Michael Karnjanaprakorn

2025 Lipoprotein(a) Update

2026-01-27T15:57:58Z

I recently ran another round of bloodwork and wanted to share a brief follow-up focused specifically on my lipids, building on my last update.

Here’s a summary of my latest results:

I first started taking Repatha in April 2024. Compared to earlier results when everything was fully dialed in, these numbers are trending in the wrong direction.

What Happened

The main driver was a change in my Repatha dosing.

During the second half of 2025, I was taking Repatha once per month instead of the prescribed twice-monthly schedule. I’ve since learned (the hard way) that while PCSK9 inhibitors are incredibly effective, they’re also very dose-dependent.

Repatha works by blocking the PCSK9 protein, which normally breaks down LDL receptors in the liver. When those receptors are preserved, the liver can clear LDL and ApoB more effectively. PCSK9 inhibitors can also lower Lp(a) modestly (often ~20–30%), but they’re not Lp(a)-specific therapies.

By taking only 140 mg once a month, I was effectively on a sub-therapeutic dose. Standard protocols are either 140 mg every two weeks or a much larger 420 mg monthly dose. Without enough drug on board to continuously suppress PCSK9, LDL receptors weren’t being recycled fast enough to keep up with particle production. The result was a gradual but noticeable drift in my markers.

I’ve since returned to the standard twice-monthly schedule, on the 1st and 15th of each month. I expect these numbers to move back into the optimal range by this summer.

Pro Tip: Managing the Cost

If you are paying out-of-pocket, the price of Repatha can be expensive, but there are ways to bring it down.

If you’re paying out of pocket, Repatha can land in the ~$600–$700/month range depending on pharmacy. GoodRx coupons can drop that substantially (I’ve seen as low as ~$239).

The State of LP(a) Drugs

One reason I write these annual updates is to stay on top of progress in Lp(a)-specific treatments.

TLDR: real Lp(a) drugs are finally close.

Here’s a high-level snapshot of what’s coming.

Pelacarsen (The Pioneer)

Company: Novartis (NVS) & Ionis Pharmaceuticals (IONS)
What it is: Monthly injection
How it works: Antisense therapy that blocks the liver from producing Lp(a)
Results: ~80% reduction in Lp(a)
Stage: Phase 3
Timing: Lp(a)HORIZON outcomes data expected H1 2026. Earliest realistic approval in 2027.

Olpasiran (The "Long-Acting" siRNA)

Company : Amgen (AMGN)
What it is: Injection every three months
How it works: siRNA that silences Lp(a) production
Results: 95% or greater reduction at higher doses.
Stage: Phase 3
Timing: OCEAN(a)-OUTCOMES trial completes December 2026; targeting 2027/2028 approval.

Lepodisiran (The Very Infrequent Shot)

Company: Eli Lilly (LLY)
What it is: Potential once-yearly injection
How it works: Long-acting siRNA
Results: ~94% reduction for nearly a full year (48 weeks).
Stage: Phase 3
Timing ACCLAIM-Lp(a) trial runs into early 2029; approval unlikely before late 2029.

Muvalaplin (The Daily Pill)

Company / Ticker: Eli Lilly (LLY)
What it is: Daily oral pill
How it works: Small-molecule drug that prevents Lp(a) particles from forming
Results: Dose-dependent reductions reaching the mid-80% range in Phase 2
Stage: Entering Phase 3
Timing: MOVE-Lp(a) Phase 3 trial currently active; results expected 2029–2030.

While the drugs above require ongoing doses, a new frontier is emerging that aims to permanently "silence" the Lipoprotein(a) gene.

CTX320 (The One-and-Done Edit)

Company: CRISPR Therapeutics (CRSP)
What it is: One-time IV infusion
How it Works: In-vivo CRISPR therapy that permanently disables the Lp(a) gene in the liver
Results: Over 90% reduction in non-human primates with durable effects
Stage: Phase 1; initial clinical data expected Q2 2026.
Timing: 2030 or later.

VERVE-301 (The "Pencil & Eraser")

Company : Verve Therapeutics (VERV)
What it is: One-time infusion
How it works: Base editing that permanently changes a single DNA letter in the Lp(a) gene, preventing protein production
Results: 90%+ reduction in preclinical models
Stage: Phase 1
Timing: 2030–2032

Next Steps

I’m back on the standard twice-monthly Repatha schedule to bring my lipid markers back into range.

I also plan to do whole-genome sequencing. Blood tests tell you what your levels look like today, but genetics explain why they’re high and how aggressive your long-term risk really is.

Lp(a) is largely genetic and barely moves with lifestyle, so knowing your underlying “code” helps determine how hard to push on LDL targets now and which future therapies may make the most sense. It’s the difference between reacting to a number and understanding the blueprint behind it.

Final Takeaways

Consistency matters: If you’re on a PCSK9 inhibitor, the 14-day cadence is the ‘magic number’ for receptor recycling.
Lp(a) Timing: We are within 12 months of the first Phase 3 data.
Know your code: If your levels are high, consider sequencing. It’s the difference between managing a number and understanding your blueprint.

As always, this is not medical advice. If you’re dealing with elevated Lp(a) or cholesterol, work with a clinician who understands lipidology and cardiovascular risk at a deeper level. I’m just a random guy on the Internet!

Advice

2025-06-16T15:43:39Z

Takeaways:

Don’t ask for advice if you’re really just looking for permission.

The only advice worth seeking is the kind that might actually change your mind.

Most advice isn’t meant to be followed. It’s meant to sharpen your filter.

Most people should ignore advice.

Not because advice is worthless, but because most people aren’t honest about what they’re really doing when they ask for it.

They say they want input. What they actually want is permission. The decision’s already been made. They’re just looking for someone to cosign it.

That’s the trap. It’s not taking bad advice. It’s pretending to seek good advice when all you’re doing is stalling. Acting open-minded when you already know what you want to do.

And when we do ask for advice, we fall into egocentric discounting — overvaluing advice that confirms what we already believe and ignoring the rest. Which means most advice-seeking is just a validation loop. We’re not trying to change our minds. We’re trying to feel better about them.

The truth is that most advice is irrelevant anyway. It’s shaped by someone else’s context, failures, and blind spots. You’ll hear frameworks like, “Did they make the same mistake?” or “Are they in the same industry?” But even then, what didn’t work for them might work for you. Or vice versa.

So, what’s the better move?

If you’re going to ignore advice anyways, just own it. Don’t waste your time (or anyone else’s) gathering input you’re not going to use. Put that energy into sharpening you gut. Because if you’re going to trust yourself over everyone else, you better be right.

But if you’re going to ask for advice, be open to changing your mind. But know that you’ll still ignore most of it. That’s the point. You need to hear enough of it to train your filter. You don’t build instincts by avoiding advice. You build them by learning what to reject and what to keep.

That’s the real skill: building a high hit-rate gut. One that gets better through pattern recognition, reflection, and making your own mistakes. The goal isn’t to avoid failure entirely. It’s to be wrong less often.

I’m not saying ignore all advice. Some of it is worth taking, especially in low-risk, high-certainty areas like hiring, accounting, or legal setup. Don’t reinvent the wheel. Just follow best practices and move on.

But for the big stuff like your company vision, who you build with, and what bets you make, you’re on your own. That’s where your gut has to lead.

I’ve wasted time pretending to be open to advice when I wasn’t. Now I just make the call. If I’m wrong, I’ll own it. If I’m right, my gut get sharper, and I get more confident trusting it.

Playing to Win

2025-03-13T13:04:16Z

There’s a fundamental difference between playing to win and merely playing to avoid losing. It sounds obvious, yet I’ve seen many founders—especially when things get tough—shift into survival mode. While survival might feel like success in the short term, adopting a purely defensive stance is often the first step toward a slow, inevitable death.

Growth isn’t optional for startups. It’s oxygen. The moment growth stalls, momentum fades, and everything becomes much harder. It becomes much harder to recruit talent, raise capital, and motivate your team. A plateau isn’t stability; it’s a warning sign that the company needs to evolve or fade into irrelevance. The best companies recognize this moment as a turning point. It’s an opportunity to take bold bets and build the next growth wave.

Take Shopify as an example. During the economic uncertainty of 2020, many companies tightened budgets, froze hiring, and cut innovation efforts, hoping to ride out the storm. Shopify did the opposite. Rather than retreat, they aggressively doubled down—launching Shopify Balance (a banking service for merchants), expanding fulfillment solutions, and pushing into international markets. They understood that crises create opportunities, positioning themselves as an indispensable partner for small businesses. The result? Shopify’s strategic bets fueled massive growth, cementing their dominance in e-commerce while others struggled to regain footing.

Of course, it’s natural to hesitate about big moves when your runway is limited and you might run out of cash. But calculated risks aren't reckless; they’re deliberate bets with asymmetric upsides. If you are cost cutting, there is a point where you can cut costs too deep where you just sealed your own fate because you’re playing to not lose.

If you want your startup to survive, you can’t just optimize for profitability to merely “control your destiny.” You have to proactively create your next growth curve. Each curve is followed by another wave. If you pause too long between waves, you risk sinking. Sometimes, the bold move you’re avoiding is the move you need to make.

Playing to win means embracing uncertainty as a competitive advantage. Founders who adopt this mindset will always outpace those who are just trying not to lose. The riskiest strategy of all? Playing it too safe.

Rate of Learning

2025-03-07T16:53:18Z

Since I started playing Magic the Gathering competitively. I’ve noticed one thing that separates great players from good ones — their rate of learning.

The best players aren’t just good at the game; they learn faster than everyone else. They’re constantly iterating, adapting, and refining their approach.

And this applies to everything: startups, investing, life.

One of the best things I did in my 20s was to focus on how fast I could learn.

IMO, it’s more important that talent, connections, or even raw intelligence. The people who succeed in the long run are the ones who can download information quickly and put it into action faster than anyone else.

A lot of people confusing “learning” with reading books, taking courses, or taking lots of notes. Yes, that’s traditional learning, but real learning happens when you’re in the game taking action, making decisions, and figuring things out in real time.

