Dr. Eric Topol (2:20)

It drives me nuts. It's things that we have validation with all kinds of great studies and the highest level peer review liter literature could take years before it gets to implementation.

Manoush Zamorodi (2:32)

This is Dr. Eric Topol.

Dr. Eric Topol (2:34)

I am a cardiologist, the author of Superagers and I'm a professor and executive vice president at Scripps Research.

Manoush Zamorodi (2:43)

Eric is an expert on the best ways to expand not just our lifespan or how long we actually live, but our health span.

Dr. Eric Topol (2:53)

A lot of this longevity fixation is related to lifespan rather than Health span, healthy aging. The average American health span is 64. That's when major diseases creep in and lifespan is 79 on average. So you've got a big gap of about 15 years where your health span has ended and your lifespan continues.

Manoush Zamorodi (3:19)

In some ways, Eric's career has been driven by his own personal obsession with the idea that through science and medicine, we can change our aging destiny.

Dr. Eric Topol (3:29)

I grew up with so many of my family members dying at very young ages. My grandparents and aunts and uncles. I spent a lot of time when I was a kid going to funerals. And, you know, my parents also died at a young ages. So I feel, well, I'm condemned. You know, I'm gonna. I'm gonna be signing out anytime here. So part of it was just understanding our fate, if you will. Part of it is also to shed some light on a field that's had lots of confusion and this equivalence of health span with lifespan, which is so different that, you know, we need to really compartmentalize these and understand that what drives them are altogether different.

Manoush Zamorodi (4:10)

Long before he made a breakthrough discovery in the science of healthy aging. We'll get to that in a minute. He was a curious college student, sure that people's genes held the answer to how long they would live.

Dr. Eric Topol (4:23)

I always was fascinated by genetics, and I basically set up a major in genetics and wrote a thesis in 1975 called Prospects for Gene Therapy in Man. Long before we could sequence genes, of course, that was about 40 years early, I think, but it was more like understanding what makes us tick. And I was working as a respiratory technician, night shift, and I saw. While I was in the intensive care unit changing the equipment, it was like a Lazarus. These patients. I was thinking the next day I would. They wouldn't be there, and then all of a sudden, they would come back to life on their way to full recovery. That prompted me to change my plan of going on to be someday a genetics professor of sorts to, oh, maybe I should just be a doctor and change into medicine.

Manoush Zamorodi (5:16)

So it's interesting then, that some of your most recent research is actually saying genes. We thought you were super important when it comes to aging. Actually, not so much.

Dr. Eric Topol (5:30)

Yeah, that was a real shocker. So many years ago, we started a unique project of finding people who were at least 80 years old, who'd never been sick and on no medications. This is a rarefied group. But the whole idea was there'd been so little work on the genetics of healthspan, there'd been a fair amount to look at. Some genetics of people who were centenarians with extreme lifespan. But that's different from people who never had an age related disease.

Manoush Zamorodi (6:02)

Eric and his team called this group of super aging healthy anomalies over the age of 80 the welderly.

Dr. Eric Topol (6:09)

It took seven years to find 1400 participants. And then once we had them all together, we did whole genome sequencing to look for what was the genomic underpinnings to see if they were different than the people who are we call the elderly.

Manoush Zamorodi (6:28)

That's ilderly the people most of us who typically have at least one major age related illness by age 65. Eric and the Scripps research team looked for the longevity secrets in the DNA of welderly superagers. And what they found changed everything they thought they knew about how humans age.

Dr. Eric Topol (6:50)

The stunning result was while there were some small differences, otherwise there was not much to be able to say this was a genetic story at all. So this was either due to luck, which seems that's far fetched to say all these people were so lucky, or something else. And I think the something else is what we've learned so much about in the last couple of years. Especially that the immune system of people, when it's intact, really helps to withstand these major age related diseases. So although that has some connect with our genetics and our DNA, it's also highly influenced by our lifestyle choices and our environment and so many other factors.

Manoush Zamorodi (7:38)

So we want those last few decades of our lives not to be infirm or lonely or in pain. We want to feel vibrant and part of the world and enjoy ourselves. So you have said that the real opportunity now isn't just helping people live longer, but preventing those big diseases that make aging hard, really awful. So the big three you say are Alzheimer's, heart disease and cancer.

Dr. Eric Topol (8:06)

Exactly. So a welderly or superager as we would define it now is somebody who's reached 80 and older and has never had a significant cardiovascular disease, a cancer or neurodegenerative disease. So they basically are intact of the big three age related diseases and that's not common, but that's what we should be achieving at a much higher frequency.

Manoush Zamorodi (8:33)

Eric says there are five domains that help predict risk and prevent age related diseases. The first he calls lifestyle plus.

