The Enduring Power of Daily Habits

Despite technological advances, the foundation of preventive health remains remarkably consistent: what you do every day matters more than any single intervention. The science behind this is more compelling than ever.

Recent research from Stanford’s longevity institute shows that people who maintain five key daily habits can add up to 14 years to their lifespan:

• Quality sleep
• Regular movement
• Stress management
• Nutritious eating
• Meaningful social connection

What’s particularly striking is how these habits compound over time, creating protective effects that extend far beyond their individual benefits.

The key insight: consistency trumps intensity.

At Eudēmonia, we talk ad infinitum about these big health pillars, and we’ve gone deep on them in past issues. Here’s a refresher on the essentials:

• Sleep
• Supplements
• Superfoods
• Gut Microbiome
• Heat and Cold Exposure

Diagnostic Test Stacking

Comprehensive preventive medicine starts with a new paradigm: advanced diagnostic testing. And while any single test can provide valuable insights, the real power lies in strategic test “stacking”—combining complementary diagnostics to create complete pictures of health that no individual test can provide.

Please note, these tests give you a ton of data, and it can be overwhelming to make sense of them. Make sure you do this testing with a great functional medicine doctor or medical practitioner who can help make sense of the data and provide you with a plan to tackle whatever issues arise. It’s important to turn these fragmented data points into a cohesive roadmap for prevention.

Here’s what we can test.

Comprehensive Blood Analysis

Beyond basic panels, we can now measure 100+ biomarkers, including advanced lipid particles, inflammatory markers, metabolic indicators, nutrient status, and early disease markers like liquid biopsies for cancer detection.

Hormone Mapping

DUTCH testing reveals not just hormone levels but how your body processes them. We can see cortisol patterns throughout the day, estrogen metabolite ratios indicating cancer risk, testosterone conversion pathways, and stress response patterns, all from dried urine samples.

Gut Ecosystem Analysis

Advanced stool testing now sequences your entire microbiome (28,000+ species), measures inflammatory markers, assesses digestive function, and evaluates intestinal permeability. We can identify specific pathogenic organisms, beneficial bacteria ratios, and functional capacity of your gut microbiome.

Advanced Cortisol Assessment

Beyond single-point blood tests, we can now measure cortisol rhythm throughout the day using saliva testing, evaluate cortisol metabolites in urine, and assess cortisol awakening response (CAR) to understand stress resilience and HPA axis function. This reveals whether you’re producing enough cortisol, making too much, or if your natural circadian rhythm is disrupted—critical information for addressing chronic fatigue, sleep issues, and stress-related health problems.

Cellular Metabolic Function

Organic acids testing reveals what’s happening inside your cells—mitochondrial efficiency, neurotransmitter production, detoxification capacity, and nutrient utilization at the cellular level. This shows functional deficiencies that blood work often misses.

Body Composition and Performance

AI-enhanced DEXA scans provide precise body fat distribution, bone density, and muscle mass by region. VO2 max testing determines cardiovascular fitness and mortality risk. RMR testing reveals exact metabolic rate and fuel preferences.

The magic happens when these tests are combined. A person with “normal” cholesterol might show elevated ApoB particles from extensive bloodwork, disrupted cortisol rhythms from a CAR test, gut dysbiosis from a stool test, and poor metabolic flexibility from an organic acids test, revealing cardiovascular risk invisible to traditional testing.

Someone struggling with weight loss despite a perfect diet and exercise might have normal thyroid tests, but advanced testing reveals the real culprits: disrupted evening cortisol preventing fat burning, low beneficial gut bacteria affecting metabolism, and poor cellular energy production. The issue isn’t willpower; it’s fixable metabolic dysfunction.

A woman with unexplained anxiety might have normal thyroid function but reveal estrogen dominance, disrupted neurotransmitter production, gut issues affecting mood chemistry, and mineral deficiencies impacting nervous system function. The anxiety isn’t “just stress.” It’s treatable biochemical imbalances.

Someone with “normal” blood sugar and A1C might actually be heading toward diabetes. Advanced testing could reveal elevated insulin levels, poor glucose responses on continuous monitoring, disrupted cortisol patterns driving sugar cravings, and gut bacteria imbalances affecting blood sugar control. Early intervention can prevent progression years before traditional tests would catch the problem.

When you test regularly, you get a detailed picture of your health, and the story gets much more dynamic—showing not just where you are today, but how your body is trending over time. And you start to see the interconnected nature of your body’s health systems.

Real-Time Health Intelligence

Preventive medicine is also predictive medicine: it anticipates problems before they manifest, using real-time data and advanced analytics to guide decisions that keep you healthier for longer.

Wearable technology and advanced diagnostics are turning biology into something closer to a live feed. Heart rate, sleep stages, blood oxygen, HRV, body temperature, glucose, ketones, and even lactate can now be tracked not once a year in a lab, but second by second. What’s emerging is a living dashboard of human health.

Once a tool exclusively for diabetics, continuous glucose monitors are now revealing something profound: each of us has a unique metabolic fingerprint. The idea that one diet fits all collapses under the data. Oatmeal spikes one person’s blood sugar into pre-diabetic ranges while barely nudging another. Meanwhile, eggs and avocado might stabilize one individual while causing subtle issues in another.

The conclusion is undeniable. Food is not universally “good” or “bad”—it’s contextually beneficial or harmful depending on your biology.

This same principle is expanding well beyond glucose.

Heart Rate Variability (HRV)

Once niche, it’s now a leading indicator of stress resilience and recovery. Elite athletes use it to fine-tune training loads. Clinicians are using it to flag autonomic nervous system imbalances long before they present as disease.

Wearable ECGs

Catch atrial fibrillation in real time instead of years later.

Continuous Ketone and Lactate Sensors

Get insights into metabolic flexibility and endurance capacity as you live your day.

Biosensors

Noninvasive patches and even contact lenses are being developed to track hydration, cortisol, uric acid, and dozens of other markers.

Real-time health intelligence is not just about measurement; it’s about pattern recognition. Machine learning is being trained to spot early warning signs across these signals: changes in HRV predicting infection days before symptoms, rising nighttime glucose indicating insulin resistance creeping in, or subtle shifts in body temperature predicting illness onset.

This is a new frontier. Your body is becoming its own diagnostic lab, your daily data the map, and preventive medicine the practice.

Disclaimer: This newsletter is provided for educational and informational purposes only and does not constitute providing medical advice or professional services. The information provided should not be used for diagnosing or treating a health problem or disease, and those seeking personal medical advice should consult with a licensed physician.

Your Internal Weather System

Every moment of your life, your vagus nerve is making micro-adjustments to keep your internal environment stable. Think of it as your body’s thermostat. But instead of just regulating temperature, it’s calibrating your entire physiological state based on what’s happening around you and within you.

When you’re safe and relaxed, high vagal tone activates the parasympathetic nervous system. Your heart rate becomes more variable (a good thing), your breathing deepens, your digestive system kicks into gear, and your immune system focuses on repair and maintenance. You’re in a state of ease. This is also when your body produces the highest quality deep, restorative sleep that consolidates memories, repairs tissues, and clears metabolic waste from the brain. Many people use vagal stimulators before bed—more on that later.

But when a threat or stress appears, your vagal tone can drop, and the sympathetic nervous system takes over. Your heart rate becomes rigid and elevated, breathing becomes shallow, digestion shuts down, and your immune system shifts into inflammatory mode.

This is the “fight or flight” response—and it’s supposed to be temporary.

The problem is that modern life often keeps us stuck in this activated state. Chronic stress, poor sleep, inflammatory foods, social isolation, and constant digital stimulation all suppress vagal tone. When your vagus nerve is underperforming, your body loses its ability to shift fluidly between activation and rest. You become physiologically stuck in survival mode.

Poor vagal tone also disrupts your sleep architecture, making it harder to fall asleep, stay asleep, and achieve the deep sleep stages necessary for recovery. This creates a vicious cycle: poor sleep further suppresses vagal function, which makes quality sleep even more elusive.

But here’s the remarkable thing: unlike many aspects of your nervous system, vagal tone is trainable. You can literally strengthen this nerve through specific practices, improving your body’s ability to regulate itself and respond to life’s inevitable stresses with greater resilience.

The Domino Effect of Vagal Health

When your vagus nerve functions well, it creates an upward spiral that touches every area of your life. Better sleep and mood regulation are just the beginning. They’re foundational dominoes that topple into much bigger changes.

Decision Making and Mental Clarity

• Stop operating from chronic stress and fatigue
• Clearer choices about food, relationships, work, and health
• Respond from clarity and intention rather than reactive survival mode
• Mental resources freed up for creativity, problem-solving, and strategic thinking

Relationships and Social Connection

• High vagal tone makes you literally more socially engaging
• You listen more deeply and respond rather than react defensively
• Create emotional safety that allows genuine connection to flourish

Physical Health Cascade

• Reduced systemic inflammation and stronger immune function
• Optimized digestion and cardiovascular health
• Body shifts from damage control to repair and optimization mode
• Nagging health issues often begin to resolve

Research shows measurable improvements in just 4-6 weeks of consistent vagal training. Participants in breathing-based studies showed 23% improvement in heart rate variability, significant reduction in cortisol levels, and significant improvements in sleep quality scores. Those practicing cold exposure therapy report better stress recovery times within 3 weeks.

Signs and Threats of a Sluggish Vagus Nerve

A weakened vagus nerve leaves unmistakable fingerprints throughout your body and mind.

Physical Signs

• Digestive issues: chronic bloating, irregular bowel movements, acid reflux
• Heart always racing or pulse that barely varies throughout the day
• Chronic fatigue and sleep difficulties
• Frequent headaches and muscle tension that won’t release
• Body never fully relaxes

Mental/Emotional Signs

• Anxiety as your default setting
• Difficulty bouncing back from stress
• Overreaction to small irritations
• Struggling to feel genuinely calm
• Sense of disconnection from your body and emotions

Lifestyle Factors That Suppress Vagal Function

The biggest culprits are:

• Chronic stress
• Poor sleep
• Processed foods
• Social isolation
• Shallow chest breathing

Vocal Practices

These tap into the vagus nerve’s connection to your throat and vocal cords. Humming, singing, chanting, or even gargling water creates vibrations that stimulate the nerve. Many meditation traditions discovered this connection centuries ago. The reason “Om” and other mantras work isn’t mystical; it’s neurological.

Heart Rate Variability Training

Use technology to give you real-time feedback on your vagal tone. Devices or smartphone apps can show you how your breathing patterns affect your nervous system.

Meditation and Mindfulness Practices

These consistently show benefits for vagal health. The key is regularity rather than duration. Even 10 minutes of daily practice can measurably improve vagal tone over time. The practice teaches your nervous system to observe without immediately reacting.

Gentle Movement Practices like Yoga and Tai Chi

Yoga is almost perfectly designed for this purpose. The combination of deep breathing, gentle inversions, and mindful movement hits multiple vagal pathways simultaneously. Even gentle walking, especially in nature, supports vagal function through rhythmic movement, deeper breathing, and potential for awe-inspiring moments.

Pay Attention to What You Eat

The vagus nerve is sensitive to inflammation, so anti-inflammatory foods help keep it strong. Omega-3s from fish, walnuts, and flaxseeds lower inflammatory markers. Fermented foods such as kimchi, sauerkraut, and kefir support the gut microbiome, which communicates with the brain through the vagus nerve. Fiber feeds gut bacteria that produce short-chain fatty acids, boosting vagal pathways.

