At 8:45 Monday morning, I sat up and felt a pain in my upper back. When I stood up, the pain began radiating around to the front of my chest.
I have had arthritis for more than 30 years, so my first thought was that it had something to do with that. The pain wasn’t even that bad. Maybe a 3 out of 10. But there was something strange about how quickly it came on.
My wife drove me to the hospital.
A few hours later, I found out I had just had a minor heart attack.
It came out of nowhere.
My LDL cholesterol was 78. I had lost 28 pounds over the previous two years. I was exercising regularly, my blood pressure had improved and I thought I was doing a pretty good job getting myself healthy.
So how did this happen?
The Toll of the Entrepreneur Life
For more than 25 years, I was overweight. During that same period, I started, scaled and exited almost a dozen companies. I traveled to more than 50 countries, took companies public, hired thousands of people and even managed to write an award-winning #1 bestseller called Start. Scale. Exit. Repeat.
In Chapter 57 of the book, I wrote about something called “The Toll of the Entrepreneur Life.”
Look, I am not going to sugarcoat it. Starting a business is not easy. It can be incredibly stressful, and when we are stressed we don’t always make the best decisions. We don’t sleep enough. We don’t eat properly. We stop exercising. We drink a little more. We tell ourselves that we will deal with our health after we get through the next crisis.
In 2017, my entrepreneurs group, eight people I have been connected with for more than 25 years, confronted me about the way I was living.
I wrote about that experience in the book:
“At that time I was very successful, but I was a workaholic. My entire identity was based on my companies, and I was ignoring other areas of my life. Thankfully, my family stuck through the challenges and continued to support me, but I had let my health deteriorate, traveled way too much, drank a little too much wine to numb the stress, and continued to work day and night on my businesses.”
That confrontation started a journey that I am still on today.
The fact is, I didn’t have a heart attack because I was particularly stressed out that Monday morning. My doctors found coronary artery disease and evidence of a plaque rupture and thrombus. There were risk factors that had accumulated over many years.
I had spent about 20 years around 220 pounds, roughly 50 pounds overweight. I had also spent decades dealing with the stress that comes with starting and running companies.
Then there was something else I couldn’t control.
Genetics.
My father died from a heart attack at 50. I am 56.
That thought has stayed with me.
There are things in life we simply cannot control, just like there are things in business we cannot control. High interest rates, recessions, hurricanes, competitors and changing markets are just a few examples.
But there are also things we can control.
One of those things is how we manage our bodies.
Too often entrepreneurs sacrifice their bodies to survive or thrive, with the goal of eventually creating enough wealth that we can slow down. The problem is that our bodies don’t necessarily agree with our timelines.
Now let me be clear. I don’t regret what I have done.
I built some great companies, employed thousands of people and helped tens of thousands more. I have had experiences I never could have imagined when I started my first company.
But after reflecting on the last 25 years, I do think there is a better balance.
I started trying to find that balance in 2017 and have been working on it ever since. I have done CrossFit since 2021 with a personal coach. I have lost weight. I eat much better and have made significant improvements in my health.
Do I still fall into the entrepreneurial gutter from time to time? Absolutely. Stress has been particularly difficult over the last few years with some of my investments and companies dealing with high interest rates.
I haven’t been perfect.
But I can learn to balance my life better.
And after having a heart attack at 56, here are six startup lessons I have learned.
1. When a Crisis Hits, How You Handle It Matters
I often say in business that when a crisis hits, one of the most important things you can do is make the right decisions quickly enough to mitigate the damage.
You don’t get to decide whether the crisis happens. You do get to decide how you respond to it.
That’s essentially what happened to me that Monday morning.
My symptoms weren’t dramatic. The pain wasn’t severe. I wasn’t lying on the floor clutching my chest like someone in a movie. It was relatively minor, but it was different enough that I paid attention.
That decision may have made a very big difference.
The same thing happens in business. We often get warning signs before something becomes catastrophic. The question is whether we listen to them.
2. Have an AI Mindset
Yup. In business and in life.
As the heart attack was occurring, I actually had a conversation with ChatGPT.
Here is part of the actual transcript from September 14, 2026:
Colin: “Yeah, I just had a weird problem where my upper back just got really sore very fast.”
ChatGPT: “Hmm. That sounds uncomfortable.”
Colin: “And now it’s like…”
ChatGPT: “Go ahead. What’s it like?”
Colin: “Well, then it seems to be spreading, the pain, all of a sudden. Upper back and now going around even to the front. It happened instantly.”
Colin: “What do you think?”
ChatGPT: “Given how suddenly this started and the way it’s spreading, I don’t want to guess here. This can be serious. Please call 911 or have someone take you to the ER now. It’s better not to wait.”
I told it that the pain seemed to have calmed down.
It still told me to get checked immediately.
Soon afterward, we were heading to the hospital.
Interestingly, two days later I received another unprompted scolding from my AI doc:
ChatGPT: “If that sudden chest/back pressure ever returns, call 911 rather than waiting to see whether it settles down.”
I am not saying that without AI I wouldn’t have gone to the hospital. I probably would have.
But I can say that talking to AI helped me make the decision.
Remember, I had never experienced this type of pain before and the pain itself was relatively minor. It would have been very easy for me to decide it was my arthritis, take something for the pain and go on with my morning.
