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This is an iHeart podcast. Guaranteed Human.
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On this episode of Newts World, 95% of Americans over 60 have at least one chronic disease, and almost as many have two chronic killers. Diabetes, obesity, heart disease, cancer, and neurodegeneration are all diseases that need treatments to begin long before middle age. In 30 years, we'll have five times as many people at least 100 years old, and they will be healthier than ever because of new medical breakthroughs. In his new book, An Evidence Based approach to longevity, Dr. Eric Topol provides a detailed guide to a revolution transforming human longevity. And let me say, I have been through several briefings and meetings over the years that Dr. Topol is one of the most brilliant, extraordinary people I've ever had the privilege of learning from. And I'm thrilled that he's here. His unprecedented evidence based guide is about how you and your family and friends can benefit from new treatments coming available at a faster rate than ever. From his unique position as a leader overseeing millions in research funding, Dr. Topol also explains the fundamental reasons, from semaglutides to artificial intelligence, that we can be confident these breakthroughs will continue. I'm really pleased to welcome my guest, Dr. Eric Topol. He is the executive vice president and a professor of molecular medicine at Scripps Research, the largest nonprofit biomedical institute in the United States. He is also founder and director of the Scripps Research Translational Institute and a practicing cardiologist. He is one of the top 10 most cited researchers in medicine. Known for his groundbreaking studies on AI in medicine, genomics, and digitized clinical trials. He was named to the Time 100 list of the most influential people in health in 2024. Doctor Topol, thank you very much for joining us.
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Oh, thank you. It's wonderful to be with you and to have a chance to have another conversation.
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Well, in superagers, you expand the definition of healthy lifestyle into what you call lifestyle plus. Why is this broader approach factoring in things like pollution, loneliness, posture, and even social connection so important to living longer and better?
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Right. So we have been traditionally just thinking of diet, exercise, and in more recent years, sleep health as the big lifestyle factors. But we've learned so much about these other layers of data and factors. As you mentioned, the environmental burden of air pollution, microplastics and nanoplastics, the forever chemicals, the consumption of ultra processed foods. But the good things about social interactions, avoiding isolation, being out in nature. I mean, there's so many different things now that add to the mix. And that's why I try to come up with a term to encompass it all, because lifestyle factors was the best one I could come up with and they are really important as part of our path to prevention. We are in a position now to prevent the three major age related diseases, cancer, cardiovascular, neurodegenerative. We've never been able to do that. It's been a fantasy for millennia in medicine. But we now, not just because of the lifestyle factors that we understand as at a much more granular level, but because of other ways that we'll be discussing. This is a really propitious moment in medicine.
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Now you suggest, and I found this fascinating, that the idea of a one size fits all healthy diet is fundamentally flawed. Why is it flawed and should we be looking at a more personalized focus on nutrition?
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Well, everything about us is unique. I mean, even identical twins are unique. So the fact that we would prescribe a diet or anything for all people is really a miscue. So there is a lot of work being done right now for this whole concept of personalized nutrition for certain foods that are really exacerbating the health of people because of promoting inflammation, whereas others, it doesn't have that effect. So in the years ahead, a lot is being done to understand what is the best diet at the individual level.
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I've recently been going through a series of briefings on the whole concept of making America healthy again. And they keep talking about ultra processed food. And you make a case that clearly ultra processed food has a huge impact on cardiovascular and metabolic diseases. I'm absolutely fascinated by the degree to which ultra processed food is a major problem.
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It is. And the United States is the worst offender in the world. The problem here is that we have allowed big food to spike their foods with all sorts of things that are alien. If you look at the ingredients on packages, you'll see things you'll never seen before that aren't in our kitchen. And it turns out whether it's to promote texture, whether it's to give a rush of the food that it's absorbed more quickly, these are things that are in a classification. There's a classification called Nova Nova 4. These are things that are really promoting inflammation throughout the body and in the brain and it's really bringing on a much higher risk of these age related diseases. So we have to get our arms around this and very little has been done because the food industry of course, is opposed to it. What's really interesting is that when people are taking these GLP1 drugs like ozempic and Mounjaro, it changes their reward circuits and they eat less ultra processed foods, they shift to healthy food. It's amazing. You know, it isn't just losing weight, it isn't just about less inflammation in their body and their brain, but they actually somehow or other they don't get rewarded like they did previously by these, I would say, contaminated or alien foods that are really bad for our health.
