My Vitality Protocol

I believe that I have only one chance to live, and I want to do it in the most fulfilled and meaningful way possible. Considering that the human mind creates every part of my reality (in fact, is identical to my reality), working on what is going on in there is a top priority.

Because I want some control over my emotional and cognitive state—beyond what mindfulness, reframing, and psychotherapy can offer—I also leverage my biology directly, including making strategic lifestyle choices, hormone optimization, and utilizing pharmacology. While some may think of this as “cheating”, given that the outcomes of my mind are all that I have to offer to others, I believe this is an ethical thing to do.

In this article, I lay out my current protocol, which remained more or less unchanged for quite some time now. At the end, I try to rank the interventions discussed.

My current protocol

For a long time, I have put a prime on personal growth. I have listened to tons of podcasts, read lots of books, and have gone to psychotherapy. However, the things that really helped me were rarely pieces of “knowledge”. Once everyday life hit, most of what I had “learned” was swiftly forgotten.

For me, more “knowledge” was not the answer. Knowledge mostly helped if I could practically apply it. For example, knowledge about how to remove distractions, how to redesign my environment, why I should quit social media, and why I should complete my most important task of the day first.

However, what really stood out was knowledge of my biology and how to optimize it. Because biological intervention changed my thinking, behavior, and life quite unlike anything else.

My primary motivators for starting biohacking were (presumably) curiosity, wanting “more” out of life, and a feeling of not being good enough. In retrospect, had I consistently “felt fine”, it would have prevented me from self-experimentation, possibly ending up being a net detriment.

Even though self-experimentation is risky, some of my biggest mistakes and failures resulted in the most important “innovations”. In this way, failures and mistakes were an important stepping stone towards finding something that suits my individual preferences and biology.

In the past, I have relied more on stimulants than I should have. Now, I am much more interested in interventions that improve my baseline vitality (the way I feel and function on a daily basis) and I am turned off by interventions that worsen it. In my experience, when it comes to short-acting drugs, there is rarely a biological free lunch (e.g., drinking coffee today has me paying for it tomorrow).

Also, I gave up on the idea of finding a perfect final state. For such a state to exist, I would need to be in an unchanging environment, which is neither possible nor desirable. Therefore, I adjust as needed depending on my physiology, preferences, priorities, and life circumstances.

Nonetheless, similar to how many investors switch from day trading to more long-term investments, over time I switched from fiddling with my interventions a lot to a more stable protocol, which I now vary rarely.

I always assumed what works for me must work for anybody else. However, I came to realize that this is not true at all, and people respond very differently to the same things – sometimes radically so.

I found that my response to a certain intervention is a very individual thing, and it is awfully hard to tell in advance whether I respond well to something or not, regardless of what doctors, the medical literature, or anecdotal online reports make me believe. The only sure way to figure out how I respond to something is to try it.

For me, all of the following interventions have stood the test of time, meaning that I have been doing them consistently for at least two years (most of them for longer) and still derive benefits. This is quite unlike most of the online reviews I usually encounter, where someone tries out X for one week, hops online and writes a glaring review claiming “X changed my life”, and then vanishes from the face of Earth.

So, without further ado and in no particular order:

Sleep

Out of diet, exercise, and sleep, sleep is the one I am most sensitive to. When I am sleep-deprived, I am a worse version of myself in almost every way, and my area-under-curve levels of productivity and well-being are significantly reduced. Basically, if my sleep is awful, so is my entire day.

I sleep in a cold, dark, and quiet environment. I also use earplugs and a cooling blanket. Before sleep, I take magnesium and glycine. I usually sleep from 10.00 to 6.00, and my sleep quality is quite sensitive to going to bed later than usual.

Most nights, my sleep is quite good, and I wake up refreshed without an alarm. Upon waking, I use a 10.000 lux daylight lamp while doing my morning routine.

I discuss my sleep optimization routine in more detail here.

