In my practice, I care for many patients obsessed with longevity. They fast, they microdose, they meditate, they cold plunge, they gulp down supplements by the handful. They optimize their labs with the fervor of a hedge fund manager optimizing a portfolio. They read Peter Attia and Andrew Huberman like scripture.

And yet, they still die.

This is not cynicism; it is reality. Over the years, I have watched patients do everything right, eat perfectly (at least until the nutrition dogma shifts), exercise diligently, track every biomarker, and still succumb to cancer, heart disease, Alzheimer’s, or simply life running out.

Yes, maybe they buy themselves a few extra months, perhaps even a year or two. But what strikes me is not the effort, it is the arrogance.

It is the belief that if they just dial in the right combination of biohacks, they can outwit mortality. That aging is a puzzle they are smart enough to solve. That death only happens to the lazy, the ignorant, or the unlucky, never to them.

But here is what I see behind the curtain:

I do not see ninety-two-year-olds thriving on NAD patches, rapamycin, and ketone esters. I see people at the end of life (regardless of their past VO2 max) frail, forgetful, lonely, and tired. I see that health span and life span are not the same thing. I see that even the healthiest lifestyles cannot escape genetic fate or random chance.

Do I believe in taking care of the body? Of course. I recommend it every day. But I no longer promise, or even hope, that it will buy immortality or even vibrant old age.

What I wish my patients would hear is this:

Live well, not because you think you will cheat death, but because it makes today better. Exercise because you feel strong. Eat well because you feel clear-headed. Sleep well because you feel alive.

And maybe, just maybe, let us stop pretending that biohacking is the secret password to outliving the rest of us.

In the end, none of us get out alive, no matter how many supplements we subscribe to.

Larry Kaskel is an internist and “lipidologist in recovery” who has been practicing medicine for more than thirty-five years. He operates a concierge practice in the Chicago area and serves on the teaching faculty at the Northwestern University Feinberg School of Medicine. In addition, he is affiliated with Northwestern Lake Forest Hospital.

Before podcasts entered mainstream culture, Dr. Kaskel hosted Lipid Luminations on ReachMD, where he produced a library of more than four hundred programs featuring leading voices in cardiology, lipidology, and preventive medicine.

He is the author of Dr. Kaskel’s Living in Wellness, Volume One: Let Food Be Thy Medicine, works that combine evidence-based medical practice with accessible strategies for improving healthspan. His current projects focus on reevaluating the cholesterol hypothesis and investigating the infectious origins of atherosclerosis. More information is available at larrykaskel.com.