg/dL or lower for men and 50 mg/dL or lower for women are considered low.
If you have three or more of these risk factors, you have metabolic syndrome, as do about 40% of Americans.
Concept #3 – the best medicine is exercise
There are many tools covered in the book to live a healthy life, and to prevent the Four Horsemen – e.g reducing stress, sleeping well, eating a healthy diet, and having meaningful relationships. However one tool stands above the others in terms of impact: exercise.
Any exercise is better than none, and ideally you should do both cardio and strength/ weights training.
Cardio training:
A study found that someone below – average VO2 max for their age and sex is at double the risk of all – cause mortality compared to someone in the top quartile ( 75th to 97.6th percentiles ). Thus , poor cardiorespiratory fitness carries a greater relative risk of death than smoking.
Strength training:
Subjects with low muscle strength were at double the risk of death , while those with low muscle mass and / or low muscle strength , plus metabolic syndrome , had a 3 to 3.33 times greater risk of all – cause mortality
Preventing #1 – Cardiovascular disease (CVD)
John Ioannidis , a Stanford scientist found that in randomized clinical trials, exercise – based interventions performed as well as or better than multiple classes of pharmaceutical drugs at reducing mortality from coronary heart disease , prediabetes or diabetes, and stroke.
To note: The book does go into detail also on the importance of reducing LDL-cholesterol (more specifically APO B) – if needed through medication.
Preventing #2 – Cancer
..I suspect that the association between obesity , diabetes , and cancer is primarily driven by inflammation and growth factors such as insulin . Obesity, especially when accompanied by accumulation of visceral fat, helps promote inflammation , as dying fat cells secrete an array of inflammatory cytokines into the circulation.
What I am saying is that we don’t want to be anywhere on that spectrum of insulin resistance to type 2 diabetes , where our cancer risk is clearly elevated . To me , this is the low – hanging fruit of cancer prevention, right up there with quitting smoking . Getting our metabolic health in order is essential to our anticancer strategy.
Preventing #3 – Neurodegenerative disease
The single most powerful item in our preventive tool kit is exercise , which has a two – pronged impact on Alzheimer’s disease risk: it helps maintain glucose homeostasis , and it improves the health of our vasculature.
The epidemiology linking strength and cardiorespiratory fitness to lower risk for neurodegeneration is so uniform in its direction and magnitude that .. .. I now tell patients that exercise is, full stop and hands down , the best tool we have in the neurodegeneration prevention tool kit .
Conclusions
I don’t want to sound hyperbolic, but IMO this book should be essential reading for every human being. This book should be taught in class-rooms around the world, until every-one understands these concepts thoroughly, because they are so fundamental for our health.
I’d wanted to learn about the benefits of cold therapy, to extract the physiological and psychological effects, benefits of getting into cold water, especially as it relates to health benefits, insulin sensitivity etc.
As an intro to this topic – this post covers Professor Andrew Huberman interviewing Dr. Susanna Soberg, an expert in deliberate cold and heat exposure protocols, talking about the science and impact of deliberate cold exposure from this study (Cell reports). The interview also covers the importance of the cold shock response and how to approach a deliberate cold exposure protocol.
FYI – this post has been ‘co-written’ using tools such as:
The study was done in Denmark on a male cohort, and carried out by having participants do winter swimming for minimum two days per week, measuring brown fat activation with an infrared camera, and taking fat biopsies. The study was done in a field setting, and participants were encouraged to do the winter swimming whenever they had time. The relevant ‘minimum viable dose’ was 11 minutes of weekly cold exposure.
Why cold therapy?
Cold exposure can improve insulin sensitivity, which can help to prevent type 2 diabetes.
“ We did see that the winter swimmers had an increased insulin sensitivity. They produced less insulin on all the experimental days. We measured insulin when they were fasting, meaning that they hadn’t eaten in eight hours before the study day. We could see that the winter swimmers had lower production of insulin. Also when they had glucose drinks, the winter swimmers had a faster glucose clearance in the bloodstream. So after two hours, we could see that they had a lower level and the curve went down faster than in the control group.”
Cold exposure can increase brown fat, which is a type of fat that helps to burn calories and generate heat.