In contrast, processed foods, sugar, trans fats, and alcohol drive inflammation and weaken vagal tone. Regular drinking in particular lowers heart rate variability.

Connect with Others

Perhaps most importantly, genuine social connection is one of the strongest vagal stimulators of which we know. Eye contact, physical touch, laughter, and meaningful conversation all activate the social engagement system that Stephen Porges identified as the highest function of the vagus nerve. This is why isolation is so damaging to our physiology, and why community is literally medicine.

Vagus Nerve Stimulation

The medical world has begun to take vagus nerve stimulation seriously, with FDA-approved devices now treating conditions from depression to epilepsy. Implanted vagus nerve stimulators (VNS) send regular electrical pulses to the nerve, often with considerable results for treatment-resistant depression and severe seizure disorders.

More recently, transcutaneous vagus nerve stimulation (tVNS) has emerged as a non-invasive alternative. These devices stimulate the nerve through the skin, typically at the ear or neck, without requiring surgery. Early research suggests they may help with depression, anxiety, inflammation, and even cognitive performance.

The danger of focusing too heavily on devices and technology is that it can make vagal health seem complicated and expensive, when in reality, the most powerful interventions are free and available to everyone. Your breath, your voice, cold water, and human connection are technologies that evolution spent millions of years perfecting.

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The key is using technology as a tool for awareness rather than a replacement for the fundamental practices that actually build vagal strength.

After all this talk of breathing patterns and cold showers and stimulation, it’s worth stepping back to consider what we’re really training for. The vagus nerve doesn’t only regulate biology; it underlies some of the most human states of being.

Psychologist Dacher Keltner calls it the “caretaking nerve.” When the vagus activates, your heart rate slows, your face softens, your voice steadies. In those moments, your body is physiologically primed for compassion.

It is also the nerve of connection. A calm vagus helps you make eye contact, read micro-expressions, modulate your tone of voice, and signal safety. This is why you feel more at ease around someone whose presence is calm and grounded: their vagus nerve is literally guiding yours toward trust. Researchers sometimes call this “co-regulation”—our nervous systems syncing in real time.

And then there is awe. In Keltner’s research, experiences of wonder (standing before a redwood forest, losing yourself in music, watching a child take their first steps) consistently activate the vagus nerve. Heart rate slows, breathing deepens, and self-focus diminishes. Awe dissolves the boundaries of the ego and opens us to belonging. The vagus nerve is the bridge between the vastness of the outer world and the quiet resilience of the inner one.

What’s remarkable is that awe doesn’t require grand gestures or exotic locations. A sunset viewed without distraction, the intricate pattern of frost on a window, the unexpected kindness of a stranger. These everyday moments of transcendence are equally potent vagal stimuli. The key isn’t the magnitude of the experience but the quality of attention you bring to it. When you pause long enough to truly witness something beyond yourself, your nervous system responds with the same physiological signature: a deep exhale, a softening in the chest, a momentary forgetting of your endless to-do list.

This suggests that cultivating awe might be one of the most accessible forms of vagal training.

It requires no discipline, only receptivity. The world is constantly offering moments of wonder; the question is whether your nervous system is calm enough to notice them.

What this means for longevity is profound. Compassion lowers stress hormones and inflammation. Connection strengthens immunity and buffers against disease. Awe restores perspective, quiets the ego, and reduces chronic stress. Together, these vagal states don’t just make life longer, they make it richer. Or, they make life richer, which in turn might make it longer.

The vagus nerve represents one of the most direct pathways we have for influencing our own physiology and psychology. In a world that often feels chaotic and overwhelming, developing this internal capacity for regulation isn’t just helpful. It’s essential.

But the most promising frontier might be the simplest: recognizing that we already have the tools to stimulate our vagus nerve naturally. Every breath you take, every song you sing, every moment of genuine connection with another person is a form of vagus nerve stimulation. The question isn’t whether we have access to this system, it’s whether we’re using it.

Disclaimer: This newsletter is provided for educational and informational purposes only and does not constitute providing medical advice or professional services. The information provided should not be used for diagnosing or treating a health problem or disease, and those seeking personal medical advice should consult with a licensed physician.

What Are Mitochondria and How Do They Work?

Mitochondria are your cells’ energy-making machinery. You have between 500 and 2,000 of them in every single cell, with the highest concentrations in your most energy-demanding organs: your heart, brain, muscles, and liver. These microscopic factories take the food you eat and the oxygen you breathe and convert them into ATP—the actual energy currency your body runs on.

Here’s where it gets really interesting and what explains why so many people struggle with weight and energy issues that seem to come out of nowhere.

Your mitochondria don’t just make energy; they control your entire metabolic system. When they’re functioning optimally, they efficiently burn both glucose and fat for fuel, keeping your blood sugar stable and your metabolism humming. But when mitochondrial function declines, several things happen.

Your fat-burning ability shuts down. Damaged mitochondria struggle to utilize fat as fuel, forcing your body to rely primarily on glucose. This leads to increased hunger, cravings, and fat storage, especially around your midsection.

Your blood sugar becomes unstable. Healthy mitochondria help regulate insulin sensitivity. When they’re impaired, your cells become resistant to insulin, leading to blood sugar spikes and crashes that leave you exhausted and craving more food.

Your metabolic rate slows. Since mitochondria are responsible for cellular energy production, having fewer or less efficient mitochondria means your overall metabolic rate decreases. You burn fewer calories at rest, making weight loss increasingly difficult.

This explains why some people can eat the same foods and do the same exercises they’ve always done, yet suddenly find themselves gaining weight and losing energy as they age.

Mitochondrial dysfunction has been linked to a wide spectrum of conditions—from chronic fatigue, migraines, fibromyalgia, and metabolic syndrome to cardiovascular disease, insulin resistance, and Type 2 diabetes. It’s also associated with neurodegenerative disorders like Alzheimer’s and Parkinson’s, certain autoimmune conditions, allergies, asthma, and even increased susceptibility to infections.

Because every cell depends on mitochondrial energy to function, problems here can ripple across multiple systems at once. Emerging research now connects impaired mitochondrial function to liver and heart disease, post-viral syndromes such as ME/CFS and Long COVID, and other complex, chronic conditions once thought to have entirely different origins.

What’s Damaging Your Mitochondria?

Understanding what harms these crucial cellular structures is the first step to protecting them. Here are the main culprits.

Chronic Stress

Perhaps the biggest mitochondrial destroyer in modern life. Constant stress hormones create oxidative damage and interfere with mitochondrial repair processes.

Poor Sleep and Disrupted Circadian Rhythms

Mitochondria repair and regenerate during deep sleep phases. Chronic sleep deprivation, irregular sleep schedules, and poor sleep quality prevent this crucial maintenance work. Your circadian clock directly controls mitochondrial function.

Processed Foods and Sugar

These create inflammatory compounds that damage mitochondrial membranes and overwhelm their processing capacity.

Environmental Toxins

Heavy metals, pesticides, and chemicals interfere with mitochondrial enzymes and create oxidative stress.

Endocrine-Disrupting Chemicals (EDCs)

Common chemicals like BPA, phthalates, and PFAS found in plastics, food packaging, and household products directly impair mitochondrial function by disrupting the electron transport chain and increasing oxidative stress.

Sedentary Lifestyle

Your body makes mitochondria based on demand. No physical challenge means fewer, weaker mitochondria.

Gut Microbiome Imbalances

Your gut bacteria directly influence mitochondrial health through the production of short-chain fatty acids and other metabolites. An unhealthy microbiome creates inflammation that damages mitochondria and reduces energy production.

How to Test for Mitochondrial Dysfunction

If you suspect your energy issues stem from mitochondrial problems, testing can provide valuable insights. However, be aware that comprehensive functional medicine testing can be expensive and is generally not covered by insurance.

 

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Work with a qualified physician to determine which tests are most appropriate for you, and to interpret the results—these tests are complex and not intended for self-diagnosis.

 

 

Start with the Most Important Tests

• Comprehensive adrenal stress profile ($150–300): Four saliva samples throughout the day to measure cortisol and DHEA patterns
• Organic acids test ($300–400): Urine test that can identify markers of mitochondrial dysfunction and nutrient deficiencies
• Basic comprehensive metabolic panel ($100–200): Including lactate, which may be elevated in mitochondrial disorders

Additional Functional Medicine Tests

• Intracellular micronutrient analysis ($300–500): Measures vitamin, mineral, and amino acid levels inside your cells
• DUTCH hormone test ($400–500): Comprehensive hormone panel measuring cortisol, DHEA, sex hormones and their metabolites

Advanced Mitochondrial-Specific Tests

• MitoSwab test ($400–600): Non-invasive buccal swab measuring mitochondrial enzyme activity with 84% correlation to muscle biopsy results
• Comprehensive metabolic panel with mitochondrial markers ($500–800): Includes energy production markers, nutritional status, and detoxification capabilities

Supporting Tests to Consider

• Food sensitivity panels ($200–400): Can identify inflammatory triggers
• Gut microbiome analysis ($200–500): Since gut health directly impacts mitochondrial function
• Heavy metal and toxin panels ($300–600): To identify environmental factors damaging cellular function

Testing Timeline

Plan to give interventions at least 3–4 months before retesting to see meaningful changes in these markers.

Which Doctor Should You See?

Traditional doctors often don’t recognize symptoms of mitochondrial dysfunction or adrenal fatigue, but functional medicine practitioners use specialized testing to evaluate stress response, recommend targeted nutritional supplements, and address root causes rather than just symptoms.

Functional Medicine Doctor

Functional medicine clinicians are specifically trained to consider the totality of a patient’s health journey and address root causes of chronic fatigue and energy issues through comprehensive testing and personalized treatment plans.

Integrative Medicine Physician

Integrative medicine physicians blend conventional medical training with evidence-based complementary therapies. They take a whole-person view, considering physical, emotional, and lifestyle factors, and may combine prescription medications with nutrition guidance, herbal medicine, acupuncture, or mind-body practices.

Naturopathic Doctor (ND)

Naturopathic physicians focus on nutrition, lifestyle factors, and addressing underlying metabolic dysfunction that affects mitochondrial health. They often emphasize dietary changes, targeted supplementation, and detoxification strategies to support the body’s natural healing processes.

What to Expect

Functional medicine appointments often cost $200–500+ per visit and may not be covered by insurance. Many practitioners offer package deals for comprehensive programs. While effective, this approach requires both time and financial investment.

Here’s what you can expect:

• Comprehensive health history review (including family history)
• Detailed symptom assessment across multiple body systems
• Advanced functional lab testing beyond standard blood work (expect to invest $500–2,000+ in initial testing)
• Personalized treatment protocols addressing nutrition, supplements, lifestyle, and stress management
• Follow-up testing and appointments every 3–4 months to monitor progress
• Be prepared for a 6–12 month commitment to see significant results

If Functional Medicine Isn’t Available

Look for conventional doctors who are “integrative-minded,” endocrinologists for hormone-related issues, and progressive primary care physicians who understand functional testing.

Remember: There are hundreds of potential causes of fatigue, and a full functional medicine evaluation can assess multiple factors and personalize treatment just for your unique situation.

The Mitochondrial Recovery Plan

Your mitochondria are remarkably adaptable. With the right approach, you can repair damaged ones and even create new ones. As with all aspects of health, success comes from a combination of lifestyle, exercise, diet, and targeted supplements.

