Aging is not a preordained program locked in our DNA – that’s one of the eye-opening messages Nobel laureate Venkatraman “Venki” Ramakrishnan delivered at the Milan Longevity Summit 2025. Ramakrishnan, a structural biologist renowned for uncovering the ribosome’s structure (Nobel Prize in Chemistry, 2009) and author of Why We Die, provided evidence-based insights into the biology of aging that debunked popularized “anti-aging” myths. In a field awash with hype and hope, his perspective, firmly grounded in evolutionary biology, challenges many mainstream longevity narratives while affirming where legitimate progress is being made.
From why evolution “does not care” about longevity to why no miracle cure for aging exists (yet), the Nobel laureate’s recent discussions provide a reality check on what science tells us about extending life. The main takeaway: Longevity science is advancing, but claims of age reversal require scrutiny, and the most potent tools at our disposal might just be the fundamentals often overlooked.
Evolutionary Truths: “We Are Not Programmed to Die”
One of Ramakrishnan’s key points centers on the fact that humans are not genetically programmed to die at a certain age. In other words, no built-in “death clock” gene forces us to expire. Instead, lifespans are a byproduct of evolution’s focus on reproduction. As Ramakrishnan explains, “Death, contrary to what one might think, is not programmed by our genes. Evolution does not care how long we live, but merely selects [for] the ability to pass on our genes.” Traits that help us survive youth and successfully reproduce will be favored – even if those same traits contribute to aging and decline later in life. In evolutionary biology, the trade-off between reproduction and longevity, referred to as antagonistic pleiotropy, suggests nature prioritizes maturation to the age of reproduction over maintaining long-term health.
This truth challenges any notion that there is a single “aging gene” that can be switched off to stop aging. It also debunks the idea of a fixed maximum lifespan set in stone by the genome. If humans are not programmed to die, then extending the lifespan is allowed by biology – a point Ramakrishnan noted by saying no physical law dictates a set lifespan for any species. Indeed, lifespans vary wildly across the animal kingdom, from mayflies that live a day to Greenland sharks that live 400+ years. The difference is how evolution has tuned each organism’s investments in maintenance versus reproduction.
This insight supports the mainstream scientific view that aging is malleable: if evolution didn’t strictly program it, scientists may be able to intervene in its processes, at least to improve healthspan. However, it comes with a sobering reminder: humans must tackle what evolution hasn’t optimized (post-reproductive longevity) with science and medicine, and that is no easy feat.
The Cost of Living: Maintenance vs. Reproduction
Ramakrishnan highlighted another misunderstood aspect of aging biology: aging is not simply a result of “wear and tear.” While systemic damage accumulation is a driving force, it only reflects part of the aging process. The more crucial factor is how organisms allocate energy and resources between self-repair and reproduction. “Lifespan is the result of a balance between the expenditure of resources needed to keep the organism functioning and repairing it and those needed to make it grow, mature, and keep it healthy until it reproduces,” he explained.
In youth, most creatures channel resources into growth and fertility. However, later in life, traits that initially favored early survival can lead to deterioration; this phenomenon is known in research as the “disposable soma” theory, which is supported by extensive evidence across various species. For example, animals that naturally invest in body maintenance tend to live longer (e.g., giant tortoises or bats) compared to those that prioritize rapid reproduction (mice, for instance, live fast and die young). Disposobale soma as a concept helps explain why different species have varying lifespans despite all experiencing similar levels of wear and tear. Aging results when maintenance and repair processes don’t keep pace with accumulating damage, and evolution only ensures enough maintenance to get organisms through their reproductive years in the wild.
Practically, boosting the body’s maintenance processes is a prime target for extending healthspan. Many mainstream longevity strategies – from calorie restriction to certain drugs – aim to reallocate the body’s resources toward cellular repair, mimicking an evolutionary state of low food availability for preservation. Caloric restriction has consistently extended lifespan in lab animals, likely by shifting biology into a high-repair, low-growth mode. At the molecular level, calorie restriction suppresses growth signaling pathways, such as mTOR. It activates mechanisms for cellular cleanup and recycling, such as autophagy. Ramakrishnan noted that when nutrients are scarce, cells dial back protein synthesis and instead “recycle junk,” which is beneficial for aging. This discovery has spurred the search for calorie restriction mimetics – drugs that can trigger the same pro-longevity pathways without the need for severe dieting.
