Friday Q&A: optimizing for longevity; muscle cramps from statins; birth control pills after 40; & sleep supplements

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The following questions have been lightly edited for length and clarity.

QUESTION #1: OPTIMIZING FOR LONGEVITY

Hi! I feel like the longevity conversation is everywhere, and there are new recommendations to live a longer, better life coming out everyday. But honestly, most of these suggestions don't feel feasible for the average person (like me.) I'm 59 and I’ve always thought that staying active, eating a decent diet, and keeping up with my regular doctor appointments was enough. But now I’m wondering if I’m being naive or complacent. Thoughts?

—Rick

Hello Rick,

It sounds like you’re being sensible, not complacent! The longevity-slash-optimization movement has turned aging into a daily battle—something that requires constant vigilance, intervention and monitoring. But the (boring) truth is this: the basics you’re already doing—staying active, eating well, limiting alcohol, maintaining social connections, getting good sleep, not smoking, and seeing your doctor for regular checkups—are still the foundation of healthy aging and backed by the strongest medical evidence.

These aren’t trendy, but they work. The more elaborate protocols—extensive supplement regimens, continuous biomarker tracking, cold plunges, restrictive diets—might offer marginal benefits for some people, but they’re not necessary for most of us to age well.

That doesn’t mean there’s nothing to learn from the longevity-focused messengers. Heck, my entire job is to help people live longer! The emphasis on strength training, metabolic health and inflammation has real merit. And being proactive about health is always good. But there’s a difference between thoughtful health optimization and turning your life into a full-time science experiment.

The question to ask yourself is: what feels sustainable and aligned with how you actually want to live? If tracking metrics and following protocols fits your lifestyle and holds you accountable to your goals, great. But if it would add stress, cost, and rigidity to your life without clear benefit, then sticking with your current approach makes more sense. You can always add targeted interventions if specific issues come up—for example checking testosterone, hemoglobin, vitamin D, iron, thyroid and B12 levels for fatigue, or adding more protein if you’re losing muscle mass—without overhauling everything. Ideally you could have a medical guide who centers medical evidence and YOU in the same conversation!

The upshot: don’t let anyone make you feel like basic healthy habits aren’t enough.

QUESTION #2: GLUTEAL CRAMPING FROM STATINS

Hi Dr. McBride, I have high cholesterol and high Lp*a*. I’m on a statin but have been getting a lot cramping after workouts. What other options do I have besides statins which would be covered by insurance? Should I get tested for the gene that can cause muscle aches from statins?

-Sally

Hi Sally,

Gluteal cramping after workouts is a potential side effect from your statin, but before you assume this is the issue, I suggest confirming with a simple blood test (CK, or creatine kinase), because it also could be from a structural/skeletal problem such as piriformis muscle strain, lumbar disc disease, sciatica, or gluteal tendinopathy.

Given your elevated Lp(a), it’s important to be aggressive about your LDL cholesterol level. The goal isn’t to back off cholesterol-lowering treatments, it’s to find a version of it you can tolerate.

Also know that not all statins are created equal: some people do better simply switching to a different statin or adjusting the dose, since muscle symptoms vary surprisingly from one statin to another. If you can’t tolerate statins, Ezetimibe (aka “Zetia”) is a reasonable next step if that doesn’t work. It’s an oral, non-statin medication, lowers LDL by roughly 15 to 20 percent, rarely causes muscle issues, and is typically well covered by insurance. Bempedoic acid is a newer oral option, often used for people who don’t tolerate statins well. PCSK9 inhibitors (aka “Repatha” and its cousins) are the most powerful tool in this category, cutting LDL by 50 to 60 percent, though they’re injectable and insurance usually wants to see that you’ve tried other options first.

One thing worth knowing about your Lp(a): statins don’t reduce this number much, so think of it as a separate piece of the puzzle. There’s nothing FDA-approved yet that targets Lp(a) directly, though there’s promising research underway, which means your best lever right now is staying on top of everything else that’s modifiable.