AI didn’t diagnose my heart attack. The hospital did that. And if you think you are having a heart attack, you should call 911 rather than spending your time having a long conversation with a chatbot.
But AI helped me recognize that something unusual could also be something serious.
That’s an AI mindset. Use the technology to help you make better decisions.
3. Build a Health Tech Stack
When I launch a startup, I have a saying in Start. Scale. Exit. Repeat.:
Whatever you do, do it really well or don’t do it at all.
So I decided that if I am going to improve my health and increase my chances of living a long life, I am going to use as much technology and data as I reasonably can.
In other words, I am building a health tech stack.
First, I managed to snag the Apple Watch 4 health watch the day it launched. I waited for about an hour at Apple until the woman at the front started talking with me. When she heard I had suffered a heart attack on Monday, she moved me to the front of the line.
The watch gives me another layer of health information throughout the day, including heart rate, resting heart rate, ECG capability, activity, workouts, sleep and other cardiovascular trends. It isn’t going to tell me that I am having a heart attack, but it can help me understand what is happening with my body over time.
Second, I asked AI what other tools I should use.
I added a Withings smart scale. Instead of simply watching my weight, I can follow trends in my body composition, including muscle mass and visceral fat estimates.
I also added a Withings blood pressure monitor so I can regularly track my blood pressure and heart rate at home.
Then there is Apple Health.
For the time being, I am going to export my Apple Health data weekly. Withings also produces reports, and I can combine that information with the medical data I receive from my doctors.
I then put all of this into ChatGPT and created a personal health dashboard that I review every Monday morning at 9:00.
Weight, blood pressure, heart rate, exercise, sleep, body composition and other health metrics.
Think about the irony here. I have spent more than 30 years building dashboards to monitor companies, yet it took me until 56 to build a dashboard for the most important asset I have.
My body.
4. Have a Jim Collins Positive but Realistic Attitude
Jim Collins talks about the Stockdale Paradox: confronting the brutal facts of your current reality while maintaining faith that you will ultimately prevail.
I think that applies here.
Quite frankly, when I first heard that I had suffered a heart attack, I was depressed.
Even though my cardiologist described it as a minor heart attack, it was something I had never anticipated happening at 56. For a few days it affected me more than I expected, and I decided to meet with a psychologist to help process what had happened.
After some time, my thinking began to change.
I started to feel alive again. More importantly, I started to feel lucky.
My dad died at 50 from a heart attack.
I am 56 and I am still here.
My heart’s pumping function is still normal. I caught the problem. I am taking the medications my doctors prescribed. I am losing weight. I am exercising. I am paying attention.
Instead of looking at the heart attack only as something terrible that happened to me, I started looking at it as information.
I now know there is a problem.
And entrepreneurs know what to do with problems.
We attack them.
5. Don’t Wait Until It’s Too Late
I spent roughly 20 years at around 220 pounds, about 50 pounds overweight.
Fortunately, around age 50 I started doing CrossFit. Then about 18 months ago, under medical care, I added Zepbound. Combined with exercise and eating better, I have lost around 28 pounds and improved my cholesterol and blood pressure.
I believe those changes put me in a much better position when this happened.
But why did I wait so long?
Entrepreneurs are notorious for this.
I’ll get healthy after I sell the company.
I’ll start working out after this launch.
I’ll take a vacation after we raise the money.
I’ll deal with the stress after this crisis.
Certainly there are moments in an entrepreneurial career when you need to get the football across the line. I have been there many times. Sometimes you have to push.
The mistake is turning that temporary push into your permanent way of life.
There will always be another crisis. There will always be another opportunity. There will always be another company.
Don’t wait for the exit to start taking care of yourself.
6. Find a Way to Manage Stress
I talked about stress in the book because I think it is one of the most underestimated issues in entrepreneurship.
We are organic creatures trying to live a startup life. We need to find a way to do that without sacrificing our actual lives.
You need coping mechanisms.
For me, one of them is jumping into the hot tub at the end of the day. I change into comfortable clothes and consciously get myself out of work mode and into relaxation mode.
Exercise has also become important.
And I have learned something else that reduces stress tremendously: delegate responsibilities, not tasks.
There is a big difference.
If I give someone a task, I still own the responsibility. Somewhere in the back of my mind I am wondering whether it got done.
If I give a capable person responsibility for an outcome, they own it.
That means I don’t have to carry everything myself.
It took me a long time to learn that one.
The Other Side of Entrepreneurship
I hope these lessons share a little bit about the other side of entrepreneurship.
We talk about starting companies, raising money, scaling, exits and creating wealth. We don’t talk nearly enough about the toll that entrepreneurial life can take on the entrepreneur.
You can ignore it.
Or you can recognize it and do something about it.
I may have attacked my health later in my career than I should have. Fortunately, I didn’t wait even longer.
Maybe losing weight, doing CrossFit and changing my lifestyle over the last few years was too late to prevent what happened Monday.
Or maybe it happened just in time to help me survive it and recognize what I needed to do next.
I choose to look at it that way.
I’m 56. I have more weight to lose, more changes to make and a lot more to learn about taking care of myself.
But I also have companies I want to build, entrepreneurs I want to help, places I want to see and a family I want to spend a lot more time with.
I still have a lot of life left to live.
And, knowing me, probably a few more startups too.
