[Traubenfuchs]

PDE5 (viagra, cyalis) improve the health of the cardiovascular system, thus improve kidney health and I greatly enjoy them.

This is well researched and just like with semaglutide I believe a big part of the population should take daily tadalafil.

Better cardiovascular health, more erections and many positive downstream effects (lower E:T ratio, weight loss) that are beyond the scope of this comment.

[iamacyborg]

People should probably try improve their CV health via exercise, rather than pills, wherever possible.

[nosianu]

Better than exercise is a better normal lifestyle. Trying to compensate in an hour what went wrong most of the day or week, and with your diet, is far from optimal.

One of many, looking at just one detail (sitting): https://www.health.harvard.edu/staying-healthy/sitting-may-i...

From a personal experience, so it's just a guess, a contributor may be fluid movement in the body. Fluid in blood vessels are pumped directly, but must fluid is not in blood vessels. The heart has a diminishing effect outside the vessels (capillaries have small holes to let water and small molecules through into extracellular space, and then to collect it back, rest goes through the lymphatic system which also drains back into the bloodstream). Muscle and body movement helps. From what I experienced and experimented, just walking did a lot more than running. I focus on this specifically due to personal health experiences that I don't want to go into that let me feel a clear difference, where intensive running did hardly anything but then just walking did, an experiment I performed during a period of my life when "getting stuff out from all over my body" mattered.

Personally, I choose to run only when my brain/body tell me to, when I feel like it. Definitely not when I would have to fight myself to get going. (If your body/brain tells you the opposite then it is what it is, personal feel over generic advice)

[iamacyborg]

Exercise is a better normal lifestyle. Standing isn’t of sitting isn’t going to fix much, given the key finding in most relevant studies is that frequent movement is necessary (albeit it’s easier and more natural when already standing).

[nick49488171]

How about walking desk?

[sigmoid10]

Doctors have been telling us that for decades now and still noone does it despite overwhelming evidence. I guess the average Joe will always need a cheap workaround drug rather than putting themselves at any level of physical discomfort.

[kakacik]

Lazy people will be lazy, whatever nasty side effect it brings down the line. These days they will also 'brag' about it online.

[arijun]

Why not both?

Every person has a limit of how much time and energy they can put into exercise. If they can go beyond that with a pill (with no other cost), why wouldn't you want everyone to take it?

[iamacyborg]

Sure, but let’s start with promoting the 90 percenter rather than the 1 percenter then.

[froggit]

Kinda seems like taking boner pills encourages certain types of physical activity.

[mulnz]

Why?

[iamacyborg]

Because of all the other physiological and mental benefits that come from the exercise that the pill won’t give you?

[smokel]

It might be empirically sound, but it does not make a priori sense that exercising a body will improve it. If I use almost any object in the universe frequently, it typically degrades rather than improves.

The health benefits of exercise are most likely due to improved blood flow and related physiological effects. In principle, pills could theoretically achieve similar outcomes by enhancing circulation or other underlying mechanisms.

Not taking sides here, just reasoning out loud.

[motorest]

> It might be empirically sound, but it does not make a priori sense that exercising a body will improve it. If I use almost any object in the universe frequently, it typically degrades rather than improves.

Rejecting all evidence, denying observations, and leaning heavily on half-baked hypothesis that culminate somehow on a gotcha. That sounds an awful lot like something someone who "does their own research" would say.

Yes, extreme levels of high-intensity exercise have adverse side effects. Cross-fit and rhadbo is an example.

https://en.wikipedia.org/wiki/Rhabdomyolysis

Drinking water also does everyone good, and everyone's health will improve if they increase their water intake, but drinking water in excess can also be fatal. Does this mean that the idea that drinking water does you good "does not make a priori sense"?

No, it doesn't.

[twelvedogs]

i kinda see where he's coming from, wear and tear on joints and such

however any kind of "pill" that would have anywhere near the same health effects as exercise is decades away at least.

hips and knees acls tend to be a failure point but the non-existance of said "pill" is probably a fairly big tick for the excercise side, and our tech for repairing those failure points continues to progress at speed

[iamacyborg]

In the context of running, physiological benefits I’m familiar with include improvements to bone density and joint health, increased capillarisation and therefore blood flow in the muscles and improved energy efficiency in cells.

