We like to imagine time as something fixed; an hourglass slowly emptying, grains of sand falling without pause or mercy. Dr Andrea Maier, one of the world’s leading experts on ageing, argues that while we cannot stop the sand from flowing, we can choose how well we use it. We cannot buy time. But we can earn it, through daily investments in our health that alter the trajectory of our lives.
This is not just about living longer. It is about living stronger, with fewer years of frailty, and more years of vitality, connection, and purpose. Welcome to the emerging field of gerotherapeutics and precision geromedicine, where science is rewriting the script of ageing.
The biology of ageing: what is really going on inside
We are all ageing, every day. From the moment our first cell divides, the process of decline begins. At 20, we reach peak biological performance. From there, the gradual loss of function sets in, more gradually for men, and more steeply for women after menopause around 50.
Ageing is not binary, though our medical system tends to treat it that way. We are labelled “healthy” until suddenly we are “sick.” But the truth is more continuous: beneath the surface, cells are accumulating damage, proteins are misfolding, mitochondria (the powerhouses of our cells) are weakening, and communication between cells begins to falter. A sick cell can infect its neighbours with dysfunction.
This cellular decline shows up in ways we instinctively recognise. Doctors can often predict a patient’s trajectory by subtle clues: the firmness of a handshake, the quality of a fingernail, the temperature of the skin. These small signs (our phenotype) speak volumes about risk, resilience, and the next decade of life.
The hallmarks of ageing
Researchers now describe twelve hallmarks of ageing—from cellular senescence (sick cells that refuse to die) to DNA instability, mitochondrial decline, and chronic inflammation. Each hallmark not only describes a process but also represents an opportunity for intervention.
Take senescent cells. These “zombie” cells no longer function but refuse to switch off, spreading dysfunction. New therapies are emerging to clear them, potentially reversing aspects of ageing. Misfolded proteins are another hallmark. When bad copies accumulate, they multiply, creating pathways to diseases like cancer, itself a “replicating disease.”
By understanding these hallmarks, geromedicine aims not just to treat disease but to slow or even reverse the ageing process itself.
Lifespan versus healthspan
At 60, around 60% of people already have two or more chronic diseases. By 70, it’s 70%. By 80, 80%. On the one hand, this is a medical success story: conditions like diabetes once killed quickly, but today people live for decades with managed disease. On the other hand, it raises the question: what kind of life is that?
Here lies the crucial distinction between lifespan and healthspan. Modern medicine has extended the former (although there is an argument that says just because we can doesn’t mean we should, which is likely the subject for a whole other article). Geromedicine seeks to expand the latter. More years of life lived in strength, purpose, and joy, before decline overtakes.
Genes, behaviour and the clock inside
Each of us carries around 100 trillion cells, each with DNA inside—a script of potential. Should we read it? Increasingly, yes. But our genes are not destiny. The famous Dunedin Study in Nature Ageing (2021) showed that lifestyle choices from as early as 26 already set the trajectory of decline.
Twin studies reinforce the point. Identical genomes, but differences in behaviour (exercise, sleep, diet, smoking) can create up to an eight-year difference in biological age. Put simply: your choices often matter more than your genes.
Measuring biological age, then, becomes crucial. Tools now exist (molecular, digital, and clinical) to compare biological with chronological age. If the gap is wide, we have an obligation to intervene.
Food, fuel and the microbiome
Our mitochondria (tiny engines inside each cell) need the right inputs. Sleep recharges them. Protein sustains them. Dr Maier recommends 1.2 grams of protein per kilo of body weight per day to maintain muscle mass as we age.
Meanwhile, the gut microbiome (two kilograms of living organisms inside each and every one of us) plays a central role in signalling health across the body. Feed it well and you send healing signals; starve or stress it and you spread dysfunction.
Dietary choices matter. Evidence-based changes (more fibre, fewer spikes in blood sugar, a balanced intake of proteins and plants) can add up to eight years of life. That’s a meaningful ROI. Contrast that with supplements: 60% of Singaporeans take at least two regularly, yet research shows one-third contain nothing, one-third are underdosed, and one-third are overdosed. The market is largely unregulated. Precision, and evidence, is what counts, not marketing. (For those looking for reliable information, you may wish to explore independent, evidence-based platforms like Examine.com or ConsumerLab.com, or else check out the Journal of Dietary Supplements for more in depth research.)
Technology and tracking: the new frontiers
One of the most exciting shifts in geromedicine is the rise of digital biomarkers. Wearables now track sleep stages, breathing patterns, glucose levels, and more. Continuous glucose monitors, for example, reveal how not just what you eat, but when and in what sequence you eat it, affects your health. Eating vegetables before carbohydrates can flatten glucose spikes, reducing long-term damage. This is called damage control; small adjustments with huge impact.
Cognitive tests, imaging, plus trending data from wearables are building predictive models of risk, essentially early warnings of likely decline. Used well, they offer a ten-year forecast that can guide intervention today.
The ethics of immortality
Not all scientists agree on the limits. Aubrey de Grey famously argues that the first immortal human is already alive. But Andrea Maier cautions that while the biology may be shifting, the moral and ethical questions are profound. What kind of society are we building if some can afford to extend life indefinitely while others cannot? Geromedicine is therefore not just about innovation but about democratization, making sure discoveries are available globally, not only to the wealthy. The World Health Organisation and other bodies are already exploring frameworks for equity.
Practical steps and how to earn more time
So what can we do now, today, to “not let the old man in” so to speak? The science suggests a layered approach:
- Annual Screening – Don’t wait for disease. Track biological age, glucose, blood pressure, and organ performance early.
- Protein Intake – Aim for 1.2g per kg daily to protect muscle mass.
- Prioritise Sleep – Recharge mitochondria and stabilise metabolic processes.
- Feed Your Microbiome – Fibre-rich foods, fermented products, and variety.
- Exercise as Medicine – Build muscle, improve cell communication, and reduce multimorbidity.
- Digital Tracking – Use wearables to measure trends and correct course early. (I have just invested in a wearable ring from a company called Ultrahuman as a test to better understand how this kind of technology works.)
- Damage Control Dieting – Reduce glucose spikes by adjusting food sequence and composition.
- Community and Connection – Behaviour is not just individual. Our social environment shapes our choices and health outcomes.
A new ritual of investment
Dr Maier calls it the “ritual of investment.” Every decision (what we eat, how we sleep, whether we move, how we connect) is a deposit in the bank of future vitality. Unlike financial investment, the returns here are guaranteed. Ageing is not a cliff we suddenly fall from. It is a slope we can choose to descend slowly, with dignity and strength. We cannot buy time, but we can earn it. And that is perhaps the greatest gift of this science: it places the power not in the hands of billionaires chasing immortality, but in all of us, in the simple daily rituals of living well.
So don’t let the old man in. Invite in instead a spirit of curiosity, discipline, and investment. Your future self will thank you.