Working with the right doctor is essential to improve mitochondrial function. They can identify underlying causes, select the most appropriate tests, and tailor your protocol. The strategies below outline the lifestyle foundations that support optimal mitochondrial health.

1. Fuel Your Mitochondria

Eat mitochondrial-supportive foods:

• Fatty fish (salmon, sardines, mackerel) for omega-3s and CoQ10
• Colorful vegetables for antioxidants that protect against oxidative damage
• Grass-fed meat for B vitamins, iron, and CoQ10
• Nuts and seeds for magnesium and healthy fats
• Organ meats for concentrated nutrients (if you can tolerate them)

Consider key supplements:

• Urolithin A (500–1,000mg daily) promotes mitophagy (the removal of damaged mitochondria) and stimulates mitochondrial renewal, improving endurance and cellular efficiency
• CoQ10 (100–200mg daily, ideally ubiquinol form) is essential for mitochondrial energy production
• Magnesium (400–600mg daily, glycinate or malate forms) is required for over 300 enzymatic reactions, including those in ATP synthesis
• B-complex vitamins (high-quality methylated forms) are critical for cellular metabolism and mitochondrial enzyme function
• Alpha-lipoic acid (300–600mg daily) is a potent antioxidant that protects mitochondria and helps regenerate other antioxidants
• PQQ (10–20mg daily) supports mitochondrial biogenesis (the creation of new mitochondria)

2. NAD⁺ Supplementation

Among all the compounds that fuel your mitochondria, NAD⁺ (nicotinamide adenine dinucleotide) deserves special attention. This crucial coenzyme powers over 400 enzymatic reactions, especially in mitochondrial energy production. As NAD⁺ levels decline with age, mitochondrial efficiency suffers, impacting everything from muscle endurance to cognitive sharpness.

Studies demonstrate that NAD⁺ precursor supplementation can enhance muscle function, protect against muscle stem cell loss, and contribute to extended lifespan in animal models. Human clinical trials show increases in mitochondrial number, improved muscle cell differentiation, and even shifts in gut microbiota composition.

Delivery Methods

• Oral supplements (NR/NMN): Nicotinamide riboside (300–1,000mg daily) or nicotinamide mononucleotide (250–500mg daily). More research exists for NR.
• Transdermal patches: Deliver steady NAD+ absorption over 12–14 hours, bypassing digestive breakdown, though direct research on patches is limited
• IV therapy: Provides immediate high-dose delivery but is expensive, requires medical supervision, and may cause dramatic fluctuations

Realistic Expectations

While NAD+ supplementation shows promise for mitochondrial function, most human trials have not yet demonstrated significant improvements in weight loss or insulin sensitivity in healthy overweight individuals. Benefits appear more pronounced in people with existing mitochondrial dysfunction or age-related decline.

Cost Consideration

Quality NAD+ supplements typically cost $40-150+ monthly, patches can be $100-300+ monthly, and IV therapy ranges from $200-500+ per session.

3. Exercise Effectively

The right kind of exercise is one of the most powerful ways to stimulate mitochondrial growth and efficiency.

• High-Intensity Interval Training (HIIT): Short bursts of intense activity followed by recovery periods signal your body to create more mitochondria.
• Strength training: Builds muscle mass, which houses more mitochondria and increases metabolic rate.
• Zone 2 cardio: Moderate intensity exercise that specifically trains mitochondrial fat-burning capacity. Think brisk walking or easy cycling where you can still hold a conversation.

Start gradually if you’re currently dealing with fatigue. Even 10–15 minutes of gentle movement can begin the recovery process. If you experience chest pain, severe shortness of breath, or heart palpitations during exercise, stop immediately and consult a healthcare provider.

4. Optimize Sleep and Circadian Health

This one’s simple. Prioritize sleep quality and quantity.

See our guide on how to get the best sleep ever.

5. Master Your Stress Response

Here are a few ways to implement stress management:

• Practice daily meditation or deep breathing (even 5–10 minutes helps)
• Spend time in nature regularly
• Engage in activities that bring you joy and connection
• Consider yoga, tai chi, or other mindful movement practices
• Build strong social connections and support systems

6. Support Your Gut–Mitochondria Connection

Nourish your microbiome.

Check out our guide on the gut microbiome.

7. Strategic Fasting

Intermittent fasting and time-restricted eating can powerfully support mitochondrial health by:

• Triggering cellular clean-up processes (autophagy)
• Improving insulin sensitivity
• Stimulating mitochondrial biogenesis
• Reducing inflammatory markers

Start with a 12-hour overnight fast (like 7:00 p.m.–7:00 a.m.) and gradually extend if it feels good.

If you have diabetes, eating disorders, or are pregnant or breastfeeding, consult your healthcare provider before trying any fasting protocols.

8. Hot and Cold Therapy

Cold exposure (cold showers, ice baths) and heat therapy (saunas, hot baths) both stimulate mitochondrial adaptation and improve cellular resilience.

Check out our heat and cold exposure guide.

People with heart conditions, uncontrolled high blood pressure, or pregnancy should avoid extreme temperature therapies.

9. Minimize Toxin Exposure

Reduce your toxin load by:

• Choosing organic foods when possible, especially for the “Dirty Dozen” produce list
• Using natural cleaning products and personal care items
• Filtering your water (consider a whole-house or at least drinking water filter)
• Avoiding unnecessary medications when possible
• Supporting your body’s detoxification with foods like broccoli sprouts, cilantro, and green tea
• Ensuring proper ventilation in your home and avoiding synthetic fragrances

Also called photobiomodulation or low-level laser therapy, red light therapy supports mitochondrial health by directly influencing one of the key enzymes in the electron transport chain.

Specific wavelengths of red and near-infrared light (typically 660–850 nm) are absorbed by cytochrome c oxidase (Complex IV), a copper- and heme-containing enzyme inside mitochondria. This interaction improves the enzyme’s ability to transfer electrons and pump protons, leading to more efficient ATP production — the energy currency of your cells.

Key mitochondrial benefits include:

• More energy output: cellular ATP levels can increase significantly, giving cells more fuel for repair, growth, and daily function
• Better electron transport: improves efficiency in the mitochondrial respiratory chain, reducing energy waste
• Mitochondrial biogenesis: stimulates the creation of new mitochondria by activating PGC-1α, a master regulator of mitochondrial growth
• Lower oxidative stress: triggers a mild stress response that upregulates antioxidant defenses and reduces harmful free radicals over time

Improved mitochondrial function can translate into faster muscle recovery, reduced inflammation, enhanced wound healing, healthier skin, and potentially better cognitive performance. It may also help counteract some aspects of age-related mitochondrial decline.

While research is promising, dosing matters. Too much light can reduce benefits. Response varies depending on tissue type, depth of penetration, and baseline mitochondrial health.

What to Expect: Your Recovery Timeline

Mitochondrial recovery doesn’t happen overnight, and progress varies significantly between individuals. Many people start noticing improvements within 2–8 weeks of implementing these strategies, but some may need 3–6 months or longer to see significant changes.

Here is a general timeline:

• Weeks 1–2: Better sleep quality, slightly more stable energy levels
• Weeks 3–6: Improved mental clarity, reduced afternoon crashes, better stress tolerance
• Weeks 7–12: Enhanced exercise performance, more consistent energy throughout the day
• Months 3–6: Significant improvements in overall energy, metabolic health, and vitality

An Important Reality Check

Not everyone will see dramatic improvements. Some people have underlying genetic conditions, chronic infections, or other health issues that require additional medical intervention.

If you don’t see any improvement after 2–3 months of consistent effort, work with a functional medicine practitioner to dig deeper.

Remember, this is a lifestyle approach, not a quick fix. The goal is to create sustainable habits that support your cellular health for life.

When to Seek Immediate Medical Attention

If you experience severe fatigue accompanied by chest pain, shortness of breath, heart palpitations, sudden weight loss, severe digestive issues, or neurological symptoms, consult a healthcare provider immediately. These could indicate serious underlying conditions.

The Bigger Picture

Disclaimer: This newsletter is provided for educational and informational purposes only and does not constitute providing medical advice or professional services. The information provided should not be used for diagnosing or treating a health problem or disease, and those seeking personal medical advice should consult with a licensed physician.

But this isn’t entirely new territory. In spiritual circles, these medicines have always been respected for their ability to dissolve rigid thinking, surface buried truths, and reconnect individuals to something larger than themselves. What began in jungles and underground ceremonies is now showing up in peer-reviewed journals and FDA breakthrough designations.

The renaissance is unfolding across multiple fronts. Clinical studies reveal therapeutic benefits for depression, PTSD, and addiction that often surpass conventional treatments. Neuroimaging labs are mapping how these compounds rewire neural networks and restore brain plasticity. Policy reform is creating legal pathways for therapeutic access. And as research advances, we’re moving from one-size-fits-all protocols toward personalized medicine—where genetics guide dosing, therapy meets neurochemistry, and healing is tailored to individual biology.

Yet describing psychedelic experiences remains like describing color to someone who’s never seen light. No matter what is written about them, there is no substitute for direct experience. And decades of stigma—along with potentially challenging situations—have made people cautious. Rightfully so.

These substances demand courage and respect, and can be disorienting, physically uncomfortable, emotionally intense. They’re not gentle medicines or quick fixes. But for many, navigating that difficulty becomes the catalyst for lasting transformation: clarity where there was confusion, connection where there was isolation, hope where there was despair.

Not everyone needs that journey. And there are real risks, real limitations, and real reasons to proceed with care. The field faces legitimate challenges around study design, safety protocols, and translating clinical results to real-world outcomes.

But the mounting evidence suggests we’re witnessing something significant—a fundamental shift in how we understand consciousness, mental health, and human potential. Below, we move through the major psychedelic compounds gaining traction, tracing where the science stands and where it may lead.

The Four Frontiers of Psychedelic Healing

Mental Health Disorders

Psychedelics and empathogens are showing remarkable promise for some of the most stubborn psychiatric conditions. From treatment-resistant depression to PTSD, clinical trials have repeatedly demonstrated rapid and durable improvements—often after just 1–3 guided sessions. Patients report not only symptom relief, but also a renewed sense of perspective, agency, and emotional connection.

Unlike conventional treatments that often require daily medication, these compounds offer a more profound and punctuated model of healing—one that rewires rather than suppresses.

Addiction & Substance Use

Substance use disorders are notoriously difficult to treat, but psychedelics may offer a breakthrough. Rather than replacing one dependency with another, they appear to interrupt the underlying psychological and neurological patterns that drive compulsive behavior. Patients frequently describe confronting the root causes of their addiction—often trauma, isolation, or shame—in a setting that allows for emotional resolution and meaning-making. Long-term remission rates in early studies are outperforming many conventional approaches, especially when paired with skilled therapy and integration.

Brain Health & Cognitive Resilience

Beyond treating mental illness, a new frontier is opening around brain health. Psychedelics appear to enhance neuroplasticity, stimulate the growth of new synaptic connections, and reduce inflammation in ways that may support long-term cognitive vitality. Early research suggests potential applications in emotional regulation, learning, creative thinking, and even aging. While still early, this line of inquiry positions these compounds not just as medicine for what’s broken—but as tools to strengthen what’s already working.