I suspect you’re not going to find a pill or combination of pills that can achieve those outcomes. And again, we’re ignoring the mental health benefits.

[untrust]

Doing resistance training will mechanically stress the ligaments, bones and muscles which results in your body reinforcing and strengthening them. This is important to do on a localized level, as hypertrophy of the heart is not good whereas hypertrophy of the leg muscles is. You cant do this in pill form (at least yet)

[froggit]

Excessive exercise might not be healthy? No shit?

[dredmorbius]

It turns out that there's a wealth of evidence which shows that appropriate introductions of stress (cardio training, resistance training, fine-motor-control practice) do in fact lead to improvements: greater heart health, better pulmonary function, increased strength, greater bone density, improved blood sugar regulation, decreased overall stress response, and more.

Yes, overtraining is possible (and not infrequent, particularly by those who fail to read or ignore the evidence). But an absolutely sedentary lifestyle is exceptionally fatal.

Medications (as with exercise) come with both intended and unintended consequences, as well as costs and inconveniences. Generally the more extreme the condition you're treating, the more likely that medications will carry some of these disadvantages (e.g., chemotherapy against cancer, where the goal is often to kill the malignancy at least slightly faster than one kills the patient). Exercise operates through complex feedback cycles and mechanisms, not all of which are well-understood (as an example, why muscle grows in response to strength training being a fundamental case despite much information on how muscle responds to which specific training protocols). Medications can amplify training response (e.g., anabolic steroids for strength training athletes), but often don't by themselves substitute for it.

This is why, in a broader sense, that the Baconian scientific method does not rely simply on a priori hypotheses, but tests these with experiment and evidence, that is, empirically. The ultimate critique of pure reason is that whilst it can be a useful guide for what you then want to test empirically, it has a phenomenal tendency to lead one to utterly fallacious and/or irrelevant conclusions.

One of the more robust sets of evidence on both the negative effects of a zero-stress lifestyle and of the benefits of regular cardio and strength training is that accumulated through long-term space missions, largely aboard the International Space Station (ISS). Microgravity would be the ultimate low-stress environment, and it turns out to be seriously harmful. Astronauts there are tested before and after missions, with various measures of fitness loss. With time-in-space being an immensely valuable resource, astronauts also spend two hours per day engaged in physical exercise (<https://www.asc-csa.gc.ca/eng/astronauts/living-in-space/phy...>), or 1/8 of their waking schedule.

Online, ExRx (<https://exrx.net/>) has a large library of fitness information, including a list of online journals (<https://exrx.net/Journals>) and expert talks (<https://exrx.net/Talks>). Good books on fitness will link to research substantiating recommendations (Lou Schuler's New Rules of Lifting series is a good example of this).

[dredmorbius]

Medication frequently (though not always) provides benefits that may be achieved at least in part by non-medical means: lifestyle (adequate sleep, low stress, reduced exposure to contaminants and pollutants), diet (preferring healthier to unhealthier foods, generally), and exercise (itself comprised of multiple modalities, including cardio, strength training, fine motor control, and others).

The best results are achieved when these are working together toward some health or fitness goal. It's far more effective to align your lifestyle, diet, exercise, and medications than to have these working against one another (I'll take this pill to compensate for my drinking / smoking / drug use / pollution exposure / stress, etc.). Of course, that's not always possible, and there are circumstances where it's difficult or impossible to attain some of these mechanisms (parapalegic, living in a highly polluted environment, inherently stressful living conditions, GI compromise limiting eating or diet, congenital or genetic conditions or predispositions). Even here, if the patient can make some progress in a specific modality, they'll probably see some benefit.

