[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.

[dredmorbius]

I very much wish there were a category of doctors...

"Sports medicine".

<https://my.clevelandclinic.org/health/articles/24627-sports-...>

<https://en.wikipedia.org/wiki/Sports_medicine>

You might also look into nutrition and dietetics and exercise physiology. If you're looking at cognitive function, neuropsychology and possibly some psychotherapy specialisations.

"Wellness coaching" is starting to get into the woo / overly-self-interested / conflicted domain, though there are probably a few good apples. I'd proceed with extreme caution however. There are plenty of docs who're more than happy to provide what a patient asks (and is willing to pay top dollar) for.