Exercise

I put a prime on exercise. Exercise improves my sleep, energy levels, mood, metabolic health, and cognition. Whenever I do not exercise for a day, something is missing. And if I do not exercise for multiple days in a row, I get antsy, irritable, and my energy and mood drop significantly.

I try to integrate different kinds of exercise (resistance training; aerobic; anaerobic; mobility) as they all have partially independent benefits. The best all-in-one solution I have found so far is CrossFit, which I thoroughly enjoyed.

Thanks to CrossFit I have also undergone “fitness menopause”, changing my focus from aesthetics to vitality. After 18 months of doing it regularly, I decided to stop and switch to more longevity-focused exercise considering that many people seem to eventually get hurt with CrossFit.

I now alternate between steady-state cardio (zone II exercise) and the gym. Recently I have also implemented a mobility routine focused on lower body mobility.

I discuss my exercise regimen in more detail here.

Diet

I have experimented with many different diets. Nothing stuck. Sometimes I felt great initially, but over time I felt worse, for example with intermittent fasting or a ketogenic diet. For me, how I feel is more important compared to how well a diet performs “on paper”.

Furthermore, for me, going on semaglutide (explained next), made dietary experimentation obsolete, and I now only try to adhere to three loosely held rules.

• I cut out most of the processed food and sugar (80/20 principle).

• I adjust my carbohydrate intake to my leanness and activity levels.

• I make sure to eat a sufficient number of calories.

I believe that, for me, these rules are sufficient to get about 80% or so of the benefits that are maximally attainable through dietary intervention. I believe that if I am already on a reasonable diet, dietary intervention is a low-leverage lever to pull, especially compared to sleep and exercise.

I particularly like Huel shakes with lots of olive oil, which give me stable energy and are convenient to prepare. With semaglutide & Huel, I outsourced 80% of my nutrition.

I discuss my diet in more detail here.

Semaglutide

I naturally have quite a strong appetite, and throughout my life, I have wasted a lot of energy and brainpower on food. The addition of a low dose of semaglutide, which modifies the homeostatic and hedonic aspects of feeding, has been a huge hack for my productivity, looks, and well-being.

The major downside is that semaglutide makes it hard to meet my caloric requirements if I do not count calories. I do not use semaglutide to lose weight (in fact, I actively try not to lose weight) but rather to decouple appetite from caloric intake. Thus, semaglutide helps me to be in charge of my drives and not the other way around, which I think is a very human thing to do.

Other than its cost, the need to count calories, and some loss of pleasure from eating, for me, there were no side effects as of yet (at least for the two years I have been using it). My resting heart rate is unchanged and I even built about 3-4 kg of lean muscle on it. I currently only use a very low dose (2 clicks per day, which is about 0.2mg per week – so a single pen lasts me about half a year).

I discuss my experience with semaglutide in more detail here.

Supplements

I use quite a few supplements. Other than vitamin D, fish oil, and magnesium I am not sure whether they are of any benefit, and I mostly take them with a just-in-case mentality.

Honestly, I kind of feel bad about taking them because I have so little data. However, I feel equally bad about not taking them because they all have theoretical benefits in a variety of domains. For now, I simply close my eyes and hope that they do more good than harm.

I discuss the supplements I take, and why I take them, in more detail here.

Blood tests & monitoring

Every quarter, I get extensive blood work done and monitor a number of things, ready to intervene accordingly. I do a full-body MRI every three years and a DEXA scan once to twice per year. I track my sleep and exercise parameters and occasionally also my blood glucose with the use of a continuous glucose monitor (CGM). I also have ready access to great doctors from multiple fields and some of them are among my best friends.

I discuss the blood tests I do in more detail here.

Longevity interventions

My goal is to live a long and happy life. If I had to choose between longevity and vitality, I would choose vitality without a second thought. Fortunately, these two are not necessarily mutually exclusive.

I describe my approach to longevity in detail here.

Thyroid hormones

Until very recently, I have been supplementing with low doses of thyroid hormones for about six years despite not having hypothyroidism.