You become a chess grandmaster by playing thousands of games. Not by reading about it.

When I started my career, I didn’t wait around for the perfect startup idea. I didn’t have any worth pursuing, and the ones I had in my early 20s were terrible.

Instead, I joined Behance as employee #6, and became Chief of Staff to Scott Belsky (who’s now the Chief Product Offer at Adobe). In two years, I learned more than I ever could have in business school—probably more than I would have learned launching my own startup at that point, too.

Why? Because I was inside a fast-moving startup, seeing how things actually worked—not just reading about them.

For example, at Behance, I got to see network effects in action—not just in theory, but in the small, counterintuitive ways they actually played out. These were things no book would have covered, because they weren’t obvious until you were deep in the trenches.

I took that lesson to Skillshare, where instead of chasing sheer volume, we focused on getting a critical mass of engaged teachers. Because when teachers invested in the platform, they stuck around, attracted students, and created a flywheel that scaled on its own.

You don’t learn things like this from reading about it. The most valuable lessons come from being inside the machine—seeing what actually moves the needle, what doesn’t, and what defies conventional wisdom.

Joining an early-stage startup was the right move for me because I wanted to learn as fast as possible. But if you have an idea you’re obsessed with — even if it’s not perfect - starting you own thing is just as good, if not better.

Ask any founder about the first idea they executed. Most of them were terrible — and they’ll probably be embarrassed to talk about it. But they’ll all tell you the same thing: it was a stepping stone to the next idea, and the next one, which eventually lead to the one they’re working on now.

The key is to avoid overthinking or waiting for the perfect idea. The opportunity cost of waiting is too high.

Whether you join an early-stage startup or start your own, the goal is the same: optimize for the fastest rate of learning.

There’s a popular belief that you should learn from failure. And sure, failure teaches you what not to do.

But learning from success is even more valuable — because it teaches you what to do.

It shows you what actually works, which in turns accelerates your rate of learning.

If you were one of the first 50 employees at Stripe, Airbnb, or OpenAI, you’d walk away with a playbook that only a few hundred people in the world have experienced. You’d know firsthand how to scale a company, design a product that grows exponentially, and navigate hyper-growth.

That experience is a moat.

This is why getting into the right environments—where you can learn as fast as possible—is one of the highest-leverage moves you can make.

Paul Graham talks about how the more you learn, the faster you can learn — what he calls superlinear returns. Knowledge compounds, just like money.

The problem? Most people don’t take advantage of this. They wait for the perfect opportunity, or they think reading about success will actually lead to success.

But the most successful people I know don’t just learn—they execute. And because they execute constantly, their learning accelerates exponentially over time.

Most people never reach their full potential — not because they aren’t smart enough, but because they never push past the threshold where learning compounds exponentially.

Take Magic the Gathering as an example. The best players don’t just play the game—they see it differently. They’ve crossed a knowledge threshold where the game slows down, patterns become obvious, and decisions feel automatic.

They’re playing the game on a different level.

A beginner plays the cards in their hand.
A great player plays five turns ahead.
An elite player forces their opponent into a position where they have no good options.

Most people never get there—not because they can’t, but because they quit before the breakthrough happens.

Learning feels slow and frustrating at first, and they assume they’ve hit a wall. But if they had pushed just a little further, they would have seen the game in a completely new way.

The fastest learners are relentlessly curious, highly adaptable, and action-oriented.

They ask better questions.
They experiment constantly.
They apply feedback faster than others.
They don’t just consume information — they test in the real world.

If you want an edge — whether in Magic, startups, or life — optimize for your rate of learning. Put yourself in high-velocity situations. Take on challenges where you have no choice but to get better, fast.

That’s how you go from good to great.

How to Get Hired at a Startup

2025-02-20T14:02:34Z

Most people approach job applications the wrong way — especially for tech startups.

They send out a hundred resumes and hope to land an interview. That can work, but it’s not the best way.

If there’s a company you really want to work for, you need a different strategy.

I’ve built companies, hired hundreds of people, and reviewed thousands of applications. The biggest mistake I see? People take a numbers-game approach when they should be taking a bullseye approach.

Instead of mass applying, pick a few startups you actually care about and go all in.

Think like a Founder

The most constant thing about startups is that it will always change. Startups are chaotic. They need people who don’t just follow orders but figure things out.

The best startup employees think like founders. If you instinctively start solving problems when you seem them, you’ll thrive at an early-stage startup.

The best hires learn fast, adapt, and figure out what needs to be done before they’re even told.

The ability to learn faster than others is the ultimate competitive advantage.

Be Extraordinary

Resumes are boring. What really stands out is when someone is extraordinary.

I once hired an Eagle Scout. Another time, I hired a world-class magician.

Neither had "impressive" resumes, but both had done something hard, unusual, and cool. That told me a lot about them—discipline, creativity, and the ability to get good at something difficult.

If you’re early in your career and don’t have much work experience, show something impressive you’ve done. Built an app? Run a side project? Top 100 ranked in a video game?

Don’t be afraid to humblebrag. These things reveal far more than a standard resume ever could.

A Story

When I was CEO, I’d get maybe one cold email a month from someone who wanted to work at my company.

Out of those, 10% stood out.
And of those, 80% got hired.

Why? Because they didn’t just ask for a job. They showed they could contribute and were passionate about our company’s mission.

One candidate sent me a PDF with their background, their story, and specific ideas for how we could improve our marketing.

It wasn’t a generic application—it was a pitch. I fast-tracked them in the hiring process because it was obvious they had already done the work to understand what we needed.

What’s the most surprising? That I would only get one of these a month. That’s it! It’s not as much as you think.

The Bullseye Approach

If you want to work at an early-stage startup, here’s how to do it :

Go Deep on Research – Learn everything about the company. What do they do? What are their biggest challenges? Who are the key players? Most people barely skim the website. DO your homework.
Find a Warm Intro – Cold applications go to the bottom of the pile. Tap your network, engage with their content, or find a way to make a personal connection.
Send a Killer Email – A generic cover letter won’t cut it. Write a short, clear email that shows you understand the company, outlines why you’d be a great fit, and adds some value.
Prove Your Value Before You Even Apply – Instead of saying, “I’d love to work here,” offer a fresh perspective, suggest an improvement, or build something useful for them.

It’s more work, but the odds of getting a response (and the job) are way higher—especially if it’s a place you really want to work.

Getting hired at a startup isn't about following the traditional playbook. It's about showing initiative, demonstrating value, and proving you can think differently.

Most people don’t do this. That’s why it works. It’s how to stand out.

Energy

2025-02-17T16:09:51Z

I used to think that when you’re stuck, the answer is to step back. Rest. Recharge. Go on vacation or even a sabbatical. Give yourself time to think.

That’s what all the advice says — take a break, gain clarity, wait for the big epiphany, then come back with a plan.

But I’ve realized something different: clarity doesn’t come from stepping away. It comes from following what gives you energy.

For a long time, I ran in circles, thinking about the same ideas, asking the same questions over and over. What should I focus on? Which idea should I execute? What’s the right strategy?

I assumed I just needed more time to reflect. But the more I sat with it, the more stuck I felt.

Then I started executing. Instead of obsessing over the “right” idea, I just did things. I wrote. I launched. I experimented.

And what surprised me the most? All my assumptions were wrong! The idea morphed into something completely different. Or, the thing that I thought I would enjoy doing, I didn’t.

Now, instead of waiting for the perfect plan, I use a simple filter for work, for hobbies, for friendships, for everything:

Does this give me energy? —> Keep going.
Does this drain me? —> Drop it.
Not sure —> Keep doing.

I still overthink—it’s just how I’m wired. But when I feel truly stuck, I follow energy and momentum. I’ve quit more things that I can keep count of (but no one’s watching so who cares?). That’s balanced by discovering things— personally and professionally— that actually energize me. It’s messy, but it works.

Yes, recharging has its place. But too much rest turns into stagnation. You can sit in “recovery mode” forever, waiting for clarity that never comes. Or you GSD, follow your energy, and let clarity find you.

Lipoprotein(a) Update

2024-10-08T13:54:47Z

I just got some follow-up bloodwork done, and I wanted to share the results as a follow-up to my previous article on tackling high Lipoprotein(a).

Here’s a quick look at the numbers:

Both my ApoB and LP(a) levels have dropped since starting Repatha in April 2024. ApoB decreased immediately, while LP(a) dropping by around 30% - 40%, which aligns with the expected 20-30% reduction after three months of treatment.

Additionally, my total cholesterol saw a significant reduction as well. It dropped from 201 to 116, with LDL decreasing from 129 to 41. This is the lowest it’s been in my entire life, which is surreal.

Dr. Peter Attia recommendations for optimal cardiovascular health are:

ApoB: 30-40 mg/dL (I am at 44)
LDL: Below 30 mg/DL (I am at 41)
LP(a): Below 50 nmol/L (I am at 73.9)

I’m really pleased with the results, especially the reductions in ApoB and LDL. While I wait for LP(a) targeted drugs to become available, I’ll continue with this treatment plan. So far, I haven’t experienced any side effects.

What’s driving these changes? I attribute the biggest drops to starting Repatha. In September, I also started to dial in my sleep, nutrition, and exercise as I began training for a half marathon, so I would imagine that played a role as well.

Next, I’m focusing to increasing my V02 max (linked with longevity) by training for a half-marathon, and dialing in my supplements, focusing on the 20% that will deliver 80% of the results.

Overall, I'm encouraged by these results and will continue to monitor my progress. This journey is a reminder that with the right approach and medical guidance, we can make significant changes in our cardiovascular health. As always, consult with your healthcare provider before making any changes to your health routine.

Stay tuned for more updates on my health journey and insights into longevity-focused lifestyle changes!

Ideal Work Lifestyle

2024-10-03T19:27:22Z

A lot has been written about designing an ideal life or lifestyle, but rarely do we consider designing our ideal work life. Why don’t we treat work the same way?

I believe in manifesting my future. Every year, I write down a vision of what I want and review it weekly. More often than not, the things I envisioned start to happen—not because I read them each week but because I took small steps towards them.

