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> Nobody wanted to live a long time but be unhealthy in their older years.

If nobody wanted that, then why have we spent so much effort keeping older people alive and in agony for a couple more days, often in direct opposition to their preferences and DNRs?

If nobody wanted a medical system that caused such suffering for such little reason, then how come the excellent How Doctors Die[0] needed to be written?

[0] https://www.saturdayeveningpost.com/2013/03/how-doctors-die/

An even stronger cultural and legal opposition to anything resembling suicide?

That appears to me to be a revealed preference for lifespan over healthspan, except couched in different language.

Which study are you referring to for keto having a negative impact on cardiovascular health? I've unfortunately found studies and metastudies reaching all sorts of conflicting conclusions on keto.

The top metastudies on a simple google search both conclude positive effects on CVD.

Ketogenic diet research is fascinating in itself for how many manipulated or misleading studies get published.

The most recent example is the KETO-CTA paper, which was released in April to loud claims that high LDL in a keto diet was not really bad. It got picked up by various news outlets as vindicating ketogenic diets. The authors posted long Twitter threads full of meme animated gifs celebrating their victory over keto skeptics.

Yet when people started looming into the study they noticed that the study failed to report the data from the pre-registered trial endpoint. This is highly unusual because if you establish an entire clinical trial, you are expected to publish the primary results you pre-registered.

After a lot of prodding, people finally got the authors to release the percent change in non-calcified plaque volume (NCPV) values that they pre-registered for and they were extremely high. Even higher than seen in certain serious medical conditions. It became clear that they chose to hide the values because they were so incredibly bad.

> The top metastudies on a simple google search both conclude positive effects on CVD.

There are a lot of die-hard keto defenders who produce papers, blogs, and podcasts claiming it’s either neutral or good for CVD. You have to look past the SEO optimized content and go to actual CVD experts who do not have their internet presence tied to promoting keto diets.

Thank you for your response. I've certainly found keto seems to inspire quite a tribal approach in many people - the r/keto subreddit has a certain dogma that is rigidly enforced, there's a pro-saturated-fat pro-meat tribe etc.

I initially gave keto a shot for two weeks, and I found unexpectedly high benefits in increased energy, weight loss and an end to some long-standing stomach ulcer issues. So my two-week trial has ended up lasting 3 months.

It's been frustrating that trying to learn about keto is like drinking from a firehose of bullshit, because I'm really rather enjoying my extra energy, weight loss and lack of stomach pain and ulcers. I actually feel 20 years younger.

I'm quite skeptical of the long term elimination of whole grains though, so soon I'll be easing off keto with some vegetables and whole grains.

Nobody wanted to live a long time but be unhealthy in their older years.

Obviously, but they operated (and continue to) under a medical paradigm where preventative medicine means just avoiding a few major harm factors and getting just enough exercise to maintain the average observed health metrics for their age group.

People increasingly do not want to wind up like average 70 or 80 year olds, so it is absolutely appropriate that they start shooting for upper 10% or 5% -ile attributes now while they are younger so that in their old age the relative decline still keeps them at those same upper percentiles they will objvetively need to do the things in old age they want to do.

I've read Attia's book, and all he said there about diet was that it was really hard to study, but the best study he knew of made the Mediterranean diet look pretty good.

He went into quite a bit of detail on exercise though, focusing on the predictable ways you'll lose capability as you age, if you don't work really hard on avoiding that.

I thought the whole trend of "healthspan" as a word was a direct response to / attempt to sidestep the many people who are convinced that any artificial increase to "lifespan" will doom humanity to either Tithonus or Altered Carbon and will fight you over it if you dare propose such a terrible, terrible thing.

I think that at best the jury is still out on Rapamaycin. It has healthspan- and lifespan-increasing effects on most animals studied.

Bryan Johnson quit using it, but he’s on 40 other things and there are bound to be drug interactions.

That said, limiting consumption of health and fitness influencers is bound to be good for lifespan: you’ll have more time to live.

And yes, it’s hard to make a living as an influencer saying “eat food, mostly green, move your body, and spend time with friends and loved ones.”

Your comment ignores the main point of the comment you are replying to: namely, a lot of reporting on studies that find that some intervention increases lifespan ignore strong evidence that the same intervention fails to increase (or worse, actively decreases) healthspan. A diet low in protein for example, will tend to increase your lifespan while tending to make you one of those 70-year-olds (or 60-year-olds if you're unlikely or maintained a diet very low in protein) with very little muscle left -- and no way (that we know of) to regain muscle: at that age, neither exercise nor increasing dietary protein quantity and quality will significantly increase muscle mass even if muscle mass is very low.

I suspect that something similar can be said of not doing enough exercise.

We are commenting on a press release from a university, i.e., written by professionals whose job is to increase the prestige of their employer. It is rich for you to criticize Peter Attia, M.D., and ignore that little gem. At least Attia is trying to understand some aspect of reality more fundamental than impression management and increasing the public's awareness of whatever their employers tasks them to target.

> A diet low in protein for example, will tend to increase your lifespan while tending to make you one of those 70-year-olds (or 60-year-olds if you're unlikely or were very protein deficient) with very little muscle left

Low muscle mass is correlated with shortened lifespan, though. Very low muscle mass is known to be a high risk for early mortality.

> It is a rich for you to criticize Peter Attia, M.D., and ignore that little gem.

I don’t feel bad at all for criticizing Peter Attia, especially after his ringing endorsements of the Oura Ring and claimed “investor” status were revealed to be a contractual deal where he got shares in the company in exchange for promoting the Oura Ring. He’s been revealed to be very oriented toward fame and self-promotion, as evidenced by his recent claims that Kevin Spacey’s accusers were all wrong and Kevin Spacey was totally innocent after Kevin Spacey’s team set up a promotional dinner between Attia and Spacey. I know a lot of listeners develop sorts of parasocial defensive relationships for their podcasters, but you can’t deny the irony of a CVD-focused podcaster starting his podcast career deep into Ketogenic stuff before he saw the writing on the wall and backed off.

> and no way (that we know of) to regain muscle

https://www.theguardian.com/wellness/2025/mar/11/older-adult...

TL;DR: In the 1980s, Maria Fiatarone got 9 patients in their 80s and 90s to do 2 months of progressive resistance knee extension training. The minimum increase in 1RM strength was 61%.

OK, but did the subjects add any glycogen storage capacity to their musculature? The muscles capacity to remove glucose from the bloodstream (and store it as glycogen) is very useful in avoiding uhealthy, high levels of glucose after a meal containing carbs.

I don't know. Regardless, a 61% increase in strength is astounding.