Spiritual Health & Existential Well-Being

Not everything that needs healing is diagnosable. For many, psychedelics provide a path to meaning, perspective, and a deeper relationship with life. These substances have long been used in spiritual traditions to facilitate ego dissolution, mystical experience, and a sense of unity—with nature, with others, or with the divine. Today, those same effects are being explored in settings as diverse as hospice care and grief support. At their best, these experiences don’t just reduce suffering; they reconnect us to what makes life worth living.

 

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Sponsor Message from Journey Clinical

The future of psychedelic therapy isn’t just about compounds—it’s about infrastructure, safety, and access.

Journey Clinical is leading that future. Their collaborative model empowers licensed psychotherapists to offer Ketamine-Assisted Psychotherapy (KAP) in private practice, supported by an in-house medical team for screening, monitoring, and prescribing with psychiatric medication management.

This keeps care anchored in the therapist–client relationship, while ensuring clinical oversight. And it works: 87% of patients report improvement in symptoms after a course of treatment.

Journey Clinical has also partnered with COMPASS Pathways to help shape how psilocybin-assisted psychotherapy can be delivered if approved by the FDA, from therapist training to real-world protocols.

In a field driven by potential, they’re focused on what makes it real: clinical rigor, accessibility, and systems that scale.

The compounds may lead the headlines—but Journey Clinical is building the care delivery system.

Start your journey today!

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Microdosing: The Subtle Revolution

While high-dose psychedelics make headlines for their dramatic therapeutic breakthroughs, a quieter movement is reshaping everyday life. Microdosing—the practice of taking sub-perceptual amounts of compounds like psilocybin or LSD—has become a popular entry point for those seeking enhanced focus, emotional balance, and creative flow without the intensity of a full psychedelic experience.

The approach typically involves taking one-tenth to one-twentieth of a recreational dose every few days, often following systems like the Fadiman protocol (one day on, two days off) or the Stamets stack (psilocybin combined with lion’s mane and niacin). Anecdotal reports span the spectrum—from improved mood and cognitive flexibility to deeper empathy and subtle shifts in perspective that integrate seamlessly into daily routines.

Scientifically, the picture is more complex. Some studies suggest modest benefits for mood and neuroplasticity, while others argue the effects may be largely placebo. Measuring something meant to be sub-perceptual presents its own research challenges. But the cultural momentum is clear: from tech executives to burned-out parents, people are turning to microdosing as a gentle tool for mental and emotional resilience.

Its appeal lies not just in what it offers—but in what it doesn’t demand. No therapist, no ceremony, no surrender. It’s a path to optimization rather than transformation. Yet with that accessibility comes risk: less structure, more variability, and the potential for subtle dependencies masquerading as self-improvement.

Still, as science evolves and legal frameworks catch up, microdosing may emerge as a middle path—bridging the gap between underground experimentation and clinical use. A reminder that psychedelics don’t always need to be profound to be powerful.

A Compound-by-Compound Breakdown

Now, let’s take a closer look at the compounds themselves—what they are, what they’re doing, and where each one stands in this evolving field.

Psilocybin

Psilocybin is the active psychoactive compound found in over 200 species of “magic mushrooms.” When ingested, it converts to psilocin in the body, which acts primarily on serotonin 2A receptors in the brain.

Effects typically begin within 20–40 minutes and last 4–6 hours, producing altered visual perception, emotional amplification, and shifts in consciousness. Unlike synthetic drugs, psilocybin has been used by indigenous cultures for thousands of years and has a well-established safety profile with very low addiction potential.

Clinically, psilocybin is being studied—and in some cases, already used—to treat conditions like:

• Treatment-resistant depression
• End-of-life anxiety
• Obsessive-compulsive disorder
• Substance use disorders

But its benefits appear to reach further. Neuroimaging shows psilocybin increases connectivity between brain regions that don’t normally communicate, which may help “reset” entrenched patterns of thought and emotion—supporting both recovery and cognitive flexibility.

And for many, its impact is spiritual as much as neurological: the experience of ego dissolution, interconnectedness, or awe can leave lasting shifts in worldview, values, and meaning. Psilocybin, in other words, doesn’t just relieve suffering—it helps reorient the mind, the brain, and the self.

Regulatory Status

Psilocybin has received Breakthrough Therapy designation from the U.S. FDA for addressing treatment-resistant depression and major depressive disorder, helping to accelerate clinical research and development.

In 2023, Oregon became the first jurisdiction in the world to launch a legal psilocybin therapy program, allowing supervised adult use with trained, licensed facilitators. Colorado approved similar reforms, with a regulated therapeutic program expected to roll out in 2025. More than a dozen US cities—including Denver, Seattle, and Oakland—have decriminalized psilocybin, and several states are exploring therapeutic access or research programs.

Internationally, Canada permits limited therapeutic use of psilocybin under its Special Access Program for patients with serious or life-threatening conditions. In 2023, Australia reclassified psilocybin as a prescription-only medication for treatment-resistant depression, making it available through authorized psychiatrists in controlled medical settings.

More states and countries are likely to follow, as the evidence grows too compelling to ignore.

MDMA

MDMA (3,4-Methylenedioxymethamphetamine) is a synthetic compound that acts as both a stimulant and a mild psychedelic. It works by increasing the release of serotonin, dopamine, and norepinephrine, while also dampening activity in the amygdala—the brain’s fear center. Effects typically begin within 30–60 minutes and last 3–5 hours, producing heightened empathy, emotional openness, and reduced defensiveness.

Originally synthesized in the early 20th century, MDMA has demonstrated a favorable safety profile in clinical settings when administered with proper medical screening, psychological support, and therapeutic protocols. While not without risks, MDMA-assisted therapy for PTSD has shown promise in late-stage clinical trials under controlled conditions.

Clinically, MDMA is being studied—and is on the verge of approval—for treating:

• Post-traumatic stress disorder (PTSD)
• End-of-life anxiety
• Social anxiety in autistic adults
• Treatment-resistant depression (early stage research)

But MDMA’s value isn’t limited to clinical diagnoses. In therapeutic settings, it helps individuals access and process painful emotions without becoming overwhelmed—making it especially powerful for trauma work. Neuroimaging shows it increases connectivity between emotion and cognition networks while reducing fear responses, which may explain why difficult memories become more accessible, yet less distressing.

Spiritually and relationally, MDMA is often described as a heart-opening compound—one that fosters connection, compassion, and a felt sense of safety. Many report a renewed capacity for trust and intimacy, both with themselves and others. In that sense, MDMA doesn’t just heal trauma—it helps restore the conditions for human bonding and emotional wholeness.

Regulatory Status

MDMA received Breakthrough Therapy designation from the FDA for PTSD and showed promising results in two Phase III trials led by MAPS, with around two-thirds of participants no longer meeting PTSD criteria after three sessions. However, the FDA declined to approve MDMA-assisted therapy in 2024 due to concerns about study methods and safety, requesting further research.

In 2023, Australia became the first country to allow MDMA-assisted therapy under psychiatric supervision, and several US states are developing access frameworks in anticipation of future federal approval.

When approved, MDMA will be the first empathogen legally available for widespread clinical use—a major inflection point in the future of trauma treatment.

Ketamine

Ketamine is a dissociative anesthetic first synthesized in the 1960s and FDA-approved for surgical use in 1970. Unlike classic psychedelics, it works primarily by blocking NMDA receptors, which are involved in pain, mood regulation, and synaptic plasticity. At sub-anesthetic doses, ketamine produces a dreamlike, dissociative state that can include altered perception of time, space, and self.

Effects begin within minutes and typically last 45–90 minutes. Originally developed for human surgery and trauma care, ketamine also became widely used in veterinary medicine for its fast-acting, safe anesthetic properties. Today, it has quietly become one of the most widely available psychedelic therapies in the world.

Clinically, ketamine is already being used to treat:

• Treatment-resistant depression
• Suicidal ideation
• Generalized anxiety disorder
• Chronic pain syndromes
• PTSD (off-label use)

While not FDA-approved for PTSD, ketamine is widely used off-label in clinical settings, with growing evidence supporting its role in trauma relief and emotional reset.

But ketamine’s therapeutic value may go beyond symptom relief. Research shows it stimulates the rapid release of brain-derived neurotrophic factor (BDNF); promotes synaptogenesis; and enhances neuroplasticity, biological mechanisms that support healing, learning, and resilience.
Patients often describe the experience as emotionally clarifying—less a direct confrontation with trauma and more a spacious reframing of self and circumstance.

Though not traditionally associated with spiritual insight, some report profound states of ego detachment, inner stillness, or perspective shifts, especially when used with intention and integration support.

Regulatory Status

Ketamine is FDA-approved for anesthesia and for treatment-resistant depression. Spravato (esketamine) is available by prescription under strict clinical protocols, while generic ketamine is legally prescribed off-label for a wide range of conditions.

Dozens of ketamine clinics now operate across the US, offering IV, IM, nasal-spray, or lozenge-based treatments—though practices vary widely in quality and oversight.
Because it is already legal and prescribable, ketamine has become the most accessible psychedelic medicine in modern psychiatry—opening the door for a new model of rapid, non-daily treatment for mood disorders.

LSD

Lysergic acid diethylamide (LSD) is a semi-synthetic psychedelic that was first synthesized in 1938 by Swiss chemist Albert Hofmann at Sandoz Laboratories in Basel, Switzerland. It became widely known in the 1960s for its role in counterculture, but its roots lie in psychotherapy. Early practitioners explored its use for depression, alcoholism, and creativity.

LSD is one of the most potent psychedelics, active in microgram doses. It primarily affects serotonin 2A receptors, but it also influences dopamine and other neurotransmitter systems. Effects begin within 30–60 minutes and can last 8–12 hours, often producing vivid visual distortions, time dilation, deep introspection, and a sense of cosmic or existential awareness.

Clinically, LSD is being researched for:

• Anxiety associated with terminal illness
• Depression
• Alcohol use disorder
• Cluster headaches
• Emotional resilience and cognitive flexibility (early-stage research)

While it shares some similarities with psilocybin, LSD offers a longer and often more mentally intricate experience. Early studies suggest it may reduce rumination and improve mood in patients with anxiety or depressive symptoms. Some research also points to enhanced creative thinking and increased openness—a personality trait linked to psychological growth.

Spiritually, LSD has long been described as a consciousness-expanding substance. It can surface deep emotional material, evoke archetypal visions, and—at times—instill a profound sense of wonder, meaning, or interconnectedness. While not always comfortable, the depth of the experience has made it a tool for transformation in both clinical and ceremonial settings.

Regulatory Status

LSD remains a Schedule I substance in the US, with no current FDA breakthrough designations. However, research restrictions have eased in recent years. Clinical trials are ongoing in Switzerland, the US, and the UK, with organizations like MindMed and the Beckley Foundation leading studies into its therapeutic potential.

Compassionate use programs in Switzerland allow licensed therapists to work with LSD in controlled environments. No jurisdictions have legalized therapeutic use, but decriminalization measures in several US cities have included LSD in broader reforms.

As public perception shifts and research expands, LSD may soon re-enter the clinical landscape—not as a relic of the past, but as a precision tool for mental, cognitive, and existential health.

DMT & 5-MeO-DMT

DMT (N,N-Dimethyltryptamine) is a naturally occurring psychedelic compound found in hundreds of plant species—and in trace amounts in the human body. When inhaled or vaporized, it induces a powerful, immersive experience that lasts only 10–30 minutes but often feels much longer. Sometimes called “the God molecule,” DMT has long been associated with mystical experiences, encounters with otherworldly intelligence, and the dissolution of the self into something vast and ineffable.

