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Feel Better, Live More with Dr Rangan Chatterjee
How To Live Longer and Better: The Secret to Super Ageing with Dr Eric Topol #626
01:38:37
What if the secret to living well into your 80s and 90s is nothing to do with your DNA? What if the longevity hackers have got it wrong, and it’s actually far more simple than you think to become a ‘super ager’?
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- [00:01]
Dr. Eric Topol
Let's accept that we're aging right, it's a biologic process. But let's not accept that we can't make a huge dent in age related diseases. With AI, multimodal AI and all these new layers of data, we're going to go into an era of prevention that I am really excited about. Treatment is not the end all, it's prevention.
- [00:24]
Dr. Rangan Chatterjee
Hey guys, how you doing?
- [00:26]
Podcast Host / Narrator
Hope you're having a good week so far. My name is Dr. Rangan Chatterjee and this is my podcast Feel better live more 95% of Americans over the age of 60 are living with at least one chronic disease. Almost as many have two and the picture is similar in the UK. Is this really what we want our later years to look like? You see, there's so much talk about longevity these days and I don't know about you, but I sometimes really question the value in living longer if it means living with poor health and being a burden to our loved ones. But today's conversation presents an appealing achievable alternative. My guess makes the case that focusing on healthspan rather than lifespan by making some very achievable lifestyle changes can give each of us an extra 7 to 10 years of disease free living. Dr. Eric Toppol is a cardiologist and one of the world's most cited scientific researchers who has spent years at the cutting edge of genomics and the use of artificial intelligence in medicine. And yet his findings consistently point back to a wonderfully empowering solution. The Basics in his new book, An Evidence Based Approach to Longevity, Eric explains that the big three diseases that reduce health span cancer, heart disease and NeurodegenerationEach take around 20 years to become symptomatic. And that means we have a huge window of opportunity to take preventative action. Whether you're in your 20s or your 80s, you're going to learn so much. From this enlightening conversation. Eric and I take a detailed look at what really works when it comes to looking after our long term health and discuss why knowledge and your own data is power. He also shares his Lifestyle plus approach, which factors in influences like environmental toxins, social connection, and even your outlook on life. On top of the lifestyle factors you may well have heard me talk about for years, Eric is clear that an extended healthspan is ours for the taking and that technology can help us achieve it. This conversation is hopeful and empowering and I'm certain it will leave you feeling motivated, inspired and ready to take action.
- [03:16]
Dr. Rangan Chatterjee
You are one of the most respected and most cited Researchers in medicine and in your brand new book Superages, you make the case that practicing the right lifestyle can give us an extra 7 to 10 years of healthy aging. That's a very hopeful and empowering message. But I wonder if we could start this conversation with the reverse.
- [03:42]
Dr. Eric Topol
Right.
- [03:42]
Dr. Rangan Chatterjee
In your view, what are the top things that many of us are doing that are negatively affecting our health and increasing our risk of early death?
- [03:55]
Dr. Eric Topol
Right. So you're getting at this big gap between health span, you know, average age, let's say 65 is the end of health span.
- [04:04]
Podcast Host / Narrator
Yeah.
- [04:05]
Dr. Eric Topol
Versus lifespan 80. So what happens in those 15 years and why do we lose it? And lifestyle like lack of exercise. In the US 75% of Americans don't even get close to basal physical activity. Then there's a problem with obesity and poor diets and poor intake of ultra processed food, some of those constituents. And of course there's poor sleep health and there's environmental exposures too rangan, like the air pollution, like our plastic burden forever chemicals. So you know, there's a mixture of many different factors that play a role in compromising our health span or years of healthy aging.
- [04:53]
Dr. Rangan Chatterjee
Yeah. Why do you think so many of us these days seem to be obsessed or preoccupied at least with living longer rather than living better?
- [05:06]
Dr. Eric Topol
Yeah. This is a really important question and I don't really understand this fixation on longevity when that gap is basically people who are either have dementia or incredibly frail and not functional. I mean, we really should be targeting the years of healthy aging. And this idea of living to 120 or longer is crazy. And we can do that now. As you know, if we put somebody on life support, they have no life, but we can support them for many, many years. What good is that? So that's the way I look at this difference of keeping people alive when they basically are not at all functional, they have no quality of life. And that's something that is just the wrong target. We should be focusing on healthspan or you know, what we call the welderly. You know, that whole concept that we don't have enough of these people who are 85 plus and don't have ever had cancer, cardiovascular disease or neurodegenerative disease.
- [06:13]
Dr. Rangan Chatterjee
Yeah, I was gonna ask you about that. Actually. One of the most striking things in the book for me is the worldly project that you and I think some colleagues of yours started to investigate. Was it back in 2008?
- [06:27]
Dr. Eric Topol
Yes. Yes.
- [06:28]
Dr. Rangan Chatterjee
Can you tell us a little bit about that?
- [06:30]
Dr. Eric Topol
Yeah. It took us a long time to assemble 1400 people who their average age was in their late 80s and they'd never been sick. There are no medications. So they were in this rarefied group. And we got them together so we could do whole genome sequencing to see whether there was a genetic underpinning heritability of healthspan. Now this is very different than lifespan where in fact that we just learned that there's a fair amount of heritability for lifespan. But this is really how do you get to 89 years old average without ever being sick, no age related conditions and no medications. And what we found, very little was accounted by genomics in that sequencing. And so we have to say that there's something else to explain this now. Good luck. Maybe that's a small part of it. But the biggest thing as we've learned since is that our immune system is so fundamental for our healthy aging. And as we were just talking about Rangan, the lifestyle factors interact with our immune system. And so for example, people who exercise on a frequent basis have a much healthier immune system than those who don't. So we're learning the immune system. Maybe why there's such a big difference that we didn't expect. We were surprised. Yeah, we thought there would be a genetic story for healthspan and that turns out to be such a minor component. And now I think we're understanding what is the explanation.
- [08:14]
Dr. Rangan Chatterjee
Reading about the worlderly project was striking to me for a number of reasons. Firstly, the fact that it took you guys so long to find 1800 people who met the criteria. I mean, what were those criteria? Did you want basically people above the age of 85 who had no chronic disease? Is that what you were looking for?
- [08:38]
Dr. Eric Topol
Yes. And so we were really stringent, you know, so 85 plus the average was 89. And they couldn't have had, they were on no medications and they couldn't have any diseases. So we had to of course verify all that with their records. And this is a really hard group to find. We're talking about, you know, much less than 1% of people who are 85 plus.
- [09:04]
Dr. Rangan Chatterjee
Yeah.
- [09:04]
Dr. Eric Topol
Because most people by then, you know, have one of these age related diseases. So it was a really difficult project to not just get all these people enrolled who fit the bill, as you say, but also then when we did the whole genome sequencing, that was in the early days of doing that work. Now of course it's becoming more common, less expensive. But we learned a lot from these people and in my view it completely altered our perception that this is, we're Stuck with our parents story for healthspan. It's not true at all.
- [09:45]
Dr. Rangan Chatterjee
Yeah, some of the statistics in your book really shock me. You know, obviously I'm a physician here in the UK, but in America you say that 60% of adults have at least one chronic disease, which is pretty striking. 40% have two or more. And then this one really shocked me. If you're an adult who is 65 years or older in America, 80%, right. That's the vast majority. 80% have two or more chronic diseases. That is remarkable, isn't it Eric?
- [10:22]
Dr. Eric Topol
It really is. And this is why I say that's the end of their health span. It's over. And now the rest of their years is gonna be a whole different state compared to, you know, when they ultimately succumb. So I don't know that it's different much in the UK or many other high income countries. It's really sobering and there's no question about these data. And I don't think a lot of people realize that our health span is relatively short and this gap is so, so expansive.
- [10:56]
Dr. Rangan Chatterjee
I really enjoyed your use of the term lifestyle plus. I think we're very used to the word lifestyle, but lifestyle plus I thought was really interesting. And I wonder if I could just read to you a section from chapter three which I found very, very thought provoking. When we get into discussions of healthy lifestyle, it usually refers to diet, exercise, sleep, an intake of alcohol, coffee and tobacco. My that is your much broader definition is lifestyle plus. And it adds environmental conditions such as exposure to toxins, including air pollution, microplastics, forever chemicals, socioeconomic status, loneliness and social isolation. Then you say, Eric, thinking about diet must now include consideration of ultra processed food, time restricted eating and the optimum amount of daily protein. For you specifically. And exercise means more than just aerobic fitness. It includes good posture resistance, weight training, and that which maintains your sense of balance, along with more standard notions. The reason to address this dimension first is that many more healthy years can be added to our lives without fancy expensive technology. Now Eric, I think that's one of the most important paragraphs in the entire book because I think in those few lines I think you've nailed it. It's broadening out this idea of lifestyle. It's not just saying, oh, you need to eat better and move your body a bit more. Yes you do. And there is subtlety, there is nuance, there's personalization. Isn't there within that? So yeah, I very much enjoyed reading that paragraph and I think it really does Broaden out the word lifestyle, which I think some people just think about through the lens of diets, exercise and alcohol.