To your question about “pharmacogenetic” or PGx testing, this is a way of analyzing your DNA to determine how effectively your body processes cholesterol-lowering medication. Sounds sexy, right? In clinical practice, though, it’s rarely necessary. If your doctor is tuned in to your story and side effect profile, testing like this is just an expensive way of documenting what patients already know from experience. That said, genetic testing can help doctors and patients feel more comfortable selecting the appropriate statin and dosage to maximize effectiveness while avoiding muscle pain and other adverse side effects. It’s reasonable to ask your doctor about getting tested for a gene called SLCO1B1 which is linked to statin-related muscle symptoms if you’ve cycled through a couple of statins already. Labcorp can test you for this with a doctor’s order.

Upshot: I suggest keeping it simple and consider the CK muscle test first. It’ll tell you a lot about where to go from here. I wish you the best!

QUESTION #3: BIRTH CONTROL PILLS AFTER 40

Hi Dr. McBride, I’m 35 and have been using a combined oral birth control pill continuously for the past five years to stop my period. My gynecologist told me when I turn 40 I can no longer use the pill because the estrogen puts me at a higher risk of clot/stroke and suggested switching to an IUD. My periods are can’t-leave-the-house debilitating, so I’m concerned with switching because I don’t know for sure the IUD will work the same as the pill. Can you tell me what the literature says about the estrogen risks my doctor mentioned?

-Kristin

Hi Kristin,

Thank you for sharing this, and I completely understand the anxiety around switching something that’s been working so well for you for so long. Your doctor’s guidance isn’t wrong, however the picture is a bit more nuanced than a hard cutoff at 40.

The concern is specifically about combined oral contraceptives, which contain estrogen taken orally. Oral estrogen passes through the liver, which increases clotting factor production and raises the risk of venous thromboembolism and stroke. That risk is low in healthy young women but rises with age, and the combination of advancing age, the pill’s estrogen, and any additional risk factors—smoking, migraines with aura, obesity, family history of clots—is what providers are weighing when they recommend stopping by 40 or shortly after. It’s not that age 40 is some absolute biological cliff; it’s that the risk-benefit calculation shifts with age.

On the IUD question: a hormonal IUD, such as Mirena or Liletta, delivers progestin locally to the uterus with minimal systemic absorption and no estrogen at all, which is why it doesn’t carry the same clot risk. The tradeoff is that it works differently. The pill suppresses ovulation and creates a predictable, lighter, often absent withdrawal bleed through its hormonal regulation. A hormonal IUD often reduces periods significantly, and many women stop bleeding entirely after several months, but the timeline and degree of improvement vary more by individual than with the pill, and some women take 6 to 12 months to see the full effect.

Given how debilitating your periods are, this transition deserves a sturdy plan rather than an abrupt switch. I’d talk with your gynecologist now about a transition strategy, like overlapping the two methods briefly (completely fine!) or trying the IUD before you’re forced to stop the pill rather than after.

You have years before this decision is urgent. I hope this gives you some peace of mind!

PS. Weighing risks and benefits and making decisions like this thoughtfully with your providers is a topic I cover in my forthcoming book, Beyond the Prescription!

QUESTION #4: SLEEP SUPPLEMENTS

I'm 79 and have been experimenting with magnesium and melatonin to help with sleep. Both seem to be working, but I've noticed some grogginess during the day. Are there risks to relying on supplements like these long-term, especially at my age?

-Helen

Hello Helen,

Magnesium and melatonin are generally safe choices for sleep.

On melatonin: it’s a hormone your body produces naturally, and production tends to decline with age, so supplementation can genuinely help. But more isn’t necessarily better. Higher doses don’t always work better and can increase the odds of next-day grogginess, which may be what you’re noticing.

On magnesium: it’s safe for most people, though higher doses can cause digestive upset and, less commonly, affect how other minerals are processed by the kidneys. This matters a bit more as we age, when kidney function naturally declines somewhat. (I have a breakdown of the many types of magnesium supplements and their effects here.)

The bigger picture: both supplements are reasonable for most people in the short to medium term, but they’re worth periodic check-ins rather than indefinite, unsupervised use, especially if doses keep creeping up. If you find yourself needing more and more to get the same effect, be sure to mention it to your doctor.

You're clearly paying close attention to your body, and that's the best tool you have here!

My book, Beyond the Prescription, comes out on August 11! I wrote it with you in mind.