Dr. Eric Topol (8:42)

So the lifestyle one we've learned a lot more about like for example, sleep regularity being so important and deep sleep when our brain washes out all of its metabolites that are really pro inflammatory toxic to our brain. That's why deep sleep is so important. And exercise not just Aerobic, but also strength resistance training and balance training. And we've learned also how social engagement is so critical, being out in nature and you know, many, many different lifestyle factors which we didn't realize how important they are.

Manoush Zamorodi (9:17)

The next area to focus on in prevention is what Eric calls omics.

Dr. Eric Topol (9:22)

Now omics refers to the biologic layers. We're talking about genes, DNA, our so called polygenic risk score because these diseases we've been talking about are not from one gene but from hundreds of different genes that can interact, but also our proteins. There's big breakthroughs in proteins. Now we have these organ clocks where we can tell the pace of each organ in our body from our brain, our immune system, artery, heart, liver, and on and on. And then there's these biomarkers. We have this big, big breakthrough for Alzheimer's to be able to predict even 20 or more years in advance, so called P Tau217. So omics are proteins and genes and the microbiome of our gut and the side chains of our DNA called methylation, those are omics.

Manoush Zamorodi (10:15)

Then there's our cellular health.

Dr. Eric Topol (10:18)

This is a big area because we're going to be using cell therapy for lots of things like autoimmune disease. We've seen cures potentially for people with refractory lupus and multiple sclerosis and many autoimmune diseases which was unfathomable until recent times. Using cell therapy, not just take cells out of the body, but working with lymphocytes that are in the body next

Manoush Zamorodi (10:45)

to be a superager. Eric says we need vaccines and drugs to help treat aging's biggest culprit, inflammation.

Dr. Eric Topol (10:54)

Vaccines and drugs that basically keep our immune system healthy and are potent anti inflammatories. We've seen a remarkable class of drugs, the Ozempic GLP1 drugs that have that property.

Manoush Zamorodi (11:08)

Finally, to tie all that bio data together, you guessed it, artificial intelligence.

Dr. Eric Topol (11:15)

We couldn't pull all these data together in any individual without multimodal AI. It's billions and billions of data points for each person. We couldn't think of being able to prevent these diseases without the help of the tools of AI for the analytics. So those are the five domains. They're all going to be part of our ability to predict a person's risk and prevent their age related disease in the future.

Manoush Zamorodi (11:45)

So can you explain how inflammation relates to that? Because I think a lot of us have been hearing that word. Women's magazines for years eat a low inflammatory diet, blueberries and almonds, and we think okay, yes, I will do that. But what exactly is inflammation?

Dr. Eric Topol (12:01)

Yeah. So when our immune system, which is all of our cells and proteins that fight off not just infections, but keep us from getting cancer and heart disease and neurodegenerative diseases, our immune system starts to lose its integrity as we get older. And it's the process of immunosenescence. And then interdependent with that is inflammaging. Okay. So it's inflammation with aging. And so when the immune system is dysregulated, when it's just getting off the rails, it starts to go haywire and makes a lot of these proteins that are basically untoward inflammation, whether it's in the brain or throughout the body, in the walls of arteries. And this is what causes so much trouble. So some inflammation is good and important for healing, but inflammation is really accelerating and making these age related diseases take hold.

Manoush Zamorodi (13:04)

When we come back, Dr. Eric Topol explains why AI has changed the way he thinks about preventive care and how our modern medical advances could give us all a shot at being superagers. You're listening to the TED RADIO Hour from npr. I'm Anoush Zamorodi. We'll be right back.

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Manoush Zamorodi (14:54)

It's the TED RADIO hour from npr, I'm Minouche Zamaroti. Today on the show how to Become a superager. When Dr. Eric Topol studied the DNA of healthy people over 80 years old, so called superagers, he expected to see something in their genes that was protecting them from major age related diseases. Instead, he found that genes had a pretty minimal effect. It was lifestyle choices and preventive measures that extended their health span. Because of course, a long life is great, but not if you're miserable and suffering.

Dr. Eric Topol (15:33)

We can accept that we're going to age, okay, so maybe there'll be reversal of aging someday, but that's a little more far fetched. But we don't have to accept that we are going to have these age related big three diseases, heart disease and cancer or neurodegenerative diseases. And so that's where the opportunity lies that there's so much going on right now that with 20 years advance warning of these conditions in individuals, determining that risk, predicting it, we should be able to get ahead of it and make a big dent in these big three age related diseases.

Manoush Zamorodi (16:13)

So does that mean that essentially as you age, keeping your immune system in good shape is the whole game?

Dr. Eric Topol (16:21)

That's a real big part of it. What we eat is a part of that story. How we exercise, how we sleep, how we have social engagement, a long list of lifestyle plus factors. But also we've only learned in recent times that there are other ways to keep that immune system intact. And one of the big surprises was, for example, the shingles vaccine we didn't know. And now with four huge natural experiments in four different countries around the world, in Wales, in Canada, Australia and the US We've learned that the shingles vaccine reduces Alzheimer's and dementia by at least 20 to 25%.