- [13:01]
Dr. Eric Topol
Well, thanks for finding that paragraph, which I think does have a lot of depth of meaning. I struggled Rangan for the right word because the lifestyle plus you're trying to bring in so many different aspects there, but I couldn't come up with a better term. And you've really, I think, summarized the issue so well that when we think about the things that we can do to improve our healthy aging, we're not talking about expense, high tech. You know, most of the things that we can do now are something that are either free or eminently affordable and make a big difference. So there are so many hucksters out there that are selling things, all sorts of treatments that don't have any data. But the real truth is, and that's what the evidence that I tried to review in the book was that there's so much we can do that basically don't cost anything or are minimally as far as an economic burden.
- [14:10]
Dr. Rangan Chatterjee
It's really interesting to me, Eric, that you are clearly fascinated in cutting edge research. You're on top of all the breakthroughs in AI and genomics and robotics, yet your research keeps pointing back to the basics. Movement, diet, sleep, social connection. Does it surprise you after all these decades in practice and research, that for all the advances in modern medicine, and we're going to get to those throughout the conversation, but does it surprise you still that, you know, despite all the technological advances that we made as humans, good healthspan still comes down to nailing those basics?
- [14:51]
Dr. Eric Topol
It's absolutely true. I mean, in my practice as a cardiologist, I spent a lot of time with each patient reviewing their lifestyle plus factors and, and have for the 40 years that I've been a cardiologist, because it's fundamental. And so while you're right, there are all these other things that we are gonna be getting into in our conversation, like AI and like proteomics and clocks and all sorts of things that are gonna take it to a new level. None of that is gonna be important without attention to these lifestyle factors. So this is really the essentiality of health and anything else we can do is on top of that.
- [15:36]
Dr. Rangan Chatterjee
Yeah, The things that are killing us and reducing our health span are what you call the big three Cancer, heart disease and neurodegeneration. I wonder if you could just give us an overview of how big an issue those three illnesses are and why you decided to focus your book in such a large way. On them.
- [16:07]
Dr. Eric Topol
Yes. So when you look at the big age related diseases, those three, cardiovascular cancer, neurodegenerative, account for 85% of the healthspan compromise, that is that gap between health span and lifespan. And what's important about them is they have lots of common threads. They each take about 20 years or more to incubate in our bodies before we start to have the first signs and symptoms. And so the other thing that's so common about them is they each invoke our immune system and inflammation, untoward inflammation, whether it be in the brain for neurodegenerative disease or in our artery wall for atherosclerosis, or to compromise our immune system so a cancer can get going in our body and spread. So they are remarkably homologous in many ways. And the amount of time that we have to anticipate them and that's really the most exciting thing going forward is beyond our attention to lifestyle. We, we're going to have an opportunity to prevent these three diseases and that will really close this gap and extend healthspan and make the likelihood of people to become Superagers, that is 85 plus without these three dreaded conditions. Really that's going to become more common in the years ahead. And I actually would say in advance that will be the singular biggest contribution of AI in medicine is helping us to find high risk people and to help prevent diseases ultimately.
- [17:59]
Dr. Rangan Chatterjee
Yeah, it's a couple of things you said there which I want to come back to a bit later on. This idea that these top three illnesses are taking at least two decades to develop. And as we both know, modern medicine for many years typically has got involved quite late. Certainly Here in the UK you hit the age of 40 as a man and you get offered, you know, you can come in and have your blood pressure done, your waist circumference and maybe a set of bloods, that's great. But I would say in 2026 it's probably not enough. And so I want to come back to that bit later. You know how we think about prevention at this time in history. Before we do that, let's really go into these lifestyle plus factors so that it's super practical for people, Eric, you know, what are the things that they can think about in all of them? And perhaps as we go through them, let's keep in mind those three conditions, cancer, heart disease and neurodegeneration. So diet, for example, it's one of the earliest chapters in the book. In that chapter you say that poor diet is linked to 22% of all deaths. That's a lot of deaths that you're attributing to poor diet, isn't it?
- [19:21]
Dr. Eric Topol
Yes. And that comes from multiple sources, particularly the global burden of disease studies. And I think it's a reasonable estimate and that's huge. And I think we're understanding, you know, not only the poor nutrition of the average person, but the work, for example, Chris van Tullegen did in the UK really called this out, that many of the foods and beverages that we intake in that ultra processed category, not all, but many, are toxic, they are pro inflammatory and we're not doing much about that. And in fact the US and then the UK are the two worst countries in the world for consumption of these foods and beverages. But then of course beyond that, average person is taking in way too many calories, not having a good macronutrient balance of protein and carbs and fats. And so we do know that there's a diet that through randomized trials and very impressive prospective studies, the Mediterranean diet, that has reduced cardiovascular disease substantially as well as made a dent in cancer and neurodegenerative. But we don't, that's not the average diet for people. Right. So red meat is extremely popular and we know that it has its pro inflammatory features. So we just don't pay attention to what is healthy to eat and drink. And that's a real problem.
- [21:08]
Dr. Rangan Chatterjee
When we think about diets. How much do you think that personalization matters? Because we can look at these big data sets and go, the Mediterranean diet has been shown to do A, B and C in a variety of populations. But then of course, as we both know as people who practice for a long time, you meet an individual and that individual has their own preferences, their own cultural inputs. And you know, for example, a few weeks ago I had David Unwin, Dr. David Unwin on this podcast, he's a primary care physician, I think in his 60s now. And he got type 2 diabetes in his 50s and that led to him to do some research and try and figure stuff out. And he has actually published a lot of data now showing that in his practice, it was just a regular practice in Merseyside, basically in the northwest of England. By adopting a low carb diet with many of his patients with type 2 diabetes, they managed to show remission of type 2 diabetes. I think in 155 patients now, all documented blood markers getting better. In his data set there's not been a big increase in LDL cholesterol. And so I guess what I'm Trying to get to. I understand the research on the Mediterranean diet. I've seen it. And, and I do think this is one of the themes in your book and maybe we'll bring that in later with genomics. How much do you think we can apply these big data sets and populations to individuals, knowing that we all react and respond slightly differently?
- [22:57]
Dr. Eric Topol
Yeah. What you're bringing up is so important, which is every one of us is truly unique. Even if we had an identical twin, we're still different. Our metabolism, our epigenomics are different. So the quest to have an individual diet that is most healthy for that person, we're still working on that. We don't know whether we're going to get there. There's a big investment here in the US by the nih, a couple hundred million dollars to see if we can find that. And of course, there's lots of features here like the gut microbiome and cannot be modulated as well, not just what you eat, but, you know, our resident bacteria and flora that is a big factor in our immune system and in our health. So I don't think it's intriguing that some people, if they bring, if they get down to a low carb diet, it's very healthy for them. Some people, a high keto, ketogenic diet can be helpful. So there is no one diet that's right for all people. And in fact, that's really the cornerstone of medicine is we have all these population guidelines, but we don't take in consideration that each of us are unique and may not apply to what we come up with for all people. The all people thing just doesn't exist.
- [24:29]
Dr. Rangan Chatterjee
Yeah, exactly. The research tells us what the average is and none of us is average. Right. We're all unique. And, you know, I have, I've had some patients who seem to, on the, you know, on the subjects of red meat, there's, there's a difference, I think, between, you know, unprocessed red meat and processed red meats. And then I found some patients seem to do really well with some red meat in their diet, whereas others don't seem to as well. And I wonder, you know, as AI gets more involved with medicine and as we understand our own personal genome more and more, I wonder if we'll get to a point in the near future where we can be trying out different diets and then you can basically look at the biomarkers, the important biomarkers, and go, is this working? Right. Because ultimately there are certain biomarkers that we know we would like in A certain range we would like our, you know, the HBA1C, our average blood sugar. We know we want, we know roughly where we want it. You know, I think there's some research showing that even an HBA1C above 5.2 will start to increase your all cause mortality, even though, you know, you're not diagnosed with Pre diabetes until 5.7 in the US and 6.0 here in the UK. So it's kind of interesting to me that we could get to a point where saying, look, the population shows us the Mediterranean diet is great. That's a great starting point. And now let's you try out a few things and let's keep checking your biomarkers and see on which diet are you thriving the best. And your biomarkers are in the best range. That seems like a reasonable approach going forward to me.
