Under Load

Andre Heeg
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Under Load is the weekly audio edition of Andre Heeg’s newsletter for senior leaders and business owners carrying heavy responsibility. Each episode examines how demanding work affects your health, energy, judgment, and life outside work. Andre draws on current research through the lens of his medical training and business experience. The result is practical guidance built for the reality of leadership. New episodes every Sunday. Read the full editions and supporting evidence at andreheeg.com.

  1. 4日前

    My Prostate Report Wanted 25%. I Had 10%.

    On my way home from San Francisco, I checked my Function Health results. My PSA was 5.0, higher than the usual cut-off of 4. Only 10% of it was floating free in the blood, and the report wanted more than 25%. The clinician note called it "a red flag." I'm a doctor, so I knew PSA can change for harmless reasons. I still made an appointment with a urologist. This episode follows that result from the lab report to the MRI, and checks the numbers along the way. It starts with why men wait: the rectal exam many dread, and a pattern I call information loses to incentives. Your Tuesday meeting has a calendar invite. Your prostate doesn't. Germany's 2025 guideline says doctors should not use the finger exam for early detection, yet public insurance still pays for the finger exam from 45 and not for the PSA test. Then the evidence. The largest European trial invited men aged 55 to 69 to regular PSA tests and followed them for 23 years: one death from prostate cancer prevented for every 456 men invited, with 12 extra men diagnosed for each death prevented. A Swedish study found that men in the top tenth of PSA at age 45 to 49 accounted for 44% of later prostate cancer deaths. And in one American study, about 4 out of 10 men with a high PSA had a normal result at one or more later yearly checkups. The 25% free-PSA cutoff comes from a 1998 study of men aged 50 to 75 with a PSA between 4 and 10, nearly half of whom had cancer. With 25% as the line, 95 out of 100 men with cancer fell below it, and so did about 80 out of 100 men whose biopsies were normal. My Berlin lab uses 15% for the same ratio. Along the way: the strongest case against screening, from Germany's evidence institute IQWiG, and what a British trial showed when doctors watched instead of treating. The episode closes with how I chose between an MRI and micro-ultrasound, what the one large trial of micro-ultrasound showed, what my MRI found, my verdicts, and three things you can do today. In this episode: Why men wait, and the exam that's on its way out as a screening test.Germany's mismatch: insurance pays for the finger exam, not the PSA test.Screening saves lives, slowly: one death prevented for every 456 men invited.One PSA at 45 tells you a lot.A high PSA is a question: size, inflammation, ejaculation and finasteride.Where the 25% free-PSA cutoff comes from, and who was in the study.MRI or micro-ultrasound: I chose by calendar.What my MRI found, in three words of German.My verdicts, and three things to do today.Visit The Upward ARC and subscribe. Under Load is the Sunday edition of The Upward ARC, by Andre Heeg, MD, DDS, doctor and dentist, trained in facial surgery. This edition sits within the Capacity pillar: what helps you carry the load at 50 and at 70. This episode is general health education, not individual medical advice. If your PSA is high, or you're not sure when to start testing, talk to your doctor. Key sources Leitlinienprogramm Onkologie, 2025: S3-Leitlinie Prostatakarzinom, Kurzversion 8.1.Prostate Cancer Foundation of Australia, 2026: 2026 guidelines for the early detection of prostate cancer in Australia.Cornford et al., 2026: EAU guidelines on prostate cancer (March 2026 update).Gemeinsamer Bundesausschuss, 2025: Früherkennung von Prostatakrebs: G-BA prüft risikoabhängiges Angebot.Roobol et al., 2025: European study of prostate cancer screening: 23-year follow-up.Hamdy et al., 2023: Fifteen-year outcomes after monitoring, surgery, or radiotherapy for prostate cancer.IQWiG, 2026: Risikoadaptiertes PSA- und MRT-Screening, Vorbericht S25-02.Vickers et al., 2013: PSA at age 40-55 and long-term risk of metastasis.Lin et al., 2026: Updates to early detection of prostate cancer: AUA/SUO guideline (2026).Nadler et al., 1995: Effect of inflammation and benign prostatic hyperplasia on elevated serum PSA levels.Tchetgen et al., 1996: Ejaculation increases the serum prostate-specific antigen concentration.D'Amico & Roehrborn, 2007: Effect of 1 mg/day finasteride on serum PSA in men with androgenic alopecia.Eastham et al., 2003: Variation of serum PSA levels: year-to-year fluctuations.Catalona et al., 1998: Use of the percentage of free PSA to differentiate prostate cancer from benign prostatic disease.Kinnaird et al., 2025: Microultrasonography-guided vs MRI-guided biopsy: the OPTIMUM randomized clinical trial.Kasivisvanathan et al., 2018: MRI-targeted or standard biopsy for prostate-cancer diagnosis (PRECISION).