In my 20s, I lived the tech startup lifestyle: high risk, high reward, intense focus. It was right for that season of my life. But now, in my 40s, that version of work doesn't resonate anymore. I still want to work, but I’ve realized work isn’t my only source of meaning or purpose. It’s still an important pillar—just not the entire foundation.

When I started considering what I wanted to do next, I realized I’d never actually designed my “ideal work lifestyle”—a vision for exactly how I want to work. So, I decided to map it out. Here’s my vision for the next year:

Calm Business: A balanced approach where work fits around life—not the other way around. I want the flexibility to go on a run, spend time with family, and ensure work supports my lifestyle. This principle should apply to everyone in the company.
Minimalist Approach: Keep it simple with minimal management layers, minimal meetings, and minimal complexity. A self-sustaining, bootstrapped business with low overhead, free from investor pressures or payroll stress.
Work Split: My week would be divided between creating content and building software. The software would solve a personal pain point — something I am passionate about, and a product I use daily. It should break even, with any profits reinvested into improving the product.
Content Creation: My focus would be on storytelling. I want to tell stories that reflect where I am in life and also help others. Editing would be handled by someone else to free up my time for creativity.
Small Team: A lean team with 1 Editor (Content), 1 Engineer (Software), and 1 Virtual Assistant (Ops). Keeping the team as small as possible, for as long as possible.
Friends: This small team would feel like a family. My goal is to create a company where we prioritize a balance that leads to true life profitability.

And that’s it.

My vision of an ideal work lifestyle is about creating work that enhances, rather than competes with, the rest of life.

Designing an ideal work life is just as important as designing the rest of your life. Work that integrates seamlessly with everything else you value.

Minimalist Finances

2024-09-24T14:04:26Z

I keep my finances as simple as possible because I’ve learned that when it comes to money and investing, less is more.

For tracking, I use two tools:

Tiller for detailed expense tracking (micro level)
Kubera for monitoring net worth (macro level)

Each month, I review our expenses and generate a personal P&L, which is easy to do with Tiller. I set an annual budget and try to stay within it. If we overspend in a given month, I dig into the details, and make adjustments. This keeps things on track without needing to obsess over every little expense.

With spending, I’ve restructured my priorities to align with what truly matters. I have an unlimited budget for health because it’s the best long-term investment. I’ve also set a minimum budget for experiences to force myself to invest in memories.

Over the years, I’ve shifted away from buying material things because I’ve realized that owning things means they end up owning your time. For example, owning a second home can be a huge time suck, dealing with renters and maintenance issues, especially if you barely use it. Instead, I prefer to invest my time, money, and energy in things that enhance my life without adding unnecessary stress.

I also check our net worth monthly to ensure we’re progressing towards long-term goals. I try not to make any big changes often, but it’s a simple way to keep an eye on the big picture without getting lost in the details.

On the investment side, I’ve also shifted to a minimalist strategy. I used to dive into alternative investments, such as startup investing, but the time and energy required to find and vet these opportunities became too much. I’ll still invest if it’s a close friend, or friend of a friend, but the illiquidity just doesn’t align with my priorities anymore.

I realized I value my time more than squeezing out an extra percentage point or two in returns—especially when the paperwork at tax time became cumbersome.

Now, I focus on index investing with a straightforward portfolio:

Crypto: BTC, ETH, SOL
Stocks: VT, VTI
Fixed Income: BND, Treasury Bills
Real Estate: Primary Residence
Cash

My portfolio is built around simplicity and diversification without the complexity of constant management. This approach gives me peace of mind and more time to focus on what matters.

And that’s it: simple, low-maintenance, and far less stressful.

Tackling High Lipoprotein(a) aka The Silent Heart Killer

2024-09-18T23:43:06Z

Disclaimer: I am not a doctor or an expert. I’m just some random guy who decided to look into heart disease for myself. I am sharing what I learned along my journey. Please consult a medical professional if you have any questions.

I am a healthy 41-year-old, or so I thought. I got my biomarkers checked, and my test results revealed a surprising risk for heart disease.

I exercise regularly, have stopped drinking alcohol, and typically get eight hours of sleep every night. My diet is rich in protein. I was doing all the right things.

Despite what I thought was a healthy lifestyle, I was surprised to learn that I was at significant risk for heart disease. A specific biomarker, Lipoprotein(a), puts me at a higher risk. It most likely runs in my family. I think my dad and grandfather had it based on their health history, and now I have it.

Since it’s genetic, lifestyle changes won’t help as much. There’s no cure or drug I can take to “fix” the problem. It wasn’t something I expected to deal with in my early 40s. I went through all the emotions. I was in denial and then angry, and after a few months, I decided to figure out a plan.

This essay was a long time in the making. Over a year, I documented my journey from diagnosis to initial treatment. I waited to compare my initial test results to my latest numbers. I’ll share all of my biomarker data and my long-term plans.

I feel fortunate to have learned about this at age 41 and to have the time, energy, and resources to address it. Recognizing that many don’t have these advantages, I’ll outline various options I’ve explored. I hope anyone reading this prioritizes getting tested and beginning early prevention efforts against heart disease.

The biggest lesson I've learned? Heart disease is preventable, but early detection and prompt action are crucial.

Background

For 15 years, I led a high-stress, fast-paced lifestyle as a tech startup founder. The low odds of success and high expectations bred constant stress and anxiety. Because work was my top priority, I deprioritized my health, which eventually caught up with me.

When I turned 40, I stepped away from the world of startups, and went on a sabbatical. I set a decade goal: to make my biological age a decade younger and my mental age a decade wiser.

To achieve this, I implemented several lifestyle changes, like exercising more, eating healthier, getting better sleep, and quitting alcohol. I also started seeing a therapist to figure out my shit.

I was curious about my health, so I signed up for a longevity clinic called Bionic. There, I had my biomarkers checked, including my lifespan (how long we live) and healthspan (how long we will be healthy).

I wanted to learn more about my risk for the four horsemen: heart disease, cancer, neurodegenerative disease (such as Alzheimer's), and type 2 diabetes.

That’s when I received the surprising news: I have a high risk for heart disease...

Initial Results

My test results were mixed. We checked my cholesterol levels and other biomarkers that are not typically checked for but are strongly linked to heart disease risk.

My overall risk assessment falls somewhere between moderate to high. My lipid panel showed high or borderline high scores:

Total Cholesterol: 201 mg/dL (borderline high)
- LDL-C: 129 mg/dL (high)
- HDL-C: 61 mg/dL (good)
- VLD-C: 11 mg/dL (normal)
Triglycerides: 61 mg/dL (normal)
Apoliopoprotein B (ApoB): 93 mg/dl (borderline high)
Lipoprotein(a) (Lp(a)): 124.6 nmol/L (very high)
CT Calcium Score: 11 Agatston units (moderate risk)

The combination of high LDL-C, high ApoB, and very high Lp(a) is particularly concerning. This combination indicates elevated levels of harmful cholesterol, a high number of atherogenic particles (that contribute to plaque), and a genetic predisposition to plaque formation and thrombosis (blood clots).

In other words, I have a perfect storm of conditions to promote atherosclerosis (narrowing and hardening of the arteries), significantly increasing my risk of heart attacks and strokes.

To provide some additional context, here’s a breakdown of each:

Total Cholesterol: This measures all cholesterol in your blood. High levels can lead to fatty deposits in the blood vessels, increasing the risk of heart disease and stroke. Cholesterol is essential, but too much can clog your arteries. Ideally, it should be below 200 mg/dL.
LDL: This is "bad" cholesterol because it can contribute to artery blockages when levels are too high. LDL is like the junk that clogs up your arteries. Levels below 100 mg/dL are generally considered good, with less than 70 mg/dL recommended for high-risk patients. Dr. Attia recommends even lower levels, around 30-50 mg/dL, for those at very high risk.
HDL: This is "good" cholesterol because it helps remove excess cholesterol from the bloodstream. Think of HDL as the cleaner that removes excess cholesterol. Higher levels are better, ideally above 60 mg/dL.
VLDL: This type of lipoprotein carries triglycerides through your bloodstream. It's another type of "bad" cholesterol that can contribute to plaque buildup. Ideally, VLDL levels should be between 2 and 30 mg/dL.
Triglycerides: These are a type of fat in the blood that the body uses for energy. High levels can contribute to the buildup of plaque in your arteries. Normal levels are < 150 mg/dL. Dr. Attia wants the triglycerides to HDL ratio to be 2:1 or better or less than 1:1.
Apolipoprotein B (ApoB): This is a protein that carries LDL and other potentially harmful lipids. ApoB helps bad cholesterol travel through your body. It's a good indicator of cardiovascular risk. Optimal levels are below 80 mg/dL, while above 100 mg/dL are concerning. Dr. Attia’s target for ApoB is to get it down to 30-40 mg/dL for those in their 30s and 40s. A good rule of thumb is that your ApoB targets should be about 10 mg/dL higher than your LDL targets.
Lipoprotein(a), or LP(a): This genetic factor can increase plaque buildup in your arteries. An optimal level is below 50 nmol/L, while a level above 100 nmol/L is considered very high risk.
CT Calcium Score: This shows how much calcium is in your heart’s arteries, indicating the extent of coronary artery disease. At younger ages, a score of 0 is ideal, while above 100 is generally considered high risk.

I also had a DEXA scan measuring body fat, lean muscle, and bone density. The results were unexpected: my total body fat percentage was 26.6%!

Most concerning was my fat distribution. The scan showed an android/gynoid ratio of 1.35, indicating a higher proportion of fat in my abdominal area compared to my hips and thighs. Ideally, this ratio should be below 1.0 for men. This type of fat distribution is associated with greater metabolic and cardiovascular risks.

It also revealed concerning levels of visceral fat, with 1.45 lbs of fat surrounding my abdomen and organs. Ideally, visceral fat should be less than 1 lb, as it is the most harmful fat linked to artery plaque, diabetes, and high blood pressure.

