Part I: "Super Agers … An Evidenced-Based Approach to Longevity".... Dr. Eric Topol, Author, Prof., and EVP, Scripps Ranch
Doctor Eric Topol joins me to talk about what we know and what we don't know about longevity. Science has something to say about some areas and is curiously silent in disagreement about others. His book is superagers, an evidence based approach to longevity. You're listening to part one of a two part interview. Doctor Topol, welcome back to Tech Nation.
Dr. Eric Topol:Hey. It's great to be with you, Moira. It's been too long.
Dr. Moira Gunn:Been too long. Yet, I love what we're talking about, superaging. So the subtitle to your book says it all, an evidence based approach to longevity. You've collected a lot of evidence, you've seen a lot of evidence, how much evidence? What kind of evidence?
Dr. Eric Topol:Yeah, well, as you say, it's a huge body of evidence, and that's why I'm especially optimistic that for the first time we have the ability to prevent the major age related diseases that is cancer, cardiovascular, and neurodegenerative, which we never really done ever before in a, in a meaningful way. But that's what's the big change. That's what's exciting. And it's something, an opportunity that we have to seize at. We have to go for it because it's unique in time in life science and medicine.
Dr. Eric Topol:What most people have been thinking, the science of aging is going to bring about a new magic potion or pill that's going to reverse our aging. More of that may someday be possible, but what is possible right now is to use the science of aging. And we'll talk more about what are those advances, these metrics in particular that help us guide the age related disease prevention. That's where you don't have to have big risk, but you have big gains, much bigger gains than trying to cure or treat a disease is just to prevent it from ever happening in the first place.
Dr. Moira Gunn:Now I was thrilled to see that you quote president John F. Kennedy right in the front of the book. He says, it's not enough for a great nation merely to have added New Years to life. Our objective must also be to add new life to those years. Seems to me you're talking just exactly about that.
Dr. Eric Topol:That's exactly the story, Maura, that this fixation on longevity is not the goal, even though that's in the subtitle of the book, because the publisher demanded it to happen. You know, I wanted to call the book The Welderly, but they said, Well, no one knows what that is. That's a word, you know, that's been coined. But basically we, the goal here is health span, not lifespan, health span. And we have to get the most years we can that we are free of the big three age related diseases.
Dr. Eric Topol:If we can do that, we've accomplished the mission. And I would submit to you and your listeners, we can do that now. That's what's so extraordinary. We we've moved on to a time when primary prevention of these diseases is becoming possible. Whereas for millennia, we dreamed about it.
Dr. Eric Topol:It was a fantasy that can be fulfilled in the future.
Dr. Moira Gunn:Now you see these driven by five dimensions. Let's talk about those five dimensions.
Dr. Eric Topol:Yeah. So the one that pulls it all together is the AI. And so a lot of people are saying, AI? No. We need AI because us humans can't deal with billions of data points for each human being.
Dr. Eric Topol:And that's what is now become possible with these large language models and large reasoning models. We could never done that before. Now that is bringing in these other four dimensions, lifestyle plus factors, which is not just diet, exercise, and sleep. It's bringing in the omics, which are our biological data. That's our genes and our proteins and our gut microbiome, our epigenome, our immuno, which we desperately need.
Dr. Eric Topol:And then we have cells, cells as a drug, as a therapy, it's emerging to be much bigger than we ever expected. And then finally is the drugs vaccine group, which really are going to be coalesced more because we're gonna use vaccines, for example, to rev up an immune system, like a drug, which we can use to tone down like a rheostat, the immune system. So all these things together is enabling this new extraordinary time in medicine.
Dr. Moira Gunn:Now I kept coming back to, as I was reading that, you know, eat, drink, and be merry as in what are you eating? What are you drinking or not drinking? Are you upbeat? All of that. Let's talk about the welderly study.
Dr. Eric Topol:Yeah.
Dr. Moira Gunn:Who are welderlies?