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I've really gotten into this recently. I've been sort of startled because you talk about that Big Food spends so much on lobbying and such a huge impact that it has been able to basically block efforts to get nutrition in a serious way back into the core decisions of the government.
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Absolutely. You know, one of my colleagues in the UK was a great physician scientist named Chris Von Teliken. He wrote a book called Ultra Processed People. And in that book he did an experiment on himself which is representative. I mean, he's a healthy guy who is not overweight. For 30 days he took as much ultra processed food as he could. Before he started, he took a brain scan and all these blood tests for inflammation. And by 30 days his brain structures showed marked inflammation. All his blood tests did and he gained 20 pounds. So this is a huge problem in this country because we are way out in front of the rest of the world on our consumption of ultra processed foods. And that's going to really impede our ability to, to prevent diseases. I mean, we have a path now to do that. But the fact that our food supply is so poor, particularly its consumption of these foods, because they're made to help people want to eat more of them, not be satiated. And so we have to do something about it.
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I've been sort of thinking this may be goofy, that you almost need to have an N factor for nutrition because the same tomato, depending on where it's grown, can be radically different in how much nutrition it has. And there has to be some way for an average normal person, in the same way you could pick up a package and look at calories, you ought to be able to see, you know, is this 100% nutrition or 20% or 10%? Because a lot of the stuff that we buy that's inexpensive is mass produced in a way that actually makes it less healthy.
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That's right. I mean, I think if we stick to fruits and vegetables, whole grains, there was a really big study of over 105,000 people followed for 30 years, and only 9% of them made it to this superager status without the age related diseases. And what did they eat? They ate this diet, you know, Mediterranean like diet low in red meat, not necessarily, you know, absent, but mainly concentrating on a plant based diet. That is what correlated with their ability. Adjusting for all other factors of how they could go to their 70 age, 75, and not have these diseases.
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You bring a lifetime of study, and I really regard you as one of the leading students of human health. What are the practical steps listeners to this podcast could take to ensure healthy aging?
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Yeah, so it isn't just the lifestyle factors as we've been discussing, you know, and ways to improve deep sleep because that gets reduced during our aging as we get older, and exercise being paramount and not just aerobic, but, you know, resistance, strength, core exercise, balance, you know, posture, all that. But what we really need to do is to define the risk of people because we have 20 years before any of these diseases actually take hold in our body and show up. So with 20 years and inflammation being the common thread, we have a way, partly using lifestyle factors. But first we have to identify, so we have to say, what, if any, disease are you at risk for in your 40s and 50s, ideally, and then how are we going to prevent that from ever occurring in your lifetime? We have a way to do that now because what's happened, you know, there's this amazing science of aging progress. Some of it, of course, is being directed to the private sector startup companies to try to reverse aging. Now that's exciting, but we're not there yet. We're good at that in mice, but not in people. Right. And it carries risk. The other part of the science of aging, which is extraordinary, that most people don't know about, are these clocks, organ clocks. So, like, if I could draw a tube of your blood, I could say, you know what, I got eight organs I'm tracking and your immune system from these plasma proteins. Up to 11,000 plasma proteins in your body. And I can say, you know, you check out. Well, all your clocks are at your real age, your chronologic age or one of them. Let's say your heart is out of sync and it's accelerating its pace of aging. That gives me a clue as to what I need to zoom in on and find out, are you at risk for, let's say heart disease and get all over it long before you ever would have a significant artery problem. So this is the capability we have right now. We have markers for Alzheimer's that show up more than 20 years before a person would have mild cognitive impairment. We have a capability now to really make a huge dent in these big three age related diseases and we're not taking advantage of it.