These DEXA results, lipid panel, and other biomarkers showed my cardiovascular risk. Despite my outwardly healthy lifestyle, I was facing significant health challenges that required immediate attention.

These results were overwhelming. On one hand, I am glad that I found out before I had a stroke or heart attack. On the other hand, it wasn't what I expected to deal with at my age. I'm only 41, but I had the arteries of someone a decade or two older. It wasn’t a good start to my decade goal.

Navigating this journey, I experienced a rollercoaster of emotions: denial, avoidance, and fear. But I eventually came around and accepted reality. That's when I started digging deeper to educate myself and determine my next steps.

I needed to develop a comprehensive plan to address these risks. This would involve not only continuing my healthy habits but also exploring medical interventions to manage my cholesterol levels and reduce my risk of heart disease.

Heart Disease

“While heart disease is the most prevalent age-related condition, it is also more easily prevented than either cancer or Alzheimer’s disease. Unlike other diseases like cancer or dementia, we can estimate our risk factors and measure the progress with high accuracy. There are proven steps to lower these risks and, in turn, your risk of a heart attack.” - Peter Attia

Heart disease, despite being the leading cause of death globally for both men and women, is largely preventable with early intervention. It accounts for an estimated 32% of all deaths worldwide (source), with someone in the United States having a heart attack every 40 seconds (source).

The most common form of heart disease is Coronary Artery Disease (CAD), which is primarily caused by atherosclerosis, the buildup of plaque—a combination of fat, cholesterol, and other substances—in the arteries. Once plaque has developed in the arteries, it cannot be entirely reversed, but its progression can be slowed or stabilized.

What's particularly alarming is that atherosclerosis can begin in young adulthood and progress silently for decades. Nearly 25% of heart attacks occur in men aged 54 and younger (source), emphasizing that heart disease can significantly impact younger populations as well.

Fortunately, modern medicine has provided us with the tools to effectively prevent and manage heart disease. Regular exercise, a healthy diet, and stress management can significantly reduce the risk. Early screening and monitoring are crucial, especially for those with a family history of heart disease or other risk factors.

By detecting and addressing potential issues early on, we can prevent the progression of atherosclerosis and reduce the likelihood of a heart attack or stroke. With advancements in medical technology and our understanding of heart disease, doctors like Peter Attia believe we have the power to remove it from the top 10 leading causes of death. But it starts with a proactive approach to our health.

Lipoprotein(a)

Recent attention about Lipoprotein(a) started with a 2018 New York Times article titled “A Heart Risk Factor Even Doctors Know Little About.” The article highlighted that while doctors routinely test for other lipoproteins like HDL and LDL cholesterol, few tests for LP(a), even though high levels can triple the risk of having a heart attack or stroke at any age.

Lp(a) is similar to LDL (the "bad" cholesterol), but it has an extra protein attached called apolipoprotein(a). This extra protein Apo(a) increases the risk of blood clots and plaque buildup in arteries, making Lp(a) more dangerous and harder to clear from the bloodstream compared to other cholesterol particles. It's like having extra traffic on the roads, which can sometimes lead to accidents (blockages in your arteries).

What makes Lp(a) particularly concerning is that it's largely determined by genetics, meaning you inherit it from your parents. It’s not something you can control through lifestyle changes like diet or exercise.

Lp(a) contributes to cardiovascular risk in several ways:

It promotes atherosclerosis (the buildup of fatty deposits or plaques in the arteries).
It increases blood clotting and impairs clot breakdown, raising the risk of thrombosis.
It causes inflammation and plaque instability, increasing the risk of plaque rupture and subsequent formation of dangerous blood clots in the arteries."
It increases the risk of aortic stenosis, a narrowing of the main outlet valve to the heart which can cause a different type of heart failure from that of coronary artery disease.

Approximately 20-30% of people have elevated Lp(a) levels which start between 30-50 mg/DL (source), with some populations having an even higher prevalence (source).

Your risk of having a heart attack or stroke increases with high levels of LP(a) as well. The graph illustrates how elevated Lp(a) levels significantly raise your risk over time compared to normal levels (source).

This graph also eerily uses similar stats to my own: 42-year-old male, who is a little overweight with a BMI of 26.1, has a systolic blood pressure of 135mmHg, an LDL cholesterol of 4 mmol/L (155 mg/dl) and a family history of heart attacks.

My Lp(a) levels were in the 80th to 95th percentile, putting me at very high risk. While I can continue to lower my ApoB through lifestyle changes, I will need medication to bring down my Lp(a) score. This realization led me to explore treatment options, including the approach recommended by Dr. Peter Attia:

Eradicate ApoB to a physiologic level (the level a child has), with a target of 30-40 mg/dL.
Use PCSK9 inhibitors to reduce Lp(a), which can lower levels by an average of 30%.

Encouragingly, there are promising new therapies in development for those with high Lp(a) levels (source):

Olpasiran (AMG 890): In phase 2 trials, olpasiran has shown a reduction in Lp(a) levels by up to 90%. This therapy works by targeting and degrading the RNA that encodes apolipoprotein(a), significantly lowering Lp(a) levels.
Pelacarsen (IONIS-APO(a)-LRx): In phase 2 trials, pelacarsen has shown a reduction in Lp(a) levels by up to 80%. It targets the RNA responsible for producing Lp(a), thereby reducing its production in the liver.
SLN360: In a phase 1 trial, SLN360 has reduced Lp(a) levels by approximately 98% at the highest dose. This therapy uses RNA interference to silence the gene responsible for Lp(a) production.
Muvalaplin: In phase 1 trials, it’s the first oral therapy to lower Lp(a). This small molecule works by inhibiting Lp(a) formation through blocking the apo(a)-apo B100 interaction, demonstrating up to a 65% reduction in Lp(a) levels.

Also, these new drugs look highly effective for lowering LP(a) levels in clinical trials, ranging from 65% to 98% (source).

Additionally, gene editing therapies are being developed to permanently turn off the LPA gene in the liver, potentially offering a one-time treatment to reduce Lp(a) levels and cardiovascular risk (source).

These advancements give me hope for more effective treatments in the future. However, for now, I needed to focus on the best available options to manage my heart disease risk.

Treatment

The general approach to managing heart disease risk is to keep LDL and ApoB levels as low as possible, for as long as possible.

Treatment for heart disease risk typically falls into two major categories: lifestyle changes and medication.

Lifestyle

Diet: Following Michael Pollan's advice, "Eat food, not too much, mostly plants," can be beneficial. The Mediterranean diet, which emphasizes plant-based foods, healthy fats, and limited processed foods, is often recommended. Focus on consuming a variety of vegetables, fruits, whole grains, lean proteins, and healthy fats.
Exercise: Combining strength training (to increase lean muscle mass) and cardio training (to increase VO2 max) is ideal. Zone 2 training, which involves moderate-intensity exercise, can widen and maintain the elasticity of arteries, improving blood flow and reducing arterial stiffness.
Sleep: Aim for 7-9 hours of quality sleep per night (actual sleep, not just time in bed), with 25% of that in deep sleep and 25% in REM sleep.
Stress Management: Develop strategies to manage stress levels, such as practicing meditation, engaging in hobbies, and seeking support from friends and family.
Vices: Quit smoking and reduce or eliminate alcohol consumption.

Medicine

There are several cholesterol-lowering medications available:

Statins: These drugs effectively lower ApoB concentrations and reduce the risk of heart disease. They work by 1) slowing down cholesterol production in the liver and 2) helping the liver remove more cholesterol from the blood. While widely prescribed and generally safe, they may cause side effects such as muscle pain, liver damage, and increased blood sugar levels. But they are not as effective in reducing Lp(a) levels.
- Critics argue that the benefits of statins are marginal and do not justify their widespread use. There are also concerns about the lack of transparency in clinical trial data, which may be biased towards showing positive results. (source).
PCSK9 inhibitors: This newer type of medication can lower LDL cholesterol by about 50% and reduce Lp(a) by 20% to 30%. PCSK9 inhibitors work by blocking the action of PCSK9, a protein that reduces the liver's ability to remove LDL cholesterol from the blood. By inhibiting PCSK9, these drugs allow more LDL receptors to remain active in liver cells, increasing LDL cholesterol removal from the bloodstream. They're often prescribed when statins alone are insufficient or not well-tolerated.

However, PCSK9 inhibitors have some drawbacks:

Cost: Annual treatment can range from $5,000 to $12,000, and many insurance plans don't cover these medications or require prior authorization.
Administration: They're given via injection every 2-4 weeks, which may be inconvenient for some patients.
Long-term safety: Critics worry about the long-term safety of PCSK9 inhibitors and the potential for unforeseen adverse effects with prolonged use.

It's important to note that achieving these low levels often requires cholesterol-lowering medications, such as statins or PCSK9 inhibitors, and lifestyle changes. Working closely with a healthcare provider to develop a personalized treatment plan is crucial for effectively managing heart disease risk. Your doctor can help you weigh the pros and cons of different medications and determine the best approach for your individual needs and circumstances.

Experimental Approaches to Lowering LP(a)

While lifestyle changes and PCSK9 inhibitors are proven to manage cardiovascular risk, some researchers are exploring alternative approaches to lowering Lp(a) levels. It's crucial to note that these methods are still experimental, and their effectiveness and safety are not yet well-established.

Niacin (Vitamin B3): Niacin is a B vitamin that plays a role in metabolism. High doses of 1-3 grams daily may reduce Lp(a) levels by up to 30%. However, niacin can cause side effects such as flushing, itching, and gastrointestinal issues and may interact with other medications (source).
Soluble Fiber: Soluble fiber is dietary fiber that dissolves in water. Consuming 10-15 grams of soluble fiber daily might reduce Lp(a) by up to 10%, possibly through improved lipid metabolism. While generally well-tolerated, increased fiber intake can sometimes cause bloating or gas (source).
L-Carnitine: L-Carnitine is an amino acid derivative involved in fat metabolism. Taking 2-4 grams daily has shown mixed results, with some studies reporting a 20% reduction in Lp(a), while others show no significant effect. Potential side effects include nausea and abdominal discomfort.
Coenzyme Q10 (CoQ10): CoQ10 is an antioxidant produced naturally by the body. Daily doses of 100-300 mg may reduce Lp(a) by up to 15%. CoQ10 is generally well-tolerated, with few reported side effects (source).
Vitamin C: Vitamin C is an essential vitamin with antioxidant properties. High doses of 1-3 grams daily have been suggested to lower Lp(a) levels by reducing oxidative stress and inflammation. However, the evidence is limited, and high doses can cause gastrointestinal issues and interact with certain medications.
Nattokinase: Nattokinase is an enzyme extracted from natto, a traditional Japanese fermented soybean food. Some studies suggest that doses of 2000-4000 FU (fibrinolytic units) daily may help reduce Lp(a) levels, though research is limited. Nattokinase has blood-thinning properties and may interact with anticoagulant medications. Side effects can include digestive discomfort (source)(source).

