In Monaco, where interest in longevity is particularly strong, the focus is increasingly shifting from extending lifespan to preserving cognitive function, independence and vitality. Drawing on current scientific evidence, Dr Aleks Letnikovs outlines the key mechanisms that influence ageing and the practical strategies that can meaningfully support healthier, longer lives.
Cellular ageing and inflammation
As we age, senescent “zombie cells” accumulate and release inflammatory molecules that damage surrounding tissues. Research from the Mayo Clinic has shown that senolytics — compounds that help clear these cells — can improve physical function. Other emerging approaches, known as senomorphics, aim to neutralise the harmful signals these cells produce.
At the same time, immune function declines. Diets rich in Mediterranean nutrients, calorie restriction, and intermittent fasting promote autophagy and strengthen immunity. Studies from the University of California also show that meditation, time in nature and adequate sleep reduce inflammation. High activity of NK immune cells, found in centenarians, appears to be stimulated by regular aerobic exercise.
Muscle, cognition and vitality
Muscle tissue is now recognised as an endocrine organ producing irisin, a hormone-like molecule that supports regeneration, neuroplasticity and immune balance. Maintaining lean muscle — through strength training and daily activity — is strongly associated with better cognitive performance and reduced “inflammageing”.
Longevity research from Japan also highlights the importance of social connection, emotional stability, and continuous learning, including languages and music.
Dr Aleks Letnikovs
Gut health and the brain–body connection
A balanced gut microbiome influences mood, immunity and healthy ageing. Adequate levels of serotonin, B vitamins, fatty acids and diverse microflora help reduce inflammation. Prebiotics, probiotics, synbiotics and psychobiotics support this balance and contribute to overall mental and physical resilience.
Ageing is closely linked to mitochondrial decline. Rather than using excessive “energy stimulants”, targeted correction of deficiencies — such as ubiquinone for patients on statins or alpha-lipoic acid for nerve injury — helps restore function safely.
Metabolic flexibility, the ability to switch efficiently between glucose and fat as energy sources, is another key factor in long-term health.
Hormones and safe optimisation
Hormone therapy can be effective in age-related decline but must be closely monitored. The goal is not to recreate youthful levels but to restore physiological function. For example, progesterone in perimenopausal women supports both endometrial health and sleep.
Environmental toxins also influence hormonal balance. Beyond reducing exposure to pesticides and plastics, supporting the body’s detoxification pathways helps reduce cellular damage.
Epigenetics, peptides and experimental therapies
Epigenetic research shows that lifestyle influences a large proportion of age-related disease risk — far more than inherited genetics. Epigenetic “reprogramming” through lifestyle, nutrition and targeted interventions is emerging as a promising approach.
Peptide therapy, used in specific medically supervised contexts, can support weight control, tissue repair and collagen production. However, unauthorised “youth injections” using stem cells or exosomes remain unproven, risky and are banned in Europe due to safety concerns, including potential cancer development.
Diagnostics and personalised longevity
Innovative laboratory tools, such as liquid biopsies, can detect cancer years before symptoms appear. Neurodiagnostics help delay cognitive decline, while metabolic profiling can identify early risk factors for age-related diseases. Emerging longevity models integrate these results — using metabolomics, genetics, and AI — to create personalised strategies.
Ultimately, effective health optimisation requires metabolic synchronisation: aligning nutrition, circadian rhythms and hormonal patterns. For instance, people with elevated cortisol or insulin resistance benefit more from front-loading food intake earlier in the day than from simple calorie restriction.
Longevity is not a quick fix but a personalised system grounded in science — from nutrition and sleep to metabolism, risk assessment and regular monitoring. As I see it, true healthy ageing begins with a shift from treating disease to actively cultivating health.