    My Prostate Report Wanted 25%. I Had 10%.

  2. 10月31日

    14.8% Vape. 3.4% Smoke.

    The tumor is out, and the hole is bigger than you'd expect. During my surgical residency, I was at the table for dozens of mouth cancer operations. When the cancer reaches the jaw, surgeons rebuild it from the fibula, the thin bone in the lower leg. Most of those patients smoked. Years later, I put a nicotine pouch under my own lip to see if it would sharpen my focus. Fifteen minutes later, I was in the bathroom. This episode looks at where the nicotine went: into vapes, into pouches, into the office fridge. It starts on the maxillofacial ward, with the pattern we called the deadly triad, and with an uncomfortable fact: doctors know exactly where smoking leads, and plenty of them still smoke. I call that information loses to incentives. A cigarette pays out within minutes. The bill comes twenty or thirty years later. Then the numbers that matter. In a pooled analysis of 17 studies with more than 11,000 head and neck cancer patients, heavy smoking plus heavy drinking came to about 14 times the odds of these cancers, compared with people who did neither. The good news is just as clear: quitting before 40 was linked to avoiding about 90% of the extra risk of dying early that smoking adds, and quitting in your 40s still avoided most of it. Among US 18- to 24-year-olds, 14.8% vaped in 2024 and only 3.4% smoked. For a smoker, the evidence is on the vape's side: across 11 trials, about 4 more people in every 100 quit with a vape than with patches or gum. For someone who never smoked, none of that applies. The episode closes with a check of ZYN's new FDA-authorized claim, my verdicts on each nicotine product, and three things you can do this week. In this episode: - The deadly triad: smoking, drinking, and a mouth nobody looked after.- Information loses to incentives: why doctors who know still smoke.- Smoking plus drinking: about 14 times the odds of head and neck cancer.- Quit before 40, and most of the extra risk is gone. The mouth recovers too.- Why teenagers pick flavored vapes over cigarettes.- For a smoker, a vape is the best exit, with two catches.- Heated tobacco and the trials funded by tobacco companies.- The pouch I tried once, and the mechanism trap behind nicotine for focus.- ZYN's new claim and the comparison in the fine print. [Visit The Upward ARC and subscribe](https://www.andreheeg.com). Under Load is the Sunday edition of The Upward ARC, by Andre Heeg, MD, DDS, doctor and dentist, trained in facial surgery. This edition sits within the Capacity pillar: what you can still do at 70, from thinking clearly to eating and talking without effort. This episode is general health education, not individual medical advice. If you want to stop smoking, vaping or using nicotine, talk to your doctor. ### Key sources - [Gioino (Fortune), 2026](https://fortune.com/2026/03/04/palantir-tech-companies-offices-vending-machines-tobacco-worker-productivity/): Palantir and other tech companies are stocking offices with nicotine products to increase worker productivity.- [Hashibe et al., 2009](https://doi.org/10.1158/1055-9965.EPI-08-0347): Interaction between tobacco and alcohol use and the risk of head and neck cancer.- [Cho et al., 2024](https://doi.org/10.1056/EVIDoa2300272): Smoking cessation and short- and longer-term mortality.- [Marron et al., 2010](https://doi.org/10.1093/ije/dyp291): Cessation of alcohol drinking, tobacco smoking and the reversal of head and neck cancer risk.- [Agaku, 2026](https://doi.org/10.1056/EVIDpha2500339): Tobacco product use among U.S. adults, 2023–2024.- [Park-Lee et al., 2026](https://doi.org/10.1093/ntr/ntag116): Tobacco product use among middle and high school students in the United States: National Youth Tobacco Survey, 2025.- [U.S. Department of Health and Human Services, 2016](https://www.ncbi.nlm.nih.gov/books/NBK538680/): E-cigarette use among youth and young adults: A report of the Surgeon General.- [Lindson et al., 2026](https://doi.org/10.1002/14651858.CD010216.pub11): Electronic cigarettes for smoking cessation (Cochrane).- [Hajek et al., 2019](https://doi.org/10.1056/NEJMoa1808779): A randomized trial of e-cigarettes versus nicotine-replacement therapy.- [Goniewicz et al., 2018](https://doi.org/10.1001/jamanetworkopen.2018.5937): Comparison of nicotine and toxicant exposure in users of electronic cigarettes and combustible cigarettes.- [Tattan-Birch et al., 2022](https://doi.org/10.1002/14651858.CD013790.pub2): Heated tobacco products for smoking cessation and reducing smoking prevalence (Cochrane).- [Heishman et al., 2010](https://doi.org/10.1007/s00213-010-1848-1): Meta-analysis of the acute effects of nicotine and smoking on human performance.- [Mallock et al., 2024](https://doi.org/10.1136/tc-2022-057280): Levels of nicotine and tobacco-specific nitrosamines in oral nicotine pouches.- [U.S. Food and Drug Administration, 2026](https://www.fda.gov/tobacco-products/ctp-newsroom/fda-authorizes-20-zyn-nicotine-pouches-be-marketed-specific-modified-risk-claim): FDA authorizes 20 ZYN nicotine pouches to be marketed with specific modified risk claim.- [National Health Service, n.d.](https://www.nhs.uk/conditions/mouth-cancer/symptoms/): Mouth cancer: Symptoms. ### Audio note The recording is the written edition adjusted for listening. Some figures are rounded, and citations are left out. Every study is referenced in the written edition at andreheeg.com.