Dr. Eric Topol:Yes. So we spent seven years here at Scripps Research to bring together, find these 1,400 people that were willing to participate, which meant having their genome, whole genome sequence and telling us everything about them. Fortunately, they didn't have any medical records of much because they were so healthy. The entry criteria was over age 85 and it got up to age 102, and they couldn't have had any chronic diseases. Okay.
Dr. Eric Topol:So they, they were certainly free of these major age related diseases, but they were free of, you know, other age and chronic diseases. They had to be healthy without medications. I mean, they were, you know, kind of Teflon coated, bulletproof, whatever you wanna say. They were amazing people. That's why it took seven years to find them.
Dr. Eric Topol:They were such stringent entry criteria that we're talking about, you know, zero point one percent of people in their late eighties and nineties. Now we expected, you know, how you go in with a bias, we're gonna find all these genes because there's never been a study like this. And we're gonna find what is the secret in their genomes. And we basically found nothing, nothing. That they were- we had control groups that were the elderly, are, you know, the usual suspects who have a chronic disease, one of these, or more than one chronic disease, we compared it to various control groups and we didn't see much difference.
Dr. Eric Topol:So the conclusion of that is really that, okay, genes are playing some role, but it's not the dominant factor. And of course, I introduced the book with a new elderly, a patient of mine who I saw recently, Lee Russell, who at the age of 98, all her relatives, parents, her brothers, they died in their fifties and sixties. So why is she 98 and is a welderly, right? So that's really what the book is all about, how we can all become welderly in the future. And we will see many more people like Lee Russell and my other patient who I presented, Mr.
Dr. Eric Topol:RP. We're gonna see a lot more of these folks going forward. In this kind of dark times for life science and medicine, with all the challenges that we're facing, resources, funding, getting gutted and whatnot. This is really brimming with optimism. We've got a bright future ahead of us.
Dr. Moira Gunn:Well, let's start with the eat of eat, drink, and be merry.
Dr. Eric Topol:Yeah. Yeah. Yeah.
Dr. Moira Gunn:You talk about restricted diets or individually optimal or optimized diets or you know, there's a set of they're not distinct. I mean, this is sort of verbiage around this. What are we talking about for the What did you discover about these people with regards to eating?
Dr. Eric Topol:Yeah. So the diet that is the one you have to say is the winning diet for healthy aging is Mediterranean diet, mainly plant based diet, you know, reduction of red meat, this diet with lots of fruits and vegetables and legumes and whole grains, it's a winner. And a recent study reinforced that, Moira, because one hundred and five thousand people were followed thirty years and only nine percent of them got to this elderly state. And what's interesting is what did they eat just the same as what the randomized studies and all the other data point to. So we now know what is the healthiest diet to promote healthy aging.
Dr. Eric Topol:And people who wanna eat some red meat, that's okay, but just not on a frequent basis. And mainly it's of course to keep up with avoidance of ultra processed foods and not to overdose on protein. There's a protein craze right now. And there's at least one major main author who's advocated for one gram per pound per day. That's a huge amount of protein load, and that can promote inflammation and atherosclerosis as we've seen.
Dr. Eric Topol:So, you know, not to go for data that's not backed up by evidence when it can actually be harmful. So the diet, I think that's the main outline, stick to, you know, predominant plant based, with as low and ultra processed foods that are very pro inflammatory and be careful about overdosing on protein. It's good to increase it some as we get older, but don't go wild.
Dr. Moira Gunn:Well, here's a question that I was gonna ask later, but just the way you've been talking about this, brings it to mind. How do we know when we're listening to pseudoscience or quackery, shall we say, how do we know when we're listening to that? What do you say?
Dr. Eric Topol:Yeah. So there's several ways that you can kind of ferret out the facts, the truth, the evidence versus the lack thereof of any of those. One thing of course is, you know, the person who's writing, you know, are they credible? Like for example, if they're Hawking supplements, they're automatically not credible, right? What is their academic, accomplishments and track record?