5-MeO-DMT, a closely related compound found in certain toads (Bufo alvarius) and plants, produces a similarly intense but less visual experience often described as ego-erasing and profoundly unitive. Both are known for their rapid onset, overwhelming intensity, and deep spiritual or metaphysical content. Users frequently report a complete dissolution of ordinary reality, encounters with “other intelligences,” or the sensation of being reabsorbed into consciousness itself.

Clinically, these compounds are being investigated for:

• Treatment-resistant depression
• Anxiety and existential distress
• End-of-life preparation
• Addiction and compulsive behaviors (early trials)

Though research is still early, DMT and 5-MeO-DMT are showing potential as fast-acting antidepressants. In studies using intravenous DMT, people experienced quick improvements in mood—possibly because the drug makes brain activity more flexible and breaks the mental loops tied to depression and overthinking.

In therapeutic settings, these brief but profound experiences may allow patients to access deep emotional material, reframe existential fears, or shift ingrained psychological narratives.
Spiritually, these compounds are often described as life-changing—offering the kind of radical shift in perspective that people report after near-death experiences or moments of extreme clarity. 5-MeO-DMT, in particular, is known for inducing a complete loss of ego and a sense of oneness with all existence. When held in the right container, the result can be not only cathartic, but life-altering.

Regulatory Status

Both DMT and 5-MeO-DMT are Schedule I substances in the United States, making them illegal to manufacture, possess, or distribute. However, decriminalization measures in cities like Oakland, Santa Cruz, and Denver have removed local penalties for the use of plant-based DMT preparations. Colorado’s 2022 ballot initiative decriminalized natural DMT statewide, though synthetic forms remain prohibited.

Internationally, regulation varies. Some countries allow traditional use of DMT-containing plants (like ayahuasca), while synthetic DMT remains illegal. 5-MeO-DMT is less widely studied or regulated, though some retreat centers operate legally in Mexico and other jurisdictions.
As clinical trials expand and public interest grows, DMT and its analogs may soon shift from esoteric to essential in the evolving field of psychedelic medicine.

Ayahuasca

Ayahuasca is a psychoactive brew traditionally used in Amazonian healing ceremonies, made by combining two plants: Banisteriopsis caapi, which contains MAOI inhibitors, and Psychotria viridis, which contains the potent psychedelic DMT. On its own, DMT isn’t active when taken by mouth, but the MAO inhibitors from the vine allow it to take effect when consumed as a tea, producing a 4–6 hour experience characterized by intense visuals, emotional (and physical) purging, and deep introspective insight.

Often referred to as a “plant teacher,” ayahuasca is not just a compound; it’s a cultural and spiritual practice. It is typically consumed in ceremonial settings, guided by experienced facilitators or shamans, and often accompanied by rituals, music, and integration practices.

Clinically, ayahuasca is being studied for:

• Treatment-resistant depression
• PTSD and trauma resolution
• Grief and loss
• Substance use disorders

Research suggests that ayahuasca may support emotional healing through a combination of psychological insight and neurobiological effects. It increases brain-derived neurotrophic factor (BDNF), modulates serotonin receptors, and may enhance mindfulness and emotional regulation long after the experience ends. Patients often describe encounters with symbolic or archetypal imagery, revisiting formative memories, or feeling reconnected to a deeper sense of purpose.

Spiritually, ayahuasca is revered for its capacity to confront the unconscious. Many report experiences that are not merely therapeutic, but transformational—catalyzing shifts in identity, relationships, and worldview. It is sometimes described less as a drug and more as an intelligence—something that shows, teaches, reveals.

Ayahuasca exists in a complex legal gray area. In the US, the Supreme Court has granted legal protection to specific religious groups to use ayahuasca in sacramental contexts. However, therapeutic use outside those contexts remains federally prohibited. Several US cities have decriminalized plant medicines, including ayahuasca, under local ordinances.

Internationally, countries like Peru and Brazil legally recognize and regulate traditional ayahuasca use, with retreat centers offering structured ceremonial experiences. However, safety, training, and ethical standards vary widely.

While formal medical access is limited, the growing body of research—and thousands of reported anecdotal outcomes—suggest that ayahuasca may soon play a larger role in integrative mental and spiritual health care.

Ibogaine

Ibogaine is a naturally occurring psychoactive extracted from the African shrub Tabernanthe iboga, traditionally used in Bwiti spiritual ceremonies in Gabon and Central West Africa. Unlike other psychedelics, it interacts with multiple neurotransmitter systems—serotonin, dopamine, NMDA, and opioid receptors—producing intense experiences lasting 12–24 hours. The journey typically unfolds in two phases: an initial flood of vivid, waking dream-like visions, followed by an extended period of deep mental processing and introspection.

Clinically, ibogaine is being used to treat:

• Opioid addiction and withdrawal
• Alcohol and stimulant dependence
• Trauma-driven compulsive behaviors
• Treatment-resistant depression (exploratory research)

What makes ibogaine unique is its potential to interrupt addiction at both the physiological and psychological level. Anecdotal reports and early studies suggest it can eliminate withdrawal symptoms, reset dopamine pathways, and reduce cravings after a single high-dose session. Patients often report reliving key emotional memories, processing long-buried trauma, and experiencing what some describe as a neurological “reset.”

Spiritually, ibogaine is considered a teacher rather than a tool—demanding, unfiltered, and unsparing. The experience is rarely euphoric but often life-altering. For many, it delivers hard truths and deep clarity—especially when paired with structured integration and support.

Regulatory Status

Disclaimer: This newsletter is provided for educational and informational purposes only and does not constitute providing medical advice or professional services. The information provided should not be used for diagnosing or treating a health problem or disease, and those seeking personal medical advice should consult with a licensed physician.

Today, your body tells a different (and longer) story. Your heart rate is tracked 24/7. Your sleep stages are logged. Your glucose levels spike and dip in a tidy little graph. Your ring knows when you’re getting sick before you do.

Wearable health technology has evolved from simple step counters into something more ambient, more personal, and potentially more powerful. These devices aren’t just tracking your fitness—they’re rewriting how we relate to our health. From reactive care to proactive insight. From checkups to continuous awareness.

The market is exploding and expected to reach $186 billion by 2030, driven by aging populations, chronic disease, and a growing appetite for self-optimization.

But the more interesting questions aren’t economic. They’re personal. Are wearables actually making us healthier? Or just more obsessed with (and anxious about) our data?
Where do they help? Where do they fall short?

Let’s take a look at the landscape and walk into this new future together.

The Start of the Modern Health Revolution

Wearables are amazing—not because they’re perfect, but because they were first. And they ignited a movement.

Fitbit was the tipping point. Suddenly, millions of people were paying attention to their health in a new way. They were counting steps and bragging about it to their friends. For many, it was the first time they tracked anything related to their health. That awareness changed everything.

Yes, these devices have accuracy issues, and the data can be noisy or incomplete. But that misses the bigger point.

Because what wearables really gave us was a new relationship to our bodies. They helped make health visible, daily, and a little more actionable.

Wearables give us a kick in the butt. A reason to move. A better sense of how we’re doing. A glimpse into systems we could never see before—like heart rate variability, sleep, recovery scores, or blood oxygen trends.

In some cases, they’ve even saved lives.

Wearables aren’t a perfect solution. But they’re a powerful start.

Expanded Capabilities of Modern Wearables

Wearable tech now delivers continuous, real-time monitoring across nearly every major body system. We’re far, far beyond counting steps and checking heart rates.

Cardiovascular and Respiratory: Devices track heart rate variability, ECG, blood pressure, SpO2, respiratory rate, and detect arrhythmias or early signs of asthma and COPD. Some include smart inhalers for medication tracking and environmental alerts.

Metabolic and Chronic Conditions: Continuous glucose monitors, hydration and cortisol sensors, and blood pressure patches support diabetes, hypertension, and kidney disease management, remotely and in real time.

Neurological Disorders: Wearables detect seizure precursors in epilepsy and monitor tremors, gait, and medication response in Parkinson’s Disease.

Mental Health and Sleep: Stress and mood tracking via HRV and skin conductance enables early intervention. Devices also link sleep quality to mental health conditions.

Rehabilitation and Fitness: From calorie tracking to movement analytics, wearables aid in weight loss and physical therapy by offering posture correction and adherence feedback.

Women’s Health: Specialized tools track ovulation, hormonal shifts, fetal heart rate, and maternal health for fertility and pregnancy monitoring.

Infection and Early Illness Detection: Biosensors can flag fever and infection risk by continuously monitoring subtle shifts in temperature and vitals.

Remote Care: All of this data feeds into telehealth and remote patient monitoring platforms—reducing hospital visits and enabling proactive, personalized care.

Inaccuracies and Limitations

Here’s what the marketing materials won’t tell you: consumer wearables are often less accurate than you think. And the inaccuracies aren’t random—they’re systematic and predictable.

Wearables are often precise (consistent) but not accurate (correct). Your device might consistently read your resting heart rate as 65 BPM when it’s actually 70. For trend tracking, this is fine. For medical decisions, it’s not.

Heart Rate: Pretty Good, With Caveats

Most wearables are accurate for resting heart rate and general trends.

But here’s where they struggle:

• Dark skin tones: Optical sensors work by detecting blood flow through light reflection. Darker skin absorbs more light, reducing accuracy.
• Tattoos: Ink blocks the sensor’s ability to detect blood flow.
• Movement: Any wrist movement during exercise can throw off readings.
• Cold weather: Poor circulation makes optical sensors less reliable.

Medical-grade chest straps are still the gold standard for heart rate accuracy during exercise.

Sleep Tracking: Useful Trends, Questionable Details

Wearables are reasonably good at detecting when you’re asleep, but sleep stage detection (REM, deep sleep, etc.) is often educated guesswork.

What’s reliable: Total sleep time, wake-ups, general sleep efficiency.
What’s not: Precise sleep stage timing, especially the difference between light sleep and REM.

Blood Oxygen: Inconsistent and Overrated

SpO2 sensors in consumer wearables are notoriously unreliable. They can be off by 5-10%, which sounds small but matters a lot when the normal range is 95–100%. Factors affecting accuracy include skin tone, nail polish, movement, and ambient temperature.

If you have breathing concerns, see a doctor. Don’t rely on wearable SpO2 readings for medical decisions.

Industry Challenges

Despite the hype, several fundamental problems are slowing wearable adoption in serious healthcare settings.

Data Overload

Wearables generate massive amounts of data—thousands of data points per day per person. Healthcare systems aren’t equipped to handle this. Primary care doctors already see 20+ patients per day; they can’t review continuous data streams from each patient.
The challenge is building systems that can automatically identify what matters and what doesn’t, presenting only actionable information to healthcare providers.

Regulatory Confusion

The line between “wellness device” and “medical device” is blurry—and getting blurrier. This isn’t just bureaucratic nitpicking—it fundamentally affects what claims companies can make and how doctors can use the data.

Wellness devices (like most fitness trackers) face minimal FDA oversight. Companies can’t make medical claims, but they can market for “general wellness” and fitness. Most wearables fall into this category.