Thyroid hormones increased my baseline vitality by a good amount, particularly the addition of a small amount of T3 (the active thyroid hormone that is rarely prescribed). I particularly liked their effect on morning energy levels. Overall, for me, thyroid hormones made life a little bit easier and better.

I recently stopped taking them because I found that the drastic increase in caloric intake for a year or so had boosted my thyroid hormones from the low-normal to the high-normal range, and I felt that the additional T3 dehydrated me and made me a tad more restless. Time will tell whether I go back to thyroid hormones or not.

I discuss my experience with thyroid hormones in more detail here.

Moclobemide

Despite not having depression or anxiety, I have experimented with many antidepressants and similar molecules aiming to enhance my productivity and well-being (“cosmetic neuropharmacology”) in the same way many others use e.g., caffeine for similar purposes.

I found low doses of bupropion and vortioxetine useful but the one I liked the most was a low dose of moclobemide. It felt natural and it did not mess with my appetite, libido, or sleep.

On moclobemide, I had more energy, I was almost always in a great mood, and anxiety and worrying were mostly absent. However, I was also less “deep”, a little less capable of feeling profound feelings, and slightly less sharp. At the very least, it is fair to say that making me “happier” than I would normally be is a double-edged sword. Eventually, because of the slight emotional and cognitive blunting, I decided to come off, though one day I might return to it.

I discuss my experience with moclobemide in more detail here.

Hypnotics

Occasionally, I use a low dose of a sleeping pill. I feel that if used sparingly, the risks and side effects of poor sleep are greater than the risks and side effects associated with hypnotics. I have experimented with many hypnotics, though few have stood the test of time. Currently, I use two hypnotics occasionally:

• On days when I want to ensure a great sleep, such as before an important meeting, I take 1mg of eszopiclone. For me, this medication virtually guarantees a restful night’s sleep with no hangover. I do this about once per month.

• On days I have a particularly tough time falling asleep, I use ¼ of a 0.25mg triazolam pill sublingually, which has me fall asleep within a couple of minutes. I do this about once per week.

However, long-term use of CNS depressants, such as benzodiazepines, Z-drugs, gabapentinoids, and antihistamines, is associated with progressive cognitive impairment, which does not seem to be explained by residual confounding.

I discuss sleeping pills in more detail here.

Caffeine

I mostly avoid caffeine because it not only interferes with my sleep quality but also makes me less alert whenever I do not have it. When I consume caffeine, which is perhaps once per month, I preferably consume it in the form of white tea or diet coke, which has comparatively little caffeine and does not stain teeth.

I discuss my experience with caffeine in more detail here.

Modafinil

In the past, I often used modafinil to help with studying and being more productive, but now I very rarely use it because it hampers my creativity, and on it, I tend to do things more thoroughly than intended, which usually ends up being time-robbing instead of time-saving.

Now I only use it perhaps once or twice a month, on days I slept particularly badly or little. Like other stimulants, frequent use worsens my baseline. I feel that stimulants in general are mostly “borrowed” energy, and modafinil is no exception.

I discuss modafinil in more detail here.

Nicotine

On work-heavy days I usually consume about 4-6 cigarettes’ worth of nicotine in the form of nicotine replacement products. Nicotine helps me with alertness, cognition, memory, and makes boring tasks more fun. The major downside is that nicotine is addictive, though the addictiveness depends in part on the delivery vehicle.

Warning: Nicotine is addictive and setting oneself up for a potentially life-long addiction is not to be taken lightly, even if the health effects of nicotine itself are far below those of smoking cigarettes (which is a low bar to meet).

I make sure that my nicotine tablets or gums are flavorless. For me, having something sweet or flavorful in my mouth measurably decreases my cognition (for evolutionarily obvious reasons as an ongoing pleasure reaction decreases cognition so that the animal keeps doing whatever adaptive thing it is currently doing).

I discuss nicotine in more detail here.

Non-biological self-improvement

I prioritize my community, do meditation, gratitude journaling, engage in deep work practices, drastically limit social media and the news, and follow a number of other strategies aimed at promoting well-being and good mental health. I discuss them in more detail here.