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One of the points you make is that strength training is really important at a level you had not understood before. Tell us about that.
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Yeah. So what's interesting, as a cardiologist, I was always big on only aerobic. And when I had patients come in with these big beach muscles, I'd say, well, wait a minute now. What about the aerobic exercise? Well, it turns out strength training is equally important, and its association with healthy aging is vital. As we get older, we lose muscle mass, and we also have a propensity for falls, and this is not good for longevity, particularly healthy aging. So now the data show unequivocally that we should be doing some resistance strength training, at least a couple of sessions a week. And that is a really important part of the story to promote healthy aging.
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One of the things you talk about is the importance of deep sleep. I have sleep apnea, so I actually use a CPAP machine, and I've been sort of surprised that the machine has trained me. So I actually go to sleep faster with my machine than I would if I were, say, in a hotel and did not have it with me. And presumably, it's really helpful over the long run. I can report now as a witness that it seems to have a very positive effect.
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Yeah. So there's two things there that's really important. First, there is a lot of sleep apnea that needs to be treated, and a lot of people aren't aware of that. But secondly, even if you are not having these spells of slowed or stopping breathing, there's another part of the deep sleep, so that during our sleep, particularly in the early part of the night, we need to slow wave sleep, because it's during that where we clear our metabolites from our brain, our waste products, through a system that we now know of as glymphatics. Not lymphatics, but glymphatics. And so these glymphatics, these channels in our brain, they basically get rid of all this toxic waste on a nightly basis. Now, what's amazing is we've learned now that drugs like Ambien, you may feel like you slept, but as it turns out, it actually backs up these metabolites, it prevents them from getting out of the brain. This is one of the biggest risk factors for Alzheimer's disease. So what we have to do is if we knew somebody had a risk for that, which we could know decades in advance, we would really work on their sleep. In fact, everyone should, because as we get older, our deep sleep could get down to just single digit minutes, which is really bad. And we want to get it up to as high as we can, ideally close to an hour. People 70 and older. And so with tracking it, that is, you can use a ring or a smartwatch. You can find out exactly how many minutes each night you're getting in deep sleep. It's pretty accurate. And then you can work on it. Like what is it that you're doing in exercise or lack of it, what is it you're eating, how late in the evening are you eating? How do you handle stress? All these things will affect it. And one of the biggest things is regularity of sleep. Our body wants to go to sleep at the same time every night, but we don't let it. And sleep regularity has a bad big association with all three of the age related diseases.
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We've noticed that we tend to go to bed earlier than we used to and I think it's probably helped us. I notice you have a ring on your finger. Do you believe in wearables and are they helpful?
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I am using this aura ring. There are several other rings like this. But what I found with it, it helped me quite a bit to get deep sleep, more deep sleep. So basically I have a smartwatch and a Oura ring and I wear them every night. Just because now I'm tracking how many minutes of deep sleep, knowing how important that is to prevent Alzheimer's, which is something I don't want to get. I was a poor sleeper. I started with less than 15 minutes a night. And just by learning about all these things like sleep regularity, like the interactions with what I was eating when I was eating, what exercise when I was exercising, all these things, I was able to get it up to over 45 minutes a night on average. For me at least, it has helped. And I think this is something that people should think about, particularly as we get older, because that's when the deep sleep becomes a big issue. We want to get that stuff out of our brain, those waste products. And the only way we can do it is with these glymphatics during deep sleep. That is the restoration of sleep, the magic that we need. You know, you could sleep maybe just six hours or even less, but if you have 45 minutes to an hour of deep sleep, that's golden.
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From a mental health standpoint, just having 30 minutes a week in outdoor green spaces leads to lower rates of depression and less high blood pressure.
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It's true. That is. The data for being out in nature is striking. I was not aware of this until I went in deep on this research and reviewed all the papers. I was really struck by it. And now we're talking about nature prescriptions for patients. We never talked about that. This is another part of that, lifestyle factors that we have to acknowledge that it's really great when you're with other people. That's even a double benefit because social interactions and being out in nature are quite important.
