The Anti-Longevity
Playbook

How I Judge the Evidence (and Why You Should Care)

When someone tells you a supplement “works,” the first question to ask is: works in what? Because not all studies carry the same weight.

Throughout this playbook, I'll tell you exactly where each intervention sits on this ladder. Some may surprise you. Things you probably assumed were proven have almost no human data behind them. Things you've never heard of have decades of it.

My System: Three Buckets

Every intervention gets placed into one of three categories:

1. Worth doing — Strong evidence in humans showing real benefit with acceptable risk. These are the things you should actually be spending your time and money on.

2. Interesting but unproven — The science makes sense on paper, there's some promising early data, but we don't have enough human evidence to recommend it broadly. Worth keeping an eye on. Not worth betting your health on.

3. Overhyped or disproven — Either the evidence doesn't support the claims, the effect is too small to matter, or the risks outweigh the possible benefits.

To be clear, I will end up being wrong about some of these. Science changes. That's why this playbook gets updated every quarter, and why I'll tell you honestly when something moves between buckets. What I won't do is pretend to be certain when I'm not.

One more thing about me: I'm not a longevity expert. I haven't spent years in a longevity research lab, and I don't run a longevity clinic. I'm a practicing primary care physician and internist. What I do know how to do is read the medical literature critically, appraise studies for quality, recognize when a claim outpaces the evidence behind it, and separate what's real from what's marketing. That's the lens I'm bringing to this playbook. Not expertise in longevity — expertise in telling the difference between hype and substance.

Let's get into it.

The Consistency Problem

Before we start: nothing in this playbook works in 12 weeks.

This is the part nobody in the longevity space wants to say out loud because it's bad for business. Supplements, peptide cycles, and IV infusion packages are built around the idea that you can buy a course of something, do it for a defined period, and come out the other side meaningfully healthier.

That's not how biology works. The interventions in this playbook that are actually proven (exercise, sleep, cardiovascular risk management, social connection) work because people do them for decades. The Finnish sauna data showing 63% lower cardiac death? That was men who used the sauna 4-7 times per week for 20 years. The exercise mortality data? Decades of follow-up. Statins? Lifetime medications.

When someone sells you a 12-week peptide cycle, or a 90-day supplement stack, or a quarterly IV drip package, ask yourself: where is the evidence that this duration produces a lasting benefit? Almost always, the answer is nowhere. The studies either don't exist, or they show that benefits disappear when you stop.

Consistency isn't sexy. You can't sell a subscription box for “keep doing the boring thing every day for 30 years.” But that's the actual mechanism behind every proven longevity intervention we have. If you're not willing to do something indefinitely, it's probably not worth starting for longevity purposes.

Know Who's Advising You

One last thing that most people in the longevity space don't know (or don't want you to know?) is that the credentials behind many of the doctors recommending these interventions are not what they appear to be.

In the United States, legitimate medical specialties are recognized by the American Board of Medical Specialties (ABMS). To become board-certified through ABMS, a physician must complete an accredited residency program (3-7 years of supervised clinical training after medical school), pass rigorous examinations, and maintain certification through ongoing education and assessment. This is the standard. Internal medicine, cardiology, endocrinology, family medicine — these are ABMS-recognized specialties with established training pathways, standardized competencies, and structures in place to maintain accountability.

“Functional medicine,” “regenerative medicine,” “integrative medicine,” and “anti-aging medicine” are not recognized medical specialties. They are not accredited by ABMS. The certificates and credentials offered by organizations like the Institute for Functional Medicine (IFM) or the American Academy of Anti-Aging Medicine (A4M) are not equivalent to board certification. They do not require completion of an accredited residency or fellowship. In many cases, they require only attendance at a series of conferences and payment of fees — though some practitioners hold these alongside traditional board certification.

This matters because the physicians most aggressively recommending unproven longevity interventions often hold these alternative credentials rather than (or in addition to) ABMS board certification in a relevant specialty. That doesn't automatically make them wrong. But it should make you ask harder questions.

When someone recommends an intervention, especially one that's expensive or unproven, it's worth knowing: Did this person complete a residency where they treated actual patients with actual diseases under supervision? Are they board-certified in a specialty recognized by ABMS? Or did they attend a certificate program and open a cash-pay clinic?

Some corners of the longevity space desperately need more doctors with rigorous training and less financial incentive to sell you interventions. Until that changes, the burden of verifying credentials falls on you, the patient.

Section 1: Things That Actually Work

Before we get into the flashy stuff like peptides and supplements, let's start with what we actually know saves lives. These interventions are backed by decades of real-world human data, massive studies, and very consistent results. They are also, not by accident, the least marketable things in the longevity world.

Exercise: The Single Most Powerful Thing You Can Do to Live Longer

If exercise were a pill, it would be the most prescribed medication in history. No supplement, drug, or biohack comes anywhere close to what regular physical activity does for your chances of staying alive.

What the research actually shows:

A major 2018 study published in JAMA Network Open tracked over 122,000 adults and measured their fitness levels using METs — metabolic equivalents — during treadmill stress testing. METs measure how much energy your body is using relative to rest: sitting still is 1 MET, brisk walking is about 3-4 METs, and an all-out sprint might hit 12+. The higher your peak METs on a stress test, the fitter you are [2].

The results were staggering. People in the least fit group had nearly four times the death rate of those in the most fit group. To put that in perspective: the gap in death rates between the least fit and the most fit was bigger than the gap between smokers and non-smokers [2].