FDA-cleared medical devices have been tested for specific medical uses and can make limited medical claims. Apple Watch’s ECG feature, for example, is FDA-cleared for detecting atrial fibrillation—meaning doctors can actually use that data clinically.

FDA-approved medical wearables are a separate category of truly medical-grade wearables that most consumers never see. These include continuous glucose monitors, cardiac event monitors, seizure detection devices, or ePatches for post-surgical monitoring.

Some newer entries include wearable insulin delivery systems and devices that monitor specific biomarkers for cancer patients. These devices are prescribed by doctors, often covered by insurance, and designed for certain medical conditions rather than general wellness.

Doctors can’t recommend devices that aren’t medically validated, but medical validation is slow and expensive. Meanwhile, patients are making health decisions based on unvalidated data.

And that’s where the risk lies: the tech is moving faster than the rules—and faster than the science.

Privacy and Security

Wearables collect incredibly intimate data about your body, behavior, and health. Most companies’ privacy policies are vague about how this data is used, stored, or shared. Health data breaches can have lifetime consequences.

It’s likely your wearable data is being used for purposes you haven’t explicitly consented to.

Read the privacy policy—seriously.

Standardization Problems

Different devices measure the same things differently. There’s no standard for what “heart rate variability” means across brands, making it impossible to compare data or switch devices without losing continuity.

That inconsistency undermines trust—and limits the clinical usefulness of the data. Until standards catch up, your health metrics are only as reliable as the brand interpreting them. But that could change fast. Regulators, researchers, and even tech companies are pushing for common standards to turn wearable data into a true medical tool.

If you want to switch devices, the smartest move is to overlap them for a few weeks. Wear both, compare the data patterns (not just the numbers), and look for trends—your own baselines matter more than the delta between the two.

Current Emerging Tech

Smart Clothing

Smart clothing sounds like science fiction: shirts that monitor your heart rate, socks that track your gait, fabrics that can detect illness before symptoms appear. Some of this is real. Much of it isn’t ready for primetime.

Smart athletic wear is the furthest along. Companies like Hexoskin and Athos make compression shirts with built-in sensors that track heart rate, breathing, and muscle activity during workouts.

Medical-grade patches are having a moment. Some track ECG continuously for weeks, others monitor glucose through the skin. These aren’t consumer products yet—they’re prescription devices for specific medical conditions.

Smart socks exist and can track balance, gait, and pressure points. They’re mainly used in physical therapy and elderly care, not for your morning jog.

Most smart clothing requires frequent charging, special care, or produces data that’s not meaningfully better than existing wearables. However, there are some worthwhile developments on the horizon.

Truly washable electronics are making progress. Researchers are developing conductive threads that can survive normal laundry cycles. When this becomes affordable and reliable, smart clothing could actually become something bigger.

Temperature regulation fabrics that respond to body heat are already in some high-end athletic wear. They don’t need batteries or sensors, but this science is still early and needs more time.

Vagus Nerve Stimulators

The vagus nerve is your body’s main highway between brain and organs, controlling everything from heart rate to digestion to immune response. When it’s functioning well, you’re in “rest and digest” mode—calm, focused, and recovering properly—but chronic stress can suppress vagus nerve activity, leaving you stuck in fight-or-flight mode.

Vagus nerve stimulators promise to hack your nervous system, reduce stress, improve sleep, and boost recovery—all by gently zapping a nerve in your neck or ear. Some of this is real science. Some of it is an expensive placebo.

Clinical studies show these devices can influence heart rate variability, reduce inflammation markers, and help with anxiety and depression. The effects are real but modest.

Most people can stimulate their vagus nerve through deep breathing, cold exposure, or meditation—and vagus nerve devices tend to work better when you’re already doing these practices.

The Future of Wearables: What’s Coming Next

We’ve already come a long way, but timelines in health tech are consistently optimistic. The hope is that these devices will get smarter and cover more. But the world of health regulations is full of red tape.

Here’s what’s actually on the horizon and when you might realistically see it.

Next 2–3 Years: Incremental Improvements

Better sensors: More accurate heart rate monitoring, especially for darker skin tones. Improved sleep tracking. More reliable blood oxygen measurement.

Longer battery life: Gradual improvements in efficiency and battery technology. Expect 10–12 day battery life to become standard for fitness trackers. A few are already touting this.

Blood pressure monitoring: True cuffless blood pressure monitoring is getting closer. A few devices already do this with decent accuracy.

5–7 Years: Meaningful Advances

Non-invasive glucose monitoring: Apple has been working on this for over a decade. When it arrives, it will be revolutionary for diabetes management. But it’s still years away from consumer availability.

Advanced disease detection: Wearables that can reliably detect early signs of infection, cardiovascular events, or other health emergencies before symptoms appear.

Smart contact lenses: Monitoring eye pressure, glucose levels, or other biomarkers through the tear film. Prototypes exist but commercialization is distant.

10+ Years: Next-Wave Developments

Implantable sensors: Truly long-term, biocompatible sensors that can monitor multiple biomarkers continuously for months or years.

Brain–computer interfaces: Consumer-grade devices that can monitor brain activity, sleep quality, or mental health indicators directly.

What to Ignore

Anything promising to “revolutionize healthcare” in the next 2 years. Real healthcare moves slowly for good reasons.

Devices that claim to replace medical testing without FDA approval. They won’t and can’t.

Miraculous health claims based on preliminary research. If it sounds too good to be true, it probably is.

The Bottom Line

After cutting through the hype and examining the reality, are wearables worth your time and money? Almost definitely, but It depends on what you’re trying to achieve and how you plan to use the data.

Definitely Worth It If You:

• Want motivation for basic fitness goals: Step tracking and activity reminders genuinely help many people move more.
• Are managing a chronic condition: Continuous glucose monitoring for diabetes, heart rate tracking for cardiovascular issues, or sleep tracking for sleep disorders can provide valuable insights when used alongside medical care.
• Enjoy data-driven self-optimization: If tracking metrics motivates you—and you understand the limitations—wearables can be valuable tools for improving sleep, fitness, and recovery.

• Are curious about your health patterns: Learning about your sleep quality, stress levels, or activity patterns can be enlightening, even if you don’t act on all the data.
• Want early warning signs: While not medically diagnostic, wearables can sometimes alert you to changes worth discussing with a doctor.

Probably Not Worth It If You:

• Expect or need medical-grade accuracy: Consumer wearables are wellness tools, not medical devices. Don’t make medical decisions based solely on wearable data.
• Are prone to health anxiety: Constant monitoring can increase anxiety for some people, especially given the devices’ imperfect accuracy.
• Want a magic solution: Wearables provide information, not transformation. They can’t fix poor sleep habits, chronic stress, or unhealthy lifestyle choices.

Disclaimer: This newsletter is provided for educational and informational purposes only and does not constitute providing medical advice or professional services. The information provided should not be used for diagnosing or treating a health problem or disease, and those seeking personal medical advice should consult with a licensed physician.

Q. What’s the most underrated biomarker you wish more people paid attention to?

Without question, it’s 8-OHdG (8-hydroxy-2′-deoxyguanosine). It’s one of the most sensitive markers for oxidative stress at the DNA level. Functionally, anything over 6 ng/mg creatinine is considered inflammatory and indicates elevated free radical damage to cellular DNA. High levels are often seen in patients experiencing cognitive issues, fatigue, and metabolic dysfunction—even when other labs appear “normal.”

It’s one of the first clues that the body is burning through antioxidant defenses and is no longer able to keep up.

This loss of redox balance puts the brain and body at risk for accelerated aging, neurodegeneration, immune suppression, and even cancer. In my practice, I’ve seen patients who look outwardly healthy but have sky-high 8-OHdG levels—they’re silently losing cellular resilience. Catching this early lets us intervene with antioxidant, mitochondrial, and detox strategies before deeper disease takes hold.

Q. If someone has high cholesterol, what’s the first biomarker you look at besides cholesterol itself?

Elevated homocysteine is one of the most overlooked yet telling markers. Functionally, anything over 6 µmol/L raises concern. Homocysteine is an amino acid that should be efficiently converted into methionine when B vitamins are being absorbed properly.

When there’s a genetic block—such as an MTHFR, MTR, or MTRR mutation—or nutrient deficiency, homocysteine builds up and becomes highly inflammatory. This directly damages blood vessels, increases blood pressure, and triggers the liver to overproduce cholesterol as a repair mechanism.

In other words, cholesterol becomes the symptom, not the cause. Yet, most people are prescribed statins without ever asking: Why is the body making excess cholesterol in the first place?

Q. If I have high cortisol, how do you determine what’s causing it?

Is it emotional stress, blood sugar, inflammation, or something else? All of the above—and then some.

Most people think stress only comes from emotional triggers like work, finances, or relationships. But only about one-third of stress is perceived. The other two-thirds comes from hidden physiological triggers like food sensitivities, parasitic infections, gluten intolerance, blood sugar imbalances, even environmental toxins and pain. These all activate the HPA axis and elevate cortisol.

The most accurate way to track this is with an Adrenal Stress Panel that includes a Cortisol Awakening Response (CAR). It shows how your brain and adrenal glands are communicating across the circadian rhythm—and that’s the key to understanding if your stress response is becoming dysregulated.

Take control of your health at Eudēmonia Summit, November 13–16, 2025.

The future of medicine is here.

Disclaimer: This newsletter is provided for educational and informational purposes only and does not constitute providing medical advice or professional services. The information provided should not be used for diagnosing or treating a health problem or disease, and those seeking personal medical advice should consult with a licensed physician.

What if your annual check-up is obsolete?

You know how it goes: blood pressure, cholesterol, a few vague remarks from your doctor about your diet. He suggests you cut down on the alcohol, maybe she prescribes you a statin, and you’re out the door.

But while your doctor ran a basic blood panel, they didn’t measure your metabolic rate, map your hormone rhythms, analyze your amino acid deficiencies, scan for early tumors, or test how your body actually processes nutrients.

Your annual physical examines maybe 5% of your measurable biology. The other 95% is where disease begins, where optimization happens, and where the future of your health is written.

Most diseases start silently. And beneath the surface, your body holds a more complete dataset—one that can reveal inflammation, oxidative stress, mitochondrial health, early disease risk, and much more.

What if you could track, reverse, or even prevent disease—based on real-time data from your own biology?

That’s the promise of personalized, proactive medicine and comprehensive biomarker testing.

Biomarkers are measurable signs of what’s happening inside you down to the cellular and molecular level. We now have access to thousands of these signals through blood, stool, saliva, urine, DNA, and even wearable devices. Some are simple. Some are cutting-edge. But taken together, they create a map—a personalized dashboard—for your internal health.

Here’s the magic: biomarkers don’t just tell you what’s happening. They tell you how fast it’s happening and where to intervene.
Are your inflammatory markers creeping up? You can course-correct before it becomes autoimmune disease.
Is your insulin climbing year over year? You can reverse the trend before it becomes Type 2 diabetes.
Are your stress hormones flatlined? You can rebuild your reserves before burnout hits.

Yet most lab reference ranges are based on statistical averages of the general population. But in a world where metabolic dysfunction is widespread and inflammation is rampant, being “normal” might just mean you’re on a slow road to disease.

Personalized medicine flips this script. It doesn’t ask, “Are you average?” It asks, “Are you optimal—for you?”

Roughly 90% of healthcare spending is on disease after it happens. Biomarker testing lets you catch the trajectory early—and potentially reverse it.