Manoush Zamorodi (17:04)

Oh, wow.

Dr. Eric Topol (17:05)

And it isn't because it's working against the virus herpes zoster so much as it's keeping the immune system intact because people that get the vaccine are older people. In the US it's age 50. In other countries it's even older. But that's just one new trick we've learned. And now, you know, that's a segue to many other tactics we'll use in the future to keep people's immune system intact.

Manoush Zamorodi (17:33)

So I recently got my first shingles shot and it certainly was not touted to me as preventive medicine for anything other than getting shingles, which I'm told is very painful and just awful. Why is this not more public knowledge that there is more information out there about the added benefits of vaccines and other preventive medicines.

Dr. Eric Topol (17:58)

This is so startling. If this was a drug to reduce Alzheimer's disease, it would be a blockbuster. Everyone would know about it because the pharma companies would be all over it. But because it's a vaccine and we live in an anti vaxx moment, and this wasn't expected. This was a surprise. It's not just been replicated, but now four different, what we call natural experiments, which are better than even randomized trials in many respects. So I don't think the word is out there. I've been trying to help get it out, but there hasn't been enough work to disseminate these very important findings. And it isn't just going to be this vaccine. We're going to have lots of other ways to improve the immune system. So, for example, very recently we learned about the importance of the thymus gland. And the thymus gland, which is.

Manoush Zamorodi (18:51)

I don't even remember what that is.

Dr. Eric Topol (18:52)

Can you remember? The medical world has forgotten it's existed as well. Yeah. Because your thymus gland is pretty big and functional when you're a child, but as you become a teenager and to adulthood, it was thought that it becomes just fatty tissue and a functional.

Manoush Zamorodi (19:10)

Wait, where is it and what does it do?

Dr. Eric Topol (19:11)

Well, it's under the sternum and the chest bone. But what we've learned, I mean, this was amazing. So researchers at Harvard, Hugo Ehertz and his colleagues, they used AI to define the thymus, quantify its health in adults. You know, average age in their late 50s, in 25,000 plus people who are followed many, many years from a chest CT scan, they could quantify the thymus health and the people who had good thymus health, that it wasn't just fatty tissue and wasn't a functional. They had incredibly improved survival. The lack of cancer, they had lack of cardiovascular disease. They had all the benefits that we saw of superagers. Right. So this is another remarkable discovery that reinforces how our immune system, which of course connects with inflammation, how that is so fundamental to healthy aging. This, to me is a landmark series of reports. It also showed through a separate paper that if you're going to get cancer treatment, if you have a healthy thymus as an adult, your chance of recovery or lack of remission is much, much higher. And here again, we thought the thymus gland was doing nothing in adults and it's doing a lot in some people.

Manoush Zamorodi (20:34)

So now I'm thinking, of course, tell me how to protect my thymus. Something that did not occur to me to ask until this very moment.

Dr. Eric Topol (20:40)

Great question. There's lots of things being considered about how we could keep our thymus healthy. But the things we talked about that work on our immune system in general. Exercise, a diet that's anti inflammatory, good sleep health. These things probably do help keep our thymus in a healthy state, but we need to do more than that. So there are various new studies in recent times that certain growth Factors, one's called FGF21, and there's this incredible Mexican salamander that has the ability to keep their thymus and regenerate it even after you surgically remove it. We're learning about the pathways from that organism, but we don't know enough about thymus health now that there's been this really remarkable discovery about its importance as we get older.

Manoush Zamorodi (21:37)

Well, I'm going to take this opportunity, Dr. Topol, to ask you about technology and mammograms. So every woman is told they should start getting mammograms. I believe it's after the age of 40. And recently I went and they said, do you want to spend an extra $40 to get an AI screen? And I was like, okay, sure. I don't really know what that is. They said it will find things more carefully. Here's the $40. Did I make the right decision?

Dr. Eric Topol (22:06)

Well, I'd say yes and no. Firstly, I don't believe they should charge patients to get the AI read. But that read does give a higher detection rate. About 30% more breast cancers are picked up from the AI as compared to the radiologists. So that part's good information. But what really unnerves me is there are other two types of AI tools that should be incorporated as well, again without charging patients. And that is the AI of the normal mammogram to detect the risk in the next three to five years. And then also the AI of the breast artery calcification, because that quantifies the risk of heart disease in that person. So we are not using AI as we should. We shouldn't be charging patients, and we're only using the first of the three different types of AI to get the superhuman interpretation of the mammogram.

Manoush Zamorodi (23:07)

Hmm. I mean, my experience just makes me think, wow, AI is arriving in healthcare as an upsell before most of us even understand what it's capable of, what it does. So set the scene for us. What is the current moment that we are in when it comes to technology and healthcare? And where are we going?