    14.8% Vape. 3.4% Smoke.

  3. 10月24日

    Perimenopause Insomnia and the 3am Wake: Estrogen, Progesterone, Hot Flashes and CBT-I Explained Simply

    Almost every night for six months, my wife Erna has opened her eyes at 3:30, sometimes 4, with her body already tense. No worry she can name, no way back to sleep. Fifteen years ago in New York, she told me she couldn't get up before 7, no matter what she did. Now her body wakes her in the dark. Erna has read and approved every word of this episode, because she wants this out in the open. This episode is the simplified version: broad strokes, so it's easy to follow. I explain what estrogen and progesterone do, what changes in perimenopause and menopause, and why the symptoms are so mixed. A large 2026 analysis found insomnia symptoms in about 27% of women in perimenopause and 42% after menopause. Then I look at three things that seem to work together to break sleep: the brain's thermostat, a missing calm, and an alarm the brain learns. In this episode: - What estrogen and progesterone do, explained over coffee.- Menopause, perimenopause, and why the hormones swing before they drop.- Why night hot flashes can wake you even when you don't notice them. In one study of 168 women, the odds of waking were over five times higher during a measured flash.- GABA, the brain's brake pedal, and why progesterone matters for sleep.- How the brain learns to wake, and why I couldn't find good evidence for the "3am cortisol spike."- A progestin prescribed for sleep, and why that prescription needed a second look.- The 2002 Women's Health Initiative scare in absolute numbers, and the FDA's 2026 label change.- What helps: hormone therapy, micronized progesterone, and CBT-I, which in one trial brought 70% of the assessed women in the CBT-I group out of the insomnia range in 8 weeks, against 24% with education alone.- What to do if you're the one sleeping next to it. The episode closes with questions to take to your next appointment. [Visit The Upward ARC and subscribe](https://www.andreheeg.com). Under Load is the Sunday edition of The Upward ARC, by Andre Heeg, MD, DDS, physician and reconstructive facial surgeon. This edition sits within the Recover pillar, with Activate: helping the nervous system return to baseline, and sleep as a daily input. This episode is general health education, not individual medical advice. For your own symptoms or decisions, talk to your doctor. ### Key sources - [Merck Manual Consumer Version, 2026](https://www.merckmanuals.com/home/women-s-health-issues/menopause/menopause): Menopause.- [McEvoy & Osborne, 2019](https://doi.org/10.1080/09540261.2018.1553775): Allopregnanolone and reproductive psychiatry: An overview.- [Balasubramanian et al., 2026](https://doi.org/10.1016/j.genhosppsych.2026.03.010): Prevalence and incidence of depressive, anxiety, and insomnia symptoms in perimenopausal and postmenopausal women: Systematic review and meta-analysis.- [Prague et al., 2017](https://doi.org/10.1016/S0140-6736(17)30823-1): Neurokinin 3 receptor antagonism as a novel treatment for menopausal hot flushes: A phase 2, randomised, double-blind, placebo-controlled trial.- [Thurston et al., 2019](https://doi.org/10.1093/sleep/zsz131): Hot flashes and awakenings among midlife women.- [Fachinfo-Service, n.d.](https://www.fachinfo.de/fi/detail/013955/jubrele): Jubrele 75 Mikrogramm Filmtabletten: Fachinformation (Desogestrel).- [Nolan et al., 2021](https://doi.org/10.1210/clinem/dgaa873): Efficacy of micronized progesterone for sleep: A systematic review and meta-analysis of randomized controlled trial data.- [British Menopause Society, n.d.](https://thebms.org.uk/wp-content/uploads/2023/04/14-BMS-TfC-Progestogens-and-endometrial-protection-APR2023-A.pdf): Progestogens and endometrial protection [BMS Tools for Clinicians].- [Rossouw et al., 2002](https://doi.org/10.1001/jama.288.3.321): Risks and benefits of estrogen plus progestin in healthy postmenopausal women: Principal results from the Women’s Health Initiative randomized controlled trial.- [U.S. Food and Drug Administration, 2026](https://www.fda.gov/news-events/press-announcements/fda-approves-labeling-changes-menopausal-hormone-therapy-products): FDA approves labeling changes to menopausal hormone therapy products [Press release]..- [The North American Menopause Society, 2022](https://doi.org/10.1097/GME.0000000000002028): The 2022 hormone therapy position statement of The North American Menopause Society.- [Cintron et al., 2017](https://doi.org/10.1007/s12020-016-1072-9): Efficacy of menopausal hormone therapy on sleep quality: Systematic review and meta-analysis.- [Edinger et al., 2021](https://doi.org/10.5664/jcsm.8986): Behavioral and psychological treatments for chronic insomnia disorder in adults: An American Academy of Sleep Medicine clinical practice guideline.- [McCurry et al., 2016](https://doi.org/10.1001/jamainternmed.2016.1795): Telephone-based cognitive behavioral therapy for insomnia in perimenopausal and postmenopausal women with vasomotor symptoms: A MsFLASH randomized clinical trial.- [somnio, 2025](https://somn.io/fachkreise/somnio-verschreiben/): So verordnen Sie somnio Ihren Patient:innen..- [Dunietz et al., 2026](https://doi.org/10.1016/j.chest.2025.08.001): OSA in women: Associations with reproductive aging and screening challenges. ### Audio note The recording is the written edition adjusted for listening. Some figures are rounded, and citations are left out. Every study is referenced in the written edition at andreheeg.com. ### How I use AI AI assisted with research, drafting and adapting this piece for different formats. I chose the argument and examples, reviewed the evidence, edited the final text and take responsibility for every published claim.

