Health Optimization: Is Longevity Medicine the Future of Wellness?

“WE MIGHT BE the first generation that doesn’t die.”¹ It’s a bold statement, one that entrepreneur and originator of the Don’t Die protocol Bryan Johnson built a health and wellness empire upon. His goal is simple: Stay alive, and share his strategy with the world.

For centuries, people have sought the fabled Fountain of Youth. Could it be that this generation has finally found it in the form of longevity medicine? For Johnson, it’s a legitimate possibility: Thanks to the intersection of drug discovery, cellular reprogramming, biomarker tracking, regenerative medicine and artificial intelligence, he believes death is optional.² 

Johnson’s single-minded pursuit of not dying is an extreme example of the growing interest in health optimization — a proactive, personalized approach to health management that aims to help people reach their own personal optimal level of well-being, both physically and mentally. The idea is to get ahead of age-related health problems — to stop disease before it starts, and to set the body up for its absolute best possible health through protocols and practices that support wellness across the lifespan. Increasingly, this is called longevity medicine, and the goal isn’t just to live longer: It’s also to live better.

Is Aging Optional?

However drastic the methods, Johnson mirrors longevity medicine’s goal of taking the long view of one’s health. He utilizes the very same wellness habits healthcare providers emphasize all the time: prioritizing sleep, managing stress, eating nutrient-dense foods and exercising regularly. He also utilizes biomarkers, gene therapy, alternative therapies such as red light therapy, undergoes experimental procedures such as plasma exchange therapy, embraces gene therapy — anything that optimizes his health. 

Does he live well? In his mind, yes. His body is healthy and strong (“quantitatively the healthiest person alive,” he says), but he foregoes simple pleasures of enjoying a celebratory slice of birthday cake.⁴ Johnson’s efforts are clearly an extreme example of putting the theory of health optimization into practice, yet they do echo the questions longevity medicine researchers are asking: What are the processes behind aging? What can we do to slow those processes down? Does delaying physiological aging decrease diseases associated with old age such as cancer, dementia and heart disease? Is it possible to prevent death? 

Johnson’s critics oppose his strategy, explaining that at best, Johnson is encouraging people to embrace habits that are linked to a longer, healthier life, but at worst, he’s propagating false hope of immortality. 

“Death is not optional; it’s written into our genes,” explained Pinchas Cohen, MD, dean of the Leonard Davis School of Gerontology at the University of Southern California, in an article published in Time Magazine.3 Dr. Cohen is a renowned expert on the biology of aging and says “there is absolutely no evidence that [living forever] is possible, and there’s absolutely no technology right now that even suggests that we’re heading that way.”³

Aging isn’t optional either. According to Scott F. Gilbert, PhD, emeritus professor of biology (emeritus) and author of Developmental Biology, “Aging is the time-related deterioration of the physiological functions necessary for survival and fertility.”⁵ According to Dr. Gilbert, although we don’t fully understand the mechanism behind aging — is it continuous development, cellular senescence, mitochondrial dysfunction, genetic instability or something else? — it is nevertheless a certainty of the human experience. While getting older isn’t optional, experts increasingly agree that aging well is. 

The Burden of Chronic Disease

While not the key to everlasting life, longevity medicine does aim to help people age well. Its goal is to help people live longer, healthier lives by changing the practice of medicine. Instead of addressing a disease after it arises, longevity medicine aims to prevent the disease altogether.

While the characteristics of aging such as gray hair and wrinkles eventually affect everyone, the diseases of aging are a different story. Predisposition, genetics and epigenetics, lifestyle choices, family history, etc., all play a part in determining who develops disease, and when. Increasingly, understanding these data points informs individuals about interventions that can help them evade disease. The best strategies we have for prolonging life are proactive, preventive measures and early disease detection, which together can create highly personalized approaches meant to extend healthy lifespan.⁶

According to the Centers for Disease Control and Prevention (CDC), the life expectancy for males in 2023 was 75.8 years; the life expectancy for females was 81.1 years, with an average of 78.4 years for both sexes in the United States.⁷ Among the top 10 leading causes of death in the U.S. are chronic diseases such as heart disease, cancer, lower respiratory diseases, Alzheimer’s disease, diabetes, kidney disease and chronic liver disease. And, one in four Americans has at least one chronic condition, and more than half have two or more.⁸ Risky behaviors such as smoking, poor nutrition, lack of exercise, excessive alcohol and insufficient sleep not only contribute but directly cause the majority of these diseases; family history plays a role as well. Chronic disease is taking a substantial social and economic toll; these conditions drive the nation’s $4.9 trillion in annual healthcare costs.8 Experts agree that the world is set to face an unsustainable burden of chronic disease if a new medical and wellness paradigm isn’t adopted soon.⁶ 

Proactive, not Reactive — and Deeply Personal

Longevity medicine may be the answer.

Conventional medicine is reactive: It follows a model of maintenance and management by relying on routine checkups and screenings to catch diseases and leaning on symptom management during the treatment of those diseases. However, the model is impersonal, designed for large demographic groups that share the same general risk factors (e.g., mammograms are recommended for women beginning at age 40). Screenings do not necessarily consider an individual’s unique biological makeup or genetic markers, and data collection is limited. Baseline information is tracked, and diseases are treated when they arise. Routine screenings are a helpful start, but they are fragmented and only show a snapshot of what’s happening in the body at the time of the test.