Dr. Eric Topol:You know, have they been discredited? Have they, you know, do they publish and do they do, you know, top tier peer reviewed journals? Are they well regarded by peers and that sort of thing? But the next thing is show me the data, show me the references because here's the citation and you can look yourself, you know, you can see yourself what you think, because, you know, for me, I'm interpreting in this book over 1,800 citations, and maybe I didn't interpret it right. You can do it yourself.
Dr. Eric Topol:Right? I mean, everybody can look at the data themselves, but the point is here it is. And don't write things where there's no data, or at least say, you know, we don't know has to be tested and proven. You know, the problem we have is in this longevity space, we got anti aging supplements that have no data. We have longevity clinics that you could join for $250,000 or some ridiculous fee promoting longevity.
Dr. Eric Topol:We have all these companies that say they're longevity companies that are doing every test and scan known to mankind. I mean, is just full of bunk, full of, you know, complete, things that are not backed up by data. And, you know, it's predatory. That's the problem. It they got lots of prey out there and the richest people are the interesting ones because when they were young, they wanted to be rich.
Dr. Eric Topol:And now they're rich. They wanna be young. So they've made mega investments, mega investments in these companies that are, some of them are valued in the billions of dollars. So, some of them are doing really good science. Okay?
Dr. Eric Topol:They got all this capital and they're doing good work. They're not part of the illusion or part of the scam, if you will. But there are others that are promoting stuff. And then we have these extremists, like this guy, Brian Johnson, he has a Netflix special, and this guy, know, who's don't die. He has a religion now.
Dr. Eric Topol:Don't die. And, you know, we should be immortal. And he's had plasmapheresis from his son. He uses a penile sensor each night and compares it with his son's erections. I mean, just crazy stuff, 100 plus supplements.
Dr. Eric Topol:You know, we have these these people have a following, and it's scary, Moira. It's scary that we have this kinda stuff without any evidence, that people wanna wanna be part of this, like, a cult.
Dr. Moira Gunn:You're listening to Tech Nation. I'm Moira Gunn, and my guest today is doctor Eric Topol, a professor and executive vice president of Scripps Research. He's also the founder and director of the Scripps Research Translational Institute. You might know him from his earlier books, including Deep Medicine or his substack, Ground Truths. Today, we're talking about superagers, an evidence based approach to longevity.
Dr. Moira Gunn:Well, I'm gonna ask you about in my eat, drink, and be merry. You sent out something recently, and you do talk about this in the book, but you're really doing a deep dive now.
Dr. Eric Topol:Yeah. Yeah.
Dr. Moira Gunn:Alcohol, As people age, you know, their relationship to alcohol changes, and some people just want more of it. You know, it's a self it's a self medication prospect here. You know? Tell us about that. What have you figured out about alcohol?
Dr. Eric Topol:I gave you the three word answer, which is the ground truth. We don't know. And the reason I say that is I reviewed in the ground truth substack, the three new reports that are essentially based on the same data, right? And one of them, the National Academy, they did it all over again. They went scoured the, these reports and they took out people who, you know, they drank once and then they became, abstainers and they basically reanalyzed everything.
Dr. Eric Topol:One report from the surgeon general just quoted a couple of reports that coincided with his belief that alcohol is not good for you. And then another report by the HHS, said, Any alcohol is not good. Well, the interesting thing is, we talk about looking at things on a two sided way. The only one of these three reports was the National Academy. They look for benefits.
Dr. Eric Topol:Okay? The other two only look for risks. And the national academy actually found benefit up to seven drinks per week and a little bit less perhaps for women than men. Basically that was the cutoff. And the others of course said, no, no, there's just risk.
Dr. Eric Topol:Now, which one do you like? Well, if you like to have a glass of wine or a beer or cocktail, a couple of few a week, no, you might wanna take the national academy's report. If you, if you are really, worried about the alcohol impact, then you would pick the other report. Basically, we don't know because the data are lacking randomized trials. Each of the studies has its usual warts of observational studies.
Dr. Eric Topol:And you could say the people that issued the reports have their own bias, right? But the National Academies, I have to say, in reviewing them all in-depth, was the one that really was the most rigorous. And that reinforced that, Hey, you know, we wanna be socially active and interactive. And, you know, usually that may involve having some alcohol, right? But there is a movement against alcohol right now in certain countries.
