You Already Know What to Do. That Was Never the Problem.
Flying over Frankfurt at 35,000 feet, I listen to Andrew Huberman talk about winding down for sleep. He says to dim the lights two hours before bed, avoid screens in the last hour, and let melatonin work without blue light interference.
It’s Monday morning, and I’m flying to a client. I’m on my third coffee after five hours of sleep. The podcast is solid. Clear science, sharp delivery. I jot down mental notes, planning to start tonight: screens off by ten, lights low, the whole routine.
That night, I’m in another hotel room. Could be Zurich, could be Munich, they all blur together. It’s 11:30 p.m., and I’m still working on my laptop. The client deck was supposed to be done by nine. Fourteen messages wait. The room is bright, the screen cutoff long past. I know exactly what this blue light is doing to my melatonin, but I can’t close the laptop. The partner review is at 8 a.m., and the deck isn’t ready.
That morning’s episode? Bookmarked. Filed away with the other hundred-plus episodes, articles, and papers I’d saved and never acted on. My collection kept growing, and so did the gap between what I knew and what I actually did.
This went on for years.
I am a BCG managing director and partner. Three kids. A medical degree and a background in competitive wrestling. Since my wrestling days, I’ve been obsessed with performance: researching, testing, looking for any edge I could find. That drive never faded. It just changed targets. Instead of finding that 1% edge over an opponent, I was collecting health content to edge out my work performance. Podcasts, books, research papers. Hundreds of hours saved. But something else was missing, and it took me a long time to see it.
150 Bookmarked Episodes and Nothing to Show for It
In software, there’s a concept called technical debt. You take shortcuts to ship faster, and those shortcuts accumulate. They don’t sit quietly. They slow everything down until one day the whole system grinds to a halt. Not because of one bad decision, but because of a hundred small ones that compounded.
Health works the same way. Every episode you listen to and don’t act on, every paper you save, every protocol you bookmark for Monday, adds to what I call execution debt. It compounds like the financial kind, except the interest payments are guilt, paralysis, and the growing sense that you’re too far behind to start.
A meta-analysis of nearly 30,000 people found that 47.6% of those who intended to exercise never followed through [1]. Half. Not people who didn’t care. People who genuinely wanted to move their bodies and couldn’t close the distance between wanting and doing.
Researchers at Duke found something worse. They studied a thousand adults with Type II diabetes. Two-thirds reported high knowledge of what they needed to do. Nearly all agreed it was important. Zero correlation between their knowledge and their actual disease management [3]. The people who knew the most did no better than the people who knew the least.
You’ve seen this before. Just not in a mirror. Jeffrey Pfeffer and Robert Sutton at Stanford called it the knowing-doing gap [12]. Organizations with brilliant strategy decks that can’t execute to save their lives. You’ve probably sat in that room. Maybe you were the one presenting the strategy. The organization that knows the right answer but can’t act on it, and the executive who knows the right protocol but can’t follow it, are the same problem wearing different clothes.
Built for Someone Else
I overlooked this for a long time. The health advice filling my feed wasn’t wrong. It just wasn’t meant for me.
Huberman’s full morning protocol, sunlight exposure, cold plunge, and specific supplement timing, takes ninety minutes before your workday starts. That’s a part-time job. Peter Attia, whose reputation has since collapsed for reasons unrelated to his training advice, built a framework that demands 10+ hours per week across zone 2, strength, stability, and mobility. Bryan Johnson spends two million dollars a year on a personal medical team, blood draws at dawn, and protocols that treat the human body like a space shuttle [10]. In February 2026, he launched “Immortals,” a program offering his exact protocol to clients for $1 million per year each [11]. That’s not health. That’s a hobby for the very rich.
Meanwhile, the CDC’s actual recommendation is 150 minutes of moderate physical activity per week [14]. That’s 30 minutes across five days. No cold plunge. No supplement stack. No personal chef.
Popular health protocols often require 10 hours a week, while the CDC recommends only 2.5. The difference between these numbers is where the industry makes money and where people start to feel guilty.
As a BCG partner, my schedule is set by teams, partners, and clients across time zones. My day often starts before my kids are awake and ends after midnight. I cannot find ninety minutes for a morning routine or ten hours a week for training. Every week I could not follow these protocols, my execution debt increased. The science was accurate, but it was designed for someone whose full-time job is their body. My full-time job is something else.
The advice wasn’t the problem. The audience was.
Your Brain at 11 p.m.