    Perimenopause Insomnia and the 3am Wake: Estrogen, Progesterone, Hot Flashes and CBT-I Explained Simply

  4. 10月17日

    Working While Sick, Flu Shots and Immune Supplements: A Doctor's Winter Guide to Colds and Flu

    It started in my right ear. By Tuesday I was standing at the bathroom sink with a lamp, looking down my own throat at a swelling I had only ever seen in patients. As a maxillofacial surgeon I've examined countless throats, but tonsils belong to the ENT doctors, so I saw a colleague. By Thursday it was peritonsillitis. He offered the hospital and a tonsillectomy, or high-dose antibiotics. I picked the one without the hospital bed. I'm fine now. My best guess is that it started in Munich, at Bits & Pretzels during Oktoberfest, where I host a table for health care founders every year. I came home with what felt like a cold and kept going. Then I went back to work with the swelling still there. I pushed through twice. This episode of Under Load looks at why so many of us do that, and what's worth doing this winter instead. In a study of 12,935 Danish workers, more than 70% went to work sick at least once a year, and supervisors and people working more than 45 hours a week did it more often. Going in sick often was linked to more long sick leave later. When workers in the US got access to paid sick leave, flu-like illness dropped by roughly 5 to 6%. In this episode: Why a beer tent is an extreme version of any crowded winter room: loud speech releases about ten times more particles than quiet speech.What one heavy drinking session did to immune cells in 15 healthy volunteers, and what that study can't tell us.The realistic plan for when you can't take the week off: stay home while you have a fever, work from home if you feel up to it, cancel the dinner, keep the call.The NHS throat red flags that mean emergency department now.Fresh air in meeting rooms, and what Germany's Federal Environment Agency tells schools.Sleep and colds: about four times the odds of getting sick under six hours, in a small virus-challenge study.The flu shot in absolute numbers, who STIKO and the CDC recommend it for, and why I get it.Hand washing: about one in seven respiratory infections avoided.Vitamin C, vitamin D, zinc lozenges and echinacea: what the evidence shows, and what I'd stop buying.The episode closes with five things to do this week and a promise for next year's Wiesn. Visit The Upward ARC and subscribe. Under Load is the Sunday edition of The Upward ARC, by Andre Heeg, MD, DDS, physician and reconstructive facial surgeon. This edition sits within the Activate pillar, with Recover: the daily inputs you control, and knowing when to stop. This episode is general health education, not individual medical advice. For your own symptoms or decisions, talk to your doctor. Key sources Cheng, 2026, MSD Manual Professional Version: peritonsillar abscess and cellulitis.Herold et al., 2025, Health Policy: Oktoberfest 2022 and COVID-19 infection rates.Asadi et al., 2019, Scientific Reports: voice loudness and aerosol emission.Afshar et al., 2015, Alcohol: immune effects of binge drinking.Ebrahim et al., 2013, Alcoholism: Clinical and Experimental Research: alcohol and sleep.Hansen & Andersen, 2008, Social Science & Medicine: going to work ill.Nordenmark et al., 2019, Safety and Health at Work: presenteeism among the self-employed.Bergström et al., 2009, Journal of Occupational and Environmental Medicine: presenteeism and later sickness absence.Heikkinen & Järvinen, 2003, The Lancet: the common cold.Pichler & Ziebarth, 2017, Journal of Public Economics: sick pay and contagious presenteeism.Schwellnus et al., 2022, British Journal of Sports Medicine: IOC consensus on acute respiratory infections in athletes.NHS, 2024: tonsillitis.Earwood et al., 2018, American Family Physician: ear pain.Galioto, 2017, American Family Physician: peritonsillar abscess.Milton et al., 2000, Indoor Air: ventilation and sick leave.Umweltbundesamt, 2021: ventilating classrooms.Prather et al., 2015, Sleep: sleep and susceptibility to the common cold.Demicheli et al., 2018, Cochrane: flu vaccines in healthy adults.KBV, 2026: STIKO influenza vaccination recommendations 2026/27.CDC, 2025: who needs a flu vaccine.Spiegel et al., 2002, JAMA: sleep deprivation and vaccine response.Jefferson et al., 2023, Cochrane: physical interventions against respiratory viruses.Chastin et al., 2021, Sports Medicine: physical activity and infectious disease.Grande et al., 2020, Cochrane: exercise and acute respiratory infections.Klug et al., 2013, European Archives of Oto-Rhino-Laryngology: smoking and peritonsillar abscess.Hemilä & Chalker, 2013, Cochrane: vitamin C and the common cold.Jolliffe et al., 2025, The Lancet Diabetes & Endocrinology: vitamin D and acute respiratory infections.Nault et al., 2024, Cochrane: zinc for the common cold.Hemilä, 2017, JRSM Open: zinc lozenges meta-analysis.Hemilä et al., 2020, BMJ Open: zinc acetate lozenges trial.Karsch-Völk et al., 2014, Cochrane: echinacea and the common cold.Audio note Andre reads the written newsletter, adapted for speech. Inline citations are omitted, and some numbers are rounded. The written edition contains the full references. How I use AI AI assisted with research, drafting and adapting this piece for different formats. I chose the argument and examples, reviewed the evidence, edited the fina...

    Working While Sick, Flu Shots and Immune Supplements: A Doctor's Winter Guide to Colds and Flu

  5. 10月10日

    Huberman’s Protocols, Checked by a Doctor: Morning Sunlight, Caffeine, Alcohol and Strength Training