Dr. Eric Topol:You know, they have it labeled on the alcohol that this could cause cancer. And there is a risk in women for breast cancer, all the, that's the only thing the three reports agree on is that if you go beyond seven drinks per week in women, there is a risk increase of breast cancer. That we can say for sure. Everything else, the National Academy's discounted, but the other two reports, all these cancers like oral cancer, colon cancer, liver cancer, they all saw an increase. So, you know, it's murky, it shouldn't be, but that's the way it is, unfortunately.
Dr. Moira Gunn:Jury is out. The jury is out.
Dr. Eric Topol:The jury's still out. Yep. Yep.
Dr. Moira Gunn:Jury's still out. When I was reading your material, I was a little in shock because I remembered years ago when I was pregnant with my boys, I had, just a normal OB GYN who told me, oh, he said, you can have two drinks a day. And he goes, and I'm talking about a glass of wine, a really big glass of wine. You could have two of those, which would be like three, I think now or even four. I mean, it was like, sure.
Dr. Moira Gunn:That's, you know I was like, Really? And my mother smokes cigarettes all the way through her pregnancies. Life will out, I guess. Yeah.
Dr. Eric Topol:Well, I don't think alcohol would be safe during pregnancy. And your point about the what's in a glass of wine, five ounces is not much. You know, it's not much. So you pour a big glass of wine, you've already, you're getting probably, like you said, a few drinks right there, at least two to three. So, you know, we have to be careful because there is a threshold where the risk increase.
Dr. Eric Topol:And one of the things I wanna emphasize, which is a theme in the book, each of us are unique. And so these prescriptions for the whole human species, they can't be right. Some people have a cancer susceptibility. Okay. And some are resilient because they have a great immune system.
Dr. Eric Topol:So to say, this is the prescription for all human beings is wrong from the get go. Right? So that's something to keep in mind because the real theme of this book is once we have all the layers of data for each person, that's how we identify high risk. And that's how we prevent the disease. But, you know, to just to say, you know, all people do this, all people do that.
Dr. Eric Topol:No. No. It's it's just doesn't work that way.
Dr. Moira Gunn:Now we've been through AI and we've been through lifestyle. Let's go to cells. 37,000,000,000,000 in our bodies. That's another driver of good aging, if you will, super aging.
Dr. Eric Topol:Yeah, here the immune system, I have a whole chapter about that, is the big driver of our health. Because as you know, Moira, these cells in the immune system, like B and T cells and others, they can secrete these proteins, cytokines, chemokines, and incite inflammation throughout our body and in our brain. And that inflammation is usually untoward, unwanted, bad, right? And so we now can control the immune system like we'd never been able to do before. So one of the most extraordinary biomedical advances that I've seen in recent years was people with autoimmune diseases like lupus, systemic sclerosis, multiple sclerosis.
Dr. Eric Topol:They had cell therapy to knock out their B cells. And the B cells, when they came back, which they do, of course, they forgot that they were in a person with an autoimmune disease. They had like a control alt delete reset.
Dr. Moira Gunn:Yeah.
Dr. Eric Topol:And so all of a sudden they're cured. These people were cured. Okay. Who would ever guess that if we just get rid of the B cells and when they come back, they forgot to attack the person, right? So this is exciting because you know, these drugs that we use to treat these diseases, these are terrible drugs.
Dr. Eric Topol:They cause immunosuppression and vulnerability to infection, some serious infection. So we have a whole new way potentially to use cells to control our immune system. And we're talking about off the shelf cells, not necessarily taking your cells out and engineering them and putting them back in. And when we have off the shelf cells as therapy for cancer, immune diseases, and many other, you know, just treating inflammation in the body for these various indications, that's when it becomes inexpensive and practical.
Dr. Moira Gunn:I'm speaking with Doctor. Eric Topol, the author of Super Agers, an Evidence Based Approach to Longevity. Listen to part two of this interview in our next podcast.