- [26:15]
Dr. Eric Topol
Yes, I agree. And in fact, you know, in the book I talked about how, for example, just a glucose sensor for a month could help people find certain foods that cause big spikes of their glucose or prolonged spikes. Whether that should be recommended isn't clear. But what we've learned is that if you are having big and long spikes of glucose to certain foods, that does increase your risk. If you are pre diabetic, as you mentioned, Rangan, that is your somewhat elevated hemoglobin A1C or fasting glucose. Every year a few percent of those people move on to type 2 diabetes and we don't want that to happen. So for people with prediabetes, we can do some of that today to find out the particular food, the types of foods that get them into a, if you will, very high glucose and prolonged zone, which we want to avoid. But that's just the first stab at this. As you say, we need to know more. There's a lot of it's complicated. That is, it's not just glucose, it's lipids, it's your gut microbiome. It's the order of when you eat. There's so many factors, how much you exercise and there's interactions with what you eat and your sleep quality and your stress, you know, so this is of course, that's a perfect example of where multimodal AI that looks at all these layers of data can give a person guidance, you know, that's meaningful. We're not there yet, but that's what's going to. What we need to crack this is to understand all these different layers of data, how they interact.
- [28:05]
Dr. Rangan Chatterjee
What are some of the things you learned about yourself when you popped on One of these CGMs, these continuous glucose monitors. Today's episode is sponsored by Boncharge.
- [28:23]
Podcast Host / Narrator
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- [28:55]
Dr. Rangan Chatterjee
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- [28:58]
Podcast Host / Narrator
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- [29:01]
Dr. Rangan Chatterjee
Read in front of it in the.
- [29:03]
Podcast Host / Narrator
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- [29:05]
Dr. Rangan Chatterjee
And I've noticed some quite significant changes.
- [29:08]
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- [30:02]
Dr. Rangan Chatterjee
What are some of the things you learned about yourself when you popped on One of these CGMs, these continuous glucose monitors?
- [30:10]
Dr. Eric Topol
Yeah, I was sobering because you know, some of my guilty pleasures would be like tortilla chips and oh my gosh, you know, I had a big spike with that and so I gotta cut down on that. You know, I've got grandkids who love pizza, as you can imagine and try to have a slice of pizza. Oh no, you know, that's a real problem. So I learned certain foods that, you know, they're really, I don't really want to look at those spikes, you know, better not to have a glucose sensor on. But you know, I think for me, you know that other people I know can eat the same foods and they're totally flat, they don't have any, you know, jump in their glue. So it is a very individual response.
- [30:55]
Dr. Rangan Chatterjee
It's interesting because I think you finding out that tortilla chips and a slice of pizza massively elevates your blood sugar in many ways. That's the. Although blood glucose, you know, is not everything, it's clearly an important metric when we're looking at short term and long term health. In many ways you could say that is a beautiful demonstration of personalization because you have found for you, Eric, you have Discovered that if you eat tortilla chips and or a slice of pizza, your sugar shoots up. So with that information now you're empowered to go, well, what am I going to do with that? Maybe now instead of having it, and I don't mean you're doing this, but if someone was having that three to four times a week, they might go, you know what, maybe I'll just have it once a fortnight now rather than regularly. It's very empowering, I think, when you on an individual level can see the difference something makes. Let's think about protein through the same lens, which is perhaps these general recommendations. Whilst useful, wouldn't it be great if we had some sort of metric like, I don't know, we could measure our muscle mass and look at it where it should be at that age relative to the population. And let's say you're eating under the protein recommendations but you've hit that muscle mass target, then maybe we could say, yeah, for me, this amount of protein is working. Do you know what I mean? I kind of feel more and more a lot of the generic advice we give, it kind of confuses people because then they see experts fighting over, you know, well, one expert says go high protein, the other says goes low protein. And people go, well, what the hell do I do with that? Whereas in some ways, if we had an end metric, we could go, well, it kind of depends. So why don't you try that for a bit. We'll measure your. Do you know what I mean? That feels where we should be going with medicine.
- [32:59]
Dr. Eric Topol
I'm totally aligned with you here. I think what you bring up is quite, quite insightful. So the two factors that are going to change our muscle mass are, as you say, protein intake is one factor. And the other, of course is resistance training, strength training. And the problem is people want to have like, they don't want to necessarily do the work, the resistance training or just lots of physical activity. It's much easier to take a bar or a powder. But the real benefit here is in the physical activity in general. And going back to your earlier point, how do we measure this? How do you gauge it? And you don't have to have. When I learned how important resistance training was because I didn't emphasize that, I always thought it was aerobic exercise was the big thing. I got a DEXA scan, I looked at my muscle mass. That was really helpful for me to say, hey, I gotta do much better than that. And I went, you know, on a resistance training kick, I didn't change Most people get enough protein in their diet. That's not really the issue. But I think what we're learning here is that it is an individual story and what it takes is not from a bar or you know, a hyper protein intake diet, but rather you're gonna get a big kick from increasing strength resistance training, which unfortunately still most people are not into that.
- [34:33]
Dr. Rangan Chatterjee
Yeah, we've covered ultra processed food, we've covered protein. In that paragraph that I read out before under diet, you also mentioned time restricted eating.
- [34:46]
Dr. Eric Topol
Yes.
- [34:47]
Dr. Rangan Chatterjee
What's your current read of the literature on time restricted eating and do you practice it yourself?
- [34:53]
Dr. Eric Topol
Yeah. So there are a lot of randomized studies now and there's lots of different schedules as you know, 5, 2 and this one and that one. And the data are very consistent to show that time restricted eating helps to keep weight under check. It's a good way if someone wants to lose weight. But what isn't clear is that what I practice is eat a dinner, hopefully on the early side and don't eat anything till the next morning for breakfast. That's a time restricted eating because as we know, lots of people eat in the evening and snacks and whatnot. So it all depends. But if you want to have a practical time restricted eating where you're giving your body a break from metabolizing food intake, just that works and it's not having to go a day or two days a week without any, you know, with fasting. So I'm an advocate for going from evening meal on the early side to the following morning with nothing to eat in between.
- [36:02]
Dr. Rangan Chatterjee
So maybe, you know, to make it really clear for people, something like an 8:00am breakfast dinner finished by 6:00pm I mean, I mean I know it depends on your.
- [36:14]
Dr. Eric Topol
Or seven even me, it's usually seven. It's like a 12 hour thing, 12.
- [36:19]
Dr. Rangan Chatterjee
Hours where you're eating within and then you have 12 hours where no food passes your lips.
- [36:25]
Dr. Eric Topol
Exactly. I think that's the most practical and beneficial way if you want to come up with an ideal timing of food. Yeah, yeah.
- [36:33]
Dr. Rangan Chatterjee
It's kind of interesting, isn't it? 50 years ago that's probably what most humans on the planet were doing anyway. Right. We now have to give it a name like time restricted eating or fasting. But it was probably just normal living until relatively recently. And then I have found that for some patients they can experiment with increasing it, you know, so actually they can go to a 10 hour eating window, like an 8 till 6. Have you seen much difference in the data? And a lot of the data hasn't really passed out a difference between men and women. But are you familiar from your research of any difference in results when it comes to time restricted eating for men compared to women?
- [37:16]
Dr. Eric Topol
I haven't seen anything that's particularly helpful in that to differentiate by sex.
- [37:26]
Dr. Rangan Chatterjee
Okay, so we're talking about lifestyle plus at the moment. We've just sort of, I mean, there's plenty more in the book, right? But we've sort of covered three core areas of food, you know, ultra processed foods, protein intake, and time restricted eating. Let's move on to exercise. And in that paragraph, you say exercise means more than aerobic fitness. It includes good posture. That's something we don't often hear about, resistance weight training, and something which maintains your sense of balance. So I think people have heard of aerobic training on this podcast. Many people have heard over the years the importance of strength training, but you also bring in good posture and things that improve your balance. I found that really interesting.