Disclaimer: These approaches should only be considered under the guidance of a healthcare provider, as they may interact with other medications or cause side effects.

Statins Among Young Adults

High cholesterol is no longer just an ‘old person’s problem.’ More young adults are turning to statins, signaling a potential paradigm shift. This trend aligns with the principles of Medicine 3.0, which emphasizes personalized, preventive, and proactive health management based on risk assessment and early intervention.

Historically, statins have been recommended for young adults (18-39) only if their LDL cholesterol levels exceed 190 mg/dL, affecting only about 2% of this age group. Current guidelines primarily focus on a 10-year ASCVD risk for adults aged 40-75, overlooking the cumulative lifetime risk for younger individuals.

The emphasis on older adults stems from limited data on younger populations and the reliance on 10-year risk assessments, which often overlook the long-term cumulative risk of high LDL-C levels. A 2015 study found that every decade of exposure to high LDL-C increases coronary heart disease risk by 39% (source).

A recent Columbia University study (2023) suggests statins could benefit young adults with LDL cholesterol levels of 130 mg/dL or higher, comprising about 23.6 million (27%) of young adults. The study indicates that statin therapy could prevent three cardiovascular disease events for every 1,000 young adults treated over their lifetime (source).

Despite potential benefits, concerns remain about long-term safety, overtreatment, and quality of life. Prolonged use may lead to side effects such as muscle pain, liver damage, increased blood sugar levels, and neurological effects like memory loss.

Critics argue for prioritizing lifestyle modifications over medication. Diet, exercise, and other healthy habits can reduce LDL-C levels without statins. However, the long-term safety concerns should be weighed against the established risks of prolonged high LDL-C exposure.

As this debate unfolds over the next decade, a better understanding of costs and benefits could save millions from premature cardiovascular disease. The approach to managing cholesterol in young adults may be on the cusp of a major shift, potentially redefining preventive cardiology.

My Plan

Before I go into my tactical plan, I wanted to share some mindset shifts that I had to make throughout this process:

Facing health challenges as we age is inevitable. While my test results were tough to hear, I shouldn’t get too discouraged by my test results. Instead, I’m focusing on what I can control and making informed choices to take care of my health.
Medicine can be beneficial. As someone who typically avoided taking medication, even for headaches, I used to view relying on medicine as a failure to maintain a healthy lifestyle. However, I now understand that medication can be an important tool in managing health conditions and preventing serious complications.
Pick the sustainable approach. Knowing my tendencies and personality, I recognize that making drastic lifestyle changes, such as adopting a fully vegan diet, may not be sustainable for me in the long run. Instead, I will focus on making gradual, manageable changes that can become part of my habits over time.

After receiving my test results and consulting with friends and various doctors, I have developed a two-pronged approach to managing my heart disease risk:

Lifestyle: I will maintain a healthy diet, exercise regularly, prioritize sleep, and manage stress. Continue with strength training, switch to mostly plant-based diet, and begin zone 2 running.
Medication: After researching statins and PCSK9 inhibitors, I decided to start with a PCSK9 inhibitor, as it can effectively lower my ApoB and reduce my Lp(a) by up to 30%. While statins alone do not lower Lp(a), PCSK9 inhibitors have been shown to decrease LDL-C, ApoB, and Lp(a) levels.

I plan to continue taking PCSK9 inhibitors until the FDA approves a new drug that specifically targets LP(a).

I will have my blood work done again in three months to assess the medication's effectiveness and make any necessary adjustments to my treatment plan. If the PCSK9 inhibitor does not provide the desired results, I will discuss alternative options with my doctor, such as combining it with a statin or exploring newer treatments.

Follow-Up Results

Three months after starting Repatha treatment, I received my follow-up test results. We switched labs from LabCorp to Boston Heart, changing how Lp(a) was reported. The new lab reported Lp(a) in mg/DL, requiring a conversion factor of ~2.15 to obtain the nmol/L value (while some others use 2.5). This change in reporting units introduced some uncertainty about the results.

Despite the ambiguity in the LP(a) results, my cholesterol scores showed dramatic improvements:

Total Cholesterol decreased from 201 mg/dL to 145 mg/dL.
- LDL-C dropped from 129 mg/dL to 63 mg/dL.
- HDL-C increased from 61 mg/dL to 71 mg/dL.
- VLD-C remained stable, moving from 11 mg/dL to 10 mg/dL.
Apolipoprotein B (ApoB) reduced from 93 mg/dL to 47 mg/dL.
Triglycerides decreased from 61 mg/dL to 43 mg/DL.
Lipoprotein(a) was 53 mg/DL (converted to nmol/L below)

My Lipoprotein(a) results over time were:

124.6 nmol/L (July 2023)
95.4 nmol/L (Nov 2023)
114 nmol/L (June 2024)

These tests were conducted in July 2023, November 2023, and June 2024, with some metrics not tracked consistently across all dates. While I had hoped Repatha would reduce my Lp(a) by up to 30%, the results have been mixed.

Despite the LP(a) level fluctuations, I’m grateful for the improvements in other cholesterol metrics. Total Cholesterol improved by 27.86%, primarily driven by a 51% reduction in LDL.

The PCSK9 inhibitor likely accounts for 99% of these improved results. I wasn't diligent with my supplements and vitamins, so my scores could improve further if I started taking those daily. Before Repatha, my cholesterol consistently hovered around 200 mg/dL.

Having experienced no known side effects, I plan to continue with Repatha. The treatment involves injections every two weeks using Repatha Sureclick, an auto-injector containing 140 mg/ml, at a monthly cost of $546. I initially used Repatha Pushtronex (420 mg/3.5ml, once a month) but switched to Sureclick after the first three months due to Pushtronix being discontinued.

New Update (10/8/2024)

I share another updated on my Lp(a) scores which you can read here.

Updated Plan

Moving forward, I plan to stay on Repatha, retest in three months, and explore new alternative approaches. My research indicates that more substantial reductions in Lp(a) levels are typically observed within 3 to 6 months of regular use, with studies showing Repatha can reduce Lp(a) levels by 20-30% over this period.

For alternative approaches, I am going to start with Nattokinase, which is an enzyme derived from fermented soybeans. Nattokinase is known for its clot-dissolving properties. Some researchers hypothesize that nattokinase might help reduce Lp(a) levels by breaking down the fibrin-like structures in Lp(a) particles.

There are studies that have showed Nattokinase to be more effective than statins in reducing plaque size, along with increasing HDL (good cholesterol) levels, while statins decrease both LDL and HDL levels (source). (If you’re interested in testing out Nattokinase for a 3-month cycle as well, contact me.)

I am hopeful that my Lp(a) scores will decrease further. My goal is to bring the level below 45 mg/DL (or roughly 96 nmol/L). I would be happy with this, considering that this is genetic and very difficult to move, but I will continue to keep my LDL levels low.

In the long term, my plan is to stay on Repatha until there is a medicine that brings the Lp(a) score down dramatically. Hopefully, a treatment will be available within the next five years.

Final Thoughts

Initially, I sought a definite answer - a silver bullet protocol that would solve all problems if followed to the letter.

Ultimately, this is a decision only I can make based on the available information. It's better to make an informed decision, learn from it, and tweak along the way rather than remain idle.

With this plan in place, I will re-check my lipid panel every 3-6 months and continue to make adjustments as needed. Managing my heart disease risk is a continuous, lifelong process, and I hope that by taking these steps, I can significantly reduce my risk and inspire others to do the same.

It's important to remember that everyone's journey is unique, and what works for one person may not work for another. Consulting with a healthcare provider, staying informed about the latest research, and being proactive about your health is key to finding the best approach.

By sharing my experience and the knowledge I've gained, I hope to encourage others to prioritize their heart health and take action to reduce their risk of cardiovascular disease. It's never too early or too late to start making positive changes; every small step can make a difference in the long run.

Heart disease is preventable, but only if you get ahead of it and address risk factors promptly. Take charge of your health today, get tested, and start your journey towards a healthier heart.

Thanks to Johnny Bowman, Justin Mares, Adam Waxman, and Greg Campion for reading drafts of this essay.

Protocol for Heart Disease Prevention

If you’re looking to prevent heart disease, here’s a simple 4-step process:

History
1. Personal Medical History: Document your history of heart disease, stroke, diabetes, hypertension, and other relevant conditions.
2. Family Medical History: Collect information about your family’s medical history, particularly any instances of heart disease, stroke, diabetes, hypertension, and sudden cardiac events.
Lipid Panel
1. LDL (Low-Density Lipoprotein) and HDL (High-Density Lipoprotein): Assess cholesterol levels to determine your risk of atherosclerosis.
2. Triglycerides: Evaluate metabolic risk and cardiovascular disease potential.
3. ApoB (Apolipoprotein B): Measure atherogenic particles for a more accurate risk assessment than LDL alone
4. Lp(a) (Lipoprotein(a)): Test for this specific lipoprotein, which is a genetic independent risk factor for cardiovascular disease.
Imaging
1. CT Calcium Scan: Detect coronary artery calcification to indicate atherosclerosis.
2. CT Angiogram: Alternatively, consider a CT Angiogram to get detailed images of your coronary arteries and assess for any blockages or abnormalities.
Genetics (FYI – I haven’t done this yet)
1. Single-Gene Tests: Familial Hypercholesterolemia, Hypertrophic Cardiomyopathy, Dilated Cardiomyopathy, Long QT Syndrome, Marfan Syndrome.
2. Panel Testing: Comprehensive panels for multiple inherited heart conditions.
3. Whole Exome/Genome Sequencing: Broad analysis of genetic risk factors.
4. Polygenic Risk Scores: Overall genetic risk assessment for common heart diseases.

