Longevity – what really has evidence

“Longevity” has become a billion-franc business – with clinics promising a longer life for six-figure sums, and a flood of supplements making big claims.[11] Precisely for that reason the community pharmacy is called upon: it can separate science from marketing. The uncomfortable but liberating core message up front: the most effective levers are not pills, but lifestyle and the consistent treatment of classic risk factors.

What really counts: the basics

No other single measure is as well documented as physical activity. Exercise is rightly regarded as the “longevity medicine” and as the most effective preventive measure of all; as little as around 150 minutes of moderate activity per week is associated in older adults with roughly 31 % lower all-cause mortality.[2] [1] Important: both are needed – endurance and strength training, because preserving muscle is an independent survival factor in old age.

Alongside this stands a robust foundation: not smoking as the single biggest lever, a predominantly plant-based, Mediterranean diet, sufficient sleep, a healthy body weight and sustaining social relationships. Interestingly, strict caloric restriction, long touted as a longevity strategy, carries disadvantages in humans (loss of muscle mass) and is clearly inferior to exercise.[1]

Equally underestimated, because unspectacular: the consistent treatment of cardiovascular risk factors – blood pressure, LDL cholesterol (statins where indicated) and blood glucose. Here lies the most robust mortality evidence of all. In pronounced overweight, GLP-1 agonists additionally show increasing cardiovascular benefits. These are the real “longevity medicines” – where they are medically indicated.

Supplements from the pharmacy: targeted rather than scattergun

For food supplements the rule of thumb is: they correct deficiencies and support the muscles – but they are no fountain of youth. Four substances have a reasonable evidence base at the counter.

Vitamin D – clearly sensible in deficiency

Vitamin D deficiency is widespread in central and northern Europe, especially in winter and in older people, and it promotes muscle loss, falls and fractures.[12] Here substitution is well justified. A general benefit of high doses in people already well supplied is by contrast not proven – the message is: correct the deficiency, do not scattergun high doses.

Omega-3 – small, real effects

The Swiss DO-HEALTH study tested vitamin D, omega-3 and simple strength training in people over 70. Omega-3 (and the combination) showed signals for fewer infections and falls as well as a possible reduction in cancer and premature frailty.[3] A follow-up analysis additionally found that omega-3 slowed biological ageing (epigenetic clocks) by up to around four months – additively with vitamin D and exercise.[4] These are small effects on biomarkers, not miracle cures – but real, cleanly documented signals.

Creatine and protein – the muscle axis

Against sarcopenia, age-related muscle loss, two supplements are solidly documented. Creatine is among the best-studied substances of all: combined with strength training it brings older adults small but functionally noticeable gains in muscle mass and strength – without training the effects are inconsistent.[6] And sufficient protein intake is central: seniors need considerably more than the general 0.8 g/kg, namely 1.0 to 1.5 g/kg body weight; leucine-rich whey proteins can support muscle function even without accompanying training.[5]

Concrete dosages for dispensing:

Creatine monohydrate is considered safe in healthy people at usual doses (temporarily +0.5–2 kg from muscle water); in known kidney disease, clarify medically beforehand and ensure adequate fluid intake. [14]

Further supplements (magnesium, vitamin B12, folate) make sense where a deficiency is demonstrated or likely – for instance B12 in older people, vegans or under metformin/PPI. The principle remains: targeted, not blanket.

Promising, but (as yet) unproven

This is precisely where the hype takes hold – and where sobriety is called for.

Metformin: the diabetes medicine activates AMPK and showed lower mortality in observational data in diabetics. In metabolically healthy people, however, a longevity benefit is not proven; a meta-analysis in 2025 found no life extension in vertebrate models.[9]

Rapamycin: the mTOR inhibitor reliably extends life in animal experiments – as strongly as caloric restriction. For humans, however, clear clinical evidence of a longer lifespan or healthspan is lacking.[7] The growing off-label use via longevity clinics is not without risk – a prominent self-experiment was discontinued because of raised blood glucose values, susceptibility to infection and impaired wound healing.[8]

NAD boosters (NMN, NR) and resveratrol: the NAD precursors are promising in models, but hard endpoints are lacking in humans; safety and long-term benefit are unclear.[10] Resveratrol, once celebrated as a sirtuin activator, has proved a disappointment in human studies.[9]

High-dose antioxidants: mega-doses of individual antioxidants (e.g. beta-carotene, vitamin E) brought no benefit in large prevention studies and in part caused harm – beta-carotene raised the lung cancer risk in smokers. More is not better here.

The evidence at a glance