Am I worried about the consequences?

As may be evident by now, I do apply pharmacology to many areas of my life. To me, pharmacology is one of the most interesting sciences because it is one of the few things that are akin to a “superpower”. However, in order to apply it in a way that the benefits outweigh the risks, it requires a deep, well-principled understanding of a host of other medicine-related sciences such as physiology, biochemistry, neuroscience, and endocrinology.

As mentioned in the section on guiding principles, the modern world is an unnatural minefield and not very conducive to my general and mental health. Therefore, in my opinion, living in the modern world is just as unnatural as using pharmaceuticals to better navigate it.

Some of my friends & family believe that what I do is dangerous. According to my understanding of things, everything I do is much less dangerous than, for example, obesity, alcoholism, or smoking, which combined probably affect 50% of people worldwide. The only difference is that obesity, alcoholism, or smoking seem natural to most people because they are so common (“familiarity principle”).

Whether I can (and want) to keep all this up for decades, I do not know. It could be that unforeseen side effects arise, or that one or multiple of these is far riskier than I currently assume. Regardless, I would rather opt for a below-average lifespan while feeling great and enjoying my time instead of living for very long but feeling mediocre.

Also, I simply do not know how long the world as I know it will still exist. While the chances that humanity becomes something far greater in the 21st century are high, the chances we screw up or that something escapes our control are high as well, such as climate change, engineered pandemics, artificial intelligence, technological singularity, or a catastrophic war. In the case the world falls apart within the next few decades or so, I believe that I have made a good deal.

I discuss some of my philosophy in more detail here.

Ranking

What follows is my personal ranking of the interventions discussed in this article. I am n=1 and what works for me, does not necessarily work for others. Furthermore, we are all different in terms of our neurobiology and what we want out of life.

Because each of the following has its individual usefulness, I found it nearly impossible to rank the molecules discussed. However, if I had to pick, I would pick in the following order. Of note, while I have experimented with all of the below, I do not currently take all of them.

• #0 – Human connection & finding purpose: Without emotional or “spiritual” health, feeling good and performing well does not matter.

• #1 – Sleep hacks: With regularity, darkness, ear plugs, a morning daylight lamp, glycine, magnesium, and a Chili Pad in the summer, I have a refreshing sleep on most nights, which has far-reaching effects on everything I do, think and feel.

• #2 – Exercise: Other than high-quality sleep, there is little that has a greater effect on my vitality than consistent, high-quality exercise, especially cardiovascular exercise.

• #3 – Semaglutide & increasing caloric intake: I find hunger distracting and semaglutide is a potent appetite suppressant. For me, the increase in productivity and well-being can hardly be overstated. I should note that I do not use semaglutide to lose weight but rather to decouple my caloric intake from my appetite. I eat the highest possible number of calories that does not result in fat gain, which made an enormous difference to my vitality. Of note, while increasing my caloric intake may be great for my vitality, it is probably not optimal for longevity. However, vitality is more important to me.

• #4 – Thyroid hormones: Thyroid hormones regulate the “idle” state and increasing my thyroid hormones from low-normal to high-normal levels improved my energy, well-being, cognition, sleep, and general health.

• #5 – Moclobemide: While I was on it, moclobemide was a great all-in-one solution for energy levels, mood, and all while feeling natural and having few to no side effects. The downsides included a very slight cognitive and emotional blunting.

• #6 – Psilocybin: Friends use it occasionally to enjoy a day off, or to get some “deathbed” clarity in their life.

• #7 – Ketamine: Ketamine is very effective at reversing the neurobiological aspects of depression. Unlike most other antidepressants, ketamine does not distort neurotransmitters. Furthermore, it is perhaps the only antidepressant that enhances emotions instead of blunting them. Other than being hard to get hold of, the major downside is that it is potentially neurotoxic.