Multi-Faceted Identity

2024-06-28T14:33:08Z

I recently had Kevin Dahlstrom on my podcast, and one of his quotes resonated deeply with me:

"When you're young, work may constitute 80% of your identity, as you need to pay the bills and get ahead. But that should gradually change over time. For me, work is now only 10% of my identity. The biggest part of my identity is being a rock climber.”

This was the transition I was going through as I got older, but it didn’t feel right until I heard him articulate it. In my 20s and 30s, I was known as the “founder.” Now in my 40s, my identity is more multi-faceted.

Dave Kang’s “octopus” analogy offers another perspective: what if work was just one of eight arms that make life meaningful? This challenges the work-centric identity many of us adopt early in our careers.

Today, my identity includes a wide range of labels: partner, founder, writer, podcaster, YouTuber, runner, collector, philanthropist, angel investor, martial artist, biohacker, etc. Depending on who you talk to, you will get a different label.

This diversification isn’t just about having multiple hobbies. It’s about creating a layered identity that reflects who I am. As I get older, I find myself less interested in talking about work and more interested about these other facets of my life.

For me, the percentage within each of these buckets constantly changes. Family will always be the most important, but I'm exploring other areas such as martial arts and philanthropy. "Work" has probably decreased from 80% to 20% today. However, if I had to pick a label I want to be known for professionally, it’s being a writer.

One of my focuses is curating a tribe around my layered identity and interests both locally and globally. Creating content online helps me meet like-minded people who share my interests and values. But it goes deeper than just finding people with similar hobbies.

Our identity encompasses our core values, lifestyle choices, profession, interests, goals, community involvement, hobbies, etc.

For me, this includes:

Core Values: Agency
Lifestyle Choices: Minimalism, Calm and Slow Life, Biohacking
Personal: Parent, Husband, Friend
Profession: Founder, Content Creator, Angel Investor
Hobbies & Interests: Running, Martial Arts, Collecting Sports Cards
Goals: Top 10% of Health, FIRE

This multi-faceted identity allows me to build more meaningful connections beyond my professional life. The goal isn’t to detach our identity from work completely. For many of us, our career will always be an important part of who we are.

It’s about creating a multi-faceted identity that reflects the full spectrum of our interests, values, and roles in life. It’s about crafting an identity as complex and interesting as we are as individuals.

Here’s what I’ve learned on my journey so far: It’s liberating to express yourself across different areas. You meet people with similar interests, and you’re not confined to just one thing. This leads to personal growth, better social connections, and more fulfillment.

Phone Addiction

2024-06-26T14:31:53Z

A few weeks ago, I wrote about dopamine addiction. Since then, I’ve come to realize that the problem runs deeper. It’s not just about dopamine; I am addicted to my phone and social media.

I’m caught in a detrimental cycle: my craving for dopamine shortens my attention span and scrambles my brain, which makes it difficult for me to stay present or engage in deep thinking that is crucial for writing.

In my opinion, our phone addiction is the world’s biggest addiction. Dr. Anna Lembke describes phones as modern-day hypodermic needles, delivering quick dopamine hits through notifications, likes, and swipes. This constant stimulation leads to compulsive behavior similar to substance dependency. This has resulted in a society that’s more anxious, depressed, and less content despite being more “connected” than ever.

I’ve tried to follow my advice, but I’ve struggled. I can’t read past a few pages of a book. I even bought a new Kindle, hoping it would kickstart my passion for reading. It didn’t.

Yesterday, I spent 4 hours and 19 minutes of my phone, opening it 111 times. That’s roughly once every 9 minutes during waking hours. I’ve managed to limit my Twitter and Instagram usage (by placing time limits), but my attention has shifted to other apps: Gmail, eBay, and Substack.

What is working? Accountability. I’ve started a daily check-in with a friend, where we share screenshots of our phone usage. I’ve also created a phone-free hour at the beginning and end of each day. My hope is that I will fill that time with healthy habits.

So, here my V2 plan:

Set clear limits: use phone settings to restrict app usage—under 15 minutes on frequently used apps and less than 2 hours total daily, excluding Google Maps.
Replace habits: recognize triggers when I reach for my phone out of boredom or avoidance and substitute with a healthier habit, starting with meditation, journaling, and reading during the phone-free hours.
Establish phone-free zones: keep the phone away during family time and during the designated phone-free hours (first hour and last hour of the day).
Create a weekly “data review”: instead of constantly checking stats, condense this into a weekly session. Turn it into a productive exercise by manually recording data and looking for useful insights.
Continue social accountability: Continue the daily screenshot sharing with my friend to maintain discipline.

If none of these work then I’ll go full digital detox to reset my brain’s dopamine levels. I might pair this with my next vacation, using only my phone for navigation.

I’m still figuring out what a healthy relationship with my phone looks like, but I know I need to find it. If you have tried anything that has worked, please contact me. I’d love to try it.

What’s the one thing that money can never buy? “A calm mind, a fit body and a house full of love must be earned.”

Retirement Number

2024-06-21T14:17:53Z

TLDR: Early retirement is more achievable than many people realize. The goal isn’t to stop being productive — it’s to gain the freedom to live life on your own terms.

What's the FU amount to retire early, live comfortably, and never have to "work" again?

It’s somewhere between $1M and $5M — much lower than what most people think. (1)(4)

Of course, many factors will dictate where you land within that range: where you live, your annual expenses, your post-inflation rate of return, tax rates, when you retire, and your withdrawal rate %, among others. (2)(3)

While these are important, here are more important factors:

Lifestyle

If you value status and material things, you will need more.

If you value minimalism and keep your expenses low, you will need less.

Spending money on “things” becomes increasingly difficult beyond a certain point — say around $10M in liquid net worth.

“Status” luxury purchases are net negatives if they contribute to financial stress. You could own multiple homes, cars, watches, etc., but you're just signing up for another “job” maintaining all of those things.

You can own your time, or your material things can own you.

Freedom

You can use your money as a tool for freedom or as a status symbol.

Choosing the latter can lead to a never-ending cycle of lifestyle creep and diminishing satisfaction — what I call the “ego tax.”

Use your money to buy freedom. This doesn’t mean you have to stop working, it means you can choose to work on your terms, with whom you want, when you want, and on what you want.

Enough

If you ask anyone with a net worth above $5 million what their "enough" number is, they'll often say it's twice what they currently have. But if you ask them what they think the number is for everyone else, they'll usually say $5 million or less.

It’s easy to fall into the trap of wanting more or comparing yourself to others or seeking external validation or wanting that next house or whatever it is for you.

But true financial independence comes from optimizing for freedom and knowing when enough is… enough.

Notes

Anyone who tells you that you need more than that likely doesn't have that much money themselves.
If you want to dive into all the math, here it is.
Here’s even better math. (You can buy a 30 year treasury at over 4% today.)
According to Perplexity:
- 8-10% of U.S. households have a net worth of $1 million or more.
- 3-4% of U.S. households have a net worth of $2 million or more.
- 1-2% of U.S. households have a net worth of $5 million or more.

Ego Tax

2024-06-20T13:22:35Z

Takeaway: "Ego Tax" is the hidden cost of prioritizing external validation over personal fulfillment.

The "Ego Tax" is the price we pay when we chase external validation at the expense of our own happiness. It's the gap between seeking recognition from others and finding true fulfillment in what we do. It's about knowing when "enough" is truly "enough."

Imagine two scenarios: In the first, you bootstrap a company to $1M while maintaining your health, relationships, and well-being. In the second, you build a $10M business, but at the cost of your physical and mental health, strained relationships, and overall peace of mind. (1)

The spread between these scenarios is the "Ego Tax." It’s the price we pay when our ambition is driven by external validation rather than internal satisfaction. This tax can deplete our happiness, health, and relationships in pursuit of something that may not truly fulfill us.

While external recognition can be a powerful motivator, focusing too much on it can lead to paying the ego tax. This is similar to success addiction, where the relentless pursuit of external rewards leaves us perpetually dissatisfied, always chasing the next level of achievement or recognition.

We are always a blend of seeking external validation and pursuing internal satisfaction. The key is finding a balance between these motivations. Are we pursuing a goal because it aligns with our values and brings genuine satisfaction, or are we doing it solely for others' approval?

The ego tax is a hidden cost that many of us pay unknowingly. By recognizing when external validation drives our actions and striving for a balance between personal fulfillment and societal recognition, we can reduce this tax and lead happier lives.

True success and happiness come from within, not from the approval of others.

Notes

Of course, not everyone who is extremely successful is motivated purely by external status. However, it's important to keep this concept in mind, as most of us will find ourselves somewhere in the middle.

Life Portfolio

2024-06-18T16:37:03Z

Key Takeaway: investing time and energy into a diversified life portfolio yields a higher return on investment in terms of overall happiness and life satisfaction than focusing narrowly on any single area of life.

People often ask me if I’m ever going to start another company. I usually respond with “probably” or “I’m open to it.” But the truth is, I don’t have any desire to do so.

Pouring all my energy into one all-consuming startup can come at a significant cost. While I’m proud of what I’ve built, (and it's what I wanted to do at that time), I’ve realized that success isn’t just about financial gains or external validation - it’s about creating a life that balances achievement with fulfillment across multiple dimensions.

There are 168 hours each week, and at this stage in my life, I’m intentionally diversifying my time and energy across a broader life portfolio. Instead of solely focusing on any one single area such as starting another company, I’m investing in areas that matter most to me:

Nurturing meaningful relationships
Prioritizing quality family time
Pursuing creative projects that energize me
Giving back to my community in impactful ways
Creating content that inspires and adds value
Building small, fun software apps as labors of love
Cultivating hobbies that bring me joy and growth
Improving my physical and mental health
Seeking out new experiences that serve as memory dividends

Initially, this shift felt strange. I often find myself resisting it because it didn’t feel ambitious, or because it feels like I’m supposed to start a company. However, I’ve come to understand that this diversified approach aligns more with what I truly want to do with my time.