Dr. Eric Topol (23:27)

Right. Well, the medical imaging is the most advanced part of medical AI, because it's been incubating and progressing for several years now. And so now for most medical images, whether it's an X ray, a mammogram, CAT scan, PET scans, whatever type of scan, and also things like the retina, the cardiogram, pathology slides, we now have very strong evidence that AI can interpret the image better than expert physicians, which is a big step forward for AI. So it enhances the accuracy. It doesn't mean that it shouldn't be reviewed by physicians, but it sees things that we can't see. Superhuman eyes, if you will. And so the problem is Minouche, we haven't leveraged that at all. And the only thing that, you know, barely we're getting at are things like just a piece of the mammogram and not having that appropriately embedded as part of the procedure, rather than putting a burden on patients for cost. And we're not doing it for most of the things that we know. It has remarkable capabilities for accuracy. So this is the area that has come along the most. But of course, it's been worked on for several years.

Manoush Zamorodi (24:51)

Dr. Eric Topol explains AI's potential from the TED state.

Dr. Eric Topol (24:56)

The thing that we don't talk much about are diagnostic medical errors. And according to the National Academy of Medicine, almost all of us will experience at least one in our lifetime. We know from a recent Johns Hopkins study that these errors have led to 800,000Americans dead or seriously disabled each year. So this is a big problem. The question is, can AI help us? This is a picture of the retina. This was the first major hint. Training 100,000 images with supervised learning. Could the machine see things that people couldn't see? And so the question was to the retinal experts, is this from a man or a woman? And the chance of getting it accurate was 50%. But the AI got it right, 97%. The ability for computer vision to pick up things that human eyes can't see is quite remarkable. Here's the retina picking up the control of diabetes and blood pressure, kidney disease, liver and gallbladder disease, the heart calcium score, which you would normally get through a scan of the heart. Alzheimer's disease before any clinical symptoms have been manifest. Predicting heart attacks and strokes, hyperlipidemia seven years before any symptoms of Parkinson's disease. To pick that up in the future, we'll be taking pictures of our retina as checkups. This is the gateway to almost every system in the body. Now, as a cardiologist, I love to read cardiograms. I've Been doing it for over 30 years, but I couldn't see these things.

Manoush Zamorodi (26:53)

In your talk that you gave this was in 2023, you explained the potential of retinal scans. This is a photograph of the back of your eye that apparently tells AI not just about your eye health, but your risk of all kinds of things. Is that happening now? How is a picture of your eye showing us whether we might be at risk for kidney disease or Parkinson's or a heart attack even?

Dr. Eric Topol (27:18)

Yes. What a great question, because again, we should be doing this. The retina is probably the richest image there is from our bodies because it's a gateway to virtually not just the brain, but to every part of our body, surprisingly. You know, things like the kidney, the liver, even things we never would have forecasted, but especially, you know, telling us about risk for Alzheimer's and Parkinson's and many other conditions. Heart disease, risk of stroke.

Manoush Zamorodi (27:50)

Wow.

Dr. Eric Topol (27:51)

So it turns out that's one area not in the United States, but in Hong Kong and in Asia, where they have started companies to provide that data from a retinal picture. So it isn't available here. Again, we're behind, but we're seeing now the output. So there's companies that are giving you your retina picture that you get from your eye doctor and telling you your risk of heart disease based on that, and also one that's giving risk of Alzheimer's disease. So it isn't here yet, but eventually it should be the norm. This is what we call opportunistic imaging, where there's so much in that image that we're leaving on the table. And AI can give us so much more. And it's just software, it's not any extra cost. So eventually we'll get there. You know, a kid that eventually will take selfies of our own retina and have an AI algorithm give us an output of like every part of our body, every condition that we might be at risk for if you want to get that information. But we're not there yet because right now we still rely on the kind of high quality retina images that you get from an eye doctor.

Manoush Zamorodi (29:09)

Do you have hope that there can be this transition from playing whack a mole with disease in terms of how we treat people and becoming more of a preventative, a more sort of resilient older population?

Dr. Eric Topol (29:25)

Yes, this is where I have the most excitement for the future of medicine and in particular the use of AI. I think in the years ahead, we will regard AI's most important contribution as facilitating prevention. Prevention, especially of these three age related diseases that we've been talking about because they are 80, 85% of the difference between health span and lifespan. So we are at a time when 20 years ahead or more we can tell a person, let's say they're age 50, not only are they at high risk for one of these diseases, but we can also tell them for the first time, when, not just if, then we can do all these things so that we changed what would be their natural history. And I am confident eventually we're going to have ways to prevent these big three age related diseases. And that's why, you know, we're starting very soon. The first prevention of Alzheimer's trial in 1200 people with very high risk of Alzheimer's because of their APOE4 genetics, their protein markers, P Tau 217, their family history, their polygenic risk. And we're going to test for the first time in this large scale study the lifestyle factors, the exercise, the sleep, the diet and stress in a coached group. Intensive coaching versus a group that just gets some educational material. And then after that we'll start looking at different drug candidates on top of lifestyle. Assuming that we show and validate that that makes a difference in these markers like the brain aging clock and The P Tau217, which are really reliable ways to project the arc of a person's Alzheimer's risk. So we're in a new day.