- [38:15]
Dr. Eric Topol
Yeah, and of course, they're interconnected, of course. So as we get older, our proprioception is compromised and so we're much more prone to fall and our posture often deteriorates. And so having a good upright posture is important for, you know, every part of our body, whether it's our lungs for expansion, whether it's our bones, our muscles, and also, of course, balance. So attention to that balance training. What's really interesting as, as we get older, our balance can really be that because we don't have that perception, the proprioception of our body parts in our brain. But training is easy to get that back and keep it at a level that's much younger. And so, as you know, because of falls, so many terrible things happen. You know, not just hip fractures, but, you know, just important musculoskeletal injuries. So this is a part of a workout. It's really important to spend a couple few minutes to keep up the balance training and all the time to focus and think about posture. And when you are better strength training promotes better posture, as does balance training. So it's all, you know, interdependent.
- [39:42]
Dr. Rangan Chatterjee
Yeah. Eric, a few days ago, I had Courtney Conley in my studio. She's, you know, she's many things, but one of the things she specializes is in foot health. And she was showing and presenting to me research showing that your big toe strength is one of the most critical factors when it comes to your fall risk. Because of course, we just look at general macro balance. Because when you really look down to it, one of the key factors is Your big toe strength. So it's really all these things you can go into a lot of detail. And one of the other things she told me, she said in your foot rung and there are four kinds of receptors that give you proprioceptive input. But I think she said after the age of 50 you need way more pressure being put through them to activate them. That is like you mentioned in your book, you know, you mentioned how the brain changes structurally as we age, which I found absolutely fascinating. But the way our nerve fibres in our feet change as we age. And it does seem to me that 40 or 50 seems to be the point in life where the sort of habits that we maybe got away with before we stop getting away with. And I'm, you know, I knew balance was important you're talking about it, but I really got that from Courtney as well, that this is something that really needs to be trained. Probably from your 40s if you want that exceptional balance in your 80s.
- [41:12]
Dr. Eric Topol
I couldn't agree with you more about that. And I think she is very much right about calling on the strength of our lower extremities and feet. And you know, that's why part of that balance is also strengthening our calves and you know, getting attention to the lowest part of our lower extremities. For sure.
- [41:38]
Dr. Rangan Chatterjee
When we think about exercise and there's these multiple components. How do you think about exercise for. Through the lens of the big three. I mean what's the impact of exercise on. On cancer? What's the impact of it on heart disease? What's the impact of it on neurodegeneration?
- [41:56]
Dr. Eric Topol
Yeah. If there is one thing that has a big, the biggest impact of lifestyle factors, this would be it because it's across the board and it has been shown to slow biological aging, the body wide aging with these so called epigenetic clocks. And it has a protective effect as we conceive it through the immune system. That is it. It's anti inflammatory. So it has the more while you're exercising you're getting your. It's like a trial run for immune system. You know, you'll have a little inflammation of muscles from doing that and then you're basically training your body to deal with the most intact high integrity immune system. So its effect is profound and it's really vital across all three of these age related diseases. If you're gonna just pick one thing to concentrate on, this would be it.
- [42:59]
Dr. Rangan Chatterjee
Yeah, it's hard to not get away from that when you look at the research. I mean look, everything's important, food's important, sleep's important, you know, stress management's important, all these things are important. But I mean, really, the research on exercise is frankly overwhelming. And we need to challenge the societal narrative that as you get older, you take it easy. In many ways, you get away with taking it easy in your 20s and 30s. I'm not recommending that, but you kind of get away with it. But as each age passes, for me, I'm paying more attention to daily movements. And walking, frankly, is, yes, I understand aerobics and resistance training, but I try and make sure I walk. I don't always manage it, but for at least 60 minutes a day, sometimes in one go, sometimes two 30 minute walks, sometimes three 20 minute walks. Because even on just walking alone, the research shows a massive reduction in risk of many different types of cancer.
- [44:02]
Dr. Eric Topol
I'm so glad you mentioned that because there was a really big study from last week that compared to all the different types of aerobic activity, walking and swimming, jogging, running and on and on, walking stood out as a major, major protective. Well beyond what people think. And I think a brisk walk is a great thing. In fact, if you're into other very vigorous physical activity, it shouldn't be at the exclusion of walking. Walking is really important and it brings in all those things we were just talking about, like posture and balance. And there's something about walking that is more than you would think with respect to its contribution to healthy aging.
- [44:48]
Dr. Rangan Chatterjee
Yeah. Going back to your worldly project, you noticed that genes weren't really telling the story, you know, back in 2008. Back then we did think, didn't we, across society, that it's all gonna be genetics. Once we sequence the genome, we're gonna know what's going on. And so obviously back then you guys thought, we've got these couple of thousand people, we're gonna find the genes that promote healthy aging. And then you find, oh, we can't see any similarity. It's all to do or mostly to do with their lifestyle. One of the things you also identified, and I found it interesting that you mentioned the research nurse who was Sarah, your daughter, who was, who was, you know, helping you with the trial, which must have been lovely to work on something like that with your daughter. But you point in the book that she noticed that everyone in that group were remarkably upbeat.
- [45:45]
Dr. Eric Topol
Yeah.
- [45:45]
Dr. Rangan Chatterjee
And I found that really, really interesting. We can look at the hard, you know, the hard health things, you know, diets, exercise, sleep, all those things, but this is almost the softer side of medicine. You know, what is Their personality, What is their approach to life? And I think it's amazing that your daughter actually noticed that they were all upbeat.
- [46:07]
Dr. Eric Topol
Yeah, I'm glad you picked up on that. I was struck by it because she would visit them in their home and take their blood for the sequencing and, you know, have a discussion conversation with them. And that's what she noted was the theme across all the most common thread was that their disposition, they are upbeat, happy people. Now, one of the things, of course, is, are they upbeat because they're so healthy, or did that help contribute to the. And of course, it's not something that you have a switch where you can turn on people to be more optimistic folks, but there's something about that quality that is correlated, at least with healthy aging.
- [46:53]
Dr. Rangan Chatterjee
The word correlation is really interesting there, isn't it? Because, you know, you're a researcher, you're always trying to look at the data and accurately report the data. I know. In the Blue Zone documentary on Netflix, one of the themes that came up, I think, was that a lot of these people who've lived past 100, who are, well, they don't have chronic disease, have this upbeat personality. They look on the bright side of things. It also reminds me, Eric, of a conversation I had with a lady called Bronnie Ware a few years ago. She wrote the book the Five Regrets of the Dying. I'm not sure if you're familiar with it or not, but she was a palliative care nurse for eight years, and she basically noticed that on people's deathbeds, they all said the same kind of things. You know, they regretted working so much, they regretted not spending enough time with their friends and et cetera, et cetera. And I asked her, I said, bonnie, did everyone you cared for at the end of their life have regrets? She said, no. I said, what were some of the things you noticed in the people who did not have regrets? And one of the things she noticed several things. But one of those things was hope. Yeah, right. So I find it fascinating that I can look at your worldly projects. Some of the stuff we get from the blue zones, some of the things that Brawny Ware noticed with people at the end of their life, I think it's. I think we have enough correlational data at least to say, look, I think your personality, your outlook to life, I think it does make a difference. I think we can say that.
- [48:28]
Dr. Eric Topol
I wholeheartedly agree with that.
- [48:31]
Dr. Rangan Chatterjee
No question to me, in Lifestyle plus, because I think, you know, if I think about what we've spoken about, so far, I do want to come to sleep shortly. But one of the things that you talk a lot about are the environmental toxins. And I think it's a really interesting thing to put under the umbrella of Lifestyle plus because it's something that I think a lot of people are not paying attention to. So they're trying to eat better, they're trying to get their, I don't know, 10,000 steps a day in or whatever they might be trying to do, they're trying to prioritize their sleep. But I routinely see people around me ignore the plastic issue, the environmental toxin issue. So could you sort of give us an overview? Where are we with the research? How concerned are you? And then what are some of the things we can think about doing to reduce our toxin exposure?
