Longevity: Medical Establishment vs. Self-Taught Optimizers

October 5, 2024

Two Approaches to Health

There is significant disagreement within the health community, often split between two clusters: The Medical Establishment and The Self-Taught Optimizers. Below is a comparison of how these groups typically differ in their approach to various aspects of health.

Health Categories Comparison

Category	Medical Establishment	Self-Taught Optimizers	Extra Safe Take
Carb Type	Whole Wheat Low GI	Avoid gluten; eat carbs ancestors ate	Focus on fruits and low GI gluten-free foods for carbs; put gluten carbs in vinegar to minimize inflammation impact.
Meat?	Vegetarian (correlation analysis; rodent studies)	Large amounts of meat (higher quality protein)	If eating meat, focus on organic, don't overcook (limit high heat), and eat plenty of glycine. If going vegetarian, piece together amino acids.
Protein	~0.4g/lb bodyweight	1g/lb bodyweight	In-between with plenty of glycine and organic meats.
Exercise	Z1/Z2 cardio focus	Lifting focus	Mostly Zone 2 cardio + strenuous lifts with some stretching, mobility, and some higher intensity cardio.
Caloric Intake	Caloric restriction	Enough to add muscle (adding muscle does require carbs)	Intermittent fasting + muscle gain within natural ranges.
Hormones	No hormone replacement; they cause heart failures	TRT and HGH replacement	Try to naturally keep testosterone high; if pursuing TRT, take precautions to improve health outcomes and stay within a reasonable range.
Sun	Avoid to limit skin cancer; sunscreen when necessary	Get regular sun; traditional skin cancer causes questioned	Use mineral-based (zinc, etc.) sunscreen. Small amounts of regular sun on body (none on face).
Cooking Oils	Generally not supportive of high-fat cooking oils.	Avoid seed oils; consider butter, lard, and grease	Red palm oil, organic butter; avoid heating up olive oil.
Macro Focus	Carbs (limit saturated fats)	Protein and fats (limit carbs)	Carbs needed when bulking and limited when cutting or maintaining; carb cycle; take actions to minimize insulin spike; high % from healthy monounsaturated fats (olive oil, avocados, mixed nuts, fish 1-2x/w).
Body Composition	Keep weight low; stay low on BMI charts	Keep body fat low but gain natural muscle	~8%-10% body fat and medium-weight for frame.
Statins	Statins are good for people with high cholesterol	Statins are bad for health for everyone	Just try not to get high cholesterol.
Other Focus Areas & Areas of Interest	Cholesterol levels; more apt to suggest non-steroid pharmaceuticals (antibiotics, rapamycin, NMN/NAD+, metformin, vaccines, etc.)	Gut microbiome diversity / gut health (avoid antibiotics); avoid pharmaceuticals and generally let the body heal itself; more apt to supplement with natural sources; more of a focus on natural whole food sources from quality foods over processed junk (but both support this); more concerned about environmental toxins; a bit more focused on vitality vs. longevity but with the expectation they go together. Saunas / cold plunges. Grounding. Recently a focus on hand-eye coordination.	Keep LDL and triglycerides low and HDL as high as possible. Support gut health via microbiome and use antibiotics only as a last resort for sickness; whole food sources (vegetables, fruits vs. processed); avoid environmental toxins (don't heat plastic, filter water with quality filter, exercise shirtless and limit polyester when hot; sweat out toxins, etc.)

Where Everyone Agrees

Category	Suggestion
Sleep	7-9 hours; make it a priority, sleep deeply, optimize, etc.
Movement	Move throughout the day in addition to real exercise (e.g., walking especially after meals); also rest some during the day. Everyone agrees exercise adds value.
Stress Reduction	Take steps to limit stress (meditation, mindfulness, social connections, exercise, etc.).
Naps	Short naps during the day when timed properly are great for health.
Diet	Focus on whole foods, especially fruits and vegetables, over processed foods; don't eat to the point of becoming fat. Tend to stop at 80% full. Avoid sugars. Get Omega-3 fatty acids.
Hydration	Drink plenty of water.
Meaning	Find meaning/purpose, social interaction, etc.

Where Each Side Excels & Struggles

The Medical Establishment:

Has a high burden for establishing scientific evidence and a "do no harm" mindset, but can miss recent developments.
Tends to look more at population-wide statistical trends. For example, BMI correlates negatively with health outcomes (with a reasonably strong correlation), so many just assume high BMI = high body fat and is unhealthy.
Relies a bit more on animal models given the impossibility of controlled double-blind human longitudinal studies with large sample sizes.
Most of this group is highly educated, but often has less personal experience with being optimizers themselves and tends to look at trends at a population level and not based on how to best help optimizers.
There are very impressive optimizers in this group who are also well-credentialed.