This approach doesn’t offer the same status or external validation as the traditional path. It also becomes very hard to turn off the dopamine-seeking part of your brain off that craves this validation.

I’ve learned that after a certain point, additional external success doesn’t contribute to overall happiness and has diminishing returns. Also, focusing solely on work can make you one-dimensional and negatively impact your well-being.

The principles I’ve learned from startups — being ambitious, working on hard things, and compounding efforts over time — also apply to designing a fulfilling life. Success isn’t about forcing a tradeoff between professional achievement and personal fulfillment. It’s about striving for a work-life-ambition balance that allows all three to coexist and feed off each other.

Ambition is still central to this balance, but it's mindful ambition—driven by intrinsic motivation and aligned with broader life goals. It moves away from chasing external validation towards pursuing what truly matters. It’s about having just enough drive to make an impact but not so much that it eclipses all the other things that make life worth living.

It feels strange not to “work” in the traditional sense, but I’m focusing my energy on different areas in different seasons. Right now, writing occupies a significant portion of my time and creative energy. Last year, during my sabbatical, I prioritized exploring hobbies and improving my health. This summer, I’ll shift gears to focus on travel and new experiences. It’s a diversified life portfolio.

In a world that glorifies the hustle and grind of the status game, this balanced approach is… different. But I’m learning that true success isn't about conforming to society—it's about having the courage to write your own, aligning with your definition of success. Breaking away from societal expectations requires a lot of courage and discipline.

I’m still very ambitious and aim to be highly successful in my work, but now my ‘score’ extends beyond just financial success or external status. I value quality craftsmanship and work that I’m proud of putting out into the world. Of course, I want to grow an audience and generate sizeable revenue for any company I build, but I want to do it on my own terms, taking a slower and calmer approach. If that means that I grow 50% YoY instead of 100% YoY, so be it.

For you, it could be building a $10M revenue calm business that gives you financial independence and work-life balance. Or, taking a job that allows you to work remotely, offering location flexibility. Or, it might mean pursuing a career that lights you up, even if it comes with a smaller paycheck, because the joy you get from the work exceeds anything else you could be doing with your time.

In my opinion, the ROI of a well-rounded life portfolio—rich in relationships, experiences, and personal growth—far exceeds that of a purely financial one. By embracing this unconventional approach, I'm designing a life that feels authentic, balanced, and true to my values.

I encourage you to reflect on your own life portfolio. Are you investing your time and energy in ways that align with your values and bring you fulfillment?

Post-Exit Maze

2024-06-10T17:55:44Z

I've been navigating the post-exit maze for 18 months, so I thought I would share some lessons I've learned for those looking to climb their second mountain (While I'll write this for other entrepreneurs, I believe the general advice can apply to anyone.)

Here's why it's so tricky for the repeat and post-exit founder: there's a riddle to solve.

The riddle is finding the next calling. Many post-exiters become investors, entrepreneurs again, philanthropists, or some version of a dilettante. The post-exit CEO seeks something sufficiently engaging, with self-imposed constraints like working only 20 hours per week, not traveling, and not managing too many people. It's a tricky ask and requires threading a tiny needle.

While I haven’t fully figured out this riddle, here are some tips and lessons:

Explore many interests without committing.
- Dabbling in various activities without the pressure to commit helps. For example, I tested out coaching by doing it for free with the expectation it would be short-term. When I didn’t enjoy it, I moved on.
- This approach allows you to try things out rather than just thinking about them. If you find something you enjoy, you can then make the next light commit to it.
Ask yourself a new set of questions.
- What makes me feel a sense of purpose?
- What makes me feel a sense of belonging?
- (Here are 12 more questions that can guide you through this exploration.)
Diversify your life buckets.
- If you’re like me, you might have put most of your energy into the work bucket. Imagine having 100 points to allocate across different areas of your life. You might have put 80 points into work. Now, as you figure out your next move, diversify these points into other areas such as family, health, relationships, community, and hobbies. Aim for a more balanced approach.

Moving on from what you did before to find something new will be challenging. I’m still figuring it out myself and haven’t fully succeeded yet. The most challenging part is finding a new calling that offers structure, meaning, flexibility, and gives you a sense of identity and purpose.

This journey involves a lot of introspection and self-discovery. It's not linear and can often feel like you’re going in circles, but I constantly remind myself to be patient. The most rewarding part of this journey, despite the challenges, is discovering new aspects of yourself and finding a purpose that brings you joy and fulfillment.

Modern Status Symbols

2024-06-09T14:44:35Z

Traditional status symbols focused on displaying wealth through luxury items like homes, cars, and designer clothes.

However, modern status symbols have shifted towards freedom: time, location, financial independence, mental peace, and more.

Here’s a short list:

Going on a sabbatical
Spending quality time with your kids
Having a biological age significantly younger than your actual age
High energy levels
Being sober
Living in different locations throughout the year
Achieving work-life integration
Stepping off the career hamster wheel
Expressing yourself creatively
Meeting-free calendar
Having “enough”
Retiring early
Low body fat %
Traveling for a psychedelic experience
Good taste
Long attention spans
Having multiple hobbies
Having unique or novel ideas
Saying what you think
Not working a traditional job

The ultimate flex is redefining success for yourself.

Otis Careers Page

2024-06-07T14:34:19Z

People often ask if I still have the Otis Careers page link—so here it is.

This document was initially written after a candidate interview. The candidate withdrew at the final stage due to unexpected salary bands.

To prevent this from happening again, I created a transparent document outlining our culture, compensation bands, and interview process. The goal was to attract candidates who were interested in our work culture.

It was fairly novel then, as very few companies publicly shared their compensation bands and included an equity calculator. Candidates really appreciated this level of transparency.

Some aspects were successful, others not, but overall, the document proved effective.

A few things to note:

We designed the Careers page to filter out candidates who didn't fit our culture, aiming to minimize the number of interviews.
From day one, we made our compensation public (link still active!).
We implemented a four-day workweek and saw no drop in productivity.

This was written in 2019 and hasn't been updated in years. If I revisited it now:

Remove the cringe Shackleton quote 😂
Hire mostly part-time, and not full-time
Pay above market, and not at 75%
Standardize salaries company-wide, and simplify it to three bands (junior, mid, and senior)
Have a single class of stock with annual liquidity windows
One team meeting every week.
Keep the four-day work week
Prioritize life profitability

If I ever start another company, I plan on creating a similar document and making it even more transparent.

Local Politics

2024-06-04T11:46:36Z

I was looking into GrowSF and was impressed (and inspired!) by their work. GrowSF is a Political Action Committee (PAC) based in San Francisco that wants to “create a San Francisco that works for everyone.”

Outcomes matter more than ideology, and our officials have failed at the basics: public safety, homelessness, housing, public education, and more. GrowSF pursues common sense solutions to create a San Francisco that works for everyone.

Their pragmatic approach focuses on addressing fundamental issues without being swayed by political rhetoric. They measure success by tangible improvements in the quality of life for all residents.

Their strategy is simple: build a trusted brand by publishing unbiased and well-researched voter guides, running political education events, keeping voters informed through weekly newsletters, and getting their community to push for reform, like recalling the school board.

“GrowSF's midterm voter guide was seen by about half of the 300,000 city residents who cast their ballots last week, Buss estimated based on website traffic.”

Their main issues are:

Build more housing
Improve public safety
Reduce homelessness
Streamline small business regulations
Improve public schools so they treat parents like partners
Make our public transit system fast, safe, and reliable
Ensure City Hall is free from corruption

These issues benefit the entire community, which attracts a bigger community, which makes the coalition larger, which leads to a higher probability of success and ultimately change.

Key points that stood out to me:

Most local politicians win by a few hundred or thousand votes.
“Just voting for a Democrat means nothing when every candidate is a Democrat and they all believe different things.”
A small, dedicated, and informed voter base can significantly impact local elections and drive lasting change.

GrowSF's model is a blueprint for cities nationwide. There are other organizations doing something similar but their approach is practical and effective, setting a standard for local civic engagement.

Is Software Dead?

2024-06-03T01:53:07Z

Two articles are circulating about what happens in a post-AI world.

Chris Paik's article, The End of Software, argues:

SaaS, ARR, and magic numbers are remnants of an old business model where software creation costs acted as a moat. With the advent of LLMs, this protective barrier will vanish. Majoring in computer science today is akin to majoring in journalism in the late '90s.

NFX's article, AI is Like Water, echoes this sentiment:

Historically, tech differentiation safeguarded software startups. If you built something unique, it provided temporary protection. However, AI has rendered tech differentiation meaningless, shrinking this moat.

Both articles convey the same message: software is no longer a moat or barrier to entry. It has become a commodity.

In a post-AI world:

Big venture returns will come from solving complex technical problems.
Software without protective moats will become a hobby or small business.
New generative AI wrappers will be cloned immediately.

As building software becomes exponentially cheaper and faster, we will see an explosion of companies competing against each other, which will make it difficult for any single company to monopolize a big market, capping the upside.

Of course, defensibility and moats are still important: data, network effects, and brand will continue to be important but will look different in a post-AI world.

But I also think the company that can figure out the new playbook to building a moat will win. Some ideas that come to mind: deeptech integrations, interoperability, and proprietary algorithms.

These elements create a flywheel where each component strengthens the others. Data improves algorithms; better algorithms attracts more users, generating more data. Network effects and a strong brand attract more users, enhancing data and algorithms. Deeptech integrations and interoperability expand the platform’s capabilities and ecosystem, attracting even more users. And so on.

Having multiple reinforcing flywheels that grow stronger as the platform scales will always be the winning formula. Companies that effectively combine these elements will create defensible moats in a post-AI world.

So an updated list would include: data, compute power, network effects, brand, DeepTech, algorithms, and interoperability.