Manoush Zamorodi (31:23)

What will the coached people get? I'm curious.

Dr. Eric Topol (31:25)

Oh yeah, yeah. So they get 24, seven virtual and human coaching basically for all lifestyle factors, they're going to get continuous aggressive coaching with human backup for questions and encouragement. And we are able to dissect how much of the benefit, assuming there is, is related to exercise, how much of it's due to sleep and on and on, all be quantified and for each individual. Exactly.

Manoush Zamorodi (31:52)

So, like I might be a person who doesn't need quite as much sleep, but I definitely need to move regularly because of my genetic profile and because of my habits or something like that.

Dr. Eric Topol (32:04)

Right. And you know, one thing that's really important that I think you've touched on, when we tell the whole world this is what you should be doing, it doesn't really get a lot of uptake and respect. But when we talk to an individual and we define precisely what their risk is and when it might show up, the chance of them making some changes in their lifestyle which we know has impact, it's much, much greater. Everything has to work at the individual level, population level. Messages just don't have that kind of impact.

Manoush Zamorodi (32:38)

In a minute, Dr. Eric Topol on how America's health care system can make it tough to age well. And the health trends he thinks are total nonsense.

Dr. Eric Topol (32:48)

You've got the same people who wouldn't take a vaccine which has, you know, randomized trials, tens of thousands of people with overwhelming benefit to risk ratio. And those are the same people that would inject an experimental peptide in their blood.

Manoush Zamorodi (33:04)

I'm Anoush Zumarodi and you're listening to the TED Radio Hour from npr. Protein maxers and peptide curious. Stay with us. Foreign.

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This message comes from 1-800-FLOWERS. She does a lot for your family. Mother's Day is your chance to show her. You see it with a gift from a brand trusted for generations to help people get the moment right. With double blooms from 1-800-Flowers. Buy one dozen roses and get another dozen for free. It's a bigger Gesture backed by 50 years of experience delivering fresh flowers so you can feel confident sending finding something that lands. Show up for her with Double blooms at 1-800-flowers.com NPR this message comes from Schwab. With the new Schwab Teen Investor account, teens can gain hands on investing experience. It's co owned by you and your teen so you can monitor the account while your teen learns how to invest and manage money. Learn more@schwab.com this message comes from LinkedIn ads. Ever invest in something that seemed incredible at first but didn't live up to the hype? For marketers, that's impressions. When ads don't create revenue, that's a tough conversation with the CFO. Instead, invest in results your CFO will love. LinkedIn Ads generates the highest ROAS of all major ad networks. So advertise on LinkedIn, spend $250 and get a $250 credit. Just go to LinkedIn.com NPRpod Terms and Conditions apply

Manoush Zamorodi (34:46)

before we get back to the show. Have you checked out the NPR app recently? From live radio and digital stories to videos and podcasts, the NPR app has everything you love about NPR in one place. It's the TED Radio Hour from npr. I'm Minouche Zamorodi. On the show today, we're talking to Dr. Eric Topol about what it takes to be a superager in an era of make America healthy again, health fluencers and billion dollar anti aging industries.

Dr. Eric Topol (35:18)

So I take around 30 pills for

Manoush Zamorodi (35:20)

breakfast and around 20 pills for lunch.

Dr. Eric Topol (35:22)

When I first started doing the cold plunge, I was freezing, but now my

Manoush Zamorodi (35:27)

body feels so good.

Dr. Eric Topol (35:28)

Yeah so my son gave me a liter of plasma, I gave my dad a liter of plasma.

Manoush Zamorodi (35:32)

And we are in this sort of strange cultural moment where longevity has become sort of a status symbol, right? Like, can you spend money on supplements and do cold plunges? And people are biohacking and getting the plasma infusions of young relatives. People have clearly gotten the message of prevention. But where is the line between real longevity science and the pseudoscience? Because I think for some people it all sounds highly scientific or maybe there's not quite the proof, but what does it hurt?

Dr. Eric Topol (36:08)

Right. Well, you know, we have a. A moment where the medical community's word and judgment is being challenged every day. And the idea that there's these influencers who, they have the secrets they know. Right. They have big impact. So, like example, cold plunge, right? This is remarkable. I mean, I'm a cardiologist and I would consider a cold plunge a stress test much more than a treadmill. Because you get in a cold plunge, you are getting a big jump in blood pressure, you're constricting all your blood vessels, your heart rate is jacked up. And if you're going to have a heart attack, you could find out in the midst of a cold plunge or soon thereafter. I would never suggest people who might have risk for heart disease to have that. And there's no real data to show

Manoush Zamorodi (37:00)

benefit, but it makes you feel alive, Eric.