• #8 – Bupropion: Bupropion is a milder but more sustainable derivative of amphetamine. It is an effective mood brightener, stimulant, antidepressant, ADHD medication, weight loss drug, and anti-addiction agent.

• #9 – Vortioxetine: As I was taking it, it boosted my mood, energy levels, stress resilience, and cognition while having a very benign side effect profile.

• #10 – Nicotine gum: I find nicotine gum useful for increasing task salience and for boosting executive functions while working on cognitively demanding tasks. I can also take it at night without it affecting my sleep.

• #11 – Modafinil: A great stimulant to take occasionally. It lasts all day. However, as with all stimulants, the price is counterregulation, worsening of sleep, a change in personality, and doing things more thoroughly than intended.

• #12 – Rapamycin: While not directly helping with vitality in the short term, rapamycin helps to preserve vitality in the long term. According to the currently available data, rapamycin is presumably the most potent geroprotective molecule currently available to mankind. I have been on it for a little over four years.

Edit: Recent changes to my “stack” (12/2024)

I wrote this article in 2023. Since then, a couple of things have changed. While I try my best to update this article regularly, I decided against rewriting the section above to give readers a sense of how things are evolving over time. The things listed below have been a stable part of my protocol for at least six months.

• By far the #1 thing for my vitality is having an amazing group of friends and spending much of my free time with people I value. Furthermore, having purpose and a fairly set direction in my life is also having a big top-down effect on my physiology and neurobiochemistry. I´ll just briefly mention this even though that is not what this website is about.

• After having been on a low dose of semaglutide for 3 years, a couple of months ago, I came off it. I am currently trying to gain weight, which semaglutide makes impossible to do. Interestingly, for some reason, my appetite is now vastly lower than before the semaglutide, hinting at the possibility that all this time on semaglutide led to some favorable rewiring of my appetite centers.

• Then I realized that on moclobemide my IQ is roughly 10 points lower, which made me stop it. For a friend, moclobemide does not seem to affect cognition.

• For the past 10 months, I have been on TRT “lite”. Essentially, I take 100 IU of HCG per day. On this dose, my T levels are around 1000ng/dl, my E2 is at 40pg/ml, and I am not even shut down (my LH and FSH are at the bottom of the normal range). I describe my first run with TRT here. This time, my experience was much better, presumably because many other things had been fixed. I will publish an article about my “TRT lite” experience soon. In order to not virilize too much from the increased androgen exposure and to age “more gracefully” (from a visual perspective) I take a very low dose of finasteride (0.125mg/d) along with it. Background: Individuals with hypogonadism look much younger than they are vs. people on TRT (after a couple of years) usually look much older than they are. Article about finasteride soon as well.

• Whenever I have a hard time falling asleep, I still take a low dose of triazolam sublingually (as I did before). I do this about once per week to once every other week or so. There has not been an increase in frequency or dosage over the past couple of years. Article here.

• From time to time, I struggle with anhedonic depression. This happens about 3-5x per year lasting a couple of weeks. I had been dealing with this for years now. During these episodes, I do all the things I normally do (e.g., work, gym, friends) but I feel quite little. The weird thing is that from the outside nobody can tell. When I tell friends that during these times I actually feel quite a little, they usually do have a hard time believing me because I laughing, making jokes, and seeming emotional just like always. I am not even acting or putting up a facade. I also am not dissociated as far as I can tell. There is just a mismatch between what I do and what I feel. Even my psychotherapist does not believe me (“A person that feels little is not acting and talking the way you do.”). However, on the inside, there is emptiness. It is quite hard to explain. Also, these episodes seem to have very little effect on my “objective” life. I still go for walks, read, dating, and my drive is unaffected. However, I do all of these things without “feeling” much. Other than the anhedonia, I am also more fatigued. I am quite unsure whether the cause is mostly biological or mostly “psychological”. My intuition tells me that during these times neuroplasticity is at low levels as everything that is known to have neuroplastic effects brings back my feelings (at least by a bit). However, pathogenesis is not the same as etiology. Anyway, a single dose of ketamine has thus far always been sufficient to kick me out of it. I am always reluctant for a couple of weeks to use it because it is probably more neurotoxic than the medical community currently appreciates. If the “waiting it out” does not work, 24 hours after the ketamine injection, it seems as if somebody has turned my feelings back on and usually they remain on for at least a few weeks, sometimes months. I aim to not use it more often than once a quarter (ideally, less). Recently, I also found NSI-189 very valuable in terms of getting out of this state but it needs more testing. Since gaining weight (both body fat as well as muscle) I seem to get these episodes less but again here, I am not very sure. Will update next year.