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This reminds me, we currently have a sick care system when what we actually want is a health care system. That simple break point. This is a good example. If I can get you to go out for 30 minutes or more a week, and that actually lowers the likelihood of depression as opposed to taking a drug for it. Some of the stuff you've put together is, I assume it's all true, but it sure is astonishing.
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Well, I'll tell you another thing related to that which is astonishing. There's a graph in the book and also the text associated with it. There's a study so striking on people with depression taking these SSRI drugs, which are pervasive, like Prozac and all the others. And every form of exercise was better than the drugs, whether it's dancing or walking or, you name it, was better than the drugs for reducing depression.
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So a doctor who prescribed physical activity as opposed to giving you a drug.
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It's such an extraordinary study. And now one of the biggest things, though, it isn't that we don't know about these lifestyle factors, but we in the U.S. you know, we're great with technology. We're a leader, world leader in AI. And what we want to do instead of trying to treat diseases is truly prevent them. We couldn't do that before. We couldn't do it. But now the combination of lifestyle factors with AI, you know, we couldn't do this without AI. You have to assemble billions of data points on each person to say, this is your risk and this is what we're going to do about it. And so it isn't just the lifestyle factors. We got to use all the layers of data, the AI, to give us the accurate and temporal. So used to be, let's say you did a gene sequence and you say, oh, you're at risk for Alzheimer's disease. Well, we didn't know from that whether it was at age 98 or 68. Now we can pinpoint the time, not just the risk, and it's very precise. So the whole idea is that we're in a different time right now, when prevention, which is so attractive for its potential right now we need to go after this and we're the perfect place to lead the way.
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I'm a big believer that artificial intelligence is going to empower us both in efficiency and in the ability to aggregate huge volumes of data and pinpoint things that you just literally couldn't have done before. How do you see that getting applied to the system?
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Right, so what we want to do now is to prove that when you have all these layers of data, obvious things like the electronic health record, all the labs and whatever scans AI can pick up, things that we never see, for example, normal labs, you've had normal labs throughout your life. But it sees trends. We just look, is it normal or not? But these so called set points for you, then we add things like I polygenic risk score, which we have that for all common diseases, the common cancers, heart disease, Alzheimer's. So we have that and then we have these clocks, body wide clock, it's called a methylation epigenetic clock. We have organ clocks, we have all these biomarkers, proteins, all these are inexpensive. When you put it all together along with a person's current lifestyle, you can say this is your risk, whether it's a particular type of cancer, heart disease or neurodegenerative. And that's what we're not doing. We're not doing these. Well, before a person ever has a disease, for example, the marker for Alzheimer's, it's called P Tau217, that has been available in the US for two years. Nobody knows about it, but it's as good as a cerebrospinal fluid assessment. It's as good as a PET scan. And this marker is lowered by exercise and by healthy lifestyle. So it's like an LDL cholesterol for heart disease. So why aren't we using this? Why aren't we preventing Alzheimer's? You know very well how much it costs to care for a person with Alzheimer's. Who would want to get that dreaded disease? And that's why lifespan is not what we're after. It's healthspan free of these diseases. We can do this, but we're not, we haven't set our minds yet and our priorities, our resources to do it. And we have the tools and the immune system is the common thread. And we now have an immune system clock that we can use. So why aren't we doing this? That's really what the book is about, reviewing the lifestyle factors, but providing a blueprint for how we can change the face of what we call the elderly that you Started with how many people are sick to the elderly, which is the study we did of 1400 people with whole genomes, and we didn't find anything. These people, it's not their genes that are doing this, it's their lifestyle, their immune system, not in their DNA. For the most part.
