Bryan Johnson: the man who swallows less and less

Bryan Johnson is in his late forties, sold his payments company in 2013 for eight hundred million dollars and has since spent a considerable part of it on not ageing. His self-experiment, Project Blueprint, comprises a tightly scheduled nutrition, sleep and training protocol, a team of more than thirty physicians, continuous measurements and – this is the part that makes the headlines – dozens of capsules, powders and oils a day. Since 1 January 2025 there has been a Netflix documentary about it, since 2023 a supplement brand of his own, and by now a quasi-religious movement called “Don’t Die”.

One can make fun of this. More interesting is what has happened to this protocol over the past two years. In 2024 Johnson dropped rapamycin, after five years of taking it, because the data did not bear out the hoped-for benefit. In the 2026 version he takes the NAD precursors on six rather than seven days a week. The world’s most expensive and most densely measured longevity experiment delivers as its main result not new substances but a list of deletions.

And then came 30 June 2026. On that day Johnson made public that he had been diagnosed in May with autoimmune gastritis, at the age of 48 – in his own words: his stomach was digesting itself. The condition is chronic, incurable and raises the long-term risk of gastric carcinoma. It had presumably been silently present for two decades, possibly connected with a hyperthyroidism diagnosed in his twenties.

The obvious mockery runs: the most closely monitored person in the world carries an autoimmune disease around for twenty years and nobody notices. But the real point is a different one, and for the community pharmacy the more valuable. The disease was not detected via an epigenetic clock, not via a whole-body MRI and not via one of the exotic biomarker panels, but via a laboratory value every family practice knows: a persistently low ferritin without anaemia. A colonoscopy followed, which Johnson himself described as overdue and which was unremarkable, then endoscopy and biopsies.

Twenty years of latency despite constant measurement, discovered through iron status and standard endoscopy. That is the sentence you can use at the counter.

How one study moves a market

How quickly it runs in the other direction was shown by the case of taurine. In 2023 a much-noticed paper appeared in Science, according to which taurine levels in humans, mice and monkeys fall with age and mice lived longer when given taurine. A US supplier subsequently reported to a trade publication a sales jump of around three hundred per cent within a month.

In June 2025 the same journal published a paper from the National Institute on Aging that tested the underlying assumption. Longitudinal data from three cohorts were analysed, along with samples from rhesus monkeys and mice. The result: circulating taurine levels do not reliably fall with age in healthy people; they remain constant or even rise. The differences between two people of the same age are greater than the age-related change over the course of a lifetime. Associations with muscle strength or body weight were inconsistent. The authors’ conclusion: taurine is of little use as an ageing biomarker, and robust clinical data on a benefit of supplementation in humans are lacking. An independent paper in Aging Cell came to the same conclusion a few weeks later.

The point is not that taurine is harmful. The point is the speed. One publication empties a shelf in four weeks; the correction two years later never reaches the customer. Anyone working in a community pharmacy is not selling substances in this market but the half-life of headlines.

What has actually been tested in randomised trials

The best available evidence on supplements and ageing comes from Zurich. The DO-HEALTH study randomised 2,157 adults aged seventy and over in five European countries over three years: 2,000 international units of vitamin D daily, one gram of omega-3 fatty acids from algae, thirty minutes of home strength training three times a week, in eight different combinations.

In February 2025 the analysis appeared in Nature Aging, for which 777 Swiss participants were examined epigenetically. Omega-3 slowed biological ageing across several DNA methylation clocks by up to four months. Vitamin D and strength training reinforced the effect additively. Earlier published analyses of the same study had shown for these three measures a lower risk of infection and falls as well as fewer cancers and less premature frailty.

That is good news with three footnotes that belong in the consultation. Four months over three years is a small effect. Epigenetic clocks are a surrogate, not an endpoint; nobody has measured whether these participants live longer. And the sample consisted exclusively of Swiss people aged seventy and over, which the authors themselves name as a limitation.

Nonetheless it is remarkable what is having an effect here: fish oil, vitamin D and strength training in the living room. The most robust longevity intervention of recent years consists of three things that have been on every pharmacy’s shelves for decades and that together cost less than a month’s ration of most longevity stacks.

The Swiss special case on the shelf

A second substance deserves attention because it comes from Lausanne. Urolithin A is a metabolic product formed by gut bacteria after the consumption of pomegranate and similar fruits, though not reliably in everyone. An EPFL spin-off has developed a highly pure form of it and tested it in randomised controlled trials.

In a four-month placebo-controlled study in adults between forty and sixty-five, leg muscle strength improved by around twelve per cent under 500 milligrams daily, published in 2022 in Cell Reports Medicine. A further study in older adults appeared the same year in JAMA Network Open, and a paper on immune ageing in 2025 in Nature Aging.

That is considerably more evidence than the rest of the longevity shelf can show. It nonetheless remains manufacturer-funded research with surrogate endpoints, without data on lifespan or hard clinical events. The fair formulation is: well studied for muscle function in middle-aged and older people, unknown for everything else.

The NAD question

No topic shapes the longevity debate as much as NAD+ and its precursors, and none better illustrates how far market dynamics and the data can diverge. Nicotinamide mononucleotide also appears in Johnson’s protocol – there now on only six days a week.

The state of the evidence can be summed up in two sentences. That taking it raises NAD levels in the blood and is well tolerated is considered established. That a measurable functional benefit for healthy people follows from this is not; analyses of randomised trials found no consistent associations between the NAD levels achieved and clinically relevant parameters.