    For years I've told people the same thing: get outside in the morning, move, catch some daylight. The advice came from Andrew Huberman's podcast, which I had followed for years. When his book Protocols came out on September 15, I started reading right away. After about 20 pages I stopped. The book gives morning light a dose: five to ten minutes on a clear day, fifteen if it's cloudy, thirty if it's heavily overcast. I had passed on those numbers without ever asking where they came from. So I went looking. This episode of Under Load is a doctor's check of the 47 protocols in the book, from the perspective of a physician and a busy person. The book's notes hold 1,126 numbered entries and about 1,730 references. With AI help, I matched them to 1,243 different papers in PubMed and pulled 438 Huberman Lab podcast transcripts. Then I reviewed every protocol myself. About 1 in 11 of those papers is tagged as a randomized trial. 22 of the 47 protocols give a specific number of minutes, grams or degrees that I couldn't find a study to support. Follow all 47 as written and you'd need about 25 hours a week. In this episode: - Where the morning sunlight minutes came from, and what the research on daylight, sleep, mood and mortality shows.- The "50 percent cortisol" claim, and the lab study of eight sleep-deprived men behind it.- A reader who wakes up in the dark nine months a year, my Berlin winters, and the 10,000 lux lamp on our breakfast table.- Caffeine: where the book and the data agree, and the morning coffee delay I couldn't find a trial for.- Alcohol: why I'd replace the 8-hour rule with a simpler one. No amount has been shown to help you live longer.- Strength training: what the mortality data support, and why I train six to seven hours a week anyway.- Why health research describes the average person, and how to test advice on yourself without doing anything harmful.- Two protocols where the risk outweighs the benefit: warming the bedroom before waking, and sun on bare skin for testosterone. The episode closes with seven habits that made the cut, most of which take no extra time: a fixed wake time, a coffee cutoff, no nightcap, about 7,000 steps a day, strength and cardio twice a week, and a mostly unprocessed diet built on protein and plants. [Visit The Upward ARC and subscribe](https://www.andreheeg.com). Under Load is the Sunday edition of The Upward ARC, by Andre Heeg, MD, DDS, physician and reconstructive facial surgeon. This edition sits within the Activate pillar: sleep, movement and food. This episode is general health education, not individual medical advice. For your own symptoms or decisions, talk to your doctor. ### Key sources - Huberman, A. D. (2026). *Protocols: An Operating Manual for the Human Body*. Simon & Schuster.- [Burns et al., 2021, *Journal of Affective Disorders*](https://doi.org/10.1016/j.jad.2021.08.056): outdoor light, mood and sleep in UK Biobank.- [Windred et al., 2024, *PNAS*](https://doi.org/10.1073/pnas.2405924121): day and night light exposure and mortality in 88,905 people.- [Leproult et al., 2001, *Journal of Clinical Endocrinology & Metabolism*](https://doi.org/10.1210/jcem.86.1.7102): morning bright light and cortisol.- [Pjrek et al., 2020, *Psychotherapy and Psychosomatics*](https://doi.org/10.1159/000502891): light therapy for seasonal affective disorder.- [Gardiner et al., 2023, *Sleep Medicine Reviews*](https://doi.org/10.1016/j.smrv.2023.101764): caffeine and sleep.- [Zhao et al., 2023, *JAMA Network Open*](https://doi.org/10.1001/jamanetworkopen.2023.6185): daily alcohol intake and all-cause mortality.- [Bagnardi et al., 2013, *Annals of Oncology*](https://doi.org/10.1093/annonc/mds337): light drinking and cancer.- [Gardiner et al., 2025, *Sleep Medicine Reviews*](https://doi.org/10.1016/j.smrv.2024.102030): alcohol and sleep.- [Momma et al., 2022, *British Journal of Sports Medicine*](https://doi.org/10.1136/bjsports-2021-105061): muscle-strengthening activity and mortality.- [Okamoto-Mizuno & Mizuno, 2012, *Journal of Physiological Anthropology*](https://doi.org/10.1186/1880-6805-31-14): thermal environment and sleep.- [Parikh et al., 2021, *Cell Reports*](https://doi.org/10.1016/j.celrep.2021.109579): UVB exposure and sex hormones.- International Agency for Research on Cancer, 2012, IARC Monographs Vol. 100D: solar and ultraviolet radiation.- [Windred et al., 2024, *Sleep*](https://doi.org/10.1093/sleep/zsad253): sleep regularity and mortality.- [Ding et al., 2025, *The Lancet Public Health*](https://doi.org/10.1016/S2468-2667(25)00164-1): daily steps and health outcomes.- [Bull et al., 2020, *British Journal of Sports Medicine*](https://doi.org/10.1136/bjsports-2020-102955): WHO guidelines on physical activity.

    Huberman’s Protocols, Checked by a Doctor: Morning Sunlight, Caffeine, Alcohol and Strength Training

