Health & Veritas: "Eric Topol: The Keys to Healthy Aging"

Podcast: Health & Veritas
Host(s): Harlan Krumholz & Howie Forman, Yale School of Management
Guest: Eric Topol, Cardiologist, Researcher, Author
Episode Date: September 11, 2025

Episode Overview

This episode welcomes Dr. Eric Topol to discuss insights from his new book, Super Agers: An Evidence Based Approach to Longevity. Dr. Topol, a prominent cardiologist and innovator in healthcare, shares groundbreaking perspectives on the science of aging, personalizing health risk, the limitations of generalized advice, and the present and future of medical AI. The conversation delves into the critical role of the immune system, the promise (and underutilization) of polygenic risk scores, dangers of current health fads, and the importance of maintaining a rigorous, evidence-based approach amidst a sea of misinformation.

Key Discussion Points & Insights

The Surprising Keys to Longevity

• Immune System vs. Genetics
  • Topol underscores a major misconception: genetics play a relatively minor role in age-related disease risk compared to the immune system.
    • “Turns out [genetics is] just a minor component... it’s really the immune system. How well that hangs on as we get older... that’s the center of all this right now." — Eric Topol (02:03)
• Wish to Have Trained as an Immunologist or Computer Scientist:
  • "If I go back, I probably become an immunologist and a computer scientist rather than a cardiologist..." — Eric Topol (02:17)

Personalization over Generalization

• Limitations of General Lifestyle Advice
  • Advising broadly on diet, sleep, and exercise has limited impact since most people struggle to adhere, and risk profiles differ.
    • “The problem with the general recommendations, as you know, is that most people don’t do them. That’s why I think the book is trying to set up a whole different mode...” — Topol (04:38)
• Precision Prevention
  • Topol advocates for “partitioning people’s risk” using multimodal AI and personal data (“organ clocks”, genetic scores) to create truly tailored interventions.
  • Early identification of risk allows meaningful interventions—potentially decades before symptoms.

Polygenic Risk Scores & Predictive Diagnostics

• Polygenic Risk Scores: What & Why

  • Unlike single-gene inheritance, these scores aggregate hundreds of genetic variants to forecast disease risk (not timing).
    • “You’re going to find out risks that you didn’t think were in your family... polygenic... hundreds of gene variants...” — Topol (14:03)
  • Still, lifestyle is not overridden by genes:
    • “You can control your destiny to a large extent.” — Krumholz (16:22); “Yes, absolutely.” — Topol (16:24)
  • Evidence from his “Wellderly Study”: Extremely healthy older adults do not differ genetically from those with chronic disease; lifestyle is decisive (16:32–18:28).

• Current Accessibility & Frustrations

  • The technology is affordable and available, but dramatically underused in clinical practice.
    • "I can't believe this... This data has been available for almost 10 years... and no one's using it." — Topol (13:47)

Debunking Popular Health Trends

• Protein Fads & Supplements

  • Recent trends advocating extremely high protein intake (especially via ultra-processed bars) lack robust evidence and may be risky—especially due to high “leucine” content.
    • “High protein intake... will add to inflammation of the body and... promote atherosclerosis... leucine is the culprit.” — Topol (25:44–26:47)
  • The popular practice of combining high-dose leucine and rapamycin is not only unsupported but potentially self-defeating:
    • “...they're getting the yin and yang opposing effects. They're knocking out whatever the rapamycin was supposed to do...” — Topol (27:25)
  • Many of these products are ultra-processed, the very class of foods experts urge to limit (28:08).

• Influencer Misinformation & Peptides

  • Influencers push risky “miracle” interventions (peptides, off-label drugs) without evidence. Topol stresses the lack of genuine scientific support.
    • "There's no data for any of this stuff." (28:51)

Navigating Today’s Information Climate

• Skepticism of Medical Establishment vs. Evidence-Based Advice
  • Books spreading provocative messages (“secrets”, anti-establishment rhetoric) often overshadow sober, evidence-based health guidance.
    • “They tell things to people that they want to hear, like there's these secrets and that the medical establishment has got it all wrong...” — Topol (19:32)
• Coping with Misinformation & Polarization
  • Topol advocates sanity, optimism, and a focus on real scientific discovery as antidotes to the current “dark time” of misinformation:
    • “I refuse to have a derangement syndrome.” — Topol (30:08–31:48)
    • “The science isn’t going to go away... eventually great discoveries will be made... I always [have] been optimistic.”

