Optimization has become a marketing category. Cold plunges, supplement stacks, wearables, infrared saunas. Some of it works. Most of it is optional, and almost all of it is worthless if the foundations underneath are broken.
The order of operations
These are ranked by effect size, not by how interesting they are.
- Sleep. Seven to nine hours, consistent timing. Nothing on this list compensates for chronic short sleep.
- Resistance training. Two to four sessions weekly. The single best predictor of function as you age.
- Protein and body composition. Adequate protein, and a body fat range that is not driving insulin resistance.
- Bloodwork. You cannot fix what you have not measured. This is where most people should start spending money.
- Targeted correction. Thyroid, vitamin D, iron, testosterone, treat what the labs actually show.
- Optional protocols. NAD+, sermorelin, rapamycin. Reasonable to explore once one through five are handled.
What bloodwork actually changes
Most people running an optimization protocol have never measured their fasting insulin, ApoB or free testosterone. These are the markers that separate a guess from a plan. See our guide to the eight labs that matter.
Where the interesting protocols fit
NAD+, sermorelin, methylene blue and rapamycin all have plausible mechanisms and varying levels of human evidence, in most cases less than the marketing implies. They are worth exploring once the foundation is in place, with a clinician who will tell you honestly what the data supports.
How to know it is working
Pick metrics before you start. Repeat labs at six months. Track strength, resting heart rate, sleep quality and how you actually feel at 4pm on a Wednesday. Subjective measures matter, but not on their own.
Results vary. Clinical trial results apply only to the FDA-approved branded medication specifically identified and do not apply to compounded medications. All medications must be prescribed by a licensed provider based on medical necessity.