“ What happens is that you get adapted a little bit every time you go, like exercise, you get a little bit stronger. So every time you go into the cold water you will feel more comfortable in the cold. You are building your adaptation, which happens on a metabolic level, which is happening via activation of your brown fat.
The mitochondria in the brown fat cells are gonna be activated, you’ll have more of those and they will be more efficient at heating you up because the body expects you to do this again. The capillaries in your skin will also become better at constricting. So you will have a better shield of your body to prepare you for the next time.”
Also your stress response will subside a bit, so you will have a less increase of your catecholamines with time. With time also you have, because of this activation of your brown fat or your muscles, you will have an increase in your metabolism, which will then make your insulin sensitivity better.”
Cold exposure can reduce inflammation, which can improve overall health, mood and cognitive function.
The winter swimmers had lower levels of cortisol at night time – which is beneficial for sleep quality.
And I think it’s very important to think about the cold exposure and the heat exposure as something that lowers the inflammation in the body. And if we can do that, we will have an open door for preventing lifestyle diseases, right? So for type diabetes, but actually also for some mental diseases as well. So as known as depression and anxiety and also Alzheimer’s disease, which are all associated in research, also newer research showing that inflammation increases the risk of depression, anxiety, and Alzheimer’s disease, neurological diseases. So if we can decrease inflammation in the body, we will decrease our modern lifestyle diseases, but also these increasing mental diseases that we see in these modern lifestyle times.
It’s just exposure to temperature, actually just a cold or to heat that is gonna trick our body into a natural state again and reset it where the homeostasis, the balance is lost a bit. So the body is gonna repair itself in that way. And I think it’s beautiful that we can do that just by changing the temperature of our body.
Conclusion
Cold exposure is a safe and effective way to improve health. If you are considering trying cold exposure, be sure to talk to your doctor first and follow any safety tips.
I will incorporate cold baths into my health routines :
Tuesday, after cardio session – 4 minutes total time (2 x 2 min dip)
Thursday, after cardio session – 4 minutes total time (2 x 2 min dip)
Saturday, after cardio session – 4 minutes total time (2 x 2 min dip)
I wrote about my first two weeks with the CGM here, and here is a short update with new data. The overview of the data below, the new dates marked in yellow:
I wanted to try some things to reduce the average fasting glucose (FG), so here’s what I did.
Experiment 1 – keto diet
On Saturday May 5th I started a ketogenic diet , and as I’ve already been doing intermittent fasting, and generally I don’t eat a whole lot of carbs, I figured this would be easy to try. Here the results for three days:
Ok, that didn’t go as planned at all 🙁 The massive spike on Sat May 6th is from having one tiny slice of cake…
Apparently there is something called ‘adaptive glucose sparing’ which essentially means that since your muscle cells prefer fat when you are doing a low carb/keto diet, there will be more glucose floating around in your bloodstream.
I lost two pounds over the 3-4 days this lasted, and I generally feel leaner. The FG was very stable, but I don’t want to have FG that high in general. There are ‘extenuating circumstances’ (e.g insulin could still be low), but I would’ve needed a blood measurements of fasting glucose and fasting insulin to verify this, so I have try something else..
Experiment 2 – regular, smaller meals
After this I thought “hey maybe I’d just introduce smaller amounts of carbs, eat some breakfast and smaller portions”. This would allow my cells adjust to having carbs again, and with the smaller portions I don’t get as large spikes, here the next four days:
Ouch, not good either. And I wasn’t feeling too great this time, I could really feel sluggish and a bit more tired than usual.
Experiment 3 – back to intermittent fasting
So after this I thought I need to get back at least to where I was before. Here the next four days:
It’s really cool to see that after ONLY one day back to intermittent fasting, my FG normalizes again. I honestly don’t know any other health related measurement where one can see the results this quickly!!
Again I’m not worried about the higher readings around 16-17 as that is where I train, and interesting to note that movie night + salty popcorn does raise FG overnight -as can be seen on 05/15.
Conclusion
Overall I’m learning a lot re: how my body processes glucose/carbs, how intermittent fasting is really helpful for me – and it does make me want to try out some longer fasts (e.g. OMAD – one meal a day) style. Stay tuned.
