Articles on what comes before.
Clinical notes, excerpts from the book Antes and short essays on preventive nephrology, longevity, and integrative functional medicine. Content originally published on the Plenya blog, mirrored here in full.
Training to age well — the formula is Zone 2 and strength
Most people train inverted — too much medium effort, little low-intensity aerobic base, poorly directed strength. The recipe the literature supports is simple: 80% Zone 2, 20% high intensity, strength two to three times a week. It makes a difference in who you will be at 75.
The inverted pyramid of longevity — strength matters more than aerobic after 40
Most people train the body inverted — too much aerobic, too little strength. The mortality data of the last two decades say the opposite: strength and lean mass predict how long you will live with more precision than running 10 km.
Supplements that make a difference after 40 — and the ones that don't
The supplement industry in Brazil grows double digits per year, but the fraction with robust evidence fits in one hand. Four substances pass the randomized-trial filter; the rest is mostly marketing — and expense.
Protein: the target you're not hitting
Most Brazilian adults consume 0.8 g/kg of protein per day — survival RDA, not health RDA. To preserve lean mass after 40, the literature points to 1.2 to 1.6 g/kg, distributed across three to four meals of 30 g each.
Pre-diabetes is not a phase. It is a five-year window.
An HbA1c between 5.7% and 6.4% is usually treated as a vague warning — "let's repeat it in a year." The literature is more uncomfortable: every year without action increases the probability of progression and narrows the window in which reversal is still the most likely outcome.
Morning light — the free medicine that resets metabolism
Ten to thirty minutes of natural light in the first hour after waking anchor morning cortisol, nighttime melatonin, and the biological clock. It is the cheapest and most ignored signal of circadian medicine.
Menopause needs a team — not just a gynecologist
The menopausal transition is not only hormonal. It is cardiovascular, skeletal, metabolic, cognitive, sleep, mood — all at the same time. Treating it as the problem of a single specialist is the reason so many women in their 50s feel they are being managed in pieces.
Meditation that works in 8 minutes — and the kind that doesn't
The strongest evidence sits with 8-week MBSR. But consistent studies show that short daily practice, done with regularity, already shifts cortisol, blood pressure, and amygdala reactivity. The point is not the time — it is the consistency.
Loneliness as a cardiovascular risk factor — the data missing from the visit
The Holt-Lunstad meta-analysis showed that fragile social bonds increase mortality as much as smoking. The American Heart Association adopted the point in 2022. And almost no cardiology visit asks about it.
Lp(a): the test your father's cardiologist didn't order
One in five people has elevated lipoprotein(a). It is genetically determined, doubles or triples the risk of heart attack and aortic stenosis — and almost never appears on a checkup. Measuring it once in a lifetime changes decades of clinical decisions.
Intermittent fasting: who benefits, who is harmed
Intermittent fasting is not a universal diet. For the 45-year-old man with insulin resistance, it usually helps. For the perimenopausal woman, the strength athlete, the sarcopenic elderly, it usually makes things worse — and the difference lies in details few people look at.
HRV: the discreet thermometer of your nervous system
Heart rate variability is not an app metric. It is a direct window into the balance of the autonomic nervous system — and persistent drops precede disease, overtraining, and burnout by weeks or months.
Healthspan versus lifespan — why the right target is to compress morbidity
Living a long life is not the goal. Living well for a long life is. The difference between how many years you live and how many you live in full health reaches 12 years in developed countries — and almost no one is looking at the number that matters.
The four silent killers that take hold after 40
Cardiovascular, metabolic, oncologic, neurodegenerative. Four diseases account for the vast majority of premature adult deaths — and none of them appears suddenly. Each has a 10- to 20-year silent window with anticipatory biomarkers. This is not catastrophism. It is a map.
Ferritin between 30 and 100: the normality that drains women
The lab clears it as normal starting at 15 ng/mL. But menstruating women with ferritin below 50 already live with real symptoms — fatigue, hair loss, dropping performance — without ever having become anemic.