That said, I still believe that the big 10,000x venture returns will come from solving very difficult technical problems. The era of building an “app” with “XYZ features” and charging a monthly subscription is DOA.

Seed Stage Philanthropy

2024-06-01T12:25:20Z

(This is a proposed project idea.)

Last night, I went down a deep rabbit hole in the world of grants. These grants range anywhere from $1,000 to $100,000, and are given to young people, usually under the age of 25, with no strings attached.

While all of the approaches are different, they have one thing in common: support remarkable individuals.

Well-known programs include the Thiel Foundation, 776 Fellowship, O’Shaughnessy Fellowship, Magnificent Grants and Awesome Foundation. Others that stood out to me are the 1517 Medici Project, Eclipse Grants, Cache Money, Protostars, and Inflection Grants. Some are focused on hard sciences like the Flux Capacitor, Aria, and Arc Institute. (1)

1517 is from the same team behind Thiel Foundation, who count individuals like Vitalik (Ethereum), Figma, and Longevity Fund as fellows. They have provided $1,000 micro-grants to over 3,000 young people and published a compelling essay on their philosophy of why others should do the same.

One of my favorites was the now-defunct Helium Grant from Nadia Asparouhova, who has written extensively about her process on how to give away $5,000.

She shared a guide on how to start one, including templates. She termed it seed stage philanthropy, focusing on funding individuals rather than organizations.

The idea that groundbreaking work is driven by individuals probably makes sense to a lot of people, yet in practice, there’s no readily available funding for individuals.

My only issue with some grant programs is they act as a dealflow funnel for larger tech funds. They may provide no-strings-attached money but often have an underlying expectation of investing into your company, if you ever start one. This is fine if transparent but feels purer without being associated with a tech venture fund.

Why this matters now:

We need more young people pursuing ambitious projects, especially those advancing society.
Young people often have fresh, innovative ideas but lack the financial resources to bring them to fruition. Micro grants can provide the necessary funding to kickstart these projects.
There is a lot of capital on the sidelines that want to be put to “good” in non-traditional ways.

Given this, I've been considering starting a micro-grant program:

I would begin with 10 micro-grants of $1,000 each. No strings attached. Sent via Venmo, Paypal, or USDC.
Grants would be awarded on a cohort basis, with specific application periods.
Focus would be on individuals working on projects that advance society.

I would measure returns by what Nadia describes as:

“Returns are measured by social capital: if a grantee does something admirable or interesting in the world, they make you look good.”

This could create a flywheel: the more grantees who achieve something significant, the bigger the brand, making it more selective and impactful. The true value would lie not just in the micro-grant itself but in being recognized as a fellow. This recognition could open doors to additional opportunities, networks, and resources.

My hope is that it opens up doors for founders, writers, scientists, journalists, artists, scientists, and anyone looking to make an impact in the world.

If successful, this could scale to $10,000 and eventually $100,000 grants, potentially turning into a nonprofit organization. This could also foster a new type of fund where individuals raise money to issue micro-grants, similar to seed stage philanthropy.

Like most ideas I get excited about, I’ll ice this idea for a few months to see if I am still excited about it. But for now, I’ll put this out there to see if any better ideas emerge.

Notes

If you are interested in seeing a full list, someone has put together a handle excel file here.

Career Advice

2024-05-31T12:48:15Z

If I were in my 20s today, here’s what I’d do:

Get good at spotting and generating novel ideas. This is the most valuable skill in a post-AI world.
Avoid joining any seed-stage startup founded by a first-time founder, pre-product-market fit. The risk/reward tradeoff is terrible: high risk of failure, not enough equity to make it worthwhile.
Get your first win. Start with a cashflow bet to generate income, then swing for the fences with a venture bet. With money in the bank, you’ll be more ambitious.
Take asymmetric risks where the potential upside greatly outweighs the potential downside. Jump on golden opportunities when they present themselves.
Play the game in what feels like "easy mode" to you but appears as "hard mode" to everyone else. Double down on your strengths. Don’t worry too much about your weaknesses.
Build an audience. It’s a high-leverage investment that compounds over decades.
Prioritize your health. Exercise, eat well, sleep enough, manage stress. Make it a habit. Skip the alcohol. Treat it like an investment in yourself.
Get the big life decisions right. It's more important to be really right on a few key decisions than to be right often on many small ones.
Go down unconventional paths. Just because everyone else is doing something doesn’t mean it’s right for you. Redefine success for yourself.
Chase internal fulfillment. Have the courage to pursue what matters most to you, even if it defies convention.

In your 20s, you have the most abundant asset: time.

Use it to take bold bets on yourself. Optimize for the long-term over the short-term. And don’t settle.

Founder Diversification

2024-05-30T13:29:59Z

I'm noticing a trend with young founders who categorize their software ideas into two buckets:

Cashflow Bet: generates income ranging from $10K to $1M+. These are simple and boring ideas that require minimal team involvement. They tend to be bootstrapped and has a lifestyle business vibe.
Venture Bet: involves high-risk, high-reward moonshots using cutting-edge technology. It requires raising capital and has a long-term focus.

If I were in my 20s without a venture idea, I’d start with a cashflow bet. It teaches the basics of getting something off the ground, building a product, and marketing it. I’d choose this over college.

If I had a compelling venture idea and the timing was perfect, I’d pursue that. However, more often than not, a) founders lack a unique idea, and b) they rush into ventures based on current VC trends. It’s better to start with a cashflow bet since rushing into an idea often leads to failure.

This barbell approach creates a diversified portfolio. Most start with the cashflow bet to generate income, enabling them to swing for fences with the venture bet.

Founder diversification.

Calm Ambition

2024-05-29T20:20:45Z

It drives me nuts when people think a lifestyle business means you’re not ambitious.

Just because you want more balance in your life and prefer a slower, calmer approach doesn’t mean you lack ambition. The two are not mutually exclusive.

Here’s how I view it:

The goal is to build a business that complements your lifestyle, not one that consumes it. It’s possible to work on something ambitious without sacrificing health, personal relationships, or passions.
I don’t aim to build a billion-dollar company, but if we get lucky and that happens, I’ll ride that wave.
Ambition and calm can coexist, and success doesn't always have to mean burning out.
I am driven by the desire to create something meaningful and impactful while maintaining a sense of balance and peace in my life.

Operating at extremes for a long period isn’t sustainable. It leads to burnout or a complete lack of purpose. For me, being somewhere in the middle is optimal. I can fluctuate towards either side for short periods, but staying there isn’t ideal.

The tension between calm and ambition is what creates balance. By embracing intrinsic motivators like quality craftsmanship and being purpose-driven, while maintaining ambition, you can strike the right balance. Although it may sound counter-intuitive, this approach can lead to success across both dimensions.

If I bootstrapped a company and grew it to $10M while maintaining my relationships, health, and having fun, flexibility, and freedom, I would take that over building a $100M business that costs me my health, relationships, and peace of mind.

The spread between these two scenarios is what I call the “ego tax.” The ego tax is the price we pay when our ambition is driven by external validation rather than internal satisfaction. It drains our happiness, health, and relationships in pursuit of something that may not truly fulfill us.

My ambition is balanced with calm and purpose. It's about building a business that creates a meaningful impact, respects my personal relationships and health, and aligns with the lifestyle I want. A calm ambition allows me to enjoy the journey and achieve success on my own terms.

Family Values

2024-05-28T12:57:25Z

I am currently reading “The Secrets of Happy Families” by Bruce Feller, and I highly recommend it.

He borrows principles from agile development and the tech industry and applies them to family life. One example is holding weekly family meetings to discuss issues and improvements, similar to a retrospective aimed at continuous improvement.

Much like a company culture, it’s important to clarify your family’s vision, mission, values, and principles. For our family, we’re in the process of defining our values. (1)

Here’s our approach:

I’m compiling a full list of potential values (2)
Each family member will pick a few values that are important to them.
We’ll identify common values and narrow the list to 4 - 7 core values. We will start on the lower end and add more over time.

I plan to reinforce these values through daily interactions. We’ll pair our values with easy-to-remember phrases, such as “We can do hard things,” and print out our favorites.

Core values are important because they provide a clear framework for decision-making that aligns with our family’s core beliefs. For example, if Service is a core value, our actions should reflect this by volunteering at the local animal shelter, donating money, etc. This builds a solid foundation that will hopefully carry into our children’s lives as they enter the real world.

By grounding our family in these shared values, we establish what matters to us, ensuring we can create a legacy to be passed down to future generations.

Notes

I define values as individual traits, while principles are guidelines derived from those values that dictate how we should behave and interact. For example, Honest is a Value, while “Always tell the truth” would be a principle.
Here are some examples of values:

Respect: Treating each other with kindness and consideration.
Honesty: Being truthful and transparent in our actions and words.
Responsibility: Taking ownership of our actions and duties.
Love and Support: Showing unconditional love and being there for each other.
Learning and Growth: Encouraging continuous learning and self-improvement.
Health: Prioritizing physical and mental well-being.
Generosity: Being kind and giving to others.
Fun and Adventure: Making time for fun and new experiences together.

Michael Karnjanaprakorn

2025 Lipoprotein(a) Update

Advice

Playing to Win

Rate of Learning

How to Get Hired at a Startup

Think like a Founder

Be Extraordinary

A Story

Energy

Lipoprotein(a) Update

Ideal Work Lifestyle

Minimalist Finances

Tackling High Lipoprotein(a) aka The Silent Heart Killer

Background

Initial Results

Heart Disease

Lipoprotein(a)

Treatment

Statins Among Young Adults

My Plan

Follow-Up Results

New Update (10/8/2024)

Updated Plan

Final Thoughts

Protocol for Heart Disease Prevention

Further Reading

Multi-Faceted Identity

Phone Addiction

Retirement Number

Ego Tax

Life Portfolio

Post-Exit Maze

Modern Status Symbols

Otis Careers Page

Local Politics

Is Software Dead?

Seed Stage Philanthropy

Career Advice

Founder Diversification

Calm Ambition

Family Values