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You make the comment in your book that we're stuck in the 1960s in our approach to cancer, but that's true almost across the board. I mean, we have somehow culturally, in the medical professions, financially, in these big companies, including the insurance companies and the hospitals, we have gotten locked into a model which we objectively now know makes you less likely to live longer and less likely to be healthy. How do we get the transference to get the average doctor to decide they can offer you a prescription to go exercise instead of giving you an antidepressant? That's a revolution that will be culturally very challenging.
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It will be because we have such reliance on antidepressant medications that don't work very well and can be superseded by things like exercise. But I think the bigger problem, and you allude to this with the cancer, you know, this reactive rut that we're in, we screen for cancer based on only age. You know, so if you're a woman, age 40 or 45, you're supposed to have mammograms on a frequent basis. Well, 88% of women, 88% will never have breast cancer in their lifetime. Why do we put all these women through all the waste? You know, we can determine a person's risk and partition the screening, but we don't do it. We have so much more knowledge that we are implementing in the daily practice of medicine. How is that going to change if we don't really articulate the priorities, the opportunities, and make for the compelling evidence so the whole medical community, all the clinicians buy into it and change their practice.
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You are extraordinarily knowledgeable. Ten years from now this has happened. How did it happen?
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Yeah, it could happen if we said, you know what, we're going to be the world leader in preventing the big three age related diseases. That is what accounts for our health. Spanish limits. And this is how we're going to do it. And our investment in prevention is going to be so extraordinary compared to where we are today. We're going to make this accessible to all that is this risk assessment. And we're not going to do it on stupid grounds of just age. It's not about age only. There's other things here and we're going to have A systematic assessment of people as part of their annual checkup to prevent diseases. And when we discover that a person does have a high risk for one of these three age related diseases, we're going into high prevent mode. We're going to pull out all the stops. We're going to work with the person on their lifestyle. The excitement regarding these drugs like Ozempic is not just because they have such remarkable weight loss. They have potent anti inflammatory effects in the brain and in the body. And they're being tested in Alzheimer's, in thin people, large trials. And there are so many other drugs that are coming in the pipeline. These gut hormones that talk to our immune system and our brain that are going to be in pills, not just injectables. So it'll be inexpensive. We're going to be having ways to modulate our immune system like a rheostat. And if we can do that, that's how we prevent these diseases. And we get all these super agers. We want to have super agers. We don't want to have people like we have today which are just so much chronic disease. I mean, there's an article in today's Wall Street Journal about how we're the outlier of chronic diseases among all the rich countries in the world.
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That seems to be a combination of our cultural behaviors on things like big food and the degree to which we've talked ourselves out of being an active country physically and we have undervalued the importance of being outdoors.
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Those things are absolutely true. But we also want to adopt a new strategy that is getting ahead of people. When you think that we have 20 plus years before these three diseases strikes, that gives us an amazing Runway to work with. But we're not using it. We're just, oh well, the person had a heart attack. So we're going to really get on their LDL cholesterol. The person has cancer, we're going to treat it and hope for a remission. That's not when we want to get all over it, we want to just prevent these from happening. We couldn't do it before, frankly, but we sure can now.
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You talk as an example of all this about the breakthrough that the 2024 Nobel Prize in chemistry sort of outlined and really dramatically changing things. As a person who doesn't have nearly your knowledge, could you explain to me why it was such a big deal and what it means?
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Yeah. So the work by Demis Hassabis, John Jumper at DeepMind, they basically figured out that we could predict at atomic resolution the structure 3D of essentially all proteins in the universe, but hundreds of millions of them. And that used a type of AI transformer AI, now known as large language models, generative AI. And it was a huge breakthrough because it started with protein structure and now everybody's jumped on that to, you name it, antibodies, small molecules, rna. There's now models for all this. So what that's doing is accelerating drug discovery. And of course, you know, throughout the world, there's now so many different efforts to bring drugs to that will help prevent these diseases. And that's why Demis, who won that Nobel Prize, said recently on 60 Minutes that he thinks that we could eliminate these diseases in the next decade. I'm not quite as optimistic, I can say, because we don't change easily. You know, we are very kind of sclerotic in our medical community. I'm representing the medical community here, and I know it takes much longer than it should to affect. Affect the change. But I do share the optimism.