- [49:28]
Dr. Eric Topol
Yeah, and this is a real problem because we're not doing it nearly enough and things just keep getting worse. So air pollution is the one most proven to be pro inflammatory in the body and increase the risk of all these diseases and of course also type 2 diabetes. So this is a singular thing that we obviously need to work on with the climate crisis. Now, with respect to the plastics, there's still some controversy about how dangerous these that we ingest and that are in our air and throughout our environment, just so pervasive. But the most compelling study to me was the one from Italy where the microplastics found in people's arteries, their carotid arteries, when they had time of surgery, about 60% had that. And those are the people that of the years following, not only did they have vicious inflammation as a response to the plastic in their artery microplastics, but then they had a almost five fold risk subsequently of heart attacks and strokes. So that study to me cinched it that all these people that are denialists about the plastic crisis, they are off because maybe it doesn't cause dementia, although we know it accumulates in the brain, these microplastics, nanoplastics, but it does incite locally inflammation, as we've seen in the artery, and it accumulates in every part of the body, including our reproductive system, which may account for lesser fertility. So I'm worried about the plastics that we. And on a personal level, we can do certain things, but we also need big worldwide and governmental policy changes. And then the forever chemicals is the same thing. We've tolerated these companies that have this in so much of our physical environment and we're not doing anything about that now. All these things could change if we had policies to reduce their burden and we're not doing it.
- [51:35]
Dr. Rangan Chatterjee
This is where I think government and these sort of bodies really need to step in. Because the problem with the whole plastic or the environmental toxin exposure conversation is that I think to many people it just feels, oh, my God, what am I gonna do with this? That's another thing in my already busy and stressful life that I need to now think about. And it's, you know, what we don't really think about is the fact that 20, 30 years ago, we just didn't.
- [52:03]
Podcast Host / Narrator
Have all this in our lives.
- [52:05]
Dr. Eric Topol
Right?
- [52:05]
Dr. Rangan Chatterjee
And I think about, well, I think about it on a number of levels. I think about our children, right? So let's look at this through the lens of allergies, right? We know that food intolerances and allergies have gone up dramatically over the past few decades. And there's many potential reasons for that. But it does seem that the gut microbiome is a major player here. And so it's, you know, I've had a conversation with a few experts on this podcast over the years, but one of the things we've discussed is, well, could it be that your generation, Eric, and the generation older, to me, actually, actually when they were growing up, they didn't have all these ultra processed foods, they didn't have the overuse of antibiotics. Their microbiomes were healthy and robust at a very formative age. So perhaps that population just don't have all these food allergies and intolerances, whereas, and I'm not saying I know this to be true for sure, but could it be that the younger kids who grew up in the 80s and the 90s, when ultra processed foods were getting ramped up and antibiotics were probably being overused quite a lot by many medical professionals, so our microbiomes were kind of negatively affected at that age. Could that have primed us to be more susceptible to intolerances and allergies later? Now, if that's the case, we can then apply that mode of thinking to plastics. There's a generation of kids now who are growing up in plastic everything, plastic bottles for their water, go to the Starbucks or the coffee shop after school and get a trendy takeaway drink to walk around with, with your friends. But that's hot liquids going into these plastic cups, which is the worst thing in terms of releasing those plastics, Right? So I worry about what this might be doing to this generation. And speaking to your point about the denialists, it's like, well, hold on a minute. Maybe we don't have the evidence to say concretely that this is a problem, but I think we have enough evidence to adopt the precautionary principle and go, wait a minute, let's just err on the safe side. I don't think any of us would think it's a good idea to have plastic in our body in our reproductive system. Or one study, Eric, I saw it had plastic in the amniotic fluid, which I thought, this is crazy. I mean, what's your take?
- [54:34]
Dr. Eric Topol
Well, I think the worst reflection of where we're headed is to see all this cancer cropping up in young people. Where you see colon cancer, breast cancer, these are people in their 30s and even 20s and other forms of cancer. We've never seen this before. These are new spikes that have happened in recent years. And you know, whether that's any one of these environmental toxins that we're not doing anything about all of this together is worrisome. You know, we shouldn't see people new trends and spikes in cancer because that is something that should be alarming. Right. So no, I'm very concerned about this. And here's the other thing about it is as you see patients that do everything right, they are taking really good care of themselves. They check the box on every possible lifestyle factor but then they get a dreaded age related disease. Why? Well, is it because of their environmental exposures and some combination with their genetic susceptibility? So this is a concern that I all the progress we can make and we'll talk about some of the tech facilitated progress. We're chasing our tails. If we don't get onto this environmental forms of burden that are not at this point, we're doing nothing except making them worse.
- [56:15]
Dr. Rangan Chatterjee
Under this sort of umbrella of environmental toxins, you mentioned three things. Air pollution, microplastics and forever chemicals. One of the sad things about air pollution, of course is that it's out with your control and it probably affects people of lower socioeconomic status more because they're probably the ones who are living in the more congested urban environments where there is more pollution around. Of course, not all the time, but as a general rule, which is very, very sad. Yes, we need governments to change policies on an individual level, if you could afford it. Do you think there's a case for indoor air filters?
- [57:00]
Dr. Eric Topol
Yes, I mean our indoor air. We don't have enough attention paid to that whether our places of work and our home. So that's something that could improve. And your point about the inequities, they go across the board. There are more exposures, more ultra processed food so yeah, and again, what efforts we have to extend healthspan need to be considered globally for all people, not just for wealthy people. And so this also requires specific attention.
- [57:33]
Dr. Rangan Chatterjee
Okay, that's air pollution. Number two you mentioned was microplastics. So you mentioned the potential problems. I also had Professor Dale Bredesen on the show a few months ago from the Buck Institute of Aging, and he is very concerned about microplastics. And again, to be fair to Dale, he said, I don't think we've got causative proof yet of plastics and Alzheimer's, but there's enough there to worry him and there's enough there for him to immediately cut out as much plastic from his life as he can. Basically which I find when you've got some of the top researchers saying, look, I've seen enough to go, we might not have definitive proof yet, but I'm gonna reduce it as much as I can.
- [58:16]
Dr. Eric Topol
Oh yeah, yeah.
- [58:17]
Dr. Rangan Chatterjee
What would your advice be to someone listening to this? Go, ok, well, there's only so much I can do, but what are some things that I can do that will reduce my microplastic exposure?
- [58:33]
Podcast Host / Narrator
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Dr. Rangan Chatterjee
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- [60:30]
Dr. Eric Topol
Yeah, and I think we should be working on that individually even as well. And you mentioned about plastics, water bottles, heat and plastic, like microwave and hot drinks and, you know, the utensils that we use. I mean, there's so much plastic everywhere that we can reduce that to some degree. There are filters you can add to your water. There's many things you can do. It's limited to some degree, but our storage and our reliance on plastic is just way out of control and at least part of it is under our control.
- [61:13]
Dr. Rangan Chatterjee
One of the things that really helped me change my plastic exposure, and I think this speaks to the point we mentioned before about CGMS and what you discovered about tortilla chips and pizza for you. What I discovered when I, you know, I sort of started experimenting with CGMS a few years ago and it was eye opening. And what I learned has had a profound impact on me, you know, and I think with some people these things are game changing in terms of the insight they give people. But what are we now? We're in sort of January 2026, I think. In November 2024, I was in LA doing some interviews for my last book and I got a test done in la. You can get anything tested in la, right? But one of the tests came back saying that levels of BPA in my bloods were in the red range.
- [62:12]
Dr. Eric Topol
Oh, yeah, yeah.
- [62:13]
Dr. Rangan Chatterjee
And that did something because it wasn't as if I wasn't familiar with the problem with plastics. And I think this speaks to something really important, Eric, about human behavior, which I would love to get your take on. I knew a lot of the science about plastics, but it took me to get a blood test, see my levels in the red, to go, oh my God. Right, Enough's enough. And since then I don't think I've had a single hot drink in a takeaway cup. I don't think I have. I've only drunk out of a plastic water bottle. I think, what? I'm desperate. So on, let's say a transatlantic flight, when literally after a seven hour mark, I need to drink something. But that test empowered me to change my behavior. What's your take on that? Because we can talk about this stuff, but I reckon a lot of people will go, yeah, and crack on with their lives. How are we going to get people to actually go, no, it is worth reducing the plastic exposure in your life.
- [63:16]
Dr. Eric Topol
Well, what you just touched on is actually, in my view, one of the most important things we have for prevention and that is when you Give out the guidelines, recommendations for all people, it never really sinks in. But when you give a person their data, and that's data that they're a very high risk for this cancer, they're very high risk for Alzheimer's, and then you say these are the things you can do. The chance of you getting someone to change their behavior and their whole arc of health subsequently is so much greater. And that's exemplified by your experience with BPA and plastics. Wouldn't it be great if a lot more people could access that information about themselves? Because that's the thing that gets people to make changes. But we don't have enough of that.
