Most people assume the shape they're in at 65 comes down to the genetic hand they were dealt. After my conversation with Dr. Hugh Coyne on this week's episode of The Trusted Pharmacist, I can tell you the hand matters a lot less than how you play it. And how you're playing it right now, in your 30s and 40s, is deciding what your 60s and 70s are going to look like.
Hugh is a physician and co-founder of Coyne Medical, a private practice in London focused on preventative medicine and cardiovascular health. His own family story drives the work. Through genetic panel testing in his clinic, his wife Lucy found out she carried a PALB2 mutation that put her lifetime breast cancer risk at 60 to 80 percent. Because they caught it early, she was able to have risk-reducing surgery. Her breast cancer risk today is under 1 percent.
You can't change your genetics. You can absolutely change what they get to do to you.
Why Your 30s and 40s Set the Trajectory
Hugh sees the same pattern in his clinic over and over. Long hours at work. A commute. A desk job with almost no movement during the day. Processed food because nobody has time to cook. Bad sleep. Stress that never lets up. None of it feels like a health problem while it's happening. It just feels like a busy life.
But those are the same patients he sees decades later with heart disease and muscle they can't get back. He calls a sedentary life the collateral damage of modern living. I see the other end of it at the pharmacy. By the time those patients reach my counter, they're picking up prescriptions for problems that started twenty years earlier.
The fix isn't complicated. It's just specific. Here's what Hugh and I dug into.
Muscle Power Is the Marker Nobody Talks About
You've heard about muscle mass. You've probably heard about strength. Hugh made the case that muscle power is the piece most people miss. As we age, we preferentially lose type 2B muscle fibers. Those are the fibers that fire when you need to move fast, like catching yourself when you trip.
Training them doesn't require a gym membership. Hugh's version of complex training is as simple as one minute of air squats followed by ten squat jumps. Or a minute of lunges, then a few lunge jumps. He challenged every listener to do one minute of air squats after the episode. Try it. You'll be out of breath.
For longevity, the evidence he cited points to two resistance sessions a week, 30 to 60 minutes each. And a large study out of Dallas found that even one session a week makes a measurable difference. Resistance bands and body weight count.
The Protein Number to Actually Aim For
Protein might be the most argued-about topic in medicine right now, and Hugh gave a straight answer anyway. His read of the most rigorous meta-analyses lands at 1.6 grams per kilogram of body weight per day for muscle protein synthesis. If you're older or already losing muscle, some studies support going up to 2.2 grams per kilogram.
I liked how he put it. Everyone is an athlete, or at least should aspire to be. Train like one. Eat like one.
Creatine and the Kidney Myth, Settled
I get asked about creatine on social media more than almost any other supplement, and it's always the same question. Doesn't it hurt your kidneys?
Hugh was clear. At 3 to 5 grams a day, the evidence shows creatine is not harmful to healthy kidneys. The confusion has a simple explanation. Creatine breaks down into creatinine, which happens to be the exact marker doctors use to estimate kidney function. Take the supplement, train hard, and that number can climb for reasons that have nothing to do with your kidneys. Then your doctor panics over a lab that was never a problem.
Hugh gives his patients two practical fixes. Stop creatine for 72 hours before kidney labs and back off intense exercise in that window. Or ask about cystatin C, a newer test that measures kidney function without being thrown off by creatine.
The Blood Test 1 in 5 People Need and Almost Nobody Gets
If Hugh could get every doctor to order one more test, it would be lipoprotein(a). One in five people have elevated levels. Almost none of them know it. It's 95 percent genetically determined, and it's what he calls highly atherogenic. It works its way into the wall of the artery and sets off inflammation that speeds up heart disease.
This one is personal for me. I have elevated Lp(a) myself. I've been able to bring mine down to the low end of the high range with supplementation, and a quality omega-3 is a non-negotiable in my own routine. Hugh has seen the same in some of his patients.
There's no approved drug yet that lowers Lp(a), though trials are underway. Knowing your number still changes everything, because it tells you how aggressive to be with the risk factors you can control. Hugh also pointed to ApoB as a more accurate read on cholesterol risk than a standard panel. And he named blood pressure as the most overlooked longevity marker of all. It's boring. It also matters more than your recovery score.
Testosterone: Over-Diagnosed and Under-Diagnosed at the Same Time
Hugh sees fit, healthy young men convinced by social media that their testosterone is low when it isn't. Meanwhile, the men most likely to actually be deficient almost never get tested. Think men managing diabetes or chronic pain, or men on SSRIs for depression. He noted that in pre-diabetic men with true deficiency, testosterone replacement lowers the odds of progressing to diabetes.
If you're going to test, do it right. Get the blood drawn fasted and before 11 a.m., then confirm with a second reading on a different day. A single lab drawn at the wrong time is how men end up on hormones they never needed.
What to Do This Week
Two steps. First, at your next lab draw, ask for lipoprotein(a) and ApoB by name. They're inexpensive, and Lp(a) generally only needs to be checked once in your life. Second, start the one-minute habit. One minute of air squats today, lunges tomorrow, and build from there toward two real resistance sessions a week.
If You Want Help Knowing Where to Start
Longevity is one of the noisiest topics in health right now, and most of the confusion comes from people tracking a dozen metrics that barely matter while the tests and habits that actually move the needle never get mentioned.
This isn't just a longevity problem. I see it with almost every health topic.
Most people are stitching together advice from podcasts, social media, and lab results nobody ever explained, trying to guess which pieces apply to them.
That's what the Magnolia Inner Circle is for.
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