In regulatory terms the substance is an object lesson. At the end of 2022 the US FDA decided that NMN, because of parallel drug research, no longer fell under the definition of a food supplement, thereby removing a growing segment from the market. In late summer 2025 it reversed this position again. In Europe NMN counts as a novel food and is not approved as a food supplement; in Switzerland novel foods require authorisation from the FSVO.

For the pharmacy this means: a customer taking NMN has in all probability ordered it privately from abroad. That is permissible, but it shifts the entire responsibility for quality and dosage onto them. It is precisely at this point that counselling begins – not with the question of whether the molecule is any good.

What the law says and what that means for counselling

In Switzerland, food supplements are foods, not therapeutic products. What applies are the Foodstuffs Act and the FDHA Ordinance on Food Supplements, which sets maximum amounts per daily dose for vitamins, minerals and certain other substances. No official authorisation is required; responsibility lies with the manufacturing or importing entity within the framework of self-monitoring, with random checks by the cantonal chemists. Exceptions requiring authorisation exist only for novel foods, genetically modified organisms and health claims not on the list.

For communication this is the decisive point. Only those health claims are permitted that appear in Annex 14 of the Food Information Ordinance or have been authorised by the FSVO. As soon as a product promises to cure, alleviate or prevent disease, or claims a pharmacological effect, it falls under therapeutic products law and thus within the remit of Swissmedic. That is not a formality: it means that the pharmacy may not say precisely what the customer wants to hear, while the online shop writes it with impunity until somebody intervenes.

Two substances are practically relevant in this connection because they cannot be marketed as food supplements in Switzerland while being freely available just across the border: melatonin and red fermented rice. Both are regularly imported privately. With red rice this is more than a regulatory detail, because the monacolin K it contains is chemically identical to lovastatin. Anyone taking it in addition to a statin is engaged in an uncontrolled doubling of the dose, and nobody in the system sees it, because the product appears in no record.

The interaction is the product

Here lies the pharmacy’s real value in this market, and it has grown, not shrunk. The typical longevity customer does not come with a question but with a list of twelve to forty preparations they have assembled over two years and three podcasts. This list appears in no medical record.

The relevant patterns are known. High-dose omega-3 fatty acids, vitamin E and ginkgo alongside anticoagulation. Green tea extract in high doses and turmeric preparations with absorption enhancers, for which liver damage has repeatedly been described. Vitamin and mineral doses beyond the permitted maximum amounts, easily reached through orders from abroad. And the underlying assumption that more is better, refuted at the latest since the beta-carotene studies of the 1990s: there, supplementation raised the lung cancer rate in smokers instead of lowering it. A food supplement can do harm. That is the single most important piece of information a pharmacy can convey in this segment.

The case in the opening provides the most concrete instruction of the whole topic. A customer who repeatedly buys iron preparations because he is tired, and whose iron values nonetheless do not rise, does not have a dosing problem. He has an investigation problem. In autoimmune gastritis, the gastric acid needed for the absorption of ferrous iron is missing; oral iron then works poorly or not at all, which is why parenteral substitution and vitamin B12 administration are part of standard management. It is similar with long-term therapy with proton pump inhibitors.

The constellation of low ferritin, normal haemoglobin and non-specific fatigue is therefore not a case for self-medication but for referral back. Recognising it in the sales conversation costs two questions and is worth more than any longevity capsule on the shelf.

To this comes a new neighbouring field. Direct-to-consumer tests of biological age, mostly based on epigenetic clocks, are now widely available. For evaluating interventions in large randomised studies these clocks are usable, as DO-HEALTH shows. For individual counselling they are not: the variation between measurements is considerable, clinical consequences are not defined, and the researchers themselves are currently only just building consortia to validate such biomarkers. Anyone who sells a number they cannot interpret is selling a problem.

The honest business model

The obvious commercial reaction to the longevity boom is a shelf of one’s own with twenty items and high margins. The more sustainable one is different.

First, the short, defensible core. Protein intake and strength training, vitamin D where there is an indication, omega-3, sleep. This also includes creatine, which has been studied for decades, is among the best-documented substances for muscle strength and lean mass, but in public perception still stands on the strength-sports shelf rather than the retirement-planning shelf. All of this is unspectacular, it is backed by randomised trials, and it can be communicated without regulatory contortions. Anyone representing this core credibly gains the authority needed for the second part.

Second, the interaction check as an independent, paid service. The longevity customer is the ideal candidate for a structured medication review, because they take a lot, measure a lot, pay a lot and have nobody with an overview of the whole. This service is anchored in the pharmacy tariff, it is documentable, and it is precisely what an online shop cannot deliver.

Third, the link to weight medication. With the spread of GLP-1 therapies, a customer group is growing that loses weight quickly and in doing so also sheds part of its lean mass. Protein supply, strength training and micronutrient density are not longevity folklore there but a necessity accompanying therapy. That is the segment in which counselling and sales will actually overlap in the coming years.

What remains

The longevity market lives off people wanting to add something. The evidence of the past two years shows above all what can be struck out: taurine as a supposed ageing marker, rapamycin in the world’s best-known self-experiment, the notion that a higher dose automatically brings more benefit.

It is a neat paradox that of all people the man who publicly swallows the most is shortening his list. And it is an even better lesson that the actual diagnosis was delivered to him not by expensive technology but by a ferritin value and an examination he had postponed too long. For the pharmacy, both are a template. The competitive advantage over the internet does not consist in selling the same thing, only with advice. It consists in the willingness to tell a customer that they do not need seven of their twelve doses, and to explain which three of them interact with their blood thinner.

That is not forgoing turnover. It is the only reason why someone with such a list would walk into a pharmacy at all, rather than into the next online shop.