We’re focusing here on biological biomarkers—not fitness metrics like VO2 max or HRV. For those, check out The Longevity Fitness Markers Issue, where we dive deep into performance, movement, and the metrics that predict how well you’ll age on your feet.

The Full Spectrum: What We Can Actually Measure Now

Blood Biomarkers: The Foundation

Your blood is a real-time snapshot of your entire biological system. While standard labs test around 20 markers, comprehensive blood analysis can measure 140+ biomarkers, covering inflammation, nutrients, hormones, immune function, and early disease markers.

We can now:

• Detect cardiovascular disease 15–20 years before heart attacks,
• Identify insulin resistance a decade before diabetes, and
• Spot autoimmune dysfunction years before symptoms appear.

Advanced inflammatory markers like hs-CRP and IL-6 show systemic inflammation that drives aging. Nutrient panels reveal deficiencies that standard medicine misses entirely. Specialized immune markers can predict who gets sick frequently and why.

What this tells us: the difference between “normal” (statistical average of a sick population) and “optimal” (what your biology actually needs to thrive).

Metabolic Testing

This is where we measure how efficiently your body actually produces energy. Metabolic testing reveals your real calorie burn, how well your mitochondria function, whether you’re metabolically flexible (can burn both fat and sugar), and your true cardiovascular fitness.

The exciting breakthrough is discovering that “slow metabolism” isn’t a life sentence—it’s often fixable dysfunction. VO2 max testing shows your cells’ ability to use oxygen (the best predictor of longevity). Respiratory quotient analysis reveals whether you’re a sugar-burner stuck in carb dependency or a fat-adapted energy machine. Lactate threshold testing shows your exercise capacity and recovery ability.

What this tells us: Your body’s ability to produce and use energy efficiently. It shows why weight gain, fatigue, and poor recovery aren’t character flaws; they’re signs of metabolic dysfunction that can be identified and improved.

Hormone Rhythm Analysis

Hormones are complex. In many cases, they drive how you feel day to day. They are your body’s communication network, but standard testing only captures single snapshots. Advanced hormone analysis maps your daily rhythms, measures hormone metabolites (not just levels), and reveals how your endocrine system actually functions over time.

The revelation is that hormone problems aren’t just about “low testosterone” or “thyroid issues.” They’re about disrupted rhythms and broken feedback loops. Cortisol should peak in the morning and decline at night, but chronic stress flattens this curve. Sex hormones should fluctuate in healthy patterns, but modern life often locks them in dysfunction.

What this tells us: why you crash at 3:00 p.m. (cortisol rhythm disruption), why you can’t lose weight despite dieting (leptin resistance), why you wake up tired (growth hormone and cortisol imbalances), and why your mood is unstable (neurotransmitter precursor deficiencies).

Amino Acid Profiling

Amino acids are the raw materials for everything your body builds—muscles, neurotransmitters, enzymes, immune compounds. Comprehensive amino acid analysis reveals which building blocks you’re missing and why your biochemistry might be failing.

This testing is particularly exciting because it connects mental health to biochemistry. Low tryptophan means poor serotonin production (depression, anxiety). Inadequate tyrosine leads to dopamine deficiency (motivation, focus problems). Poor methylation cycle function affects everything from mood to DNA repair.

What this tells us: Many “mental health” and “aging” problems are actually amino acid deficiencies and methylation dysfunction. When you provide the right building blocks, the body often fixes itself.

Advanced Imaging

Medical imaging has moved beyond waiting for symptoms. Full-body MRI scans can detect tumors when they’re still tiny and treatable. Coronary calcium scoring shows arterial plaque decades before heart attacks. DEXA scans reveal muscle loss and bone density changes years before fractures.

What’s revolutionary is that we can now see biological age, not just chronological age. Visceral fat distribution, muscle mass, bone density, arterial inflammation—these are measurable markers of how fast you’re aging. Early detection means early intervention when changes are still reversible.

What this tells us: Reveals problems before they become major. A small tumor caught early is curable. Arterial plaque detected early is reversible.

Genetic Analysis

Your DNA isn’t destiny. Comprehensive genetic testing reveals how you metabolize medications, process nutrients, respond to exercise, and what diseases you’re predisposed to developing.

The exciting frontier is nutrigenomics: how your specific genes interact with food. Some people have variants that make them poor fat metabolizers but excellent carb processors. Others have the opposite pattern. Pharmacogenomics reveals why some medications work brilliantly for some people and cause side effects in others.

What this tells us: Instead of generic advice, you get personalized optimization. Your genes might reveal you need 3x more folate than average, process caffeine slowly (affecting sleep), or have high Alzheimer’s risk that can be mitigated with specific interventions.

Microbiome Testing

The 3 pounds of bacteria in your gut control far more than digestion—they influence mood, immunity, metabolism, and even cognitive function. Advanced microbiome testing reveals the specific bacteria strains you have, what they’re producing, and how they’re affecting your health.

This field is exploding because we’re discovering the gut–brain–immune connection. Certain bacteria produce neurotransmitters that affect mood. Others create inflammatory compounds that drive autoimmune disease. Some produce metabolites that enhance longevity, while others accelerate aging.

What this tells us: Many “mysterious” health problems—chronic fatigue, depression, autoimmune conditions, food sensitivities—often trace back to gut dysfunction. Fix the microbiome, and systemic health often follows.

Continuous Monitoring

This is the most exciting frontier: measuring your biology continuously instead of with occasional snapshots. Continuous glucose monitors show how your blood sugar responds to specific foods, stress, and sleep. Heart rate variability tracking reveals your nervous system balance and recovery capacity.

The breakthrough is moving from static measurements to dynamic patterns. Instead of knowing your average blood sugar, you see exactly how your body responds to stress, different foods, exercise timing, and sleep quality. This creates feedback loops for optimization that were impossible before.

What this tells us: You stop guessing about what works for your body and start knowing. You see immediately how a poor night’s sleep affects your glucose control, how stress impacts recovery, and which foods actually work with your biology.

The Full Picture

Here’s where it gets interesting. When you combine all these measurement systems, patterns emerge that no single test could reveal.

The Metabolic Web

Your glucose monitor shows blood sugar spikes. Your amino acid profile reveals low glycine (needed for glucose control). Your hormone panel shows elevated cortisol (impacting sleep). Your microbiome test shows bacteria that produce inflammatory compounds when you eat certain foods. Your genetic analysis reveals poor insulin sensitivity genes.

What this tells us: You’re not just “pre-diabetic.” You have a specific cascade of dysfunction spanning gut bacteria, like: → inflammation → hormone disruption → genetic vulnerability → metabolic breakdown. Each piece of the puzzle points to targeted interventions.

Your metabolic testing shows low oxygen utilization. Your bloodwork reveals iron deficiency and low B-vitamins. Your hormone analysis shows flatlined cortisol and low thyroid function. Your amino acid profile shows inadequate protein synthesis. Your sleep tracking shows poor deep sleep recovery.

You’re not just “tired.” You have systematic energy production failure at the cellular level, compounded by nutrient deficiencies, hormone dysfunction, and poor recovery. Fix the root causes, restore the energy.

The Inflammation Network

Your blood markers show elevated inflammatory cytokines. Your gut testing reveals leaky intestinal barrier and bacterial imbalances. Your food sensitivity panel identifies trigger foods. Your genetic testing shows poor detoxification capacity. Your imaging shows early arterial inflammation.

You’re not just “inflamed.” You have a specific inflammatory cascade, like: gut dysfunction → immune activation → systemic inflammation → cardiovascular damage. Address the gut, calm the immune system, protect the arteries.

Disclaimer: This newsletter is provided for educational and informational purposes only and does not constitute providing medical advice or professional services. The information provided should not be used for diagnosing or treating a health problem or disease, and those seeking personal medical advice should consult with a licensed physician.

In the last issue, we unpacked the science behind peptides: what they are, how they work, and which ones actually show promise for longevity, recovery, and more. We also broke down delivery methods, common misconceptions, and the questions you should ask before trying them.

Missed it? You can still catch up on the deep dive of The Peptides Issue.

Today, we’re featuring Nick Andrews, a biochemical engineer, peptide innovator, and the founder of several companies at the forefront of transdermal and regenerative health technology. With two decades of experience in pharmaceutical biotech, Nick brings a rare blend of deep scientific expertise and entrepreneurial execution—helping turn complex biochemistry into real-world tools for better health.

He’s the founder or cofounder of three peptide-based ventures: Push Patch, which uses electro-driven iontophoresis for NAD+ and peptides; Entera Skincare, a clinician-grade topical line; and Aseir Custom, focused on copper peptide cosmeceuticals. Across these, Nick has developed novel IP, pioneered device–drug combination platforms, and built scalable models for delivering peptides effectively—without getting stuck in regulatory quicksand.

His focus? Making peptide therapies easier to use, more effective, and more accessible for people seeking better energy, recovery, skin health, and long-term vitality.

In this Q&A, Nick goes deep on some of your most interesting peptides questions.

Q. Do peptides work better in isolation or in synergy with other compounds (e.g. NAD+, senolytics, adaptogens)?

Isolation Works But Biology Is Rarely Isolated

Running a single peptide is like hiring a top-notch carpenter: the wall will get fixed, just not as fast if the lights are dim, debris is piled everywhere, and the foreman is yelling. Clinical and pre-clinical data show that peptides alone can lower inflammatory markers, tighten collagen lattices, and improve metabolic state over several weeks.

For new users, that simplicity is powerful: one variable, one set of observations, a clear cause and effect. For those working with a clinician or comfortable guiding their own health, using multiple peptides can produce pronounced beneficial effects, outperforming each peptide alone without dose escalation.

Q. There’s enormous emphasis on weight loss in the fitness world. What is your peptide advice for those of us ectomorphs at healthy or below average weights with no interest in—or need for—weight loss but rather a need to build muscle?

Virtually every time you hear peptides mentioned these days, it is dominated by weight-loss headlines. The short answer is: muscle building lives on a different biological freeway. Here’s how to navigate it.

Weight Regulation ≠ Muscle Construction

“Calories in vs. calories out” is a convenient cliché, but body composition is throttled by a mesh of hormone loops (insulin, leptin, ghrelin); epigenetic switches; endocrine-disrupting chemicals; circadian cues; stress hormones; and sleep architecture. GLP-1 agonists calm hunger signals and slow gastric emptying—terrific for shrinking the surplus that drives fat storage. But they do little to trigger the cellular programs that build muscle, or expand contractile protein. Their job is crowd control, not stadium construction.

For ectomorphs starting at “barely enough mass,” the priority is shifting amino acids toward myofibrillar protein synthesis, not curbing appetite. When your natural frame is light and narrow—classic ectomorph—you already burn calories like a hummingbird. Your daily amino-acid “budget” is small and constantly raided for liver gluconeogenesis, gut-cell turnover, and immune patrols. The muscle fibers you want to thicken (myofibrils) only receive leftovers after those housekeeping tasks are paid. So the mission is not to dampen hunger hormones (that’s a fat-loss play) but to reroute circulating amino acids away from background maintenance and into the contractile machinery of skeletal muscle.