I received a CGM (Continuous Glucose Monitor) about two weeks ago via the Levels start-up. The package arrived a few days after ordering, and the initial setup was relatively easy and painless. I was able to easily export the data from the Levels website.
So how do the results look? The easiest way I can think of to show you the results are using Python (pandas, matplotlib, seaborn libraries) so here we go: (I’m skipping some data wrangling bits here..)
Glucose level distribution as a histogram
Glucose Level Time Series with rolling statistics
Honestly this data has me a bit worried because generally doctors, Peter Attia MD and the Levels program all suggest that fasting glucose should be less than 100/mg/dl…
Also, I wanted to correlate the glucose readings with the time of day, so we can do that eg with a heatmap:
Glucose Levels by Day, Hour in a Heatmap
This chart is really interesting to me because here a number of things stand out to me:
I was in Austin from April 26th to April 28th for a conference, and those days I did a light workout in the morning, and had a light lunch. So clearly a lighter lunch, moving around in the afternoon leads to lower fasting glucose.
I slept really badly Fri-28th-Sat 29th due to a late flight, and clearly a bad night sleep results in a bad fasting glucose.
I generally workout in the afternoon – between 4PM and 6PM, and so higher readings there are not alarming to me.
What strikes me as odd is the differences in the morning fasting glucose -say 5AM to 10AM – varies between 66 mg/dl to 120 mg/dl…The mean is still around 100 mg/dl (which is not great), but I’m surprised about the high variability.
Since I do intermittent fasting (lunch is my first meal) I had generally thought that my morning glucose would be lower.
There is a missing block on May 2nd as I switched the old sensor to the new one – as you have to do that every 10 days. The most painful thing was tearing the Levels patch off my hairy arms 🙂
All in all I’m very happy to have all this data from the CGM/Levels to explore, giving a lot of actionable intelligence – so I will try some life-style, diet modifications soon.
This post is an outline, a template of how I train in 2023.
Disclaimer: I’m a middle-aged male, 6ft 2 in, just under 200 lbs, and my goals are mainly to keep myself healthy for the long-term, and to have energy, vitality for all daily interactions. You can adapt this template to your own needs and always listen to your doctor 🙂
The basic training blocks are focused on either strength or cardio-vascular health, with each training day geared towards adaptions in either one. I train most days, with Sundays being ‘off’. This is a template, and so smaller changes can be made according to how I feel, my shorter-term goals and my schedule etc. Exercises marked e.g. 2A and 2B means they are super-setted, meaning you do one set of A, then one set of B.
Monday – strength focus
Focus
Exercise
Duration
Sets
Reps
% 1 RM
Speed
1. Front Squat
15 minutes
5
2
60%-70%
Strength
2 A) Standing Press
25 minutes
3-4
3-5
80%-90%
Strength
2 B) Weighted Chins
25 minutes
3-4
3-5
80%-90%
HIIT
3. Chins, Dips and Run (done as fast as possible)
15 minutes
3
12
60%-70% – HR 140-160 BPM
Tuesday – cardio focus
Exercise
# rounds
Duration
Comment
A – Assault Bike
3
8 min
Keep HR in Zone 2 (about 13o BMP for me)
B – Jog
3
8 min
Keep HR in Zone 2 (about 13o BMP for me)
Total
About 45-50 min
Followed by light stretching
Wednesday – strength focus
Focus
Exercise
Duration
Sets
Reps
%1 RM
Speed
Explosive push-ups & long jumps
15 minutes
3
3
N/A
Strength
Trap Bar Deadlift
20 minutes
3-4
3-5
75%-90%
Strength
Bulgarian Squat (or RFESS)
15 minutes
3
10
70%
Thursday – cardio focus (alt. yoga, alt. rest)
Exercise
# rounds
Duration
Comment
A – Assault bike
3
8 Minutes
Keep HR in Zone 2 (about 13o BMP for me)
B – Jog
3
8 Minutes
Keep HR in Zone 2 (about 13o BMP for me)
Total
About 45-50 minutes
Followed by light stretching.