When you run a high-demand job for years, your body keeps a physiological ledger. Researchers call it allostatic load, the cumulative wear from sustained stress. It shows up in your bloodwork, your inflammation markers, and eventually your brain tissue. A 2025 study in Frontiers in Aging Neuroscience found that higher allostatic load was associated with lower global cognition and reduced gray matter volume [4]. Not mood. Not “feeling tired.” Structural changes in the brain.
This explains why evening routines never worked for me. It was not a matter of discipline. After fourteen hours of work, my ability to make good decisions was gone. By 11 p.m., the part of my brain responsible for planning was spent. I would just react and take the easiest option. Using screens late at night was not a real choice. It was the result of being too tired to choose differently.
CEO lifespan drops by 1.5 years during industry downturns [5]. Not because they stopped exercising. Because stress itself is more destructive than any health routine is protective. Anti-takeover legislation that shielded CEOs from hostile bids extended their lives by roughly two years [5]. That’s the equivalent of quitting smoking before thirty. The protection wasn’t a gym membership. It was reduced stress.
And then there’s the sitting. Sedentary time beyond 10.6 hours per day is associated with a 30% increase in cardiovascular disease risk. Every additional hour adds another 5%. This holds even for people who meet exercise guidelines [6]. You can go to the gym every morning and still carry the risk if you spend the other fourteen hours in a chair.
If expertise solved health, doctors would be the healthiest people alive. In the general population, men die by suicide four times more often than women. Among physicians, that gap disappears. Female doctors die by suicide at the same rate as male doctors [7]. 58% of medical students screen positive for depression [8]. I trained inside this system. I know what it looks like when the most knowledgeable people in the room can’t apply their own knowledge. The problem was never what you know.
Try This Today
You do not reduce execution debt by adding another protocol. You do it by choosing one action that is so simple you can do it even when you are tired.
Pick one thing and delete the rest. The supplements you never took, the 5 a.m. routine you stopped, the training plan saved since October. Gone. All of it. Now pick one action. Not the optimal one. The one you’ll actually do. That might be sleep. It might be moving. It might be eating a real meal instead of whatever you grabbed between meetings. There’s no universal answer here, but if I had to push you: start with sleep or movement. Sleep because it affects everything downstream. Movement because even ten minutes changes your neurochemistry for the rest of the day. Do only that for two weeks. You don’t owe the other protocols anything.
Set up tomorrow tonight. Researchers call these implementation intentions: if-then rules that remove the decision from the equation. They’ve been tested across 94 studies with consistent results [9]. In one study, every participant who formed a specific if-then plan completed a health task, compared with 53% who just intended to [9]. Here’s what this looks like in practice. Every night, I lay out my workout clothes next to the bed. When I wake up, the decision is already made. I move, even if it’s just ten minutes. On travel days, I grab protein bars, fruit, and nuts from the hotel breakfast buffet and keep them in my bag. When I’m hungry at 3 p.m. in a client meeting, I’m not relying on willpower to avoid the vending machine. The food is already there. At team or client dinners, I don’t open the menu in hopes of inspiration. I look for two or three meal options: steak, fish, or another high-quality protein source, plus vegetables. I order one of those. I also order the fries, because life is short.
Redesign the 11 p.m. moment. The decisions you make at 11 p.m. are not the same as those you plan in the morning. Set a 9:30 alarm to turn off screens. Charge your phone outside the bedroom. The goal is not more discipline. The goal is to make the right choice automatic, since by nightfall your ability to make active choices will be spent.
Run the 80/20 health audit. Write down everything you think you should do for your health. Circle the 20% that would give you most of the results if you actually did them. Cross out the rest. The crossed-out items are your execution debt, and letting them go may be the most helpful thing you do this week. 70+ years of longevity research boils down to five things: sleep 7+ hours, move 4-5 times a week, eat mostly real food, maintain relationships that matter, and find meaning beyond your job title. Your grandmother knew all five.
The Question That Changed the Math
A few weeks into our recent sabbatical in Cape Town, I was sitting on the floor with Karla. She’s six. She was trying to explain some game she’d invented, and the rules made no sense, but she was fully committed to them. I was half-listening, mentally sorting through a training protocol I’d bookmarked that morning. Reps, rest intervals, weekly periodization. My body was in the room. My head was in another spreadsheet.
She looked up and said something like, “You’re not playing right.”
She was right. I wasn’t.
That was the moment I stopped asking “How do I implement this protocol?” and started asking a different question. How do I actually want to live? What example do I want to set for these three kids? What does it mean to be healthy for a purpose, not for a scoreboard someone else built?