Dr. Eric Topol (37:02)

Yeah, yeah. You know, it's going to give you more brown fat. I mean, help me. I mean, this is just too much. So every one of these things, the peptide craze, the protein craze, all these things are unsubstantiated and potentially dangerous.

Manoush Zamorodi (37:18)

That's the question. I have peptides and protein. If you're aging faster than you want, you want the glow stack. So it's a stack of peptides which enhance cellular. My Instagram feed is going to be filled with them that I just said those two words out loud. Protein popcorn, protein cookies, protein pop tarts, like candy. What is the deal? Well, protein builds muscle, I suppose, but peptides has become. I don't even know what they truly are. Can you talk us through both of those?

Dr. Eric Topol (37:44)

Yeah. So the protein thing, just to take that quickly, there are advocates like Peter Attia to take much higher than recommended protein daily consumption, for example, 1 gram per pound, which is about three times what the recommended allowance is. And you could make a case that maybe you should increase from what the recommended allowance is. But that level of protein, people don't know that we can't store Any protein in our body. So it just goes right out. Second, if you're taking all this extra protein, it doesn't come without other calories. You know, we have obesity and overweight epidemic and why would you want to take unnecessary extra calories? Next there's the cost of all these protein powders and bars and all that. And then finally the thing that most people aren't aware, that extra protein, especially if it's coming from animal sources, that is a problem. Red meat for example, that is pro inflammatory. We don't want that. So this is dangerous. And also unsubstantiated. There are no data to support this protein craze.

Manoush Zamorodi (38:53)

Is this just the latest version of the keto diet?

Dr. Eric Topol (38:55)

Yeah, I mean the keto diet that has some utility in certain rare examples like to manage epilepsy, potentially certain cancer treatments. But overall the keto diet faded because it has risks that were not adequately taken into account. Protein, I think is going to slide down eventually when people get it. My peptides now, peptides 157, it just makes you feel freaking good. Like you wake up, no pain, no aches. This thing teaches your body to just burn more calories. Theoretically, you could change nothing about your diet or your exercise and still lose weight. You know, this is really interesting, Manish, because I reviewed all the data which there basically are no data for the peptides.

Manoush Zamorodi (39:40)

Interesting.

Dr. Eric Topol (39:41)

This is just, you know, a couple of amino acids strung together and there are many of them that are in wide scale use, like BPC157. You know, I made up one called BS2025. That's really what they are. Right? They have no data. They mostly come from China. You don't even know what you're getting when they've sent them to independent labs. Sometimes they're not even the peptide that they say they are. Sometimes basically there's nothing there or sometimes they're contaminated. They aren't necessarily sterile. People are injecting these into their bloodstream. So these have no track record except in some animal studies. There are no good human studies that show placebo controlled. These are very expensive, usually 250 to $300. Often they're taken in stacks or multiple.

Manoush Zamorodi (40:34)

Yeah, what's your stack, Eric? Isn't that what people say?

Dr. Eric Topol (40:38)

It's incredible. This is just completely out of control. We even have the HHS Secretary, RFK Jr. Who is a big advocate of these peptides and is trying to take them off from being banned from compounding facilities throughout the country. So like supplements are not regulated by FDA peptides are not supposed to be regulated. The Biden administration improperly moved them to category three without any evidence. The only justification they have is if there's a safety concern. And there was no science that indicated a safety concern, so it was improper. We have now remediated that by moving them back. So this is a mess. People should know there are dangers. You don't have the ability to send them to independent labs before you inject. When you get them, they say on the bottles or the syringes for research use.

Manoush Zamorodi (41:30)

Oh wow.

Dr. Eric Topol (41:31)

Wow. Yeah.

Manoush Zamorodi (41:32)

I have a lot of empathy for people who think why not give it a try? Like there's no sort of cohesion when it comes to medical guidance. Certainly in the United States we have the government changing the food pyramid. There's real distrust and for good reason. Some of the Maha community, some things that they're suggesting are very dangerous. Other things like better nutrition I think you'd agree with. Right?

Dr. Eric Topol (42:00)

Yeah. No, it's really troubling because we used to have this notion that all the things that are recommended for population health should have evidence to back them up. And now we are willing to see things supported with zero evidence and worse than that, potential real harm. And so it's very troubling and it goes along the continuum of the anti science, anti vax. And what's so paradoxical here is you've got the same people who wouldn't take a vaccine which has, you know, randomized trials, tens of thousands of people with overwhelming benefit to risk ratio and there's the same people that would inject an experimental peptide in their blood. So none of it makes sense really.

