Longevity, Peptides and ‘high-end’ medicine

Frequently asked questions.

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What longevity treatments are UHNW clients buying, and which really stack up?

In my UHNW crowd, the shopping list is fairly predictable: full‑body MRI packages, coronary calcium and CT angiography, colonoscopies, advanced bloods and physiological panels, continuous glucose monitors, microbiome sequencing, polygenic risk scores, IV “longevity cocktails”, peptide protocols, and increasingly talk of Rapamycin, Metformin, GLP‑1s and even plasma‑style therapies. Some of this is genuinely exciting; some of it is simply very expensive reassurance and hype.

If we’re strict about human data, the most robust levers remain almost disappointingly simple: blood pressure control, LDL lowering, smoking cessation, weight management, physical activity, diet quality, stress management and sleep. Large cohort analyses show that clustering healthy lifestyle factors (never smoking, regular activity, healthy diet, healthy weight, moderate alcohol, good sleep, stress regulation) substantially cuts all‑cause mortality and major disease. Pharmacologically, standard cardiovascular prevention (statins, BP meds where indicated, diabetes control) has far more outcome data than most of the “biohacker” kits. But as they say, absence of evidence is not necessarily evidence of absence.

The more experimental agents – Rapamycin, SGLT2 inhibitors, Metformin, Acarbose combinations – are impressive in mice, with 10–20% lifespan extensions and more when combined. But translating mouse studies success into routine human preventive prescribing is still a work in progress, so I frame these as ‘ones to watch’ and not magic bullets. My rule of thumb: if it doesn’t yet have clear human morbidity and mortality data, it is still very much experimental.

Peptides have shown some promise in small studies and anecdotally, but it is still very much in the ‘research’ phase despite huge hype. Although, it is a potentially exciting space to look at, I would wait a couple of years, as advances with good quality data should emerge.

My concerns are the theoretical risks of cancer promotion with the ‘regenerative peptides’(given the higher cell turnover) and the body’s individual immune reaction to injecting a synthetic compound (despite masquerading as natural hormones). Also, given that it is largely unregulated, it is difficult to known the provenance and it’s safety (purity, dosing and contamination risks).

Has preventive care shifted towards advanced diagnostics and genetics?

Yes – in this demographic, prevention has become highly ‘data‑driven’, but the art is deciding which data actually change management. Longevity and executive‑health programmes now bundle whole‑body MRI, targeted cardiac imaging, deep biomarker panels, and genomic analysis into a single annual visit, often with AI layered on top. The focus is early detection of cancer, cardiovascular disease and metabolic risk long before symptoms arrive.

On the genetic side, polygenic risk scores (PRS) are evolving and very exciting. They are estimates of a person’s genetic predisposition to a disease, calculated by combining the effects of many genetic variants across their genome.

These are moving from the research world into structured pilots in health systems, with modelling suggesting that PRS‑guided screening could prevent roughly a quarter of otherwise “premature, preventable” deaths by starting surveillance and intervention earlier in high‑risk individuals.

Emerging guidelines emphasise using PRS as an enhancer to standard risk tools rather than a replacement, and warn about interpretation and over‑testing. In other words, yes, I am using more advanced diagnostics and genetics – but in a tiered, risk‑based way, not as a blanket annual scan for everyone.

How do I protect patients from overpromising and over‑testing?

I talk about the “longevity pyramid”. At the base: classic prevention and early detection; in the middle: lifestyle, environment, and cardio-metabolic optimisation; at the apex: personalised, less known or promising advances in newer interventions. We only start climbing once the base is solid, and I am usually risk averse when it comes to non-evidence based approaches.

Safeguards I use in practice:

- Clear evidence thresholds: outcome data in humans before something becomes routine, strict consent and shared decision‑making when it does not.

- Avoiding “fishing expedition” scans: full‑body CT with high radiation and uncertain benefit is usually a no from me; targeted tools like coronary calcium scoring can be helpful in selected, borderline‑risk patients when the result will change statin decisions. I tend to customise the screening on each individual, so we avoid ‘over investigating’ which results in false positives, causing increased health anxiety.

- Independent verification: I tend to lean on major guidelines and systematic reviews or reasonably sized study data, not company white papers, when advising on new tests or drugs.

I also normalise saying “no”, even to very successful people who are used to hearing “yes”. Framed correctly, most UHNW patients actually find that reassuring.

As an independent practitioner, I have no conflicts of interest. Larger organisations may be more inclined to push extra testing and novel therapies. It is an exciting space, but one must exercise caution in approaching this with blind faith.

For those willing to invest heavily, what truly extends life and health-span?

The unglamorous answer: build an exceptional version of the basics, then layer precision on top. Large reviews of lifestyle and cardiovascular prevention show that never smoking, regular physical activity, a Mediterranean‑style diet, weight/stress management, restorative sleep, good blood pressure and lipid control together account for the majority of preventable morbidity and mortality reduction. These are relatively cheap options but offer the largest return on investment. The higher precision options related to bio hacking, I suspect is only the top slice, and given the costs and efforts involved will give modest improvements. However, with advances in AI-driven medicine and a deeper understanding of biohacking, it may not be long before we discover who the true winners will be.

What high spend can genuinely buy is:

• Precision risk‑stratification: high‑quality cardiac imaging, fitness markers (VO2/HRV), endoscopies, mole-mapping, targeted MRI and other judicious scanning.  Carefully curated lab panels to sharpen risk estimates (including liquid biopsies and metabolic markers).

• Personalisation: Polygenic Risk Scores, tailored exercise and nutrition plans, sleep optimisation, stress management and continuous monitoring when appropriate.

• Relentless follow‑through: coaching, behavioural support and a team that ensures the plan actually happens, year after year.

In essence, money lets you execute the fundamentals to a very high standard and add a layer of sophisticated targeting, but it may not let you bypass biology entirely!