Coronary calcium score: the test that changes a decade
It is a quick CT scan, no contrast, no needle, with a radiation dose comparable to a mammogram. And what it shows — or fails to show — recalibrates the next ten years of your heart.
Burnout is not fatigue — it is a measurable neuroendocrine response
Flattened morning cortisol, DHEA-S on the floor, glucose climbing for no apparent reason. Burnout leaves biochemical traces before it becomes a sick note — and it is not treated with a week at the beach.
Apnea in those who don't snore — the invisible female form
A 42-year-old woman, lean, no snoring, treated for years for "anxiety." Polysomnography comes back with a low AHI and the apparent diagnosis is "no apnea." But the RDI tells a different story — and its name is UARS.
Alcohol and sleep — why two glasses destroy six hours of rest
You fall asleep faster with wine — and wake up at four in the morning thinking you slept. Wearables now show in high resolution what polysomnography already demonstrated: two glasses are enough to collapse deep sleep and REM, the very phases that restore body and brain.
12 tests worth every penny — and 12 that are wasted
A bloated checkup package that forgot ApoB and measured three tumor markers with no indication. It is not the exception. It is the rule of the market. Here is what to order and what to cut.
When "all normal" is not enough
The lab "within range" answers an important question — do you have diagnosed disease? But it does not answer the right question, which is what trajectory you are on.
What the annual checkup does not show about your heart
Half of all heart attacks happen in people with a "normal" checkup the year before. The problem is not negligence — it is that the routine exam was designed to detect obstruction, and the real disease is something else.
Training a lot and aging wrong
Volume is not virtue. Whoever trains 10 hours a week without a panel, without structured Zone 2, without adequate strength, and without recovery reading is building wear — not longevity.
The sleep that doesn't restore
Sleeping seven hours and waking exhausted is not a lack of discipline or "a phase." It is a signal — usually of underdiagnosed apnea, fragmented sleep, or absence of deep sleep. And it is investigable.
Four professionals speaking the same language
Personal trainer, nutritionist, therapist, physician — separately, each does well what they do. Together, without coordination, they replicate the fragmentation that made conventional medicine ineffective for continuous care.
Fatigue at 45 is not age — it is a diagnosis no one made
The most common complaint in the office is "I'm tired." The most common clinical answer is "it's stress, it's age." Almost always, it is neither — it is a signal no one investigated to the end.
The ACTS Method — an introduction to integrated care
The ACTS Method connects four interdependent dimensions of health — Activity, Alimentation & Smart Adjuncts; Clinical Optimization; Tending Mind, Body & Bonds; Sleep, Rhythm & Recovery — into a single, continuous, and measurable plan of care.
The silent window between normal and optimal
There is a ten- to twenty-year interval in which serious disease assembles itself without showing up on routine labs. It is in that interval that longevity is built — or lost.
Sleep, energy, and longevity — why sleeping well is clinical strategy
Sleep is not passive rest — it is the interval where metabolic repair, cognitive consolidation, and hormonal regulation happen. Neglecting sleep is neglecting outcomes.
Medicine 2.0 vs. Medicine 3.0 — alarm or detector
The medicine that treated your father is not the medicine that will treat you. The difference lies in when it acts.
Normal versus optimal — the interval the lab does not print
The reference range on a lab report was built to detect disease, not to sustain health. The distance between the two is wide, and a great deal depends on it.
The drug that cuts mortality by 80% — and no one prescribes
If a medication with that effect existed, humanity would pay any price for it. That medication exists — and the patient is rarely told about it.
Why the nephrologist sees it first — the cardio-renal-metabolic axis
The biggest revolution in preventive medicine in recent years was understanding that heart, kidney, and metabolism are a single system. And that the kidney usually speaks first.
Content originally published on Plenya Blog. Each article here is a faithful version of the original, with canonical pointing to the source.
This content is educational and does not constitute medical prescription. Each case is unique — for individual evaluation and care, consult a physician.