Manoush Zamorodi (42:52)

So what do you suggest to people? Because there's this feeling that, you know, I can do everything right, I can get the right amount of sleep, I can eat good food, I can get exercise, but I'm still breathing in microplastics or drinking forever chemicals. How do you empower individuals to feel that they can protect their health? Especially the fact that, you know, a lot of these things require health insurance. We have a broken system.

Dr. Eric Topol (43:20)

Yeah, we have a big problem here because we don't have the kind of universal health care that every other high income country does have. So that our fragmented setup is very poorly positioned to integrate these new things. And not only we have the barriers that have been entrenched for many decades, but we also have now the people that are running the public health agencies that are going against evidence. So it's a troubling time still. Everyone has agency to, as you say, do Their best with their lifestyle factors in terms of air quality, particularly indoors. There's things you can do, there's reducing the plastic burden intake, keeping an eye on the things that are in your home. Regarding forever chemicals, it's not enough Minouche, but yeah, it's difficult and this is not a good time. But hopefully it's just a transient one and that we'll get back on track eventually.

Manoush Zamorodi (44:22)

So if I go to see my doctor, what should I ask them? Because I feel like it hasn't really changed all that much in the last 20 years. What do you think people should be asking for?

Dr. Eric Topol (44:33)

Well, you're already ahead of the curve on the Shingrix vaccine, right?

Manoush Zamorodi (44:37)

Oh, good. Yes.

Dr. Eric Topol (44:38)

And that tells me you're over 50.

Manoush Zamorodi (44:40)

Yes.

Dr. Eric Topol (44:40)

That's the good age to really get ahead of what you could be seeing when you're 70 plus, because that's how long these diseases take to incubate. And of course, they start even before age 50. So the question is about heart disease. From that mammogram, why didn't you get the breast artery calcification defined to see if you're at high risk?

Manoush Zamorodi (45:02)

I didn't know about it.

Dr. Eric Topol (45:04)

Why hasn't your doctor given you a polygenic risk score for heart disease and all the common cancers and Alzheimer's disease?

Manoush Zamorodi (45:11)

Can I ask for that now?

Dr. Eric Topol (45:13)

Yeah. And why don't you have an APOE 4 to know if you're at risk for Alzheimer's? It used to be Minouche that you wouldn't want to know because nothing you could do that couldn't be further from the truth now, because we know lifestyle has a big impact on at least deferring my years. The onset of mild cognitive impairment, no less Alzheimer's. So this idea of the Cassandra, you know, I don't want to know. We're past that stuff.

Manoush Zamorodi (45:38)

So even if it doesn't run in my family, do you think it's worth asking for those?

Dr. Eric Topol (45:42)

Well, yeah, the polygenic risk score that set, basically it looks at every common disease, all the different cancers, atrial fibrillation, heart disease. And I think, you know, women, their biggest killer is heart disease and a lot of them don't know it. And when you think about your parents, just because it doesn't run in your mother or your father's lineage. The point is you're getting this combination of genes. You could have a very different type of risk when you have this combination of genomic variants. So that's why polygenic risk scores are independently useful in determining the risk of A person not discernible from their family history.

Manoush Zamorodi (46:25)

Have you run the numbers on yourself? Like given everything, you know, what sort of habits are you integrating into your life? What sort of medications, if I may ask, how are you trying to live as long and well as possible?

Dr. Eric Topol (46:41)

Yeah, that's a really important question because you practice what you preach, right?

Manoush Zamorodi (46:45)

Yeah.

Dr. Eric Topol (46:46)

So doing all the research for superagers changed my position. I always was an advocate for aerobics and I had not done hardly any resistance training or balance training and now I'm onto that several times a week. So that was a big change. The second big change for me was I had very chaotic sleep, habits of staying up very late. And now that's a big thing. I've taken my deep sleep from various things, particularly regularity up from a terrible number. It's in the right direction. I wish it was even better in addition to all that because my polygenic risk score tells me I'm at high risk for heart disease even though it never was in either parent. I was taking a statin but then I developed terrible muscle cramps. So I want to keep my LDL very low. And so I'd done that with the injectable drug Repatha that I take. And the polygenic risk score should be routine. I don't know why the medical community doesn't adopt it universally, but that helps to at least know about the risk. And of course there are other ways, as I mentioned, that we will know and it's especially in women, postmenopausal women, we gotta know that person is got heart disease risk because there's so much we can do about that.

Manoush Zamorodi (48:07)

Yeah, I feel like for women over 50 there's suddenly this new attention being paid on perimenopause menopause, whether or not hormones are a good thing. There's certainly a lot of money being made on that. I read everything that's out there and I still don't know what to do. I feel like this abundance of information can make people a little crazy.

