Getting started · Fundamentals
Where you start and what can wait.
Reading into the topic quickly leads to supplements, cold plunges and wearables. That is the most visible side and the one with the smallest effect. This guide reverses the order: first what the evidence supports clearly, then the limits, and only then the question of what diagnostics can actually add.
Four factors before anything else counts
They are unspectacular, cost little, and top every large cohort study. Anything left open here returns more than everything that follows.
Do not smoke
No other single factor comes close, which is why it leads instead of sitting in a footnote. If you smoke, every other measure returns less. Stopping recovers something at any age, including late.
Harvard cohort study, Li et al., Circulation 2018
Build and keep aerobic fitness
Cardiorespiratory fitness, measured as VO2max, is among the strongest predictors of mortality in epidemiology. The biggest jump is not between good and excellent but between untrained and moderately trained. That is the good news for starting out.
Mandsager et al., JAMA Network Open 2018
Know your blood pressure and lipids
High blood pressure does not hurt and works over decades. The same holds for ApoB, the value that counts atherogenic particles and outperforms classic LDL cholesterol in risk estimation. Both are measurable, both are modifiable, and you notice neither without measuring.
ESC/EAS dyslipidaemia guideline
Take sleep seriously
Sleep is the factor almost everyone knows and almost everyone sacrifices first. Short and irregular sleep measurably shifts glucose regulation, blood pressure and immune status. Regularity beats raw hours: consistent timing does more than one good night after four bad ones.
Windred et al., Sleep 2024
What the scene debates loudly, and what holds up
None of this is nonsense. The error is in the weighting, not in the subject.
„Supplements extend life"
No over-the-counter compound has demonstrated an effect on life expectancy in healthy people. What makes sense is correcting a documented deficiency, for instance vitamin D, iron or B12. That is medicine, not a longevity stack.
„Biological age is measurable"
Epigenetic clocks produce reproducible numbers, but different clocks disagree for the same person, and what a change means for an individual is unresolved. Interesting as a trend, not dependable as a diagnosis.
„Cold, heat and fasting are mandatory"
Sauna and intermittent fasting have data behind them, but at a different level than quitting smoking or aerobic training. If you enjoy them, do them. Starting there while ignoring blood pressure is optimising the wrong thing.
„More markers are always better"
More markers first means more incidental findings. The benefit does not come from volume but from someone reading the values in context and knowing which of them add anything to your history.
The order
Four steps. Each assumes the one before it is in place.
First, audit the four foundations honestly
Smoking, aerobic fitness, blood pressure, sleep. Anything open here returns more than any supplement. It costs nothing and needs no clinic.
Then measure what you cannot feel
Blood pressure, ApoB, Lp(a), fasting glucose and HbA1c, thyroid, liver and kidney values. Lp(a) is largely genetically determined and therefore needs measuring exactly once in a lifetime.
Only then consider going deeper
Imaging, blood-based cancer detection, genetics, microbiome. Worthwhile when a concrete question sits behind it — family history, an abnormal finding, an age at which certain conditions become more common. Not worthwhile as a starting point.
And then repeat
The real insight arrives with the second measurement. A direction says more than a number, and that requires measuring the same thing again under comparable conditions.
What this guide deliberately omits are dosages, protocols and product recommendations. What makes sense for you depends on your history and on values nobody knows without measuring — including us.
If you want to go deeper
Three entry points, depending on which question you are sitting with.
- What is a longevity check-up?Definition, components and how it differs from the statutory check-up.
- Biomarker glossary (German)245 laboratory values explained. Currently available in German only.
- What does a longevity check-up cost?Price ranges in Germany, private insurance reimbursement and the employer route.
Common questions
Longevity medicine is preventive medicine with a longer horizon. It is not about postponing death but about extending the years without disease — the field calls this healthspan as distinct from lifespan. In practice: detecting risks for cardiovascular disease, diabetes, cancer and dementia early, while they are still modifiable. The term is stretched widely in marketing, from serious prevention to anti-ageing claims without evidence. If someone promises life extension, be sceptical. If someone measures your cardiovascular risk and discusses it with you, that is established medicine.
The foundations — not smoking, aerobic fitness, sleep — apply at any age, and the earlier they are in place the more they contribute. For diagnostics there is no fixed age threshold but two triggers: family history, and the point at which risks start accumulating silently. For most people that begins between 35 and 45. Anyone with early heart attacks, strokes or certain cancers in the family should start considerably earlier. Lp(a) is worth measuring once at any age, because the value is genetically set and barely changes over a lifetime.
To begin with, a GP gets you further than most people think. Blood pressure, glucose, HbA1c, liver, kidney and thyroid values and a lipid profile are either covered by statutory insurance or inexpensive as a self-pay service. What statutory insurance usually does not cover: ApoB and Lp(a), detailed micronutrient profiles, imaging without a concrete suspicion, and anything aimed at detection without symptoms. A clinic pays off when you want that layer covered, when you want the values interpreted together rather than one by one, and when you want to build a trend over years with the same panel.
Starting at the back. Many people enter through supplements, wearables and protocols because that is the most visible side of the topic, leaving open the factors with the clearest evidence. The second most common mistake is collecting without interpretation: many values from different sources at different times, with nobody reading them together. A single abnormal value without context unsettles more than it helps. And the third: measuring once and leaving it there. Without a second measurement there is no direction, and the direction is the actual finding.
Unsure whether and when this is worth it for you?
In a free intro call we work that out with no programme in the background. If detailed diagnostics add little in your situation, we will tell you.
Free intro call