Stacks and hacks. Maybe sexy slang is where the problem begins.

Biohacks, supplement stacks, morning stacks, nootropics, dopamine fasts, contrast therapy. These are all terms related to health optimization that are thrown around by everyone from Bryan Johnson, the tech entrepreneur who has spent millions on the pursuit of “defeating death” and claims he cloned himself (and who is now sick), to wellness influencers to — possibly — your own patients.

“The good thing about it is that I think society is gearing themselves to become more healthy,” said Joseph A. Daibes, DO, a cardiologist at Northwell Health’s Lenox Hill Hospital in New York City. “The cool thing now when you go to LA and Hollywood and Miami and New York City is health.”

Societal health data in the US has not improved, and yet if you’re on social media, it’s very easy to assume millions of people now push to reach optimal levels of health in everything from fitness performance to biological age. A third of Americans surveyed claim they’re in “optimization mode” trying to get an edge on their health through smart choices, disciplined routines, and health hacks, according to The New Consumer 2026 mid-year report.

Smartphones have become everyone’s gateway device because they make it easy to overdose on everyday data. “When people who are into their health start doing this as a hobby and they start monitoring every single one of these datapoints, they can become neurotic about it,” Daibes said.

The quest for better health is a great thing at its core. And that’s the difficulty for physicians — figuring out how to help patients find the line where healthy motivation becomes unhealthy obsession.

The Doctor’s Dilemma

Someone like Bryan Johnson is simultaneously the poster boy for “optimization” and the cautionary tale. He’s documented his longevity journey, spent millions (literally), used all manner of supplements, took plasma transfusions from his son, starred in a Netflix documentary called Don’t Die, and built a social media following (1.8 million followers on X alone) just as obsessed with what he’s doing as he is. Or was. On June 30, he announced he has autoimmune gastritis. And on July 30, he tweeted the following: “Been thinking things over and wonder if I’ve taken this whole longevity thing too far.”

“Everybody wants to be well, everybody wants to live a long time,” said Jordan D. Metzl, MD, a sports medicine physician at the Hospital for Special Surgery in New York City and author of Push: Unlock the Science of Fitness Motivation to Embrace Health and Longevity. He thinks Johnson is a good example to look at because simple healthy habits — and even extreme ones — are no guarantee of anything. “There’s not a one-size-fits-all here,” he said. 

Did the burden of Johnson’s health optimization have the opposite of its intended effect? Impossible to say, but it’s easy to roll your eyes at the perfectly healthy young man asking you how he can get 10 more minutes of REM sleep or the woman who wants you to prescribe the latest untested peptide.

Experiencing the opposite of health optimization’s intended effect doesn’t just cover medical metrics. It makes one deviate from otherwise normal “healthy” day-to-day behavior. For example, if you avoid social engagements because you don’t want to encounter certain foods, drinks, or circumstances and miss out on seeing friends, you wind up with antisocial behavior, said Michael Easter, host of the Two Percent podcast and author of The Comfort Crisis. “Being social is more powerful for long-term health in most studies than nutrition assuming you’re already eating healthy. So it’s missing the forest for the trees,” he said.

What makes this tricky for physicians is a lack of real data on “optimization” while there’s an endless supply of noise on social media that may be confusing patients.

“I feel like healthcare professionals are really struggling because they’re battling against all this other information,” said Metzl. “We want people to be healthy and move and do all these things, but when they come with peptides and all these different supplement stacks and all these other things that are really just not validated, it makes it very challenging to speak against that.”

The Fixation on Health Optimization

“There is a sort of global movement to optimize health and longevity right now,” said Dana Gossett, MD, director of the Center for Sexual Medicine and Menopause at Northwestern Medicine in Chicago.

Easter sees several reasons for this shift. The big one: Your inevitable death becomes a “problem” to solve, sometimes out of boredom or a lack of day-to-day existential risks to focus on. Meanwhile, the medical system has become very easy to distrust these days, and health is now highly quantifiable, which is attractive to people. “You don’t know when you’re going to die, but if someone tells you, ‘oh, if your blood pressure is X number, or if the CGM (continuous glucose monitor) tells you Y number all the time, that’s associated with X,’ that gives you a very clear metric that you can focus your time on and try to move,” Easter said. “People tend to get more obsessive over things that can be measured and tracked because you can see, am I doing good or bad? And that’s very new in the grand scheme of time and space.”

Gossett points to social media influencers who routinely work in the realm of “no data at all to support their contentions,” and Metzl agrees, pointing out that before 2005, the vast majority of health information came from healthcare professionals. Today he suggests up to 75% of info comes from social feeds.

When people are consuming Reels where attractive people are showing their 30-step longevity routines, that invites curiosity and also a fear of missing out (FOMO, another well-used term from social media). “I think people have really become anxious because they feel like they’re doing something wrong instead of just living, socializing, exercising every day, sleeping, eating stuff that you find in nature, and keeping your body weight in a reasonable range,” said Metzl.