Dr. Eric Topol (48:29)

Right, right. Yeah. I think if you stick to the evidence and not just opinions. You know, there's evidence based and then there's eminence based. Stick to the former, you'll be okay. But you're only going to get that from the highest level of peer reviewed journals and people who are committed to presenting the evidence in a forthright way.

Manoush Zamorodi (48:55)

I mean this is what happens when information goes everywhere. Part of us wants to just be told what to do. We want there to be easy to understand rules, guidelines that we can follow without having to overthink it. Some of us get a little weird if we have too many data points. But I think what you're saying is we are heading into an era of personalized medicine that is extraordinary and we need to do a better job to embrace it.

Dr. Eric Topol (49:22)

Absolutely. Particularly this field of longevity and healthy aging. It's a bit like the dis and misinformation that we saw throughout the COVID pandemic. We gotta get this right, because there's so much opportunity here to promote healthy aging that a lot of people are not really aware of. And if we do get on track with this and people do get the right word, it can make a world of difference in their healthy age lives. Just lifestyle alone has been shown. If you start age 50 and you attend to all the things that we know, you can get seven to 10 years more of healthy aging. And people don't even know that. So there's so much we can get out there that's really high quality information that should help people.

Manoush Zamorodi (50:08)

Right. And I think that was my biggest takeaway from your book, that it's really never too late to start changing your aging destiny. We actually here at NPR partnered with Columbia University Medical School to do a clinical trial on the health benefits of incorporating short movement breaks into our days. We had 20,000 people sign up. I actually ended up writing a book about it that's coming out soon. And. And what we found was that older people actually had different challenges in terms of changing their lifestyle. You know, they're not stuck at a desk all day anymore. They're actually more active during the day. But these long periods of the evenings, from, say, 5:00pm to 11:00pm, they would sit. But when they took these movement breaks, it not only helped them sleep better, improved their mood, and, you know, and improved their glucose levels overall. They just felt healthier, and it felt like a small thing they could do. You know, little changes can make a big difference.

Dr. Eric Topol (51:09)

Absolutely. You can be stronger than ever in your life. When you're in your 70s and 80s, you can have the highest level of fitness, and all sorts of other great things can come. I mean, you might have been a bad sleeper. And of course, as we age, our sleep liability increases. But you can counter that with so many different things in your daily life. So you're absolutely right. This is critical. People just because they're older shouldn't be thinking it's too late. In fact, there's great opportunities to promote healthy aging at all ages.

Manoush Zamorodi (51:42)

That was Dr. Eric Topol. He's the author of Super An Evidence Based Approach to Longevity. You can hear his full talk@ted.com and what a great reminder that technology is is changing treatments fast. But don't believe everything you hear about quick medical fixes. Thank you so much for listening to our episode about being a super ager. This episode was produced by Phoebe Lett. It was edited by Sanaz Meshkinpour and me. Our production staff at NPR also includes James Delahousy, Katie Monteleone, Fiona Guerin, Matthew Cloutier, Hersha Nahada, and Rachel Faulkner White. Our executive producer is Irene Noguchi. Our audio engineer was Jimmy Keeley. Our theme music was written by Ramtin Arablouei. Our partners at TED are Chris Anderson, Helen Walters, Roxanne Hylash, and Daniela Valorezzo. I'm Manoush Zamorodi and you've been listening to the TED Radio Hour from n. This message comes from MIDI Health CEO Joanna Strober shares the personal experience that led her to start a virtual care platform for women in perimenopause and menopause. I was having anxiety, I had gained weight, I wasn't sleeping, and my primary care doctor never once said that perhaps I was in perimenopause and that all these things could be related to my hormones. So I had a really tough time time for quite a while and a friend recommended that I try a concierge doctor. She prescribed hormones for me, a combination of estrogen, progesterone and testosterone. And I felt very relieved that I had this care and I also had a lot of sadness that I had spent such a long period of time going through this and not getting the right care. And so essentially what we really want to do at MIDI is democratize access to this type of care. MITI Health committed to helping women in midlife with perimenopause and menopause care, accessible via telehealth visits@joinmidi.com this message comes from Charles Schwab with their original podcast Choiceology. Hosted by Katie Milkman, an award winning behavioral scientist and author of the best selling book how to Change. Choiceology is a show about the psychology and economics behind people's decisions. Hear true stories from Nobel laureates, historians, authors, athletes and more about why people do the things they do. Download the latest episode and subscribe@schwab.com podcast or wherever you listen. This message comes from Jerry Many people are overpaying on car insurance. Why switching providers can be a pain Jerry helps make the process painless. Jerry is the only app that compares rates from over 50 insurers in minutes and helps you switch fast. With no spam calls or hidden fees. Drivers who save with Jeri could save over $1,300 a year. Before you renew your car insurance policy, download the Jeri app or head to Jerry AI, NPR.