The Self-Taught Optimizers:

Tends to follow the latest research and studies but can sometimes wrongly extrapolate them or over-rely on small or poorly designed studies.
Tend to have good experience as practitioners of fitness and health but often with much less educational training.
Can sometimes over-rely on personal experience and often thinks anything that makes them feel good in the short term is also helpful in the long term.
Can sometimes get too caught up in homeopathic naturalist anti-science B.S. or choose a path based on stupid conspiracies.
There are highly educated MDs and PhDs in this group.

My Synthesis

Many of these open areas are unsettled from a scientific perspective. Generally, I think most of the fringe ideas (e.g., metformin) are primarily used to "make up for" non-optimized sleep, exercise, diet, or stress management. But for those who have already optimized those areas, I'm skeptical of significant further benefit based on today's tech. And there are a lot of correlation analyses that would suggest X intervention is beneficial at a population level but not for optimizers, which makes the science challenging. We haven't been doing incredible experiments over the last 100 years that would allow us to draw confident conclusions, and without those, we need to extrapolate imperfect science (animal studies for full lifespans, human correlation analysis, short-term impact analysis on humans, etc.).
Given this, my general train of thought is to try to avoid going too far in the direction that either group says is very unsafe, even if the other group says it's fine or slightly positive. For example, I would definitely not get 2 hours of unprotected sun each day.
If you're smart enough to understand how the systems of the body work (this takes time to meaningfully understand), you should look at the bimodal 'consensus' opinions and look at the best evidence via a literature review of both for each topic.
The Optimizer crowd will point to the many times the medical establishment has been wrong and changed its mind. I wouldn't put too much stock into that because the bro science folks are also very wrong on a regular basis, but they aren't the establishment, so it isn't made into as big of a deal.
Getting too far on the homeopathic train is definitely something to avoid, and the fringes of the optimizer camp can go that way. At the same time, analyzing holistic health optimizations is appropriate, so there is a balance.
Generally, it's a good idea to get labs and self-experiment to see the impact different strategies have on you and consider both schools of thought.
The optimizer path will definitely tend to lead to more vitality (quality of life). Whether it also leads to more longevity (quantity of life), I'm not sure. I'd bet on the medical establishment side but not with amazing odds.
Looking at the competitors at the top of the Rejuvenation Olympics leaderboards is helpful. If several folks there eat very high protein, for instance, then high protein is probably not unsafe. I noticed several but not all do consistent intermittent fasting, and there are a mix of vegetarians and meat-eaters and high and low protein eaters. Everyone there exercises and sleeps very well.
Personally, I aim for the "safe take" that either strikes a balance or substantially limits the concerns each side raises about the approach I am taking.

Links to Info About Rejuvenation Olympics Leaders

Insights from Rejuvenation Olympics Leaders

There is still room to do more analysis, but here are some quick views from this (I mostly skimmed the above links):

A lot of these folks do intermittent fasting (IF).
Some but not all do caloric restriction.
None are hugely jacked (many seem short), although David Parchomchuk does CrossFit, Siim Land is fairly big, and David Pascoe is not small.
I think Bryan Johnson is the only vegetarian. And he's actually vegan except for collagen peptides.
Some but not all take testosterone replacement therapy (TRT). I think most have naturally high testosterone from the other work they're doing.
A lot of these folks take glycine supplements (collagen, bone broth, etc.).
I think everyone on the list has a substantial exercise routine and almost all do both strength and endurance. Some add a decent amount of effort toward flexibility/balance.
Most seem to have a few areas they really over-optimize. For example, Jenvel Earth seems to really care a lot about her hair/scalp and uses powerful rosemary and bends over for a minute every day to get blood flow.
At least some of them seem to value sunlight and/or red light therapy.
All eat fruits/vegetables. Some eat whole grains/gluten and others don't, although it seems that the non-fruit carbs they eat tend to be low.
Many but not all supplement heavily (and the focus varies a lot). But this appears to be the last ~10%-20% of value-add vs. population average.
Most but not all of the folks seem to be very intelligent and can talk at length about the science.
I think there is someone in the list who does at least one of the cells for every cell on the chart above (e.g., someone eats low protein, someone eats high protein, etc.).

By: Justin McCallon

Justin has been interested in health/fitness for the last twenty years and aims to stay up-to-date on aging and fitness research.

Contact: justin.mccallon@gmail.com