• I switched out the Huel for kefir yogurt drinks, which I mix with 70ml of olive oil + 1 whey shake – totaling 900 kcal per drink. I usually drink 2-3 of these next to my normal meals. I also noticed that I feel better if I eat less clean (still far away from fast food/junk). Because I am lean and fit, I can tolerate a much less clean diet – in fact, I feel much better when I am less strict with my food choices.

• This year I purposely gained weight. I tried to gain 1kg per month, starting in March. Overall, I gained 7kg, probably half fat and half muscle. My body fat went from 9-10% to roughly 13-14%. Since gaining weight, I have not gotten sick a single time (despite working in emergency medicine during this time). Furthermore, my energy is considerably higher, which is worth a lot to me. Also, I only got one single anhedonic episode, though it is hard to infer causality. Overall, I just feel much better at slightly higher body fat levels and metreleptin can only partially hack this.

• My favorite stimulant has become yohimbine and the only stimulant I have ever used over the past half a year or so (other than some modafinil during particularly brutal night shifts). Whenever I need a push, I take 1.25mg of it. I am a homozygous CYP2D6 poor metabolizer so for me the yohimbine lasts considerably longer than for normal metabolizers. I “feel” stimulated by the yohimbine for roughly 4-6 hours. Just very clean energy. Yohimbine is an alpha2-antagonist and basically “disinhibits” noradrenergic tone (sympathetic nervous system activity). For me, yohimibine is the perfect caffeine replacement. It has barely any tolerance, no comedown, and does not mess with my sleep. For some reason, most people seem to dislike yohimbine – we are all different. Article about yohimbine soon.

• In terms of recreational drugs, once a month to once every other month I take a low dose of plant medicine (0.5-1g) to have “a month’s worth of psychotherapy in one afternoon”. Occasionally I also take a low dose of 1,4-butanediol – great replacement for ethanol, which I never to rarely (once per year) drink. No deleterious effect on sleep and no hangover. About once every other week to once per month.

• I am currently experimenting with pharmaceutical-grade NSI-189 and pitolisant. I have been only using them in cycles for a few months. Both are very interesting molecules. On NSI-189, which is a stimulator of neuroplasticity/neurogenesis, my dreams are very vivid and my libido is undeniably higher. I also seem to have more and deeper emotions. Pitolisant elevates central histamine levels and gives wakefulness without any stimulant effects (i.e., unlike modafinil and other stimulants). For me, both molecules have no side effects. Articles about these molecules will be published once I have thoroughly tested them.

• On and off I use a topical 17-beta estradiol cream for facial skin care (the same product postmenopausal women use for HRT – I just use a much smaller dosage).

• I limit my use of nicotine gum to 1 hour per day while I am reviewing notebooks from the past (e.g., science, thoughts, etc.). Nicotine is a powerful self-conditioning agent.

• I share updates regarding my protocol in my weekly newsletter. If you are interested you should sign up below.

• My longevity protocol has not changed too much.

How I Biohack My Vitality

This article is a subsection of How I Biohack My Vitality.

Disclaimer

The content available on this website is based on the author’s individual research, opinions, and personal experiences. It is intended solely for informational and entertainment purposes and does not constitute medical advice. The author does not endorse the use of supplements, pharmaceutical drugs, or hormones without the direct oversight of a qualified physician. People should never disregard professional medical advice or delay in seeking it because of something they have read on the internet.