  6. 10月3日

    Use It or Lose It: How Senior Leaders Lose Skills, and How to Get Them Back

    My flight from Berlin to Munich was delayed by an hour, so I found a seat in the lounge and opened the October issue of manager magazin. The cover story, "Das große Rauswerfen," says tens of thousands of German executives are losing their jobs. In 2025, Germany had an average of 49,000 unemployed managers, the highest number since 2015. As I read the article, many of these managers spent years coordinating other people's work. Their companies asked them to do exactly that. I don't know why any one of them lost a job, and I won't guess. The article made me ask one question: what am I doing to protect myself from a professional setback? My honest answer was uncomfortable. Over the years, I've lost the skill of making things. This episode of Under Load looks at what happens to skills you stop using, and at what I've been doing about it. In 2025, 4 economists published data on German adults aged 16 to 65 who took a reading and a math test, and took them again about 3.5 years later. On average, skills kept improving into midlife. Reading peaked at 46 and math at 41. People who used their skills more showed no average decline at any age. For people who used them less, the decline began in the mid-30s. The study measured reading and math only, and it can't prove that using a skill protects it. I also look at the hardship we buy: cold showers, the sauna, the misogi, backyard ultras. I like all of it. I haven't found any evidence that it keeps work skills sharp. We also cover: Why a promotion changes what you do every day, and which tasks are often handed off first.What Andrew Huberman told Joe Rogan about hard things and impulse control, and why I leave that question open.The misogi and Marcus Elliott's 2 rules, as told by Michael Easter.The IKEA experiment from 2011: people who built a storage box bid $0.78 for it, others bid $0.48, and the effect only appeared when they finished the job.Huberman's story of the man at the edge of the boxing ring.What my first LinkedIn posts with 5 likes taught me, and 4 things I've built since.One open question I don't answer: what happens over time if we hand even more of the thinking and doing to AI.The episode closes with 3 things to try: take stock of what you no longer make, create one first version yourself, and try a small misogi at work. Visit The Upward ARC and subscribe. Under Load is the Sunday edition of The Upward ARC, by Andre Heeg, MD, DDS, physician and reconstructive facial surgeon. This edition sits within the Capacity pillar: what you can still do, kept alive by actually doing it. Key sources manager magazin, October 2026 (issue 10/2026): cover story "Das große Rauswerfen."Handelsblatt, January 14, 2026: unemployment among managers in Germany.Deutsche Presse-Agentur via Autohaus, September 30, 2026: BMW management cuts by mid-2027.Hanushek, Kinne, Witthöft & Woessmann, 2025, Science Advances: age and cognitive skills, "use it or lose it."The Joe Rogan Experience, No. 2553, Andrew Huberman, September 14, 2026.EconTalk, July 19, 2021: Michael Easter on the comfort crisis and the misogi.Itzler, 2015, Living with a SEAL: 31 Days Training with the Toughest Man on the Planet.Runner's Tribe, June 26, 2025: backyard ultra record of 119 loops.Norton, Mochon & Ariely, 2011, Harvard Business School Working Paper 11-091: the "IKEA effect."

    Use It or Lose It: How Senior Leaders Lose Skills, and How to Get Them Back

  7. 9月26日

    Midlife Career Change: Why Successful People Start Counting Backwards