The Growth-Hormone Axis: Still the Kingmaker

Muscle hypertrophy hinges on two pillars:

1. Satellite-cell activation → new nuclei in muscle fibers
2. mTOR-driven protein synthesis → thicker myofibrils

Endogenous growth hormone (GH) kicks off both steps by elevating hepatic and local IGF-1, which in turn lights up AKT/mTOR and satellite-cell proliferation pathways. Chronic supraphysiologic GH is undesirable and can produce a number of problems from desensitization or triggering unwanted effects, but rhythmic, physiologic pulses mimic youthful nighttime secretion patterns—enough to engage IGF-1 without tipping into acromegalic territory.

Ipamorelin at a Glance

Type: Pentapeptide, first highly selective GH secretagogue
Receptor: Ghrelin/GHSR-1a agonist
Effect Profile: Sharp GH pulse (20-30 min), minimal ACTH, cortisol, or prolactin rise
Appetite/GI: Weak orexigenic drive vs. native ghrelin—good for muscle gain without appetite spiking
Downstream: Increased IGF-1 (liver & autocrine), increased fatty-acid mobilization, increased nitrogen retention, increased sleep-stage 3 depth
Practical Upside: Supports lean-mass accretion, joint-tissue recovery, sleep quality with a low side-effect ceiling

Because ipamorelin’s growth hormone (GH) pulse is both fast and selective, it allows protein-synthesis signaling without the cortisol spikes seen in first-gen secretagogues (GHRP-6, hexarelin). Pairing ipamorelin with a GHRH analog like CJC-1295 (DAC) stretches the pulse, giving IGF-1 more runway for satellite-cell activation—useful for lifters who tolerate higher anabolic drive.

While there are multiple peptides beyond ipamorelin that can engage direct muscle building effects such as PEG-MGF, IGF-1-LR3 and Follistatin-344, these peptides tend to be more specialized and may not produce noticeable results outside of specific training settings.

The Potency-Versus-Tolerance Principle

In biology, leverage often carries cost: megadose GH or exotic myostatin blockers can accelerate growth but hike insulin resistance, edema, or organ strain. Controlled, physiologic pulses mitigate that tax.

Lifestyle still dictates 70% of the outcome:

• Caloric surplus biased toward leucine-rich protein (1.6–2.2 g / kg bodyweight)
• Progressive tension overload—mechanical strain is the primary signal to justify new muscle
• Sleep ≥7.5 h with intact slow-wave phases, where natural GH pulses cluster
• Stress management—elevated cortisol blunts mTOR and robs nitrogen

Key Takeaway

Peptides amplify the signal; they do not replace the foundational inputs. Weight-loss peptides make headlines because they solve an obvious societal pain point, but the physiology of adding lean mass is another domain entirely. For naturally skinny trainees, selective GH secretagogues—ipamorelin alone or in tandem with a GHRH analog—offer a “low-noise, high-fidelity” push on the body’s native growth circuitry. Layering IGF-1 variants, myostatin antagonists, and recovery peptides such as BPC-157 or TB500 can further widen the growth window, provided diet, training, and sleep still form the base of the pyramid.

Q. In your view, which peptide has the broadest systemic impact—and why? Is there one peptide everyone should be taking?

When the challenge is “pick one peptide that touches the most real-world problems for the most people,” I still lead with BPC-157. But I acknowledge that, in a world without price tags, MOTS-C makes a powerful counter-argument.

BPC-157

BPC-157 is a 15-amino-acid fragment of human gastric juice that functions as a roaming endothelial repair signal. It detaches caveolin-1 from eNOS, freeing nitric-oxide synthase and restoring perfusion in capillaries starved by hypoxia or inflammation. Once micro-vessels reopen, oxygen and nutrients reach every downstream cell and the local transcriptome flips from “damage control” to “rebuild.”

That single mechanism explains its multi-organ and multi-tissue impact:

• Gut: tight-junction sealing and EGF/FGF up-regulation speed ulcer and colitis recovery, already through phase-II testing
• Tendon and ligament: transected Achilles tendons in rats realign collagen faster and regain higher tensile strength
• Bone: RUNX2 activation yields denser callus and fewer non-unions in long-bone fractures
• Neurovascular tissue: post-ischemic brains show smaller infarcts and tighter blood–brain barrier junctions
• Vasomotor tone: aortic studies confirm dose-dependent modulation of NO output, evidence that vascular benefits are not tissue-restricted

The peptide is water-stable, doses in low micrograms, and a single 5-mg vial often covers a month—meaning genuine systemic leverage for roughly the cost of a dinner out. While BPC-157 is the go-to choice for most people, there are two practical cautions:

1. The World Anti-Doping Agency (WADA) banned it in 2022.
2. Any pro-angiogenic agent should be approached with caution in active cancer and under close guidance of a health care professional.

MOTS-C

MOTS-C is a 16-amino-acid peptide encoded by mitochondrial DNA. Under metabolic stress it exits the organelle, migrates to the nucleus, and re-writes transcription priorities: AMPK turns on, GLUT4 floods the sarcolemma, and lipogenesis genes shut down. In mouse and cell-culture work, that yields sharper insulin sensitivity, suppressed diet-induced obesity, and a marked rise in fat oxidation. MOTS-C also behaves like an exercise mimetic: a single pre-workout shot extended treadmill endurance 30–40 % in mice of all ages and improved late-life grip strength. Beyond metabolism, it nudges mesenchymal stem cells toward osteoblasts, mitigating bone loss in estrogen-deficient models.

This metabolic rewiring at the circuit-breaker level, while compelling, is not cheap. Effective human protocols hover around 10–20 mg, 2–3 times a week, for 6–8 week blocks. At $120–$200 per 10-mg vial (prices can vary widely depending on how the peptides are sourced), a full cycle can exceed $1,000–$2,800 before labs or syringes. That price narrows the audience to high-budget bio-optimizers.

How to Choose

• General population, finite budget, diverse wear-and-tear: BPC-157 wins on “repair per dollar” and logistical simplicity.
• Metabolic syndrome, athletic performance plateaus, no budget ceiling: MOTS-C offers mitochondrial and endurance upgrades that BPC-157 cannot match.
• Unlimited resources + holistic ambition: stack them; BPC-157 opens blood flow and tames inflammation, MOTS-C upgrades cellular energy economics, synergy at the capillary and mitochondrial levels.

In everyday reality, most people will get farther, faster by starting with BPC-157 and reserving MOTS-C for targeted interventions as their budget may allow.

In most cases, peptides do their work quietly, rewiring gene programs, optimizing mitochondria, sealing leaky capillaries, so you need something more reliable than the “I-feel-it” test. The gold standard is still data (labs, imaging, performance metrics), but the first layer should be body awareness, a skill most people never cultivate, yet one that can spot real biological change days or weeks before a lab draw.

Disclaimer: This newsletter is provided for educational and informational purposes only and does not constitute providing medical advice or professional services. The information provided should not be used for diagnosing or treating a health problem or disease, and those seeking personal medical advice should consult with a licensed physician.

Last week, we broke down the science behind physical performance as a vital sign. We looked at simple, measurable tests that offer surprising insights into longevity—from the dead hang to the sit-to-stand test—and why maintaining strength, balance, and mobility is more powerful than any supplement.

Missed it? You can still catch up on the deep dive of The Longevity Fitness Benchmarks Issue.

We’re thrilled to spotlight Dr. Kelly Starrett, Doctor of Physical Therapy, movement expert, and bestselling author dedicated to helping people unlock better health and performance through movement. He is the co-author of the New York Times bestsellers Becoming a Supple Leopard, Ready to Run, and Built to Move, as well as the Wall Street Journal bestseller Deskbound. As the co-founder and Chief Health Officer of TheReadyState.com and co-founder of San Francisco CrossFit—the 21st-ever CrossFit affiliate—Kelly has worked with elite athletes and coaches across the NFL, NBA, NHL, MLB, and U.S. Olympic teams. He also consults with military special forces, first responders, and corporations seeking to improve employee health and well-being.

Kelly’s work isn’t just for high performers; his methods empower everyone—from kids to desk-bound professionals—to move better, reduce pain, and build durable bodies for life. Alongside Juliet, he coaches The Starrett System, helping members develop pain-free, high-performing bodies through science-backed training that fits into real life.

Here’s Kelly answering some of your questions about building a body that lasts—how to maintain strength, mobility, and resilience as you age, and what really matters when it comes to movement for longevity.

Q. If someone only has 20 minutes a day to invest in movement, what should they focus on?

Rethinking the 20-Minute Workout

Here’s the problem with the “I only have 20 minutes” excuse: it’s built on two flawed assumptions.

First, we’ve been conditioned to believe that movement only counts if it’s done in a formal one-hour chunk. That’s just not true. At The Ready State, we believe in the golden rule of Never Do Nothing. Twenty minutes is plenty of time to get real work done—whether that’s a 5×5 front squat session, a kettlebell complex, a few rounds of rope flow, or a quick yoga flow to reset your nervous system.

We’ve trained people to think every workout needs to be epic. It doesn’t. And the research backs this up: short, consistent training sessions can have huge benefits for performance, longevity, and mood. Also? Most people can walk a mile in 20 minutes. That walk could include sunshine, nature, your dog, and maybe even a neighbor or two. That’s movement gold.

Second, we need to reframe when movement happens. The 20-minute session is just one part of the puzzle. What if your day looked like this?

• You wake up and knock out a few sun salutations or a breath practice.
• You max out your step count by aiming for 8,000+ steps during the day.
• You avoid long stretches of sitting at your desk.
• You hit a focused 20-minute training session.
• And then you sit on the floor while you eat dinner or watch Netflix.

That’s not “just 20 minutes.” That’s a full-on movement-rich day.

The truth is: everyone has 20 minutes. But the real unlock is realizing that movement doesn’t start and end with a workout. It’s the cumulative rhythm of how you live.

Q. What are your top 3 “longevity movements” everyone should be doing into old age?

My favorite definition of fitness comes from movement pioneer Georges Hébert: “Be useful.” At the heart of it, we’re talking about useful capacity and transferable capabilities. And since we’re not the first to wrestle with this idea, let’s go back to the masters.

Coach Dan John brilliantly distilled “being useful” down to this: pick something up, put it over your head, and carry it around.

Simple? Yes. Incomplete? Sure. But also beautifully adaptable. “Pick it up” could mean deadlifts, goblet squats, or kettlebell swings. “Put it overhead” could be presses, pull-ups, handstands, or even just hanging. And “carry it around” might look like hiking, rucking, sled pushes, or heavy farmer carries. Being useful also means being durable. It means building a body that lets you stay independent, chase adventure, and say yes to whatever life throws at you. That’s the goal—and this is your recipe.

Q. You’ve worked with elite athletes and regular people—what do the most functional bodies all seem to have in common?

The answer is surprisingly simple: bone-crushing consistency. The most functional, capable bodies belong to people who are really good at showing up—over and over again. The algorithm would have you believe you can radically transform your VO2 max, bone density, mobility, and muscle mass in a matter of weeks. But that’s just not how the human body works.

Sprinting legend Usain Bolt once said, “If you’re great, you were always great.” Maybe he meant talent—but I like to believe he was talking about the quiet, relentless act of doing the right things for a long, long time. The real “secret” is no secret at all: eat real food, get good sleep, build strong relationships, play often, train hard, compete sometimes, and recover like it matters. Then repeat. For decades.

 

Disclaimer: This newsletter is provided for educational and informational purposes only and does not constitute providing medical advice or professional services. The information provided should not be used for diagnosing or treating a health problem or disease, and those seeking personal medical advice should consult with a licensed physician.