Longevity medicine is proactive: It seeks to avoid disease in the first place. The familiar foundation of regular checkups, recommended health screenings, vaccines and risk avoidance measures are augmented by advanced diagnostics — frequent, patient-specific screenings look at biomarkers to reveal an individual’s internal aging processes, which can be used to determine interventions that will improve the quality and duration of a person’s life. Specialized tests look at genetic markers, oxidative stress, metabolic health, inflammatory mediators, cellular aging, hormone levels and more.⁹ These biomarkers are regularly collected and track subtle shifts over time. The continuous monitoring gathers data points that can reveal underlying patterns and provide actionable insights such as genetic predispositions, nutritional deficiencies, visceral fat and inflammatory markers. Consistently measuring the function of various systems gives clinicians deeper insight into how the organs are working and what they might need to function more effectively. 

This approach is deeply personal. Not only are tests conducted based on individualized recommendations, not broad ones (e.g., a test reveals a young woman carries a gene for the same type of breast cancer that took her mother’s life), but lifestyle factors and individual health profiles as well.¹⁰ And, because longevity medicine tracks subtle shifts in a patient’s body that may point to what could become larger, long-term problems, catching issues early helps providers and patients work together to develop a personalized plan to address the issues that particular patient may face before those issues become significant. 

Driven by Data

In longevity medicine, data and agency go hand in hand. Patients want personal health data, and they increasingly expect personal data. In fact, a recent survey conducted by the National Institutes of Health All of Us Program showed 58 percent of adults surveyed would like to use some sort of wearable fitness tracker to track their health.¹⁰ And, patients increasingly want to be involved in their health decisions, too. According to the Personalized Care Institute, a 2022 survey showed that 44.6 percent of patients would like to be more involved than they currently are.¹² They want to be proactive with their healthcare — and their future. Longevity medicine gives patients the information they need to understand their bodies better, and empowers them to make decisions that are best for them. The data collected helps inform lifestyle choices, direct healthcare decisions and improve quality of life. 

• Advanced laboratory testing: Blood panels check for chronic disease indicators, metabolic dysfunction and inflammatory biomarkers.
• Functional and physical testing: Cardiorespiratory fitness, strength and mobility are tested to assess functional age.
• Imaging: Whole-body magnetic resonance imaging (MRI), 3T MRIs, computer tomography (CT) scans, coronary CT angiograms and more provide detailed imaging that detects age-related diseases in their earliest stages.
• High-resolution molecular profiling (multi-omics): Analysis of genomics, epigenetics, transcriptomics, proteomics and metabolomics assess molecular aging. Not only do these tests make it possible to identify an individual’s susceptibility to disease, but they also point to the therapeutic interventions that may be most successful and the epigenetic markers that can help predict life expectancy.^9,12
• Continuous data collection: The explosion of wearable health trackers use data to provide insight and encourage behavior change as well. What’s more, wearables give unprecedented access to real-time health data. According to Harvard Medical, “The newest crop of wearable devices is optimized to capture a variety of distinct patient health indicators that can provide a clear snapshot of a person’s health status during everyday activities in a more detailed way than in-person measurements typically can provide.”¹³ Devices such as smartwatches and smart rings gather data points in real-life settings in real time. They track activity levels, measure sleep quality and quantity, assess heart rate and other vital signs, which together paint a more realistic, holistic picture of patient health than can be done in a single healthcare visit.¹³
• Artificial intelligence (AI): A team of experts from the Aging Research and Drug Discovery Meeting say AI is central to longevity medicine. “AI-driven biomarker discovery is increasingly recognized as a cornerstone for advancing personalized medicine and improving healthcare outcomes.”¹⁴ AI is being used in aging research, biomarker identification, drug discovery and even longevity science itself. “Machine learning algorithms, deep learning methods and big data analytics have facilitated the discovery of novel biomarkers of aging crucial for disease diagnosis, prognosis and predicting treatment outcomes.”¹⁴ AI-powered predictive analytics analyze patient health history, lifestyle and known risk factors, along with data gathered from wearable devices, to identify potential health issues before they become serious problems.¹⁵

Together, all of this information gives providers insight into a particular patient’s unique health, enabling the healthcare team to give personalized recommendations for supporting health going forward.

Longevity Medicine for All?

Longevity medicine isn’t the norm — yet. Barriers to access remain, but there’s a growing consumer interest in and demand for preventive, proactive healthcare, and experts foresee a future in which the healthcare model is proactive and preventive, optimizing every individual’s health. In fact, Saeju Jeong, co-founder and executive chairman of Noom, a digital health and wellness company, described the consumer-led trend toward preventive medicine as a prelude to a deeper reimagining of healthcare delivery, one that is led by patients. “We need a healthcare system that acts before a crisis, not after it. A system that uses diagnostics to direct attention, uses medication to unlock agency and uses daily habits to make gains durable,” Jeong says.¹⁶ 

According to Jeong, the emerging system will be:¹⁶ 

• Predictive: Tests identify health issues before they escalate.
• Personalized: Practitioners tailor healthcare plans to each individual patient.
• Longitudinal: Continuous monitoring supports health all year, not just once a year.
• Patient-led: Information empowers patients, giving them more agency.

Toward a Data-Heavy, Patient-Led Future

Although Johnson’s dream of immortality isn’t the end goal of longevity medicine, the data-driven optimization of patient health — and thus a far better quality of life — sure is. The days of reactive healthcare — addressing health issues once they arise — are numbered. While aging itself is certain, aging well is increasingly optional.