4× higher death rate

in the least fit vs. the most fit — a gap bigger than between smokers and non-smokers. [2]

Every small improvement in fitness — measured as a 1-MET increase (a standard unit of fitness) — was associated with a 13-15% drop in your risk of dying from any cause [3]. Another study, the Copenhagen Male Study, followed over 5,000 men for 46 years and found that each unit of improvement in VO2 max added about 45 days to your life [4].

Here's the part that matters the most: there is no ceiling. The fitter you are, the lower your death risk. No point of diminishing returns has been found [2].

The three pillars of exercise for longevity:

1. Cardio (especially “Zone 2” training)

You've probably heard the term “Zone 2” floating around fitness and longevity circles. It refers to an intensity level where you're working hard enough to breathe heavier, but you can still hold a conversation. Think brisk walking, easy jogging, or cycling at a comfortable pace.

Zone 2 training has gotten a lot of attention because it “builds the engine.” It improves how efficiently your cells produce energy, helps your body burn fat more effectively, and forms the aerobic foundation that everything else sits on. These are established exercise physiology principles — not controversial.

But Zone 2 alone isn't enough. To actually improve your VO2 max, which is the number most strongly tied to survival, you need to occasionally push harder. Short bursts of high-intensity effort (intervals where you're breathing hard and can't talk) are what drive VO2 max upward.

The ideal split: about 80% of your training at a comfortable, conversational pace, and 20% at higher intensities.

What to actually do: Aim for 150-200 minutes per week of easy cardio (walking, cycling, swimming, jogging), plus 1-2 sessions per week that include some harder efforts. This is the minimum amount that moves the needle on mortality in a meaningful way.

2. Strength training

Here's something most people don't know: your grip strength is one of the best predictors of how long you'll live [6]. It sounds strange, but it's been replicated across dozens of studies. Grip strength is a stand-in for overall muscle mass and function, and muscle loss as you age (called “sarcopenia”) is directly connected to falls, fractures, metabolic problems, and loss of independence [7].

But — an important distinction: grip strength is a marker, not a target. It correlates with overall muscular strength and health because strong people tend to have strong grips. That doesn't mean you should spend your gym time squeezing hand grippers. Training your grip specifically won't make you live longer any more than whitening your teeth will make you healthier just because healthy people tend to have good teeth. It's an indicator of something deeper: total-body functional strength. The thing that actually moves the needle is compound strength training — squats, deadlifts, presses, rows. Your grip will improve as a byproduct.

After age 30, you lose roughly 3-8% of your muscle mass per decade. After 60, it accelerates [7]. The only reliable way to slow this down is to lift heavy things regularly.

Strength training at least twice a week preserves muscle, supports bone density, improves blood sugar control, and reduces your risk of dying from any cause, independent of how good your cardio fitness is [8]. Every major medical organization in the world recommends it. Yet it remains the single most under-prescribed intervention in medicine.

What to actually do: Lift weights or do bodyweight resistance training at least twice a week. Focus on big, multi-joint movements — squats, deadlifts, presses, rows, carries. These give you the most benefit for your time.

3. VO2 max — a number you should actually care about, but don't obsess over it

Forget your step count. Forget your resting heart rate. If there's one fitness number that predicts your future, it's VO2 max.

VO2 max measures how efficiently your entire system works together — your heart, your lungs, your blood vessels, and your muscles [5]. Unlike most health numbers, you can't fake it, supplement your way to a better score, or game the test. You have to earn it.

The biggest bang for your buck comes from getting out of the bottom 25%. If you're currently sedentary, getting to even “below average” fitness produces a larger reduction in death risk than any drug discussed in this entire playbook [2].

13-15% lower risk of death

for every 1-MET improvement in fitness. No ceiling found. [3]

A few important caveats about VO2 max

There are things worth understanding before you start chasing a number.

First, the landmark 2018 JAMA study that generated most of the VO2 max headlines didn't actually measure VO2 max directly. It estimated cardiorespiratory fitness using METs from treadmill stress tests performed on over 122,000 patients. These were not healthy volunteers recruited off the street. They were patients referred for clinical stress testing, many with suspected cardiovascular disease. Some of the “low fitness predicts death” signal in that study likely reflects the underlying conditions that brought those patients in for testing, not just poor aerobic fitness on its own [2].

Second, and arguably more interesting, a 2024 Mendelian randomization study published in The Journal of Clinical Endocrinology & Metabolism used genetic variants to test whether VO2 max causes better longevity. Mendelian randomization is a method that uses your DNA as a kind of natural experiment: if certain genes predict higher VO2 max, do those same genes also predict living longer? The answer was no. Genetically predicted VO2 max showed no association with longevity [111].

This doesn't mean fitness doesn't matter. It clearly does. What it suggests is that the relationship between VO2 max and living longer may be driven by confounding factors rather than the number itself. People who are fit tend to be leaner, more physically active, less likely to smoke, more socially connected, and less likely to have chronic disease. VO2 max may be a marker of all those things rather than the independent driver of lifespan.

What does this mean practically?

It means VO2 max is a useful number, but not a number worth obsessing over. The longevity benefit almost certainly comes from the exercise itself: the cardiovascular conditioning, the metabolic improvements, the muscle preservation, the mental health effects, and yes, the social connection that often comes with staying active. It does not come from the score you achieve on a test or the estimate on your Apple Watch (which estimates VO2 badly, by the way).

If you want to spend $300 on a VO2 max test at a longevity clinic so you can track a number to optimize, that's fine. But don't fall into the same trap as the supplement optimizers. The thing that matters is that you're moving consistently, building strength, and pushing your cardiovascular system. The number is a byproduct, not the goal.

Get out of the bottom quartile. Keep improving. Don't worship the metric.