What I Wish I Could Tell Every Patient Who Walks Up to My Counter

Do you ever have conversations or experiences that are etched into your brain forever?

I have one particular experience I can recall and it still evokes such strong emotions. It involves work. I was a GP Practice Pharmacist at the time. Like many people during COVID, I was working from home. 

I was halfway through a telephone medication review clinic. I was calling a patient to initiate him on metformin. For those people reading this who are unaware, metformin is a medication used for the treatment of type 2 diabetes. This gentleman had recently had some blood tests which confirmed he had developed diabetes. 

I hate that phrase - developed diabetes. It is so arbitrary. It implies that one day he went to sleep non-diabetic and the next day he woke up suddenly diabetic. This is how the guidelines typically portray it. To be confirmed as diabetic you have to have a HbA1c reading of greater than 48mmol. 

But what about those patients who hover at around the 47mmol level? Are they non-diabetic? I am being purposefully obtuse here. We do actually have a name for these patients ‘’pre-diabetic’’ - structured programmes exist to help these patients but engagement and early intervention remain inconsistent in practice and for the rest of them? We leave them sitting on the shelf and only bother to get involved when they’ve crossed the clinical boundary into full blown diabetes. 

But I would argue until I am blue in the face that this patient was placed on the road to diabetes years if not decades before that untimely phone call. 

The patient picked up the phone. I ran through the results the way I always do. I was calm, spoke clearly, without alarm, with a brief explanation of what his numbers meant and confirmed to him that clinically he was now considered diabetic.

He laughed.

Not nervously. Not politely. He actually laughed — a warm, proper, unbothered laugh — and called across the room to his wife. I couldn't make out what he said to her. Just the tone of it. Easy. Unconcerned. Like I'd told him a joke at a pub and he was calling his friend over to come and hear the punchline.

I sat with the phone to my ear for a moment after the room went quiet, and I felt something shift in my thinking. Not frustration. Something closer to recognition.

This isn't a motivation problem. It isn't a willpower problem. It isn't even an access problem, though that matters too.

It's an education problem.

That was the moment I decided I needed to build something beyond the counter. That was the moment I decided that preventative health education is the greatest tool we have.

Why I'm telling you this

I've been a pharmacist for six years. In that time I've had the strange privilege of watching health stories from a very particular vantage point. Not the beginning of their story. I usually meet the patient at the middle and end of their health story. One where years and often decades of poor lifestyle decisions fill the earlier chapters of their book.

I see what a decade of elevated blood pressure does to a body. I see what happens when someone finally takes their cholesterol seriously at 68 following a health scare. I count the tablets in bags that get heavier every year.

I also know what it means to lose someone too soon. My father died by suicide when I was four years old. I don't have many memories of him. I have the shape of an absence more than I have a person. What I've understood more clearly the older I've got is that health is not just about our own lives. It is about the people who depend on us to stay in theirs. 

Prevention is not a wellness trend. For some of us, it has sharper edges than that. Prevention is time. Time is the only currency worth worrying about.

What the NHS can and cannot do for you

Let me be honest about something I think gets lost in the conversation about the British healthcare system.

The NHS is extraordinary. I mean that without reservation. I know the NHS is the favourite proverbial ball that the British media love to put the boot into, but for me, the NHS is one of the most important institutions this country has ever built. I have watched it perform acts of genuine medical brilliance under conditions that would break most systems. I am proud to work inside it. I am proud to be part of it.

But the NHS is a safety net. That is what it was designed to be. It was designed to treat acute illness. It was designed so that if you had a workplace injury, car accident, communicable infection the state would cover your medical costs. It was not designed for the service it now operates. The NHS was never designed to manage decades of lifestyle-driven disease at scale. 

A safety net catches you when you fall. It does not — and cannot — train you not to fall in the first place. It does not have the time, the resource, or the structural mandate to invest in your future health on your behalf. By the time most patients engage seriously with the healthcare system, something has already gone wrong.

The job of building a body that carries you well into your seventies and eighties, that keeps you sharp and functional and present for the people you love — that job belongs to you. Not because the NHS has failed you. Because the NHS was never designed to do that job.

Health starts at home. Health is your greatest asset. It dictates every passing second from the moment you are born to the day that you die. Respect it.

The question I want you to sit with

Imagine you are eighty years old and someone offers you a choice.

One option is a billion pounds. Transferred into your bank account immediately.

The other is waking up tomorrow morning on your twentieth birthday.

Which do you take?

Most people, if they are honest, would wake up in their 20s given the choice. I am certainly one of those people. I think the fact you are reading this blog implies that you are too. 

Because at eighty, you understand something you could not quite articulate at thirty — that the real currency of life was never in your bank account. 