According to current scientific understanding, aging can be modulated by adjusting the balance between maintenance and reproduction. Approaches such as calorie restriction and targeted therapies (e.g., rapamycin, which directly inhibits the mTOR pathway) are based on this principle. Indeed, rapamycin has been shown to extend lifespan in mice by enhancing cellular maintenance, essentially inducing cells to enter a state of calorie restriction. Ramakrishnan acknowledged rapamycin as one of the most studied compounds in aging research – a proof of concept that maintaining cellular processes can extend life, at least in animals. However, he is quick to add that every such intervention comes with trade-offs (rapamycin, for instance, is also an immune-suppressant with risks. The challenge for longevity science is finding that “sweet spot” where we can boost repair processes without harmful side effects.
Longevity vs. Immortality: Cutting Through “Anti-Aging” Narratives
While excitement around longevity science is at an all-time high, Ramakrishnan urges that real progress be distinguished from wishful thinking. He is frankly critical of the booming anti-aging industry’s tendency to overpromise. In his Summit talk, Ramakrishnan cautioned that indefinite life extension and “reversing aging” remain distant prospects. “In principle, there are no laws or constraints that prevent us from living much longer… [but] ‘eternal youth’ [is] still far off, and very significant obstacles to increasing our maximum life expectancy remain,” he said. No scientific breakthrough has yet proven capable of significantly extending the human lifespan. Incremental gains in life expectancy, yes – but a 150-year-old human or true age reversal remains a distant promise in 2025.
He also delivered a pointed critique of pseudoscience masquerading as anti-aging medicine. “We must beware of the pseudoscience – and business – around… ‘anti-aging’ or ‘reversal of aging.’ These are often baseless concepts, unsupported by hard evidence, even though they may use language that sounds scientific,” Ramakrishnan warned. This statement draws attention to the myriad of products and protocols being marketed with bold claims to “slow aging” or “make you young again,” from unproven supplement cocktails to fringe therapies. Our fear of aging, he noted, makes us especially vulnerable to such claims, creating a lucrative market for anyone promising to delay the onset of old age. A point that is timely and relevant, as recent exposés of prominent ‘longevity influencers’ continue to reveal, not everything sold under the anti-aging banner is grounded in science – in fact, much of it is not.
Importantly, Ramakrishnan’s skepticism is not directed at legitimate longevity research, which he believes has entered a golden era, but rather at the hype that often precedes the data. He pointed out that aging biology used to be a fringe “backwater” in science but has now become a rigorous discipline attracting top researchers, major funding, and serious biotech investment. The field’s momentum is undeniable, with over 700 longevity-related companies valued at around $30 billion. The speed of progress, however, has given rise to hype. Tech entrepreneurs accustomed to quick wins have poured money into age-defying ventures, sometimes believing aging can be “hacked” like software – an attitude Ramakrishnan pokes fun at: “They think life is just some sort of software to be hacked, but biology is complicated… You can’t buy youth, but you can buy aging research,” he quipped. The result is a landscape where it can be “difficult to figure out what’s really going on” amid all the big claims.
Ramakrishnan sees his role (as an eminent scientist with “no skin in the game” of biotech ventures) as helping cut through the noise. He emphasizes fundamental science and data. In interviews, he has expressed a balanced optimism: for every far-out idea that might one day work, there are hundreds of unrealistic ideas, and right now, “there’s no evidence” of a miraculous breakthrough around the corner. That said, genuine advances are being made incrementally. Researchers have identified promising avenues to improve health in old age – from removing senescent cells to tweaking metabolism to reprogramming aged cells back to a younger state – but all of these are works in progress. “I’m fairly balanced: I think there are promising areas, but there’s a lot of work to be done to see which [will pan out], and what the risks are,” he explains.