Artificial Intelligence & the Future of Medicine

• Limits of Full Automation
  • Topol explains the analogy of “Level 5” AI autonomy (total, context-free) and why medicine may never achieve full automation—trust and human touch are essential.
    • “We will never get there. There will always be conditions that the AI... [can't handle].” — Topol (32:22)
• AI’s Greatest Promise: Risk Forecasting
  • The most profound use of AI may be in “precise and accurate forecasting of conditions long before they ever start to show up.” (32:22–33:29)

The Arc of Topol’s Work

• Integrated Vision
  • Topol’s books—from The Creative Destruction of Medicine to The Patient Will See You Now to Deep Medicine and now Super Agers—chart a coherent journey: digital transformation, patient empowerment, AI, and now evidence-based longevity.
    • “I see this as a connected group... you actually did them in a way that... have enduring wisdom associated with them...” — Krumholz (20:43)
  • He reflects that these books all offer “an optimistic forecast which has been off by years”—change takes time.

Notable Quotes & Memorable Moments

• “If I go back, I probably become an immunologist and a computer scientist rather than a cardiologist because that's the center of all this right now.” — Eric Topol (02:17)
• “You can control your destiny to a large extent.” — Harlan Krumholz (16:22)
  “Yes, absolutely.” — Topol (16:24)
• “The welderly... over age 85... don’t have different polygenic risk... it's not deterministic. These people are... thin, very physically active, socially engaged... they have a sunny disposition.” — Topol (17:32)
• “It’s a really tough mission... books like Peter Attia’s Outlive... have a lot of things that are completely off the rails and they are extremely popular, having sold over 2 million... copies.” — Topol (19:32)
• “We can't get people to control their blood pressure. But there's all these people following all this other stuff.” — Krumholz (28:51)
• “I refuse to have a derangement syndrome. You know, I just can't, I can't handle it. I’d rather try to find whatever positive out there...” — Topol (31:14)
• “We will never get [to Level 5 AI autonomy]... I hope it doesn't go there. Because the human touch... there isn't anything more essential in medical [practice].” — Topol (34:13)
• “No human being is fit to go to Mars. ... Maybe they could find a gene that’s Mars selective that could get you there.” — Topol, light-heartedly on space travel hype (34:18)

Segment Timestamps

• 00:18–01:09 — Intro, Eric Topol’s return, introduction of Super Agers
• 02:03–03:43 — Genetics vs. immune system; monitoring and measuring immune health
• 04:38–11:13 — Practical advice: exercise, diet, sleep, & the challenge of general recommendations; "partitioning risk" and individualized prevention
• 11:13–15:28 — Polygenic risk scores: what they are, how to get them, potential in preventive medicine
• 15:28–18:28 — Reconciling genes vs. lifestyle; Wellderly Study findings
• 19:32–20:43 — The evidence-based approach vs. popular, non-scientific health advice
• 22:16–24:51 — Evolution and interconnection of Topol's books, forecasting future medicine
• 25:44–28:08 — Debunking protein fads, rapamycin, leucine, and modern influencer-driven trends
• 28:08–30:08 — Ultra-processed food obsession and the challenge of countering influencers
• 30:08–31:48 — Coping with the public health misinformation crisis
• 31:48–33:29 — AI and the limits of total automation in medicine
• 34:13–34:53 — Human touch in medicine & tongue-in-cheek Mars comments
• 35:04–36:32 — Outro, thanks, and recommendations for listeners

Tone & Takeaways

The episode is dynamic and intellectually invigorating, blending cutting-edge science with humor and humility. Topol and the hosts are frank about frustrations in public health, cautious about rapid adoption of unvalidated trends, but optimistic about the growing toolkit for genuine, evidence-based healthy aging. Listeners are left inspired to look beyond fads, consider personalized prevention, and stay hopeful—and grounded—amid the noise. The science, they remind, is solid and ultimately will win out.