    "No one knows this yet." A friend I've known for more than fifteen years said it at lunch, just before the waiter arrived. Her career looked very solid. She was thinking about what comes next anyway. Within a few weeks, I heard almost the same question from five people who don't know each other. None of them are in trouble, and none of them want to retire. They're still building, still have financial goals, and are asking in the middle of their careers: how many more years do I want to keep doing this, and how do I want to spend them? This episode of Under Load looks at why that question arrives in midlife, and what it means for your health. In 1968, the psychologist Bernice Neugarten described middle age as the point where life is restructured around the time left rather than the time since birth. Laura Carstensen's research at Stanford explains the mechanism: when time feels limited, we shift from collecting knowledge, contacts and status toward what matters emotionally. Her studies showed the shift depends on perceived time, not age. It appeared in older adults, in young adults in Hong Kong before the 1997 handover, and in young men living with HIV. I argue that counting backwards is the same shift, applied to work. Age can move your horizon, and so can a health issue or an uncertain future. For me, it started with severe back pain and a summer evening on a terrace in 2024. We also cover: Why nobody says it out loud, and what psychologists call pluralistic ignorance, including a study of board directors who each doubted a failing strategy and stayed quiet.What the "midlife crisis" data shows, and why the people aged 49 to 53 in one study described "shortened futures."A German study of workers in their fifties: those who wanted to change profession but didn't had worse mental health.Purpose in life and health, from a 2026 meta-analysis of nearly 490,000 people.The honeymoon-hangover effect, and why a new job title rarely settles the question.Why any answer has to cover the household first, and why years and healthy years are two different counts.The episode closes with five things to try: the backwards count, the five-year test, a small real-world experiment, telling one trusted peer, and putting a number on the money fear. Visit The Upward ARC and subscribe. Under Load is the Sunday edition of The Upward ARC, by Andre Heeg, MD, DDS, physician and reconstructive facial surgeon. This edition sits within the Capacity pillar: what you can still learn, the skills you build, and the reserves your mind and body carry into later life. Key sources Neugarten, 1968, Middle Age and Aging: "The awareness of middle age" and time-left-to-live.World Economic Forum, 2025: The Future of Jobs Report 2025, employer-survey projections to 2030.Carstensen, Isaacowitz & Charles, 1999, American Psychologist: socioemotional selectivity theory.Fung, Carstensen & Lutz, 1999, Psychology and Aging: time horizons, the imagined 20 extra years and the Hong Kong handover.Carstensen & Fredrickson, 1998, Health Psychology: HIV status, age and perceived time.Westphal & Bednar, 2005, Administrative Science Quarterly: pluralistic ignorance in corporate boards.Wethington, 2000, Motivation and Emotion: what Americans mean by "midlife crisis."Garthe & Hasselhorn, 2022, Ageing & Society: changing and wanting to change profession in later working life.Bigos et al., 1991, Spine: job enjoyment and reported back injury.Sutin et al., 2026, Psychological Medicine: purpose in life and mortality, 488,765 participants.Boswell, Boudreau & Tichy, 2005, Journal of Applied Psychology: the honeymoon-hangover effect.Garmany & Terzic, 2024, JAMA Network Open: healthspan-lifespan gaps in 183 countries.