Some of the most impressive athletes I've seen, from a sheer grit perspective, are those who are working against some major limitation: the swimmer at a health club long ago paralyzed in both legs, the one-legged open-water swimmer, old farts with their pacemakers showing through their chests swimming in the San Francisco Bay, patients with diabetes, heart failure, Parkinsons, recovering from cancer, with various injuries or scars, still at it. Some are astonishingly good by any measure, many aren't, but damned if they're not trying and generally living far better than if they weren't.

This isn't "don't take your meds", it's "use all the available tools". Lifestyle, diet, an exercise are underrated and powerful tools.

"You don't look like your medical history" is a high compliment coming from a doctor, and I'd strongly recommend earning it.

[cj]

> This isn't "don't take your meds", it's "use all the available tools".

Agreed - low dose daily cialis/tadalafil (e.g. 5mg/day) is very common among elite athletes, bodybuilders, etc. As are GLP-1's despite elite athletes rarely being overweight.

Tadalafil is taken for its endothelial benefits (erections are a convenient side effect), and GLP's for its nutrient partitioning and insulin sensitization effects.

Medications are very often most effective when paired with good lifestyle habits, rather than one of the other.

It also depends on what your goals are, obviously.

[dredmorbius]

At a baseline, healthy vitals (blood pressure, blood sugar, heart function, preservation of bone mass/density, and lean/muscle mass, avoiding accumulation of excess fat, particularly visceral / mid-section fat).

Beyond that, if goals are for specific performance targets, in some athletic or competitive activity, you'll want to tune your training toward that. Again, the baseline is remarkably consistent, it's the high-performer tuning which varies.

Going off-label on prescriptions, especially without a doctor's supervision, carries its own set of risks. If you're lucky, it's only wasted money. If you're not, it's markedly worse.

[cj]

> Going off-label on prescriptions, especially without a doctor's supervision, carries its own set of risks.

The biggest hurdle I've encountered personally is primary care doctors deal with very sick people every day (terrible diet, terrible body composition, terrible alcohol/drug habits, etc). And that's who they optimize their care for.

If you show up to a PCP and you're in shape, all vitals on point, all bloodwork looking good, the last thing the PCP wants to do is prescribe anything because "you don't need it" and "you're not sick".

Most doctors simply don't care about helping you optimize your health once you've reached "healthier than average" status.

This leads a lot of people to doing their own research, and finding health clinics outside of insurance that cater to health optimization, anti-aging, and non-standard treatments (like prescribing GLP's to people who aren't overweight, or Cialis for people who don't have ED). These clinics also aren't very good because, while they are indeed doctors or NPs, they make money off selling you prescriptions, so they are biased and usually push medications you might not really need or want. (Which again emphasizes the importance of self-education and doing your own research).

For drugs like GLP-1's, there are a whole lot of anecdotal benefits outside of weight loss. The problem with the drug industry is once a drug is approved for its most profitable use case, drug makers don't bother to pursue additional FDA approvals for additional indications because the headache isn't worth the (marginal) extra revenue.

I very much wish there were a category of doctors specializing in treating healthy people looking to optimize their health further.

[mewpmewp2]

Do you not have any negative side effects? When I tried I felt this tightness and weird headache that I don't otherwise ever experience, brain fog and also nasal symptoms.

[Traubenfuchs]

On high dosages (20mg tadalafil daily), diarrhoea, which ironically makes the backside useless while the frontside works better. And some congestion.

5mg daily tadalafil is fine for me though and that‘s also the normal daily dosage.

[dwedge]

What about migraines though? Or do you keep the dose low enough to avoid that?

[Traubenfuchs]

Researched daily dose is usually 5mg tadalafil.

[contrarian1234]

unfortunately i was surprised that even the generic is kinda pricey to take every day. At the smallest available dose it was 5 usd a pill (last i checked in China)

[AstroNutt]

I just checked my text from Walmart last week saying my Tadalafil was ready for pickup. It was literally $25.60 for a 30 day supply of 10mg and I currently don't have insurance. 100% out of pocket.

[contrarian1234]

interesting. thanks for letting me know. in Taiwan it was also not cheap (and requires a prescription and doctor visit) Guess Ill keep looking around. id sort of given up using it regularly