Friday – strength focus
Focus
Exercise
Duration
Sets
Reps
% 1 RM
Speed
1. Power Clean
15 minutes
5
2
60-70%
Strength
2A Bench press
25 minutes
3-4
3-5
75-90%
Strength
2B Weighted Inverted Row
25 minutes
4
8-12
65-75%
Assistance
3A Bicep Curl
15 minutes
2-3
8-12
65-75%
Assistance
3B Lying tricep extension
15 minutes
2-3
8-12
65-75%
Assistance
3C Face pulls
15 minutes
2-3
8-12
65-75%
Saturday – cardio focus
Exercise
# rounds
Duration
Comment
1A – Assault bike
2
8 minutes
Keep HR in Zone 2 (about 13o BMP for me)
1B – Jog
2
8 minutes
Keep HR in Zone 2 (about 13o BMP for me)
2 – Sprinting
4-6
15 minutes
Vary shorter and longer sprints, with good amount of rest in between rounds.
Total
About 50 minutes
Followed by light stretching.
Hopefully this gave you some ideas or inspiration how to plan your own training, let me know in the comments if you have any questions.
An Integrated Product Team (IPT) is crucial for product startups to thrive in a hyper competitive landscape. Research by both academics and DoD has shown an IPT to increase customer satisfaction, reduce risk and time to market while helping better align stakeholder interests.
An IPT is a cross-functional group of professionals working collaboratively towards a common goal: the successful development, launch, and management of a product or portfolio of products. IPT members typically represent diverse areas such as design, engineering, marketing, and sales, ensuring a holistic approach to product creation, innovation, and customer satisfaction.
Key benefits of adopting an IPT approach include:
Boosted collaboration: Uniting cross-functional team members fosters open communication and swift decision-making.
Enhanced innovation: Harnessing diverse perspectives sparks creativity and cutting-edge product development.
Agile processes: Quick adaptation to changing market conditions and customer needs ensures efficiency and quality.
Accelerated time-to-market: Streamlined processes give startups a competitive edge by capturing market share faster.
Customer focus: Integrating customer feedback throughout development enhances user satisfaction and loyalty.
Engaged employees: An empowered and inclusive environment drives professional growth, satisfaction, and retention.
To embrace an IPT approach and unlock your product startup’s full potential today, contact me here or on Twitter @oskarhurme – my DMs are open.
As we are seeing ChatGPT become more widely used, companies of all sizes must ask themselves how do they adapt their products and their competitive strategies in this new world?
To recap – ChatGPT by OpenAI is a generative agent that is designed specifically for generating text by predicting what comes next in a given sequence. As a generative agent, ChatGPT can create new content, write code, carry out conversations, and even provide assistance in various tasks, depending on the context and the data it has been trained on.
Generative agents are poised to redefine product development, offering unmatched creativity, efficiency, and innovation. Here are five compelling examples of how these AI-powered systems are transforming the way we create and consume products:
1.Generative agents will enable brands like Nike or Adidas to analyze user preferences and create customized sneaker designs tailored to individual tastes. These one-of-a-kind shoes will foster deep connections between consumers and brands.
Rapid Prototyping: Hyper-Iterative Rocket Design
2. Companies like SpaceX can leverage generative agents to rapidly generate multiple rocket designs, streamlining the prototyping process, and pulling our sci-fi dreams closer to the present.
3. Generative agents can help IKEA analyze material data and environmental impact, creating innovative designs that minimize waste and promote sustainability. These eco-friendly products will resonate with environmentally conscious consumers, bolstering IKEA’s brand reputation.
Democratization of Design: Small Business AI Explosion
4. As AI systems become more accessible, Etsy’s small business owners will harness the power of generative agents to create professional, high-quality products. This democratization will unleash a wave of innovation and competition, transforming the online marketplace.
Metaverse Product Sales: The Ultimate Autonomous Agent Experience
5. Generative agents will bring the metaverse to life, creating autonomous agents that interact believably with users for product sales. Imagine the next generation of virtual real estate, where AI-driven real estate agents engage with potential buyers, personalizing the experience and providing valuable feedback to sellers.
Generative agents are set to transform the product development landscape with their AI-powered capabilities. Do you agree, disagree? Pls let me know in the comments.