    Midlife Career Change: Why Successful People Start Counting Backwards

  8. 9月19日

    Mobility after 40: Stretching, strength and everyday movement

    In a dusty square in Kathmandu, men waited for minibuses in a deep squat. I took those minibuses to the hospital, where I worked in traumatology, and began wondering why I rarely used that position myself. Years later, during an hour's wait outside an embassy with my family, I was the only person in the queue squatting. This episode of Under Load looks at mobility as we age, with a practical question for anyone whose working week involves a lot of sitting: which everyday movement do you want to keep being able to do? I discuss how flexibility, strength and balance contribute to getting into and out of a position. The LIFE trial gives us evidence about preserving walking ability in older adults with physical limitations. Stretching studies help estimate how much practice may be useful, although much of that evidence comes from younger adults. The episode covers the estimated ten minutes of stretching per muscle group each week, why that estimate needs care, and what researchers mean by tissue stiffness and stretch tolerance. I also look at resistance training's effects on flexibility and the limits of the comparisons between different training intensities. The practical section contains a supported squat, a hip-flexor stretch, a calf stretch and a supported one-leg stand. The sequence and starting amounts are my recommendation; the exact routine hasn't been tested as a package. I explain how to begin with support and observe progress without making every session harder. The closing question is about the movement you've started avoiding. That gives the practice a purpose you can recognize outside an exercise session. [Visit The Upward ARC and subscribe](https://www.andreheeg.com). Under Load is the Sunday edition of The Upward ARC, by Andre Heeg, MD, DDS, physician and reconstructive facial surgeon. This edition sits within Activate, with Capacity as the reason to continue. Key sources: - [Pahor et al., 2014, JAMA](https://doi.org/10.1001/jama.2014.5616): the LIFE randomized trial of structured physical activity and walking disability in older adults.- [Guirguis-Blake et al., 2024, JAMA](https://doi.org/10.1001/jama.2024.4166): exercise interventions and falls in older adults.- [Ingram et al., 2025, Sports Medicine](https://doi.org/10.1007/s40279-024-02143-9): static stretching dose and flexibility.- [Oba et al., 2026, Sports Medicine – Open](https://doi.org/10.1186/s40798-026-01066-1): age and other characteristics in stretching adaptations.- [Ingram et al., 2025, Sports Medicine](https://doi.org/10.1007/s40279-025-02204-7): possible mechanisms behind changes in range of motion.- [Favro et al., 2025, Journal of Strength and Conditioning Research](https://doi.org/10.1519/JSC.0000000000005000): resistance training and flexibility.- [NHS balance guidance](https://www.nhs.uk/live-well/exercise/balance-exercises/) and [strength guidance](https://www.nhs.uk/live-well/exercise/strength-exercises/): supported starting exercises and gradual progression. Audio note Andre reads the written newsletter, adapted for speech. Some figures are rounded and inline citations are omitted. The written edition contains the full references and exact reported figures. Medical note This episode provides general education. Adapt exercise to your health and current ability. Stop for pain, numbness or tingling. Recent surgery, restricted joint replacements or recurrent falls call for individual guidance from your clinician or physiotherapist.

    Mobility after 40: Stretching, strength and everyday movement
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關於

Under Load is the weekly audio edition of Andre Heeg’s newsletter for senior leaders and business owners carrying heavy responsibility. Each episode examines how demanding work affects your health, energy, judgment, and life outside work. Andre draws on current research through the lens of his medical training and business experience. The result is practical guidance built for the reality of leadership. New episodes every Sunday. Read the full editions and supporting evidence at andreheeg.com.

資料

  • 創作者
    Andre Heeg
  • 活躍年份
    2025年 - 2026年
  • 單集
    15
  • 分級
    兒童適宜
  • 版權
    © 2026 Andre Heeg. All rights reserved.
  • 節目網站
    Under Load