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It's really interesting. I just got a briefing this last week for about two hours on the whole concept of making America healthy again. And the parallelisms are eerie. And I think that the President and Secretary of Health and Human Services Kennedy are going to do a joint event maybe next Thursday and lay out that you have to have this fundamental revolution and how we think about it and that if we do it right, we actually dramatically lower the cost of sick care because people just stay healthy. Frankly, one of the biggest fights they're gonna have is Big Food. I mean, Big Food is gonna go nuts at the idea that we're gonna try to transition the country off of ultra processed food.
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Absolutely. We've never tackled them. It's just incredible, really. And you know what? If we provided incentives for people to do these healthy lifestyle things and we just promoted that like we've never done. You know, that's not been something and it's a great opportunity. And I'm glad, of course, that that's a goal now. I hope that Big Food will be put in their proper place.
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No, I think this will be one of the great historic fights. This will be comparable to taking on the railroads in the 1890s or Standard Oil or IBM or AT&T. As I think about this, you know, you could in fact have. This is just blue sky, but you could have, for example, an annual tax credit. If in fact you had a health score for every person who avoids Alzheimer's, the amount we save would be staggering. So you could, over time bend the curve by creating incentives for health rather than just payments for sickness. And I think if you said to people, I'm going to minimize your risk of heart disease, minimize your risk of cancer and minimize your risk of Alzheimer's. But that means this program, you might have astonishing uptake.
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We should be getting on it because, you know, these are easy to track. You don't have to be a spartan athlete, just go for a walk. But if you do these things and you work on sleep health and you have a healthy diet, I review this in the book. You can get seven to ten years of healthy aging without these three age related diseases. Just that it's extraordinary. And so to prevent these diseases at the individual level and at the American population level, that should be objective number one.
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And I think in that sense making clear that we are now for the first time going to create a health care system, not a sick care system. That could become a very, very exciting effort that I think would attract an amazing amount of attention.
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A
I'm excited about it. I'm brimming with optimism about what the opportunities are right now. Knowing you, you'll potentially help to make it, actualize it to a reality.
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B
Your book is coming out at, I think, an amazingly almost miraculous moment. I think because you're providing a scientific basis, a lifetime of investment. And it's pretty hard for people not to say that you are a serious person with a serious understanding that this is real. This is not just rhetoric. I hope we can work together on some of these things. I think we could be right at the edge of an extraordinary revolution that moves us decisively towards being a much healthier country with much longer lives and as a consequence, a much less expensive health system.
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You nailed it. I hope we can seize the opportunity, really.
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B
Look, Eric, I want to thank you for joining me. As I said at the beginning, every time I'm with you, it is an exhilarating experience. You are a remarkable person. Your new book, Super An Evidence Based Approach to Longevity, is available now on Amazon and in bookstores everywhere. And it's a very important book. I recommend everyone get a copy, read it, and then apply it to your life. It's not just a book to be read and say less interesting. It's a book to be read and say, wow. It's a cookbook for living longer and healthier. For listeners who want to follow your regular work, they can subscribe to your newsletter, Ground Truths on Substack. And I really appreciate you being with me today.
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A
I've enjoyed the conversation immensely. Thank you.
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B
Thank you to my guest, Dr. Eric Topol you can get a link to buy his new book, Super An Evidence Based Approach to Longevity on our show page@newtsworld.com Newts World is produced by Gingrich360 and iHeartMedia. Our executive producer is Garnzi Sloan. Our researcher is Rachel Peterson. The artwork for the show was created by Steve Penley. Special thanks to the team at Gingrich360. If you've been enjoying new I hope you'll go to Apple Podcast and both rate us with five stars and give us a review so others can learn what it's all about. Right now, listeners of Newts World can sign up for my three free weekly columns at Gingrich360.com newsletter I'm Newt Gingrich. This is Newts World.
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This is an I heart podcast. Guaranteed human.