- [64:12]
Dr. Rangan Chatterjee
I want to come back to Forever Chemicals in just a minute, that third category. But I think what you just said there, I think for me and for you, by the sounds of it, is so critically important. And it goes back to what we said earlier about prevention, Eric, this idea that in modern medicine, for all its amazing breakthroughs, of which there have been many, one of the things I think we can sort of honestly say when it comes to chronic disease is that we get involved quite late in the disease process. Whereas you say, of course, you've already said it. These big three illnesses, cancer, heart disease and neurodegeneration, which includes things like Alzheimer's and Parkinson's, you know, they're going on for at least 20 years before you get there.
- [65:02]
Dr. Eric Topol
Yeah, Right.
- [65:03]
Dr. Rangan Chatterjee
So in your view, with all the research you've done, what does ideal prevention look like today? You know, forget about the logistics. If you could design a preventive health service today, what would be some of the key fundamentals you would want to bring into it?
- [65:23]
Dr. Eric Topol
Right. So, you know, in February we're starting a prevention of Alzheimer's trial. And that I think is indicative of that. We're going, we're at least trying to prove the concepts of the new prevention era. And so what we're talking about now is you have a person's, all their medical records and not just the medical records and their lifestyle, lifestyle plus factors. Okay, but now you have at least the key genetic information, like the so called polygenic risk scores, or even their whole genome sequence.
- [66:03]
Dr. Rangan Chatterjee
Could you just say, for people who've never heard that term, could you just explain what a polygenic risk score is?
- [66:08]
Dr. Eric Topol
Right. So that means that you're getting the, of at least a million or more letters in the genome that are linked to common diseases like the cancers and Alzheimer's and heart disease. You're getting a readout of what your risk is from 0 to 100 and that's really important. It's very low cost, but we should all have that. It's a guide of risk whereby when you have that information, it doesn't tell you when, it doesn't say you're going to have Alzheimer's at age 60 or 90. We're going to get to that in a moment that we have now when. But it gives you at least a sense of something to be on the lookout for and your physician of course as well. So polygenic risk score, genome sequencing, which now can be done at very low cost, a couple hundred dollars that data is going to be. And in fact the UK is the world leader in that. The next is the proteins. So now we can get up to 11,000 proteins from the blood from a tiny sample and we get a readout of each organ clock. So we're talking about the pace of aging of your brain, your immune system, your heart, you know, your liver, every organ in your body. We can get the pace of aging, not just your body wide aging, which we can get through a so called methylation clock. Then we have these biomarkers. So for Alzheimer's we have this incredible breakthrough marker P T 217, which is related to the tau protein in the brain. So these are ways to be 20 years ahead of your health arc. It's like a health GPS if you will.
- [68:01]
Dr. Rangan Chatterjee
Sorry, you said P Tau two months. So can you just explain to people what that is, Eric?
- [68:05]
Dr. Eric Topol
Yeah, so I think people now have heard a lot about amyloid and tau. These misfolded proteins that accumulate in our brain incite lots of inflammation in our brain. Turns out that one of these on the tau protein at the residue 217, it has lots of numbers that one can be picked up in the blood. It's been available for a couple of years as a blood test. A lot of physicians don't even know about it, no less patients. And that helps to cinch that in the years ahead. If you're 50 years old and you have a high risk for Alzheimer's from your family history or APOE4 allele or your polygenic risk score, if your P tau is high, that is really put you in this high risk category. And that's who we're focused on for our prevention of Alzheimer's trial. But if it's low, it's very reassuring, right? So it's a big, big advance in Alzheimer's disease, perhaps the biggest advance in many decades.
- [69:12]
Dr. Rangan Chatterjee
Do you think everyone should be getting a P Tau217 to assess their Risk of Alzheimer's only if they have other.
- [69:20]
Dr. Eric Topol
Features of increased risk. So if they have APOE 4, 1 in 4 of us have that as a carrier. And some people, of course, have two copies. So if they have that, if they have a family history of Alzheimer's, if they have a high polygenic risk score. Yeah, if they have any of those or all of those, getting a P Tau 217 would help. Because then you'll know, you know, because.
- [69:48]
Dr. Rangan Chatterjee
Can you bring it down if you know it's up, can you do things? Because that's the key, isn't it? You can bring it down.
- [69:54]
Dr. Eric Topol
Exactly. So it's not just a marker. It's modifiable. It's like LDL cholesterol for the heart. It's the same thing. Exercise, we know, brings P Tau 217 down considerably. You know, weight loss, better diet. So lifestyle factors are doing a big thing to help us to deal with a marker. Now that is not just framing risk, but also reducing prevention, delaying at the very least.
- [70:26]
Dr. Rangan Chatterjee
And that, of course, just highlights the importance of testing. Right. Because, you know, if you were just sailing on with your life, you had no symptoms at all, which is common. You know, even though these things develop for 20 years, you may have no symptoms. Right. Or you may not notice any symptoms. If you, you know, if you have an ApoE4 allele, if your mother had Alzheimer's and then you see your P Tau217 is up, that might be the trigger to go, okay, I just can't keep sailing on and living as I'm living. This is great. I've identified it. Let me sort out my lifestyle now. Let me make some changes. That's the exciting thing, I think, in your book you mentioned with these polygenic risk scores, I think you mentioned a Norwegian trial where. Do you remember that one? Perhaps you could just explain what the. I think it motivated people to change. Right.
- [71:22]
Dr. Eric Topol
Yeah. It's exactly what you said with the bpa. So it was actually in Finland, where they gave their polygenic risk score for heart disease to thousands of people, and then they followed them to see whether it changed their behavior. It was remarkable. When they had their data for high risk of heart disease, they stopped smoking, they lost weight, they increased activity. That study really cements the idea that when people have their data, they make durable, important changes under their control.
- [71:59]
Dr. Rangan Chatterjee
Yeah. One of the interesting things in your book, which I think is going to be counterintuitive for many people, is your approach to screening for things like cancer. So perhaps you could talk, you know, Breast cancer, of course, is very common these days. And you sort of, and I've heard you say this in interviews as well, that only 12% of women are ever gonna get breast cancer. So why should we be screening the other, you know, 88%? So to some people that's gonna be quite controversial because the prevailing view, I think in society, Eric, is that.
- [72:36]
Dr. Eric Topol
You.
- [72:37]
Dr. Rangan Chatterjee
Know, well, I wanna make sure that I don't miss it. So could you kind of talk us through your approach to screening? Maybe use breast cancer as an example and why you think we need to and look at our individual risk?
- [72:52]
Dr. Eric Topol
Yeah, I know the way we screen for breast cancer today is dumb and wasteful. Now why do I say that? Well, if you take a woman age 50 and if you take 10,000 of them, this has been shown, I mean, this is data that is in JAMA, if you screen them for 10 years, there'll be a 60%, that is 6,000 of the 10,000 women age 50 over 10 years will have false positives. And that induces lots of anxiety and biopsies and all sorts, callback recalls and you know, so that's one thing. Second thing is we are using age. That is a dumbed down approach. Okay, we've already talked about how some young people can get breast cancer, young women, but also we have risk based screening. In fact, there's just a study comparing risk versus age. Risk was superior. Why aren't we acknowledging that age is a dumb way to partition with how we screen? We can do polygenic risk scores, we can do genome sequencing, but we are, as you said, we're screening all women. At least that's the advice on a frequent basis to engender false positives. And here's the other thing that is just crazy. Most cancers, breast cancer, are not detected through screening, not like over 80 some percent. So this screening isn't working. The women are showing up with breast cancer rather than being picked up from their mammogram. So we can do so much better. And everything is on detection. Why not prevention? Why aren't we preventing breast cancer in high risk women? We can do that. Now, we're not using all our knowledge in genomics. And here's another thing. You know the clocks that I mentioned, the immune system clock, that's part of the output. You can't really likely get a metastatic cancer if your immune system is intact. Why aren't we checking the immune system clock? That is, if you don't have a youthful immune system and you have a genetic predisposition for cancer That's a recipe for risk. So we are not using our knowledge base in a smart way, in a prudent way to just not put all women. It's like treating people as cattle. Okay, we should be much smarter than that. We're not the same. And this is the individualized medicine approach that, of course, that I've tried to work on for decades on a population.