The hundred-plus bookmarked episodes and saved papers looked different after that. They were not a failed to-do list. They were a symptom. The same overachiever instinct that filled my calendar also filled my content library. Collecting and organizing as a substitute for doing.
That’s what I mean by Capacity in my Upward ARC framework. Building systems that work when you’re running on fumes. After a fourteen-hour day, you will be depleted. That’s the operating condition. The question is whether you’ve set things up so the right choice happens anyway, without needing the rare, well-rested version of yourself.
I still sit in hotel rooms past midnight, sometimes. I write newsletter editions and LinkedIn posts at 5 a.m. before the kids are up. Working hard isn’t going anywhere. That was never the thing I wanted to fix. What needed fixing was the belief that I had to earn my health through some perfect protocol, instead of building it into the life I already have.
The other night, in another interchangeable hotel room, the deck was done by ten. I closed the laptop. The lights were already low. I didn’t check my phone. I just sat there for a few minutes, in the quiet, and went to bed.
Not because I finally found the right protocol. Because I finally asked the right question.
Stay healthy.
Andre
References
[1] Feil, K., et al. (2023). The intention-behavior gap in physical activity: A meta-analysis. British Journal of Sports Medicine. N=29,600.
[2] Sheeran, P., & Webb, T. L. (2016). The intention-behavior gap. Social and Personality Psychology Compass, 10(9), 503-518.
[3] Health Behavior: From Paradox to Paradigm. Diabetes Spectrum, American Diabetes Association.
[4] Frontiers in Aging Neuroscience (2025). Allostatic load and brain structure: associations with global cognition and gray matter volume.
[5] Borgschulte, M., Guenzel, M., Liu, C., & Malmendier, U. (2025). CEO stress, aging, and death. The Journal of Finance, 80, 3401-3442. Originally NBER Working Paper No. 28550.
[6] Journal of the American College of Cardiology (2024). Sedentary behavior and cardiovascular disease risk: accelerometer-based analysis.
[7] Duarte, D., et al. (2024). Suicide rates among physicians compared with the general population: gender stratified systematic review and meta-analysis. BMJ, 386, e078964. Also: Kiraly, I., et al. (2025). Female physician suicide compared to the general population. JAMA Psychiatry.
[8] Dyrbye, L. N., Thomas, M. R., & Shanafelt, T. D. (2006). Systematic review of depression, anxiety, and other indicators of psychological distress among U.S. and Canadian medical students. Academic Medicine, 81(4), 354-373.
[9] Gollwitzer, P. M., & Sheeran, P. (2006). Implementation intentions and goal achievement: A meta-analysis of effects and processes. Advances in Experimental Social Psychology, 38, 69-119. 94 studies, d = 0.65.
[10] Fortune (2025). Tech founder who spends $2 million a year to live forever. January 10, 2025.
[11] TechCrunch (2026). For $1M, you can pay Bryan Johnson to teach you how to live longer. February 12, 2026.
[12] Pfeffer, J., & Sutton, R. I. (2000). The Knowing-Doing Gap: How Smart Companies Turn Knowledge into Action. Harvard Business School Press.
[13] McEwen, B. S. (1998). Stress, adaptation, and disease: Allostasis and allostatic load. Annals of the New York Academy of Sciences, 840(1), 33-44.
[14] Centers for Disease Control and Prevention. (2024). How much physical activity do adults need? Physical Activity Guidelines for Americans.
A note for new readers:
I’m a trained reconstructive facial surgeon, medical doctor, and dentist. Before launching this newsletter, I had a varied career: competitive freestyle wrestler, management consultant (McKinsey), entrepreneur (Zocdoc, Thermondo, and docdre ventures), and corporate executive (Sandoz). Today, I’m a Managing Director and Partner at BCG.
Husband of one. Father of three. Split between Berlin’s urban pulse and our Baltic Sea retreat. I’d rather be moving than sitting. Not just hobbies. Research. My body is my primary laboratory; I’ve been conducting experiments for decades.
If this is your first time here, welcome. I’m excited to share what I’ve learned and will continue to learn with you.
DISCLAIMER:
Let’s get one thing straight: None of this, whether text, graphics, images, or anything else, is medical or health advice. This newsletter is here to inform, educate, and (hopefully) entertain you, not to diagnose or treat you.
Yes, I’m a trained medical doctor and dentist. No, I’m not your doctor. The content here isn’t a replacement for professional medical advice, diagnosis, or treatment.
If you have questions about your health, talk to your physician or a qualified health professional. Don’t ignore their advice or delay getting care because of something you read in The Upward ARC. Be smart. Do your research. And, as always, take care of yourself.