Easter agrees: “You can’t just go hang out with friends and drink a glass of wine because that’s a fun, enjoyable thing to do,” he said. “It’s like everything needs a health rationale.”

How Health Optimization Shows Up for Some Patients

Gossett, Daibes, and Metzl have all had patients come in saying their device told them they weren’t sleeping “well” even though they felt fine. The thing is, obsessively pursuing “perfect” sleep metrics — called orthosomnia — can itself lead to insomnia, according to a 2023 paper in Nature and Science of Sleep.

The doctors suggest there may be a similar phenomenon that occurs with heart rate metrics like resting heart rate and heart rate variability, health tracker metrics patients can become fixated on. Daibes points out that there’s a lot of natural variability in these numbers, but patients can worry that a slight change means something’s wrong — or at least, something isn’t perfect.

Even in the absence of devices, some patients can become overly hooked on tracking, Daibes said. He’ll give some patients a blood pressure monitor and recommend they write down the number twice a day with an old school pen and paper. “Some patients will then take their blood pressure 15 times a day. They’ll put it on an Excel sheet. They’ll obsess over the numbers to a point that they start coming back every single week anytime there’s a number that’s a little bit off,” he said. While Daibes understands the urge, the action of constantly checking can increase anxiety and stress — and therefore blood pressure. “A lot of times, even after we do an appropriate cardiovascular evaluation, which turns out to be reassuring, they continue checking and they become obsessed over it and then it becomes a vicious cycle of anxiety,” he said.

The other area of focus is not on tracking or devices but around unnecessary supplements or untested peptides or treatments. “People will take the things that (influencers) say who really are not board-certified physicians and are just essentially experimenting on their bodies and will try to copy them,” Daibes said. “There are things that these influencers as a whole are doing correctly, but there is a concept of a patient doing too much.”

Easter, not a doctor but a health journalist who interviews doctors for books and his podcast, said some physicians have told him about patients coming in armed with podcast episode transcripts and studies asking about peptides and contrast therapy. Easter himself receives reader emails pointing to the same overoptimization trend. “VO₂ max is a big one I get asked about a lot,” he said. “They’re like, ‘I had my VO₂ max tested in a lab. It was at this exact number. I want to get it to this number. What exactly do I need to do? I am doing a 4-minute whatever protocol. Is that the right thing to be doing?’”

His favorite: Someone asked if they should eat 140 g of protein or 150 g per day. “I’m like, ‘we’re talking about two bites of chicken here. Do you think two bites of chicken is going to change the trajectory of your life?’”

What Physicians Should Do About It

The doctors agree that the answer is certainly not to dismiss patients overly invested in health optimization. “We are big supporters of patients becoming engaged in their health,” Daibes reiterated, and health trackers have a lot of positives, such as helping people to move more and even potentially pick up on serious underlying health issues.

Daibes, for example, had a man in his twenties come to the hospital complaining of heart palpitations and an Apple Watch alert of an irregular heart rate. “He was having a potentially deadly arrhythmia, and it was caught by his Apple Watch,” Daibes said.

Gossett, too, said that some tracker data, such as certain menstrual cycle data, can be useful for patients to share with their physicians. She’s seen trackers identify irregular cycles that inform perimenopause, and they can even help patients notice rogue periods that can be a sign of something more serious.

“As physicians, we have to have the balance where we understand that it’s patient-generated information, but we have to interpret it with a complete clinical picture and not disregard it,” said Daibes.

When it comes to tracking in a way that’s productive, Daibes recommends patients look for patterns and trends the same way he would as a doctor (vs fixating on an individual reading). The line between healthy and unhealthy behavior, he said, is when optimization is driven by fear and/or becomes compulsive or controls how you feel or your daily decisions. In these cases, Daibes may suggest that patients temporarily stop tracking or checking numbers.

Metzl said it’s important to keep conversations with patient optimizers positive, starting by saying something like, “I’m so glad you’re taking your health seriously.” From there, if the patient has a specific concern, he’ll refer them to a specialist, such as a sleep doctor, nutritionist, or exercise physiologist, so they have a certified expert they can talk to about anything from sleep scores to supplements to heart rate metrics, respectively, vs feeling dismissed and turning to social media for answers. Gossett takes a similar approach and has referred patients to a sleep specialist over specific concerns.

She also emphasizes the importance of pointing patients toward the tried-and-true health “optimization” practices they may be ignoring in favor of buzzy new trends. “If you ask a doctor, ‘how do I live healthfully forever?’ The answer is really boring,” Gossett said. “The answer is exercise every day or almost every day, eat very little to no red meat, eat lots of fiber and fruits and vegetables, drink minimal to no alcohol, sleep, and manage your stress,” she said. “That has never changed, and it’s really not sexy. And it’s also not an easy fix.”

As Daibes tells patients, the ultimate measure of your health is not whether every one of your scores on your device is perfect or all your biomarkers are in the green. “It’s really whether a person is able to function, feel well, reduce meaningful long-term risk, and” — and this is the important part — “enjoy their life.”

The experts cited in this article reported no relevant disclosures.