We know this. Most of us know this. And yet somewhere between twenty and forty, most of us start acting like we don't.

Your genes are a starting point, not a sentence

I have an elevated lipoprotein(a). My result came back at 213 nmol/L — a level associated with increased cardiovascular risk, largely independent of lifestyle. It is, for the most part, genetic. There is currently no licensed pharmaceutical treatment that targets it directly. For a pharmacist who spends a meaningful portion of his working week talking about cardiovascular prevention, there is almost a certain irony in this.

I mention it for one reason: the idea that some people are dealt a bad hand and that is simply the end of the story — I do not believe that anymore. And the science is increasingly clear on why.

Your genome is not a fixed programme running silently in the background. The field of epigenetics has shown us that environmental factors — sleep, nutrition, movement, stress, social connection, exposure to harmful substances — influence which genes get expressed and how. For many conditions, you were not born with a fixed destiny but instead born with tendencies.  What you do repeatedly, over years, shapes which of those tendencies actually become your reality.

My family history includes type 2 diabetes, aortic aneurysm, atrial fibrillation, breast cancer, ovarian cancer, stroke, vascular dementia. What I choose to do with this information is mine to decide. You can bet your money on me opting to prevent these conditions.

Why perfection is the wrong target

The pattern (and mistake) that I see in most people who want to take their health seriously is that they wait for the day when all the cards suddenly fall into place. The perfect timing for a new diet, new gym plan, new sleep schedule, new job, new life.

I understand the appeal. But it doesn't work that way. The best time to start investing in your health was yesterday and the next best time to start is now.

Health returns compound over time in a way that is not unlike interest in a savings account. The person who walks twenty minutes three times a week for the next decade will, in all likelihood, outlive the person who planned a marathon training block and never started it. The small, consistent, unremarkable actions are worth more cumulatively than any single heroic intervention. It is what we do when nobody is watching that matters.

The ceiling nobody mentions

When someone starts a statin for elevated cholesterol, or metformin for raised blood sugar, it is easy for that prescription to feel like the problem is being solved. A lifeline. A free pass to avoid taking the necessary decisions.

It isn't.

A statin manages cardiovascular risk but it does not undo the conditions that created it. It does not fully reverse established atherosclerotic disease, though it can stabilise and in some cases regress plaque. Likewise, metformin helps regulate blood glucose but it does not reverse decades of metabolic strain. 

I am not telling you this to alarm you. I am telling you because I think most patients leave the consultation room without truly understanding this distinction, and it matters enormously for how you think about what you do in between appointments.

The identity shift nobody talks about

Most health changes fail not because people lack information, but because they do not yet see themselves as healthy people. They do not recognise themselves as the person that they need to become.

Identity tends to come before behaviour, not after it. The most durable changes tend to happen when someone begins to see themselves differently. But you don't need to earn the identity before you adopt it. 

The person who starts sleeping seven hours a night is by definition, a good sleeper. The person who starts running three times a week is a runner. The person who learns to prepare a home cooked meal from scratch is a home cook. Life is simply the stories and beliefs that we tell ourselves in our head. If you believe you can do it, often you will.

So here's what I actually want to tell you

Start before you think you need to. The goal isn't to live forever. It's to stay functional, sharp, and present for as long as possible — for yourself, and for the people who are quietly assuming you'll still be there at 75. The children. The grandchildren. The partner.

The six things that matter most are the six things you already know: sleep, nutrition, exercise, stress management, social connection, and what you choose to put in your body. Not a supplement stack. Not a biohack. The fundamentals, done consistently, will outperform almost everything else. I refer to it as my formulary for living well.

And the science of longevity is moving quickly. I won't overstate this — the honest answer is that nobody knows exactly what the next twenty years will produce. But the direction of travel is clear enough that we will develop treatments that are likely to extend healthspan and even lifespan. The safe bet is to give your future self the best possible starting point.

Not a perfect start. Just better than yesterday.

A final thought

That patient who laughed on the phone — I don't know how his story ends. I hope well. I genuinely do.

But that moment is why I built this. It is the thing that drives me to get up on a Tuesday, my day off, and write about sleep and cholesterol and genetics and the things I cannot fit into a two-minute dispensing interaction.

Prevention is better than cure. I have believed that for long enough that it has stopped feeling like a professional position and started feeling like something more personal than that.

If this has changed how you think about your health, follow along. You can find me on socials at @jakelifestylepharmacist and the newsletter sign-up below for where I go deeper. I hope to launch the newsletter over the summer and I plan to give exclusive content and tools for those who are signed up so if you’ve enjoyed the read, please sign up!

Stay healthy, 

Jake
Dose of Longevity