- [75:39]
Dr. Rangan Chatterjee
Level in, let's say, a publicly funded healthcare system like the National Health Service. Of course, utilizing your resources appropriately with the right levels of risk and reward is very important. But that works for a population. But on an individual level, Eric, what if there's a woman listening to this right now and they say, well, Dr. Topol, I'm hearing you, but I don't have any family history of breast cancer. I've got no genetic risk factors for breast cancer, but I still want a mammogram because I don't want to miss early cancer. If someone was saying that to you, what would you say to them?
- [76:20]
Dr. Eric Topol
Well, you know, that's an individual choice. That's fine. But what I would say is if you had your genetic information and you had a polygenic risk score. So people that say they have no genetic risk. Well, as it turns out, when we talk about this polygenic risk score, just to go back to that for a moment, we are the blend of our parents. And even if neither of them have a cancer risk variant, that's important, we are the hybrid. And it's these combination of letters of the genome that gives us. That's why it's called polygenic risk. So that's why we should know our polygenic risk Besides mutations like BRCA, BRCA1, BRCA2, and many others that are informative for risk. So what I'm saying is we have the goods here to tell who is really at risk and who isn't. And so, for example, if you knew you were at very low risk, maybe you'd still have a mammogram, but maybe every five or 10 years rather than every one or two years. We are not using all this great knowledge base. That's what I'm trying to get at.
- [77:30]
Dr. Rangan Chatterjee
Yeah, so I guess we're. I don't know if we're at that point or we'll get to that point very soon where, if we get your polygenic risk score, I'm guessing we might get to the point where we can pretty confidently say you're at risk of several things, but breast cancer ain't one of them. Right, Right. And so therefore, if you are really not at risk of breast cancer using the best available scientific evidence. That's another key point there, isn't there? Which. Everything has a cost. Nothing is neutral. I don't mean a financial cost. There's even an emotional cost. You know, going to the screening, waiting for your results, you know, it's very anxiety inducing. If they're not sure and you then need to go and have that biopsy, you introduce the risk of complications. So it's not as if screening has no potential downside. Right. Which is why, of course, you know, prostate cancer screening is so controversial because Some people want PSAs all the time and others like, well, wait a minute, there's loads of false positives. You're gonna have loads of guys having, you know, invasive biopsies, which are potentially unnecessary unless we do it in the correct way. And I'm not convinced the general population understands the nuances of screening. I think there's very much been this idea that all screening is good. The more we can screen, the better. But I'm with you. I don't think that's necessarily the case. Here's a question I have for you, Eric. As we think about this, we were talking before about environmental toxins. We haven't got to forever chemicals yet. I'll remember to come back to that. We've got air pollution and microplastics. Something I've been thinking about for a number of years is as the world evolves, as it always does, certain people are going to be able to thrive in a toxic modern world better than others.
- [79:24]
Dr. Eric Topol
Yes.
- [79:24]
Dr. Rangan Chatterjee
And perhaps some of that will come down to genetics. Maybe some people are better detoxifiers than others. Right. So if that is the case, we can apply what you just said about breast cancer in a similar way to, like, the toxins. Right. Let's say you get a genetic risk score and you're like, I'm really bad at detoxifying these chemicals. I don't know, maybe you're someone who would benefit from doing sauna five times a week. Right? Because I don't know, I'm just hypothesizing. Whereas if you're someone who naturally detoxifies stuff, so maybe you're gonna clear plastics quite well. Is there any research on that or what's your take on that, Eric?
- [80:08]
Dr. Eric Topol
I think it's an interesting hypothesis and it needs to be tested. Yeah.
- [80:12]
Dr. Rangan Chatterjee
Yeah. Well, let's come back to the third one of those environmental toxins forever chemicals. You know, what are they? And I saw a clip, I think, online of you. I think you Were talking to Mel Robbins and she had, she was showing you all kinds of things from her house, including hairspray, right?
- [80:32]
Dr. Eric Topol
Yeah.
- [80:33]
Dr. Rangan Chatterjee
And I think she couldn't pronounce anything that was in the hairspray. And I think you were quite concerned. So talk to us about Forever Chemicals. Talk us to us about things like hairspray and what's in these things and then what we should be doing about this basically.
- [80:48]
Dr. Eric Topol
Yeah, no, this is pervasive problem. Perfluorocarbons. And you know, there's thousands of these forever chemicals that are non degradable, that are in our environment, our furniture, our, our tires, our, you know, carpet. And we could have all these things Rangan, we could have all these things without those chemicals if we told these companies that they're prohibited. Yeah, right. But we just tolerate it. And you know, everyone knows about the, what happened with the cigarettes and cancer and heart disease and how the company suppressed all the data and refuted it for years. And then finally, you know, here it is. Well, that's what we have with the Forever chemicals. The company 3M here in the US which is the number one offender, they've known about the dangers of these, but they just kept using all these chemicals in their products. And of course there are a lot in personal hygiene and cosmetic products and I mean it's all over the place. But they are then polluted in our water and our air and it just adds to this burden of pro inflammatory, noxious for our health and we do nothing about it. Why aren't we saying to these companies, no, you take those out and you can put in other organic degradable chemicals that achieve the same thing. But there's no teeth in our regulation of toxic perfluorocarbons and other related PFAs.
- [82:33]
Dr. Rangan Chatterjee
Non stick pans, you know.
- [82:35]
Dr. Eric Topol
Yeah.
- [82:36]
Dr. Rangan Chatterjee
One of the kind of in inverted comma's, great modern inventions to improve cooking. Unfortunately that's come with a, with a dark side, hasn't it? Right? You know, absolutely. Ease of cooking, you know, you make your omelette on it, it's way easier, easier to clean. But it's forever chemicals, isn't it? That end up in your bloodstream?
- [82:56]
Dr. Eric Topol
Yes, yes, absolutely. The public doesn't even know about it. That's the other problem.
- [83:02]
Dr. Rangan Chatterjee
The problem I have with all this stuff is that I want to empower people and share it. I don't wanna stress people out. Right, right. Because I know people are living these busy, stressful lives. But if I'm gonna be honest, if we're gonna be Both honest. As healthcare professionals, we kind of have to tell people, you know, if they can't do anything about it or don't want to, that's up to them. But I think we have a responsibility to say, guys, you know, we've got rid of all our Teflon pans a few years ago. Like, you know, once I saw. I'm like, look, we just can't be having this. We're gonna be exposed to this when we eat out. Right. There's nothing I could do about that in a restaurant. Right. So my sort of philosophy is, you know, control the environments that I can control. Like, I can control what's in my house. Yet. Is it more of a pain sometimes to wash up? Yeah, but at least I'm not putting forever chemicals in my body. And I just don't, you know, we've tried to replace all ours and gone back to cast iron, basically.
- [84:02]
Dr. Eric Topol
Right. Same here.
- [84:04]
Dr. Rangan Chatterjee
Yeah. There's so much in your book that I want to talk about, but I've got an eye on time. I wonder if I might just pivot here. Eric, to. Some of my Instagram community have put in some questions that they wanted to. And so I don't normally do this, but maybe I'll try a sort of. I wouldn't quite say quick fire, but, you know, I could go into depth in all of these, but let's try and get through a few of them if possible. Someone's asked, can stress and sadness cause heart complications?
- [84:38]
Dr. Eric Topol
Yes. You know, there's the acute severe form. It's called Takotsubo syndrome, that you can actually have the heart really sick from a profound stress, but there's also the chronic stress, which can be seen to promote atherosclerosis and heart disease. So, yeah, no, the answer is yes. And that's why we want to try to, you know, reduce the stress, improve things like do that, like exercise. Really important.
- [85:11]
Dr. Rangan Chatterjee
Okay, second question that came in. What is the most impactful thing a healthy person can do to drive the biggest change in their health?
- [85:23]
Dr. Eric Topol
We touched on it rang, and it was exercise. Amp it up and, you know, with the right kind of balance of activities.
- [85:30]
Dr. Rangan Chatterjee
Okay, next question. When is it too late for me to think about changing my lifestyle? That's from, I think, one of the audience members who might have been in their 60s. So, yeah. When is it too late?
- [85:43]
Dr. Eric Topol
Never too late and never too early. Right. So the studies show at age 50, as you at the beginning of our conversation highlighted, you can get at least seven years of healthy aging by doing this. At age 50, if you're at 60, you're still going to get years of healthy aging added. But if you start even younger, it's even better. So it is never too late, never too early.
