Longevity is not a supplement protocol
The things that most change how long and how well people live are not found in a capsule. They are sleep, body composition, fitness, blood sugar, hormones where there is a real deficiency, and the strain of daily life. Supplements have a place when a deficiency is measured, but for most people they are not where the gains are. This article sets out what the evidence supports, what it does not, and how 23MD approaches longevity.
What actually works for longevity?
Sleep. Body composition. Cardiorespiratory fitness. Blood sugar control. Hormone treatment where indicated. Social and cognitive load. These are the areas where the evidence is strongest.
Fitness. Cardiorespiratory fitness (how well your heart and lungs supply oxygen during exercise) is one of the clearest predictors of long life. A Cleveland Clinic study of 122,007 people who had treadmill tests found that higher fitness was linked to lower long-term mortality with no upper limit, and that poor fitness carried a risk comparable to, or greater than, smoking, diabetes and heart disease [1].
Sleep, weight and blood sugar. The American Heart Association's Life's Essential 8, its measure of heart health, is built on eight factors: sleep, healthy weight, not smoking, physical activity, diet, blood pressure, cholesterol and blood sugar. It added sleep in 2022 and recommends 7 to 9 hours a night for adults [2]. Each of these can be measured, and each can be improved.
Social and cognitive load. Relationships matter more than most people expect. A review of 148 studies covering 308,849 people found a 50% higher likelihood of survival in people with stronger social relationships [3]. Chronic stress, isolation and overload are part of a medical assessment, not an afterthought.
Hormones. Hormone treatment has a role when a deficiency is confirmed and symptoms justify it, with proper monitoring. It is not a general anti-ageing measure. You can read more in our article on who BHRT is for, and who it is not for.
Do longevity supplements work?
Mostly not, on current evidence. Most supplement stacks, cold exposure used on its own, and most "biohacks" promoted by a single advocate without clinical studies do not have the evidence to justify the claims made for them.
The US Preventive Services Task Force, which reviews preventive treatments, concluded in 2022 that there is not enough evidence to recommend most vitamin and mineral supplements to prevent heart disease or cancer, and recommended against vitamin E and beta-carotene for this purpose [4].
There are sensible exceptions. If a blood test shows a deficiency, for example in vitamin D, vitamin B12 or iron, correcting it is ordinary medicine. The problem is not supplements as such; it is taking a long list of them without knowing whether you need any.
What does a longevity assessment at 23MD measure?
We measure first and plan second. A 23MD longevity assessment can include:
- Blood tests, including:
- a baseline metabolic panel;
- fasting blood sugar and fasting insulin;
- a lipid (cholesterol) profile;
- inflammatory markers;
- a hormone panel.
- Further assessment where indicated, such as:
- VO2 max, a direct measure of cardiorespiratory fitness;
- body composition by DEXA scan, which shows muscle, fat and bone;
- a sleep history, and sleep studies if needed.
The plan follows the measurements. Someone whose main issue is poor sleep needs a different plan from someone whose blood sugar is drifting upwards, even if they describe the same tiredness. This is the basis of our 360 Longevity approach, which looks at hormonal, metabolic, regenerative and lifestyle health together, and of our metabolic health assessment.
Is longevity medicine evidence-based?
It can be, if it is done properly and seriously. Done properly, longevity medicine looks like careful history, measured risk factors, treatment where it is justified, and review over time. It does not look like a stack of vitamins and supplements.
That also means being clear about limits. No test or treatment can promise a longer life. What the evidence does support is that improving fitness, sleep, weight, blood sugar, blood pressure and social connection lowers the risk of the conditions that shorten life [1][2][3].
Who this is for, and who it isn't for
- For people who feel their energy, sleep, recovery or body composition slipping and want to understand why.
- For people who want a measured, joined-up plan rather than a list of products.
- Not for anyone looking for a supplement stack or a single IV or other treatment to "reverse ageing".
- Not for urgent symptoms such as chest pain or sudden breathlessness: contact emergency services.
Book a longevity consultation with Dr Galy
If you would like a measured starting point, a consultation with Dr Martin Galy is the place to begin. Read more about wellness and longevity at 23MD.
Speak to our team on WhatsApp: London or Dubai.
This article is for general information and is not a substitute for an individual consultation.
Sources
- Mandsager K, Jaber W, et al. Association of cardiorespiratory fitness with long-term mortality among adults undergoing exercise treadmill testing. JAMA Network Open. 2018. Summary: Cleveland Clinic newsroom.
- American Heart Association. Sleep joins revamped list of heart health essentials (Life's Essential 8). Circulation presidential advisory, 2022.
- Holt-Lunstad J, Smith TB, Layton JB. Social relationships and mortality risk: a meta-analytic review. PLoS Medicine. 2010;7(7):e1000316.
- US Preventive Services Task Force. Vitamin and mineral supplementation to prevent cardiovascular disease and cancer: final recommendation. 21 June 2022.