A prime example is the buzz around the drug rapamycin. As evidence suggests, rapamycin has the potential to extend the lifespan of mice, and some enthusiastic proponents believe it could be equally effective in human subjects. Some scientists have even reportedly begun self-medicating with off-label rapamycin in hopes of extending their life expectancy. Yet Ramakrishnan urges caution: the excitement has “hit such a fever pitch” that it outpaces clinical evidence. His takeaway: By all means, study drugs like rapamycin, but do not treat them as proven age-delaying treatments for people today outside of clinical trials. The same skepticism should be applied to any purported “longevity pill” until robust evidence demonstrates that the benefits outweigh the risks.
Lessons for Longevity Medicine: Science, Skepticism, and the Basics
Ramakrishnan’s perspective validates the core approach of evidence-based preventive medicine. As it turns out, the best current advice for extending healthspan is not found in expensive young-blood infusions or magic supplements but in the pillars of healthy living. Ramakrishnan explains: “The trio of a moderate and healthy diet, regular exercise, and adequate sleep is probably better than anything out on the market today in terms of supplements or drugs.” To this trio, he adds two often-overlooked factors: avoiding social isolation and having a sense of purpose in life, both of which show significant benefits for longevity in studies.
Longevity medicine starts with lifestyle fundamentals. These are areas where functional and integrative medicine practitioners already excel – coaching patients on nutrition, physical activity, sleep hygiene, stress reduction, and community connection. Ramakrishnan’s message bolsters the legitimacy of that approach: investing in these basics pays dividends in lifespan and healthspan, and no pill on the market can yet replicate their broad benefits.
At the same time, his critique of “anti-aging” fads calls on clinicians to be discerning about novel interventions. In an era where patients are reading headlines about cryonics, miracle NAD boosters, or the latest celebrity biohacks, healthcare providers must help separate fact from fiction. Skepticism and science literacy are imperative. Ramakrishnan’s approach – evaluating whether claims are backed by “hard evidence” or just scientific-sounding jargon – is a model for practitioners who might be weighing unproven treatments in their practice. The onus is on longevity-focused doctors to vet the evidence before recommending any new anti-aging therapy, whether it is a supplement, an off-label drug, or an experimental procedure.
Equally important is staying informed on legitimate longevity science as it evolves. The field is dynamic; what was implausible a decade ago (for example, drugs that clear senescent “zombie” cells or partial cellular reprogramming to restore youthfulness) is now being rigorously tested in labs and clinical trials. A forward-thinking integrative practitioner should stay informed about geroscience research, but with a critical eye. Some interventions will emerge as validated treatments for aging-related decline, while others will prove ineffective or pose unacceptable risks. By understanding the mechanisms (for instance, knowing why a drug like rapamycin might work and what downsides it carries), clinicians can make better judgments about when to incorporate a new therapy and when to hold off. Ramakrishnan’s own balanced view – hopeful about areas such as senolytics, metabolic control, and gene therapies but waiting for solid evidence of safety and efficacy – is a prudent stance for physicians emulating an evidence-based practice.
Where Science Becomes Practice: The New Longevity Medicine
Ramakrishnan’s evidence-based approach to aging clarifies the significant progress made in understanding longevity and the substantial work that remains to translate that knowledge into real-world medicine. The alignment of science and practice is at the heart of modern longevity medicine. It’s also the central theme of the upcoming 33rd Annual A4M Spring Congress, the premier forum for forward-thinking functional medicine practitioners.
At the 2025 Spring Congress, the latest breakthroughs in aging biology converge with practical clinical strategies, and the science of longevity defines the practice of longevity medicine. Attendees will hear from leading experts, including pioneering reproductive longevity researcher Jennifer Garrison, PhD, and other visionaries, about separating fact from fiction in anti-aging and learn how to implement revolutionary yet validated techniques to enhance patient healthspan.
Ramakrishnan’s message is clear: aging is not inevitable in its trajectory. With sound clinical judgment and science-backed tools, practitioners can meaningfully extend both lifespan and healthspan. Longevity moves from a distant scientific promise to clinical reality and the new standard of care. Those defining this near future are gathering next week, and there’s still time to join them.