- [86:10]
Dr. Rangan Chatterjee
Other than traditional blood tests, what tests may doctors be missing when it comes to heart health?
- [86:19]
Dr. Eric Topol
Yeah, so that is going to be important because LP lipoprotein A is going to be. There's five different drugs that are going to be available soon and that's a risk factor we never had a treatment for. So that one is going to be become a. It should be part of the standard test. Other than that, we don't have good inflammation blood tests. But I do think the artery and heart clock, the pace of aging of the artery and heart, that will become standard in the years ahead.
- [86:48]
Dr. Rangan Chatterjee
Yeah, super interesting. Next question. Is lack of community and connection a factor in heart health?
- [86:56]
Dr. Eric Topol
Yes. And across all three age related diseases, you don't want to be isolated, you don't want to be. You want to be engaged with other people where that we need that, we need that for our health.
- [87:08]
Dr. Rangan Chatterjee
What do you think the mechanism is there?
- [87:11]
Dr. Eric Topol
It's a great question. I don't think we know that. Lots of theories, but the data are much more, I think conclusive than I would ever have forecasted. When you review it all, it's really solid.
- [87:26]
Dr. Rangan Chatterjee
Yeah, it really is. I agree. What is the link between blood pressure and heart health?
- [87:33]
Dr. Eric Topol
It's a big link. That is when you stress the artery wall or the heart by having too much excessive blood pressure, you're allowing injury to take place throughout the arteries in the body and certainly in the muscle of the heart to be thick and hard to relax and fill. So yeah, you want to get their blood pressure under control because it does have a big toll on your whole vascular system.
- [88:00]
Dr. Rangan Chatterjee
Going back to something we said before in the conversation about personalization, Eric, one of the things I've thought about for a while is, and this is why I like these, the more tests that we can find, the more biomarkers we can find which give us what we actually want, the more I think it helps us personalize things. So blood pressure, right. Let's say you're going for 120 over 80, right? Well, I'm 6 foot 7, so I'm a bit, you know, I wouldn't quite say I'm like a giraffe compared to a human, but I'm a tall guy, right?
- [88:34]
Dr. Eric Topol
Yeah. Yeah.
- [88:34]
Dr. Rangan Chatterjee
So is there a case that the blood pressure that would be optimal for me might be different from the average. And if so, it may not be. I'd love your take on this as an experienced cardiologist. And if so, wouldn't it be better to have some sort of real time marker of vascular endothelial function? So I could go, well, let's say it was sitting at 130 over 90, which it's not, thankfully. But if it was and if that marker was okay, I might be able to say, well, yeah, but maybe for me, it's okay. You see where I'm getting at. Getting too bad.
- [89:11]
Dr. Eric Topol
No, I think the blood pressure has to be individualized as well, because your example is a good one. You know, an atypical body height. But also, for example, in older folks, you don't want to be too aggressive. You can get them to, you know, faint and pass out. And so you have to. Everything has to be guided for that personal. We don't have markers that you mentioned. Yeah, we should. Ideally to help us guide what is optimal blood pressure.
- [89:42]
Dr. Rangan Chatterjee
We.
- [89:42]
Dr. Eric Topol
For any particular person.
- [89:44]
Dr. Rangan Chatterjee
And the last question that came, and this was an anonymous question, which I guess. I guess the reason. It will become evident why when I asked the question. But someone came in saying, should I be concerned if I've started to get erectile dysfunction in my 50s?
- [90:04]
Dr. Eric Topol
No, not necessarily. Because, you know, we're seeing that even in much younger men as well, in their 30s and even younger. So the question is, is that indicative of vascular dysfunction? You were just getting at that with your blood pressure question, so at least it should be looked at. Is there high blood pressure? Are there other explanations for that? It could just be, of course, not indexed to the vascular tree, but it should be at least considered.
- [90:36]
Dr. Rangan Chatterjee
Yeah. Okay, Ariel, listen. It's been so fascinating talking to you. There's just so much we haven't spoken about that is in this very, very thorough book. As we start to close down this conversation, is there something important or something that you're really passionate about that we haven't mentioned yet in this conversation that you'd like to bring up?
- [90:58]
Dr. Eric Topol
Yeah, thanks for giving me the chance for that. What I really want the person listening watching this to get at is I have tremendous optimism that we're going to prevent age related diseases. So, as you know, there's lots of work being done to try to reverse aging. You know, a lot of big biotechs are really going after this, and that might be great someday if we had a pill or a treatment that reversed aging. But what I'm suggesting is let's accept that we're aging right? It's a biologic process. But let's not accept that we can't make a huge dent in age related the big three diseases. So I again, through the data that we are now seeing, the ability to track the immune system, we never had that before. The ability to look at each person's organ over time to see to detect one that is starting to act up early and the fact that we have 20 years or more to work with to anticipate a person's risk and the fact that in recent weeks even there have been new AI models that have shown you can for 20 years ahead you can predict a person's health arc not just if they would get a condition, but when. So a 50 year old would present and say, you know what if we don't do Anything when you're 67, you're going to have mild cognitive impairment. Let's do all these things. So we take that and move it to age 90. So I just want to leave you with that. With AI, multimodal AI and all these new layers of data, we're going to go into an era of prevention that I am really excited about. Treatment is not the end all, it's prevention and we can do this. We couldn't do it before. We didn't have the layers of data, we didn't have the AI to process it. But we do now. And that's what I think is going to be the big change going forward.
- [92:59]
Dr. Rangan Chatterjee
Yeah, I mean that message of hope and empowerment that came through just then is also what comes through when I read Super Ages. And I think it's a very inspiring note to leave people on. You have covered this, Eric. But just very finally for that person who's listened to us and is feeling a bit down on themselves and is like, you know what? I've neglected my health my entire life. I thought the reason I had type 2 diabetes is because both of my parents had type 2 diabetes. I don't want to get out some. It's like my mum, but I fear it's too late to that person. What would you say?
- [93:42]
Dr. Eric Topol
Yeah, no longer is there room for this defeatist attitude. We can change the natural history of these conditions and part of it is our efforts, these lifestyle factors and there's a whole new pipeline of new medications on top of lifestyle and if we start ever to get our health policy alive for the environmental toxins and we hit on all cylinders, all these things are going to make a difference. So we shouldn't have this sense that we are stuck with our parents, conditions that's the wrong way to think about things. No longer is that really the way to be thinking about one's future health.
- [94:34]
Dr. Rangan Chatterjee
Dr. Topol, it's been a pleasure talking to you. Thank you for all the research you've done over the years. Thank you for writing such an empowering book and thank you for leaving people with hope.
- [94:45]
Dr. Eric Topol
Well, thank you Rangan. Really a delight to talk with you and it's been fun.
- [94:53]
Dr. Rangan Chatterjee
Really hope you enjoyed that conversation.
- [94:56]
Podcast Host / Narrator
Do think about one thing that you can take away and apply into your.
- [95:01]
Dr. Rangan Chatterjee
Own life and also have a think about one thing from this conversation that.
- [95:05]
Podcast Host / Narrator
You can teach to somebody else. Remember, when you teach someone, it not only helps them, it also helps you learn and retain the information. Now, before you go, just wanted to let you know about Friday 5. It's my free weekly email containing five simple ideas to improve your health and happiness. In that email I share exclusive insights that I do not share anywhere else, including health advice, how to manage your time better, interesting articles or videos that I've been consuming, and quotes that have caused me to stop and reflect. And I have to say, in a world of endless emails, it really is delightful that many of you tell me it is one of the only weekly emails that you actively look forward to receiving. So if this that sounds like something you would like to receive each and every Friday, you can sign up for free@drchatterjee.com Friday 5 Now if you are new to my podcast, you may be interested to know that I have written five books that have been bestsellers all over the world covering all kinds of different topics. Happiness, food, stress, sleep, behavior change and movement, weight loss and so much more. More. So please do take a moment to check them out. They are all available as paperbacks, ebooks and as audiobooks which I am narrating. If you enjoyed today's episode, it is always appreciated if you can take a moment to share the podcast with your friends and family or leave a review on Apple Podcasts. Thank you so much for listening. Have a wonderful week. And please note that if you want to listen to this show without any adverse at all, that option is now available for a small monthly fee on Apple and on Android. All you have to do is click the link in the Episode notes in your podcast app and always remember you are the architect of your own health. Making lifestyle change is always worth it because when you feel better, you live more.
- [97:09]
Dr. Rangan Chatterjee
Sam.